Anatomi menelan

8/17/2019 Anatomi menelan

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Anatomi Trias Mengisap,

Menelan dan Bernapas


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Oral Structure• Lips• Teeth• Cheecks• Hard palate• Soft palate• Uvula• Mandible• Tongue• Faucial arches


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LIDAH :- Oral portion berperan dalam proses bicara dan

fase oral proses menelan

- pharingeal portion dari uvula sampai os hyoidberperan saat fase faringeal

ROOF OF MOUTH :- Os maksila- palatum durum- palatum mole- uvula

FLOOR OF MOUTH :-Otot mylohyoid- otot geniohyoid- anterior belly of digastric


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Extrinsic Tongue Muscle• M. Genioglossus• M. Hyoglossus• M. Styloglossus•

M. Palatoglossus


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M. Genioglossus

• Posterior fibers: draw the root of the tongueforward and protrude the apex from the mouth.

• Anterior fibers draw the tongue back into the

mouth• Two muscles : draw the tongue downward, so as

to make its superior surface concave from side toside, forming a channel along which fluids may passtoward the pharynx, as in sucking.

• Innervation is by the hypoglossal nerve (CN. XII)


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M. Hyoglossus

• Runs from the hyoid bone to the side of thetongue

• Contraction depresses the tongue and pulls it

backward toward the hyoid bone• Innervation is by the hypoglossal nerve (CN. XII)


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M. Styloglossus

• Arises from the anterior and lateral surfaces of thestyloid process, near its apex, and from thestylomandibular ligament. Passing downward and

forward, blending with the fibers of theLongitudinalis inferior in front of the Hyoglossus;the other, oblique, overlaps the Hyoglossus anddecussates with its fibers

• It draws the tongue upward and backward.• Innervation is by the hypoglossal nerve (CN. XII)


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M. Palatoglossus

• Runs from the soft palate to the side of the tongue• Contraction elevates the floor of the tongue and

approximates the tongue to the palatoglossal arch

thus closing off the oral cavity from the oropharynx.It draws the root of the tongue upward

• Innervation is by the accessory nerve through thepharyngeal plexus.


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Intrinsic Tongue Muscle

• M. Superior longitudinal• M. Verticalis• M. Transversus• M. Inferior longitudinal


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1) Superior longitudinal lingual muscle: a. Runs from the tip of the tongue (apex) to the back ofthe tongue (root)b. Bilateral contraction shortens the tongue and curls the

tip and the sides of the tongue upwardc. Innervation is by the hypoglossal nerve (CN. XII)

2) Verticalis a. Runs from the dorsal lingual surface to the ventrallingual surfaceb. Contraction flattens and widens the tonguec. Innervation is by the hypoglossal nerve (CN. XII)


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3) Transversus a. Runs from the median fibrous septum to the laterallingual marginb. Contraction narrows and elongates the tongue

c. Innervation is by the hypoglossal nerve (CN. XII)

4) Inferior longitudinal lingual muscle a. Runs from the tip of the tongue (apex) to the back ofthe tongue (root)b. Bilateral contraction shortens the tongue and curls thetip and sides of the tongue downwardc. Innervation is by the hypoglossal nerve (CN. XII)


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Chewing• M. temporalis• M. Masseter• M. Internal (medial)

Pterygoid• M. External (lateral)

Pterygoid• M. Supra and Infrahyoid• M. Buccinator• M. Orbicularis oris


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• Temporalis - Runs from the floor of the temporal fossa to the mandible- Contraction elevates and retracts the mandible (closing ofthe jaw)

- Innervation is by the mandibular nerve (branch of thetrigeminal nerve, CN. V)

• Masseter - Runs from the zygomatic arch to the mandible- Contraction elevates the mandible (closing of the jaw)- Innervation is by the mandibular nerve (branch of thetrigeminal nerve, CN. V)


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• Internal (Medial) Pterygoid - Fibers run from the sphenoid, palatine and maxillary bones to themedial surface of the ramus and angle of the mandible- Contraction closes the jaw by raising the mandible against the maxilla.- Innervation is by the mandibular nerve (branch of the trigeminal nerve,

CN. V)• External (Lateral) Pterygoid

- Fibers run from the sphenoid bone and lateral surface of the lateralpterygoid plate to the condyle of the mandible and the front margin of thearticular disk of the temporomandibular joint (TMJ)

- Contraction assists in opening the mouth by drawing the condyle andarticular disk forward (grinding motion).- Innervation is by the mandibular nerve (branch of the trigeminal nerve,CN. V)


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• Supra- and Infrahyoid muscles - The supra- and infrahyoid muscles assist duringmastication by opening the jaw

- The suprahyoid muscles run from the mandible to thehyoid bone and pull the mandible inferiorly, thusdepressing the mandible and opening the mouth- The infrahyoid muscles (strap muscles) pull the hyoidbone inferiorly, thus fixing its position; when thesuprahyoid muscles contract using the hyoid bone as afixed position, they pull the mandible inferiorly andopen the jaw.


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M. Buccinator• Fibers run horizontally and blend into the fibers of the

M. Orbicularis Oris anteriorly; posteriorly they attachto a tendinous structure between the pterygoid boneand the mandible, the pterygomandibular raphe, whichis also the attachment for the upper fibers of the upperpharyngeal constrictor

• Contraction tenses the cheek thus maintaining foodbetween the molars; the muscle is also active whensucking and expelling air forcibly.

• Innervation is by the buccal branch of the facial nerve


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M. Orbicularis oris

• Fibers run from one corner to the other cornerof the mouth

• Contraction closes and puckers the lips; themuscle is responsible for preventing the bolusfrom leaking out of the mouth during the oralphase

• Innervation is by the buccal branch of thefacial nerve (CN. VII)


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Velopharyngeal Closure• M. Levator Veli Palatini• M. Tensor Veli Palatini• M. Superior Pharyngeal

Constrictor


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• Levator Veli Palatini - Fibers run from the temporal bone to the softpalate; the muscles on each side join each other

in midline (creating a sling)- Bilateral contraction pulls the palate upwardand backward toward the posterior pharyngealwall, closing off the nasopharynx from theoropharynx- Innervation is by the accessory nerve (CN. XI) viathe pharyngeal plexus


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• Tensor Veli Palatini - Fibers run from the sphenoid and pterygoidbones, wind their way around a bony hook (the

pterygoid hamulus) and insert into the palatineaponeurosis- Bilateral contraction pulls the palate taut andhorizontal, creating a platform from which theother palatine muscles can change its position- Innervation is by the mandibular nerve (branchof the trigeminal nerve, CN. V)


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• Superior Pharyngeal constrictor - Fibers run from the pterygomandibular raphe (atendinous structure running from the pterygoid bone to themandible; the buccinator also inserts on this structure) andfrom the side of the tongue, posteriorly to the pharyngealraphe (a tendinous structure running along the midline ofthe posterior pharyngeal wall) and the pharyngeal tubercleon the occipital bone- Bilateral contraction pulls the superior part of theposterior wall of the pharynx toward the palate, creating asphincter-like action when working together with thepalatine muscles- Innervation is by the accessory nerve (CN. XI)


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• Tongue base retraction is the result of a co-contraction of the following muscles:

- Palatoglossus

- Styloglossus

- Hyoglossus

- Transversus (Intrinsic tongue muscle)- Upper pharyngeal constrictor


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Pharyngeal Structures• The pharynx is a funnel shaped that is situated behind the nasal

cavities, the mouth, and the larynx.• The pharynx is a membranous tube running from the level of the

base of the skull to the level approximating the sixth cervicalvertebra

• Parts of the pharynx:o Nasal part of the pharynx: It lies behind the nasal cavities abovethe soft palate.o Oral part of the pharynx: It lies behind the mouth cavity andextends from the soft palate to the upper border of the epiglottis.

o Laryngeal part of the pharynx: It lies behind the opening intothe larynx and the posterior surface of the larynx. It extendsbetween the upper border of the epiglottis and the lower border ofthe cricoid cartilage.


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The wall of the pharynx has three layers:1) Mucous membrane:

o Mucous membrane is continuous with that of the nasalcavities, the mouth, and the larynx.

o The upper part is lined by ciliated columnar epithelium.o The lower part is lined by stratified squamous

epithelium.2) Fibrous layer:

o It lies between the mucous membrane and themuscular layer.

o It is thicker above.3) Muscular layer: It consists of Superior, middle, and inferior

constrictor muscles:


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Pharyngeal constriction (squeeze) andshortening:

• Once the bolus has entered the pharynx, withthe base of the tongue sealing off the oralcavity and the velum closing off thenasopharynx, the pharynx now starts pushingthe bolus down by squeezing its wallstogether in a ripple-like effect and by

shortening in length pharyngealcontraction


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Pharyngel Constrictor• Inferior Constrictor : It is strongest and thickest of

the pharyngeal muscles.• Middle Constrictor: It fans shaped and striated.

This muscle is overlapped by the inferior andsuperior constrictor muscles.

• Superior Constrictor: It is the weakest of thepharyngeal muscles.

• Stylopharyngeus Muscle : It runs along the sidesof the constrictor muscles. This muscle not onlyaids in the pharyngeal contraction but also aids inelevating the pharynx and larynx.


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ConstrictorMuscle of

Pharynx


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Nerve supply of the pharynx• The pharynx is innervated by the pharyngeal plexus,

which is formed from branches of theglossopharyngeal, vagus, and sympathetic nerves.

• The motor nerve supply is derived from the branch of

the vagus of the pharyngeal plexus, supplies all themuscles of the pharynx except the stylopharyngeus,which is supplied by the glossopharyngeal nerve.

• The sensory nerve supply of the mucous membrane o The nasal part is from the maxillary nerve,o The oral part is from the glossopharyngeal nerveo The laryngeal part is from the internal laryngealbranch of the vagus nerve.


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Blood Supply of the pharynx• The arterial supply of the pharynx is derived from

branches of o Ascending pharyngeal,o The ascending palatine,o The facial,o The maxillary, ando The lingual arteris

• The veins drain into the pharyngeal venousplexus, which in turn drains into the internal

jugular vein.


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Laryngeal Structure• The larynx ("organ of voice") is a valve separating the

trachea from the upper aerodigestive tract. It is placedat the upper part of the air passage. It is situatedbetween the trachea and the root of the tongue, at theupper and forepart of the neck.

• It forms the lower part of the anterior wall of thepharynx, and is covered behind by the mucous lining ofthat cavity; on either side of it lie the great vessels of

the neck.• The framework of the larynx is made up of cartilages,

which are connected by membranes and ligaments andmoved by muscles. It is lined by mucous membrane.


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• The larynx provides a protective sphincter at the inlet of the airpassages and is responsible for voice production. Above, itopens into the laryngeal part of the pharynx, and below, it iscontinuous with the trachea.

• Purpose:o Organ of communication (the "voice box")

o Important regulator of respiration

o Necessary for an effective cough or valsalva maneuvero Prevents aspiration during swallowing


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Laryngeal Cavities

• The mucous membrane of the larynx lines the cavityand is covered with ciliated columnar epithelium. .

• The cavity of the larynx extends from the inlet to the

lower border of the cricoid cartilage. It can bedivided into three parts: (1) the upper part, orvestibule; (2) the middle part; and (3) the lower part.


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The upper part of the Larynx• The vestibule of the larynx

extends from the inlet to thevestibular folds. The latterare two thick folds of mucousmembrane that cover thevestibular ligaments.

• Below, the vestibule isnarrowed by the pinkvestibular folds, whichproject medially.

• The rima vestibuli is the gapbetween the vestibular folds.


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The middle part of the Larynx• It extends from the level of the vestibular folds to the

level of the vocal folds. The vocal folds are white incolor and contain the vocal ligaments.

• The rima glottidis is the gap between the vocal folds in

front and the vocal processes of the arytenoidcartilages behind.• Between the vestibular and vocal folds on each side is

a small recess, called the sinus of the larynx. It is linedwith mucous membrane, and from it, a smalldiverticulum, called the saccule of the larynx, passesupward between the vestibular fold and the thyroidcartilage.


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The lower part of larynx

• It extends from the level of the vocal folds tothe lower border of the cricoid cartilage.

• Its walls are formed by the inner surface ofthe cricothyroid ligament and the cricoidcartilage.


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The cartilages of the Larynx

• Thyroid cartilage• Cricoid cartilage• Arytenoid cartilage• Coriculate cartilage• Cuneiform cartilage


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Laryngeal Membrane and Ligaments

• The thyrohyoidmembrane

• The cricothyroid

membrane• The vocal ligaments• The vestibular ligament•

The cricotrachealligament


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Muscle of the Larynx

• The muscle can be devided into two groups :1. Extrinsic muscle2. Intrinsic muscle


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The extrinsic muscle of the Larynx• Digastrics, anterior belly elevates,

protracts the hyoid bone• Digastrics, posterior belly elevates,

retracts the hyoid bone• Stylohyoid elevates, retracts the

hyoid bone•

Mylohyoid elevates and protractshyoid• Geniohyoid depresses jaw,

elevates and protracts hyoid• Sternohyoid depresses the hyoid• Sternothyroid depresses the

thyroid• Omohyoid depresses the hyoid• Thyrohyoid shortens distance

between thyroid and hyoid bone


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The intrinsic muscle of the Larynx

Those that control theinlet into the larynx andthose that move the vocalfolds.

• Cricothyroid • Posterior Cricoarytenoid • Lateral Cricoarytenoid • Interarytenoid:

Transverse and Obliquearytenoids

• Thyroarytenoid • Aryepiglotticus

l ll h f


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Muscle Controlling the Movements ofthe Vocal Folds

• Cricothyroid (tensor)• Thyroarytenoid (relaxor)• Lateral Cricoarytenoid

(adductor)• Posterior cricoarytenoid

(abductor)


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C i h id (T )


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Cricothyroid (Tensor):

• Origin : From the side of the cricoid cartilage.• Insertion : The muscle is triangular in shape. The upper fibers (Pars

recta) pass upward and backward and are inserted onto the lowerborder of the lamina of the thyroid cartilage. The lower fibers (Parsoblique) run backward and are inserted onto the anterior border ofthe inferior cornu of the thyroid cartilage.

• Nerve supply : External laryngeal nerve, and SLN that onlyinnervates the cricothyroid muscle (serves to raise pitch) [6]

• Action : The vocal ligaments are tensed and elongated by increasingthe distance between the angle of the thyroid cartilage and thevocal processes of the arytenoid cartilages. This is brought about bythe muscle (1) pulling the thyroid cartilage forward and (2) tiltingthe lamina of the cricoid cartilage backward with the attachedarytenoid cartilages.

Th id (R l )

http://www.hani-shaker.com/Swallowing/Swallowing_anatomy.htmhttp://www.hani-shaker.com/Swallowing/Swallowing_anatomy.htm


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Thyroarytenoid (Relaxor):

• Origin : From the inner surface of the angle of the thyroidcartilage.

• Insertion : The fibers lie lateral to the vocal ligament and areinserted onto the anterolateral surface of the arytenoidcartilage. Medial portion of the thyroarytenoid runalongside the vocal ligament and are attached to the vocalprocess of the arytenoid cartilage, and it called the vocalismuscle. The lateral portion of the thyroarytenoid muscle iscalled thyromuscularis.

• Nerve supply : Recurrent laryngeal nerve.• Action : Pulls the arytenoid cartilage forward toward the

thyroid cartilage and thus shortens and relaxes the vocalligament.

L l C i id (Add )


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Lateral Cricoarytenoid (Adductor):

• Origin: From the upper border of the arch of thecricoid cartilage.

• Insertion : Into the muscular process of the

arytenoids cartilage.• Nerve supply : Recurrent laryngeal nerve.• Action : Pulls the muscular process of the

arytenoids cartilage forward, causing rotation ofthe arytenoid, so that the vocal process movesmedially, and the vocal folds are adducted.

P i C i id (Abd )


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Posterior Cricoarytenoid (Abductor):

• Origin : From the back of the lamina of the cricoidcartilage.

• Insertion : The fibers pass upward and laterally, to

be inserted into the muscular process of thearytenoids cartilage .• Nerve supply: Recurrent laryngeal nerve.• Action : Pulls the muscular process of the

arytenoids cartilage backward, causing rotationof the arytenoid, so that the vocal process moveslaterally, and the vocal fold is abducted.


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• Muscle Controlling theLaryngeal Inlet

- Oblique Interarytenoid- Transverse Intraarytenoid

• Airway closure muscle- Lateral cricoarytenoid

- Transverse (or inter-)arytenoids


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T I t t id


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Transverse Interarytenoid:

• Origin : From the back and medial surface of thearytenoid cartilage.

• Insertion : The muscle fibers bridge the intervalbetween the arytenoid cartilages. The fibers areattached to the back and medial surface of theopposite arytenoid cartilage.

• Nerve supply : Recurrent laryngeal nerve.• Action : Approximates the arytenoid cartilages

and closes the posterior part of the rima glottides(adduct the glottis).

•

L t l i t id


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Lateral cricoarytenoid

• muscle originates from the lateral side of thesuperior border of the arch of the cricoidcartilage; its fibers run posteriorly to attach to

the muscular process of the arytenoidcartilage• Contraction rotates the arytenoid cartilages,

thereby closing the airway• Innervation is by the recurrent laryngeal nerve

(branch of Vagus, CN. X)

Tr ns erse (or inter ) r tenoids


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Transverse (or inter-) arytenoids

• This is a single, unpaired muscle runningbetween the two arytenoid cartilages

• Contraction adducts the arytenoid cartilages,thereby closing the airway

• Innervation is by the recurrent laryngeal nerve(branch of Vagus, CN. X)


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Nerve supply of the Larynx:


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Nerve supply of the Larynx:

• The sensory nerve supply to the mucous membrane ofthe larynx above the vocal folds is from the internallaryngeal branch of the superior laryngeal branch ofthe vagus nerve.

•

Below the level of the vocal folds, the mucousmembrane is supplied by the recurrent laryngealnerve.

• The motor nerve supply to the intrinsic muscles of thelarynx is the recurrent laryngeal nerve, except for the

cricothyroid muscle, which is supplied by the externallaryngeal branch of the superior laryngeal branch ofthe vagus.


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The esophageal structure• It is a muscular tube approximately 23-25 cm

long, continuous with the pharynx superiorly andthe stomach inferiorly

• It has two sphincters: the upper esophagealsphincter (UES) and lower esophageal sphincter.

• Upper esophageal sphincter – this area is really agroup of 3 muscles: the lower fibers of the lowerpharyngeal constrictor, the cricopharyngeus and

the upper fibers (striated) of the esophagealmusculature; this muscle group controls theaccess of the bolus to the esophagus.


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• It has two layers of muscles, the outerlongitudinal and the inner circular muscles.The upper third is made up of striated muscle;

the middle third is made up of combination ofstriated and smooth muscles; and the lowerthird is made up of smooth muscle.


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Tracheal Structure• The trachea is a cylindrical

tube that projects onto thespine from C6 to the level ofT5. As

• it passes downwards, itfollows the curvature of thespine, and courses slightlybackward.

• Near the tracheal bifurcation,it deviates slightly to theright.


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• 18-22 cartilaginous rings• There are 2.1 rings/cm• Becomes intrathoracic at 6 th

cartilaginous ring• Intrathoracic portion: 6-15 cm• The trachea is formed from

three layer of tissue :- Outer layer : fibrous andelastic tissue

- Middle layer : cartilage andband of smooth muscle- Inner layer : ciliated mucousmembrane


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Cranial nerves responsible for swallowing and voice

CN V -- Trigeminuscontains both sensory and motor fibers that innervate the faceimportant in chewinglocated at the level of the pons

CN VII -- Facialis

contains both sensory and motor fibersimportant for sensation of oropharynxtaste to anterior 2/3 of tongue

CN IX -- Glossopharyngeuscontains both sensory and motor fibersimportant for taste to posterior tonguesensory and motor functions of the pharynx


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CN X -- Vaguscontains both sensory and motor fibersimportant for taste to oropharynx and sensation andmotor function to larynx and laryngopharynx.important for airway protection

CN XII – Hypoglosuscontains motor fibers that primarily innervate thetongue


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