ORAL REGION

The oral region includes the oral cavity, teeth, gingivae, tongue, palate, and the region of the
palatine tonsils. The oral cavity is where food is ingested and prepared for digestion in the
stomach and small intestine. Food is chewed by the teeth, and saliva from the salivary glands
facilitates the formation of a manageable food bolus (L. lump). Deglutition (swallowing) is
voluntarily initiated in the oral cavity. The voluntary phase of the process pushes the bolus
from the oral cavity into the pharynx, the expanded part of the alimentary (digestive) system,
where the involuntary (automatic) phase of swallowing occurs.
Oral Cavity
The oral cavity (mouth) consists of two parts: the oral vestibule and the oral cavity proper
(Fig. 7.76). It is in the oral cavity that food and drinks are tasted and where mastication and
lingual manipulation of food occur. The oral vestibule is the slit-like space between the teeth
and gingivae (gums) and the lips and cheeks. The vestibule communicates with the exterior
through the oral fissure (opening). The size of the oral fissure is controlled by the circumoral
muscles, such as the orbicularis oris (the sphincter of the oral fissure), the buccinator,
risorius, and depressors and elevators of the lips (dilators of the fissure).
The oral cavity proper is the space between the upper and the lower dental arches or arcades
(maxillary and mandibular alveolar arches and the teeth they bear). It is limited laterally and
anteriorly by the dental arches. The roof of the oral cavity is formed by the palate.
Posteriorly, the oral cavity communicates with the oropharynx (oral part of the pharynx).
When the mouth is closed and at rest, the oral cavity is fully occupied by the tongue.
Lips, Cheeks, and Gingivae
LIPS AND CHEEKS
The lips are mobile, musculofibrous folds surrounding the mouth, extending from the
nasolabial sulci and nares laterally
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and superiorly to the mentolabial sulcus inferiorly (Fig. 7.77). They contain the orbicularis
oris and superior and inferior labial muscles, vessels, and nerves (Fig. 7.16). The lips are
covered externally by skin and internally by mucous membrane. The lips function as the
valves of the oral fissure, containing the sphincter (orbicularis oris) that controls entry and
exit from the mouth and upper alimentary and respiratory tracts. The lips are used for
grasping food, sucking liquids, keeping food out of the vestibule, forming speech, and
osculation (kissing).
The transitional zone of the lips (commonly considered by itself to be the lip), ranging from
brown to red, continues into the oral cavity where it is continuous with the mucous
membrane. This membrane covers the intraoral, vestibular part of the lips (Fig. 7.78). The
labial frenula are free-edged folds of mucous membrane in the midline, extending from the
vestibular gingiva to the mucosa of the upper and lower lips; the one extending to the upper
lip is larger. Other smaller frenula sometimes appear laterally in the premolar vestibular
regions.
The superior and inferior labial arteries, branches of the facial arteries, anastomose with each
other in the lips to form an arterial ring (Fig. 7.24; Table 7.5). The pulse of these arteries may
be palpated by grasping the upper or lower lip lightly between the first two digits. The upper
lip is supplied by superior labial branches of the facial and infra-orbital arteries. The lower lip
is supplied by inferior labial branches of the facial and mental arteries.
The upper lip is supplied by the superior labial branches of the infra-orbital nerves (of CN
V2), and the lower lip is supplied by the inferior labial branches of the mental nerves (of CN
V3). Lymph from the upper lip and lateral parts of the lower lip passes primarily to the
submandibular lymph nodes (Fig. 7.77), whereas lymph from the medial part of the lower lip
passes initially to the submental lymph nodes.
The cheeks (L. buccae) have essentially the same structure as the lips with which they are
continuous. The cheeks form the movable walls of the oral cavity. Anatomically, the external
aspect of the cheeks constitutes the buccal region, bounded anteriorly by the oral and mental
regions (lips and chin), superiorly by the zygomatic region, posteriorly by the parotid region,
and inferiorly by the inferior border of the mandible (Fig. 7.14). The prominence of the cheek
occurs at the junction of the zygomatic and buccal regions. The zygomatic bone underlying
the prominence and the zygomatic arch, which continues posteriorly, are commonly referred
to as the “cheek bone” (Fig. 7.3). Lay persons consider the zygomatic and parotid regions
also to be part of the cheek.
The principal muscles of the cheeks are the buccinators (Figs. 7.76). Numerous small buccal
glands lie between the mucous membrane and the buccinators (Fig. 7.74). Superficial to the
buccinators are encapsulated collections of fat; these buccal fat-pads are proportionately
much larger in infants, presumably to reinforce the cheeks and keep them from collapsing
during sucking. The cheeks are supplied by buccal branches of the maxillary artery and
innervated by buccal branches of the mandibular nerve.

Palate
The palate forms the arched roof of the mouth and the floor of the nasal cavities (Fig. 7.83). It
separates the oral cavity from the nasal cavities and the nasopharynx, the part of the pharynx
superior to the soft palate. The superior (nasal) surface of the palate is covered with
respiratory mucosa, and the inferior (oral) surface is covered with oral mucosa, densely
packed with glands. The palate consists of two regions: the hard palate anteriorly and the soft
palate posteriorly.
HARD PALATE
The hard palate is vaulted (concave); this space is mostly filled by the tongue when it is at
rest. The anterior two thirds of the palate has a bony skeleton formed by the palatine
processes of the maxillae and the horizontal plates of the palatine bones (Fig. 7.84A). The
incisive fossa is a depression in the midline of the bony palate posterior to the central incisor
teeth into which the incisive canals open. The nasopalatine nerves pass from the nose through
a variable number of incisive canals and foramina that open into the incisive fossa (see Fig.
7.87B).
Medial to the 3rd molar tooth, the greater palatine foramen pierces the lateral border of the
bony palate (Fig. 7.84A). The greater palatine vessels and nerve emerge from this foramen
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and run anteriorly on the palate. The lesser palatine foramina posterior to the greater palatine
foramen pierce the pyramidal process of the palatine bone. These foramina transmit the lesser
palatine nerves and vessels to the soft palate and adjacent structures (Fig. 7.87).

SOFT PALATE
The soft palate is the movable posterior third of the palate and is suspended from the
posterior border of the hard palate (Fig. 7.84B). The soft palate has no bony skeleton;
however, its anterior aponeurotic part is strengthened by the palatine aponeurosis, which
attaches to the posterior edge of the hard palate. The aponeurosis is thick anteriorly and thin
posteriorly, where it blends with a posterior muscular part. Posteroinferiorly, the soft palate
has a curved free margin from which hangs a conical process, the uvula.
When a person swallows, the soft palate initially is tensed to allow the tongue to press against
it, squeezing the bolus of food to the back of the mouth. The soft palate is then elevated
posteriorly and superiorly against the wall of the pharynx, thereby preventing passage of food
into the nasal cavity.
Laterally, the soft palate is continuous with the wall of the pharynx and is joined to the
tongue and pharynx by the palatoglossal and palatopharyngeal arches, respectively (Fig.
7.83). A few taste buds are located in the epithelium covering the oral surface of the soft
palate, the posterior wall of the oropharynx, and the epiglottis.
The fauces (L. the throat) is the space between the cavity of the mouth and the pharynx. The
fauces is bounded superiorly by the soft palate, inferiorly by the root of the tongue, and
laterally by the pillars of the fauces, the palatoglossal and palatopharyngeal arches. The
isthmus of the fauces is the short constricted space that establishes the connection between
the oral cavity proper and the oropharynx. The isthmus is bounded anteriorly by the
palatoglossal folds and posteriorly by the palatopharyngeal folds. The palatine tonsils, often
referred to as “the tonsils,” are masses of lymphoid tissue, one on each side of the
oropharynx. Each tonsil is in a