The oral region:

It includes the oral cavity, teeth, gingivae, tongue, palate, and

region of palatine tonsil.
Oral cavity:

Limitation:
The roof of the oral cavity consists of the hard and soft
palates.
The floor of the oral cavity formed mainly of soft tissues,
which include a muscular diaphragm and tongue.
The lateral walls are the cheeks.

Teeth:

Teeth vasculature:
The superior alveolar artery a branch of the maxillary artery
supplies the maxillary teeth.
The inferior alveolar artery a branch of the maxillary artery
supplies the mandibular teeth.
Alveolar veins with the same names.

Teeth innervation:

The superior alveolar nerve a branch of maxillary nerve (CV2)

supplies the maxillary teeth.
The inferior alveolar nerve a branch of mandibular nerve
(CV3) supplies the mandibular teeth.
Both of them form a dental plexus.
Note: there is important relationship between the lingual nerve
and the 3rd molar tooth, therefore caution is taken to avoid
injuring this nerve during their extraction.

Palate:
Vasculature:
Greater palatine + lesser palatine arteries (both of them
branches of descending palatine artery)
The veins of the palate are tributaries of the pterygoid
venous plexus.

Innervation:
The sensory nerves of the palate are branches of the maxillary
nerve (CNV2) that branch from pterygopalatine ganglion.
Note: the soft palatine consists of 5 muscles:
Tensor veli palatini
Levator veli palatini
Palatoglossus
Palatopharyngeus
Musculus uvulae
All of them are innervated by the pharyngeal branch of the
vagus nerve, Except the first one (tensor veli palatini

muscle which is innervated by a medial pterygoid nerve, a

branch of mandibular verve CNV3.

Tongue:
It is a mass of muscles that is mostly covered by mucous
membrane.
A. Extrinsic muscles of the tongue:
Genioglossus, hyoglossus, styloglossus, and Palatoglossus.
B. Intrinsic muscles of the tongue:
The superior and inferior longitudinal, transverse, and
vertical muscles.
Innervation:
All muscles of the tongue are innervated by Hypoglossal nerve
CN XII, Except Palatoglossus muscle which innervated by vagus
nerve CN X.

For general sensation (touch and temp.):

The anterior 2/3 of the tongue is supplied by the lingual
nerve, a branch of CN V3.
The posterior 1/3 of the tongue is supplied by the lingual
branch of glossopharyngeal nerve CN IX.

For special sensation (taste):

The anterior 2/3 of the tongue is supplied by the chorda
tympani nerve, a branch of CN VII.
The posterior 1/3 of the tongue is supplied by the lingual
branch of glossopharyngeal nerve CN IX.

Vasculature:
By lingual artery, a branch of external carotid artery.

The pharynx:

It is the superior expanded part of alimentary system posterior

to the nasal and oral cavities.
It is widest (approximately 5 cm) opposite the hyoid.
and narrowest (approximately 1.5 cm) at its inferior end.
It is divided into 3 parts:
Nasopharynx: posterior to the nose and superior to the
soft palate.
Oropharynx: posterior to the mouth.
Laryngopharynx: posterior to the larynx.
Vasculature:
by a tonsillar artery, a branch of facial artery.
and the venous drainage is obtained by the large external
palatine artery.

Innervation:
The nerve supply to the pharynx (motor and most of sensory)
derived from pharyngeal plexus of nerves.

The esophagus:
It is a muscular tube that is continuous with the pharynx and
runs in the thorax through the superior and posterior
mediastinum.
Limitation: it begins at the cricoids cartilage (C6) and ends at
gastroesophageal (GE) Junction, the esophagus pierce the
diaphragm to form the esophageal hiatus (T10).
General features:
The esophagus constitutes the primary posterior
relationship of the base of the heart.
The upper third of the muscularis externa of the
esophagus consists of skeletal muscles only.
The middle third of the muscularis externa of the
esophagus consists of both skeletal and smooth muscles.
The lower or distal third of the muscularis externa of the
esophagus consists of smooth muscles only.
The overall length is 23-25 cm.
From incisor teeth the GE junction is 38-43 cm.

Constrictions:
There are 5 constrictions of the esophagus along its course:
1. At the junction of the pharynx and esophagus.
2. At the aortic arch.
3. At the tracheal bifurcation (vertebral level T4) where the
left main bronchus crosses the esophagus.
4. At the left atrium [] .
5. At esophageal hiatus [] .

Sphincters:

1. The upper esophageal sphincter (UES) [composed of

skeletal muscles]
Separates the pharynx from the esophagus.
Composed of opening muscles and closing muscles
A. Opening muscles: Thyrohyoid muscle + Geniohyoid
muscle
B. Closing muscles: Inferior pharyngeal constrictor muscle
+ cricopharyngeus muscle.
2. The lower esophageal sphincter (LES) [composed of
smooth muscles]
Separates the esophagus from the stomach. [
]
Arterial supply:
It involves many arteries:
Esophageal arteries arise from thoracic aorta.
Bronchial arteries.

 Ascending branches of the left gastric artery in the

abdomen.

Venous drainage:

 Small vessels returning > the Azygos + Hemiazygos veins

> systemic venous blood.
Esophageal branches > left gastric vein > portal venous
blood
Innervation:
The esophagus is innervated by:
Esophageal nerve plexus, formed by vagal trunks.
Thoracic sympathetic trunks via greater splanchnic
nerves.
Periarterial plexus around the left gastric and inferior
phrenic arteries.

The stomach:
It is divided into 4 parts:
1. Cardia: is near GE junction.

2. Fundus: is above the GE junction.

3. Body: is between the fundus and antrum.
4. Pylorus: is the distal part of the stomach and is divided
into the pyloric antrum (wide part) and pyloric canal
(narrow part). The pyloric orifice is surrounded by the
pyloric sphincter.

Arterial supply:
Anastomosis formed along the lesser curvature by the
right and left gastric arteries.

 Anastomosis formed along the greater curvature by the

right and left gastro-omental (gastro-epiploic) arteries.
The fundus and upper body receive blood from the short
and posterior gastric arteries (branches of the splenic
artery).

Venous drainage:

The gastric veins parallel the arteries in position and course,

and all of them eventially lead to portal venous blood.
Innervation:
A. Parasympathetic innervation:
Is derived from anterior and posterior vagal trunks, which
are the continuation of the left and right vagi nerves
respectively.
[note: the posterior vagal trunk is larger the the anterior
one]
B. Sympathetic innervation:
By the greater splanchnic nerves; the sympathetic fibers
come from T6-T9 spinal segments > through the greater
splanchnic nerves > distribute to the stomach around the
gastric and the gastro-omental arteries.

Duodenum:

The duodenum has a C-shaped course around the head of the

pancreasse, Is the first, shortest and widest part of the small
intestine, Begins at the pylorus and ends at the duodenojejunal
junction, the dupdenum is divided into:

1. Superior part (first part):

Horizontal

The first 2 cm of the superior part (duodenal bulb) is

intraperitoneal and therefore has a mesentery and is
mobile, while The remaining distal 3 cm is
retroperitoneal.
It begins at the gastroduodenal junction, which is
marked by prepyloric vein.
Lies anterolateral to the body of L1.
It is overlapped by the liver and gallbladder.
The lesser omentum is attached superiorly to it while
the greater omentum is attached inferiorly.
2. Descending part (second part):

Runs inferiorly along L2, 3.

Curves around the head of pancreas.

Lies to the right and parallel to the IVC.

The bile and pancreatic ducts unite to form the

hepatopancreatic duct which enters the

posteromedial wall of the 2nd part.

3. Horizontal part (third part):

Runs horizontally to the left.
Crosses the IVC and aorta anteriorly at L3.
Crosses the SMA, SMV and the root of the mesentery
of the jejunum and ileum posteriorly at L3.
Superiorly is the head of pancreas and the uncinate
process.
Posteriorly it is separated from the vertebral column
by the right psoas major, IVC, aorta and the right
testicular or ovarian vessels.

4. Ascending part (fourth part):

Begins at the left of L3 then rises superiorly until

it reaches the pancreas.

Then it curves anteriorly to join the jejunum at

the duodenojejunal junction.

The duodenojejunal junction is supported by the

attachment of a muscle called the ligament of Treitz.

Contraction of the ligament of Treitz widens the

angle of the flexure, facilitating movement of the

intestinal contents.

Blood supply:
a. Duodenal Arteries: arise from the celiac trunk, supply
the proximal part of the duodenum, and the SMA,
supply the distal part of the duodenum.
b. Pancreaticoduodenal Arteries: lie in the curve
between the duodenum and the head of pancreas.
c. The Duodenal Veins: follow the arteries and drain into
the portal vein via the SMV and splenic vein.
Nerve Supply:
Nerves of the duodenum derive from the vagus and
sympathetic nerves through the celiac and superior
mesenteric plexuses.

Spleen
Facts:
o Is the largest lymphatic organ
o A mobile organ
o Purple in color
o Varies in size and weight
o Contains large quantities of blood
o Located intraperatoneally in the left upper quadrant
o Entirely surrounded by peritoneum except at the
hilum
o Left 9th, 10th and 11th ribs are posterior to it
o The diaphragm and the costodiaphragmatic recesses
separate the spleen from the ribs
o It rests on the left colic flexure
Relations of the spleen:
o Anteriorly is the stomach
o Posteriorly is the left part of the diaphragm
o Inferiorly is the left colic flexure
o Medially is the left kidney
Blood Supply:
o Splenic artery: a branch of the celiac trunk which
divide into five or more branches that enter the hilum

o Splenic vein: comes from the hilum then joins with

IMV and runs posterior to the pancreas. Then it unites
with the SMV at the level of the neck of pancreas to
form the portal vein
Nerve Supply:
o Spleen nerves derive from the celiac trunk and move
along the arteries (splenic), they act as vasomotor.