The Face, Mouth and Pharynx

  • Neuroanatomy and Neurophysiology Explained:

    • Identify and explain the neuroanatomy, neurophysiology, and the limbic system as relevant to the control of:

    • Speech

    • Language

    • Hearing

    • Swallowing

    • Motivational states

    • Emotional behavior

    • Learning and memory

Key Topics to Cover

  • Bones (Cranial and Facial) Overview:

    • Relevant to SLT practice through assessment, diagnosis, and treatment of speech and swallowing issues.

  • Muscle Anatomy:

    • Muscles of the pharynx.

    • Muscles of facial expression.

    • Muscles of mastication.

    • Muscles of the tongue.

Facial Bones

  • Facial Bones Overview:

    • Nasal Bones (2).

    • Maxillae (2).

    • Lacrimal Bones (2).

    • Zygomatic Bones (2).

    • Palatine Bones (2).

    • Inferior Nasal Conchae (2).

    • Vomer (1).

    • Mandible (1).

Cranial Bones

  • Cranial Bone Overview:

    • Occipital Bone

    • Parietal Bones (2)

    • Frontal Bone

    • Temporal Bones (2)

    • Sphenoidal Bone

    • Ethmoidal Bone

Tongue Muscles

  • Intrinsic Muscles:

    • Change the shape of the tongue.

    • Superior longitudinal muscle.

    • Inferior longitudinal muscle.

    • Vertical muscle.

    • Transverse muscle.

  • Extrinsic Muscles:

    • Change the position of the tongue.

    • Genioglossus muscle.

    • Hyoglossus muscle.

    • Styloglossus muscle.

    • Palatoglossus muscle.

  • Clinical Relevance of Tongue Function:

    • Intrinsic muscles allow for fine control:

    • Extrinsic muscles allow for gross movements, with emphasis on placement for speech clarity.

Styloid- bone 

Muscles of Facial Expression

  • Muscle Overview and Functions:

    • Example muscles include:

    • Frontalis

    • Orbicularis oculi

    • Zygomaticus (minor and major)

    • Buccinator

    • Orbicularis oris

Pharyngeal Muscles

  • Muscles Overview:

    • Pharyngeal Constrictors:

    • Superior, Middle, Inferior

      • Function: Constricts the pharynx during swallowing.

      • Innervation: Pharyngeal plexus for the superior and middle constrictors; inferior constrictor also innervated by the vagus nerve.

      • Insertion Points:

        • Superior: Pharyngeal tubercle on the basilar part of the occipital bone.

        • Middle: Blends with superior and inferior constrictors.

        • Inferior: Pharyngeal raphe and esophagus.

  • Additional Pharyngeal Muscles and Functions:

  • Palatopharyngeus: Shortens pharyngeal lumen during swallow

  • Salpingopharyngeus: Blends with palatopharyngeus and shortens the pharyngeal lumen during swallow

  • Stylopharyngeus: Innervated by the glossopharyngeal nerve (IX), shortens pharyngeal lumen during swallow.

Remember: Anterior, posterior.

Anatomy and Impact on Speech

Role of Pharyngeal Structures and Muscles in Resonance

  • Definition of Resonance:

    • Process of how air and sound vibrations are shaped within the vocal tract.

  • Key Structures:

    • Oral, nasal, and pharyngeal cavities act as resonating spaces influencing voice quality.

  • Role of the Velum:

    • Affects sound production:

    • Elevates for oral sounds.

    • Lowers for nasal sounds.

  • Factors Influencing Resonance:

    • Airflow vs. resistance from the nasal cavity.

    • Structural variations such as palate shape and tongue position.

Soft Palate Anatomy

  • Components of the Soft Palate:

    • Palatine aponeurosis and five key muscles involved:

    • Musculus Uvulae: Shortens and raises the uvula.

    • Palatopharyngeus & Tensor Veli Palatini: Create tension during swallowing.

    • Levator Veli Palatini: Elevates soft palate, blocks food from entering the nasal cavity.

    • Palatoglossus: Depresses the soft palate.

Swallowing Dynamics

  • Muscle Participation:

    • Approximately 8-10 muscles involved in the oral stage of swallowing.

    • Approximately 10-12 muscles involved in the pharyngeal stage of swallowing.

Consequences of Anatomy on Speech and Swallowing

  • Case Study:

    • 45-year-old woman post partial maxillectomy due to nasopharyngeal carcinoma. Waiting for prosthesis.

    • Key Questions:

    • Consequences on articulation, oral cavity function, and resonance.

    • Impact on speech clarity and nasality.

    • Potential SLT interventions: compensatory strategies, prosthetic devices, or articulation therapy.

Importance of Knowledge in SLT

  • Clinical Implications:

    • Understanding anatomy critical for effective assessment, diagnosis, and treatment of communication and swallowing difficulties, particularly in trauma and cancer recovery patients.

    • Emphasis on practical application of knowledge rather than mere memorization.

  • Assessment Preparation:

    • MCQs and diagram labeling will assess detailed anatomical knowledge, enhancing clinical reasoning and case management skills.

Summary

  • Core Knowledge Recap:

    • Understanding the structures and functions of the anatomy directly influences SLT practice, patient assessment, diagnosis, and treatment planning.