[Music] today we're going to be talking about extraoral and intraoral anatomical landmarks this module is really important as you are preparing to do extra and intraoral assessments on your patient uh when you're doing these assessments it's really important not to make anything so as you're going through that assessment you want to make sure to develop a routine really go through those assessments um very thoroughly right we make want to make sure that these are very comprehensive so we're looking at a lot of different things I want this module to really just be a basic overview of any extraoral and intraoral anatomical landmarks that within the dental hygiene curriculum you would be expected to be able to identify these will also be on board as well to start we're going to talk about how the head and face and sort of neck regions are defined when you look at this picture this is showing you all of the different regions of the head and neck within each region there are specific anatomical landmarks that you will be responsible for especially for national boards we want to highlight landmarks um and fill in the blanks on your guided readings so make sure you've done that and then as we're going through this use that guided reading and make notes or highlight anything that will help you remember these landmarks first we're going to look at the temporal region So within the temporal region right if you think of the temporalis muscle think of where that would be so that sort of is basically our ear the identifiers that we can see on the ear and what we would look for this is how we're going to describe it so if you see a lesion on any of these areas you would want to really make sure that you're using the appropriate term and location for where that is and that's why this is so important at the very top of the ear you're going to see a helix the whole entire external part of that is the Oracle on the right side of that picture you're going to see the external acoustic Maus and that's essentially the hole or the canal through which sound sound goes right right in front of that Canal you have a piece of cartilage and it sticks out kind of on its own that's the tragus and on the other side of that if you grab your earlobe and you feel the cartilage right above the earlobe that's the anti-us so you have your tragus and your anti-us right across from each other and then right below that you have something called the intertragic Notch and that is just that little loopd right between the two pieces of cartilage right under um your anti-us you also have your lobe right um everybody is pretty uh familiar with your ear lobe um some people have theirs pierced and uh that is the lobe that all encompasses the temporal region next is the orbital in the orbital you have a lot of things identified by the eye we have the lacal gland which is deep to the skin so you can't see it but you have it under there then for the eyes right we have the pupil we have the iris the whites of our eyes are considered the Scara and that's con covered by the conjunctiva on either side here in the corners we have our lateral canthus and our medial campus and then up above and below we have our upper eyelid and our lower eyelid right down there the bone here where the eye sits we call that the outline of the orbit and that encompasses the orbital region next we have the nasal within the nasal region we do have some important landmarks when it comes to actually really both um local anesthesia and radiology and so we'll talk about that when we get to those but let's start the top down right so here uh we have the root of the nose and then we have the bridge of the nose so if I look from the profile hopefully you can see my profile the root is at the top and it's kind of um what goes in interal or toward my eye is the root and then up above it kind of jets out that then I have my bridge of my nose coming down from the bridge I have my nasal septum and then that leads down to the Apex my NYS or my nostril is the opening that goes inside my nose and then right on the side here and this is the POS this is the landmark that is really important for radiology especially and when we get into local we'll talk about sort of lining up the AA also for an injection site but the AA of the nose is um really important for lining up the tube head for um part of a radiograph and I don't want to get too far ahead of your of that just remember remember the allaha it's really really important and then finally going down we have the nasolabial sucus and anytime you hear the word sucus or Groove um or any it's it's just a space essentially the sucus is a space so if you drew a line from the naso which is your nose to labial which is your lip you drew a line from the lip to the nose right here when you smile you get these smile lines right so that line right there going down that's your nasal laal sulcus and that also is within that nasal region the zygomatic buckle and infraorbital regions are essentially pretty small there's not much going on within this uh in the infraorbital region right down here you have essentially like a cheekbone right there's there's in terms of anatomy there's not much there but you're right under the outline of the orbit right if you remember from the orbital region it ends at the outline so this would be right below which is essentially your cheekbone going back from your cheekbone that's going to be like the zygomatic Arch and when we get into the bones that'll make a little more sense if you recognize that great that's a review from anatomy and physiology the zanic arch um temporal mandibular joint it's on this picture but honestly yes it's in that but it's so deep same thing with the master muscle the master muscle when you clench your jaw you might be able to feel the master muscle kind of ball up in your jaw right there yes it's in that region but it's deep and so it's not something that you're going to see there's just not a whole lot going on there angle of the mandible same thing when you clench you feel that ball of muscle bound up and then the angle of the mandible is right below it's just right where you're the angle of the mandible like exactly how it's described okay so that is all um within the zygomatic buckle and infraorbital regions pretty easy regions not much there same thing with the frontal and the mental frontal is going to be essentially your forehead the frontal Eminence is above kind of where again I'm going to go profile here you can kind of see where it um emanates out right your eminence is kind of where it juts out some people have more prominent frontal eminences than others um mine isn't super prominent then you have your glabella which is that bony space right in between your two eyebrows glabella there and then the supraorbital ridge which is right underneath your eyebrows some people again anatomical variations are very normal so if your eyebrows are really high your superorbital Ridge may be a little bit lower than your eyebrows for the most part your eyebrow is essentially right over top of that super orbital Ridge so if you can feel that you should be able to sort of feel where that bony prominence is for the mental region we have two items here we're going to talk about the laal mental Groove again Groove sulcus a space and then the mental protuberance mental protuberance is essentially your chin it protrudes out mental protuberance so that's the bone that protrudes out or the bump and then we have the Lao mental Groove we learned at with the nasal labio Focus that labio means lip right so Leo coming from the lip down to the mental Groove so that's going to be this space right here right here laal mental Groove so you see that little dip and that's how you describe it next is the oral region here we have a lot of items but essentially they're kind of um duplicates right uh turial and filtrum are like they're not even mirrors because they're not opposite they're like an extension of something so the filtrum is up on the top above your lip and it's that tiny little jut down I'm gonna take my mouse here and see if I can get my mouse so your filtrum is just right there that's where your filtrum ends that little space above that that's your filtrum and then you have this little tubercle and that's part of your lip it's at the very bottom and what we notice um I don't know if there's any statistic of averages but what we notice is that people have really distinct deep filtrum they're likely going to have a really distinct deep tubercle but um anatomical variations some people don't have deep filtrum and tubercles and so they may be a little bit harder to see so look in the mirror look on your roommate or your friend or whatever can you see their filtrum in tubercle on the left side there also we have the upper lip and lower lip that's pretty easy on the right side the Vermilion border that is just the diff delineation of the lip tissue so it's just Vermilion so Vermilion is actually a word for red so Vermillion border is the red outline that's exactly what it means labial commure the labial commure is the where the upper lip and the lower lip meet so you have two of them when I open my mouth right here that's my labial cures and this is a really common area for um some oral pathology we may see a lot happening so you may have to reference this a lot especially in elderly patients or geriatric patients um we can get a lot of stuff going on around there so this is one that you may commonly use um and then the Vermilion zone is just describing where that lip tissue begins and ends so any tissue within the Vermilion border is in the Vermilion Zone next we have the anterior cervical triangle and the posterior cerv cervical triangle these are hard to talk about without each other um basically they share a border so I'm going to start with one Landmark that both of these things share and that Landmark is the sternal clom mastoid muscle this muscle is really easy to find even though yes it's deep because it's a muscle you can't see it but you can see the outline of it uh it's very easy to see um we'll see if I can get the light right here yep there's mine right here and um you should be able to feel yours so it extends right down to the sternum see if I can get my there you go there you go and it goes all the way up and it's really wide it's really thick you can kind of feel it sternal cidal mastoid muscle so that muscle is the dividing line between the anterior and the posterior cervical triangle the borders of the anterior cervical triangle then is from the stam asteroid all the way to the angle of the mandible all the way across the border and then when I turn it's all the way down so I have a right cervical anterior cervical triangle and then I have a left anterior cervical triangle okay and so that's the border of the anterior it's important for you to know uh you know memorize this picture or come up with some pneumonic device it's important for you to remember a a really common quiz question exam question boards question things that come up a lot is if you have um any of these you have to remember what's in the anterior cervical triangle and what's in the posterior cervical triangle so kind of star these two and try to remember which is in which let's talk about the border of the posterior cervical triangle next the posterior cervical triangle if I can turn Okay so there's my sternomastoid the border of this is the Trap muscle okay so my trapezius muscle which is going to come down and then my clavicle my clavicle so that is the Border clavical trapezius sternomastoid and that is what bounds the posterior cervical triangle next we're going to go intraoral so that was mainly extraoral those are things that you can see outside obviously unless it's a muzzle and it's deep but oral um intraoral we're going to talk about next and these are things that you can identify again both items from extraoral and intraoral are going to be the looked at in your overall assessment right that's why we call it extraoral intraoral exam or assessment so intraoral now we're going for the oral cavity when we're talking about these things we want to First sort of lay the groundwork of what directions these things are are are right um anything on the top arch up above is maxillary and that's because it's that's your maxillary bones we haven't got to Bones yet but you should have sort of heard about that from anatomy and physiology this whole bone on top is your maxillary bone so these are your maxillary teeth this is your maxillary uh gingiva right on the inside that is also your pallet so if something's on the roof of your mouth we would call that palatal as well anything towards the cheek is going to be buckle anything associated with your lip is going to be labial and anything inside like the floor of your mouth or the tongue is going to be lingual and then finally at the bottom there anything on your bottom bone or your jaw bone is going to be mandibular and that's because that bone is called the mandible so maxilla mandible and so anything down there will be considered mandibular in the oral cavity we have a bunch of things that we're going to be looking at and we want to know you're going to get to a point well you be able to look at something and say is this normal is this A variation of normal or is this pathological and we will get you there throughout the program but that is going to be kind of going through your mindset because not everything is going to look the same and it's important to remember that we have to remember that not everything will look the same and we have to be able to identify if something is normal A variation of normal or pathological so when we're talking about these things that's sort of important to keep in mind in this picture for the oral cavity we get a hard and soft pallet we're going to look at delineation of those two things in a couple slides but hard and soft palette um is pretty self-explanatory down farther we have the uula which is that extension of soft tissue there at the back of the throat everybody's pretty familiar with the uula as well then way in the back we have the posterior wall of the fairings and then at the bottom of this picture we have the dorsal surface of the tongue that's actually the top of your tongue we'll talk about ventral and laterals um in a little bit then going to the right side of the picture the maxillary tuberosity I don't like on this picture it's hard to see but it's a essentially the extension of bone right behind the terminal Moler and you can probably feel it with your tongue throw your tongue back there up on your maxilla and feel and you should feel like the jut of bone that sort of is coming behind that tooth if that makes sense there's a better picture in a couple slides so I'm not going to go super into that right below that though we have the terago mandibular fold just like the allaha of the nose the Tero mandibular fold star it highlight it you need to know this especially for local anesthesia this is the insertion site for one of the hardest injections that you'll do memorize terago mandibular fold and remember where it is essentially it's the line or the connection that connects the maxillary and the mandibular gingiva or mucosa or body parts so it's the line if you took your finger and swiped down the back of your where your teeth are that's what your finger would be touching the tergo menular fold and if you're listening to this and you want to do this on a partner which we will do in lecture and class if you're a student of mine um we are going to be practicing this on each other and that's fine um but the tergo mandibular fold is right back there the posterior fasher pillar is the I'm gonna okay let's look at all three of these the posterior fer pillar the palal Palatine tonsils and the anterior Foster pillar so behind that I sort of skipped the fosies and I'm sorry about that but if you see those two extensions of they look like um curtains right so if you think about curtains you have like your blackout curtains and then maybe behind the blackout curtains you have these um sheer curtains right that if you want to open the blackout curtains you still sort of have a barrier so that's kind of what this reminds me of or what it looks like the posterior FAL pillars are like the sheer curtains in the back the anterior fos show pillars are like the blackout curtains that extend in front and right between those two pillars right between them you might have some tonsils in there unless you got your tonsils out then in which case you may not see any tonsils um but there there might be some tonsils in there it'll be interesting when you're looking in some of your first patients look for these things make sure you can identify them uh make sure you're asking them did you get your tonsils removed um that is a good question to ask when we're taking our medical history but sort of off topic anyway retromolar pad retromolar pad is the pad of bone and tissue right behind the terminal Muller on your mandibular so we talked about the maxillary tuberosity behind the terminal M on the maxillary teeth this is the same it's just on the mandibular teeth next we we have Buckle so in this picture we're going to look at a couple different things and on this picture we're going to duplicate this so on the next slide we're going to be looking at the perid donum and so some of this you'll see again but what you're not going to see again is the paraded pill that's one and that is located this this picture to me is a little bit this is a variation of normal okay this one's pretty low sometimes it can be really high up in that maxillary vest F or the space between the cheek and the bone so the pared Pilla this is something you're going to have to be able to identify on your student partner your Buckle mucosa which is the mucosa attached behind the labial commure right because anything up front of the labial commure would be considered labial mucosa kind of tricky there right anything behind the labial commissure is Buckle anything in front of the labial commissure is laal on the other side there we have Alvar mucosa so this is any alular muc any alular mucosa this is any mucosa that is above or attached to alular Bone and that's why it's named that way alv bone of the mandible there and alv bone of your maxillary it's all going to be alv because it's attached to the alular bone underneath that we have the mucco Buckle fold and so this is a space again a fold um a vestibule is also a word for a space so a vestibule think of as like a hallway the mandibular vestibule is the hallway or the path or the space between the lips and the cheeks I between the vestibule is the path between the cheek and the bone so it's like a hallway if you pull the cheek out a little bit you can kind of see that space the mucle fold is like the basement or the floor of that hallway it's at the very bottom where the alv mucosa and the Buckle mucosa meet together so if I was the fold I'm gonna that I'm the pen is in the muc Buckle fold does that make sense so the fold is at the bottom where the two surfaces it's where the bone stops and the Buckle starts okay next we have the pantum the periodontium is getting down further into where the teeth connect and how the tissues and the teeth interact with each other on the picture on the left um I'm just going to start from the top down first we have the labial freom this is the attachment of the lip to the attached gingiva or the connection there um a lot of patients may not have this one because it could have ripped or broken when they were children that's a really common thing or if it wasn't ripped or broken as children the an orthodontist might have given them a frenectomy so if you've ever had a frenectomy that means they cut your lavial freedom so so you didn't have too tight of a connection that can cause some problems especially if it's a really really tight Freedom attachment it can cause some Ortho issues so a lot of the times that frenectomy is done and released so that way you have full movement of the lip same thing with tongue ties or tongue freedoms which we'll get to later but uh then we have the maxillary teeth the mandibular teeth and another labial Freedom this one isn't cut as often it doesn't cause as many Ortho problems and they're typically not as tight so the labal freedom on the bottom is more likely to be intact and might be easier to find the alv mucosa there on the top extends all the way down until you see this wavy line and that wavy line is called The mucco gingival Junction that means that that alular mucosa and the attached gingiva have met the attached gingiva is really keratinized it's keratinized and it's thick and our body has made it that way in order to withstand all of the chewing and the pressure side toide that our teeth take the more attached gingiva we have the healthier parodont is is going to be for a longer period of time um keratinized tissue there is good and we want as much detached TOA as possible so that line we call the mucco for alular mucosa and gingival for the attached gingiva mucco gingival Junction it's just a term to describe where those two things meet so on the right picture the only thing then that we're missing here is the marginal gingiva the inner D Al gingiva and the gingival sulcus the marginal gingiva is the gingiva that is free it's also known as free gingiva so marginal gingiva and free gingiva can be used interchangeably and essentially it just means it's what creates the pocket when we get into Paro we will learn a lot more about the microscopic Anatomy but you don't need that yet for clinical skills all you need to know is that that pocket exists the marginal gingera has a space in there and when you probe or learn to probe that's where you're putting your probe you're putting your probe down into a pocket and so that pocket is going to be kind of like a little cuff if you were wearing a turtleneck it's like the it's like the tooth has a little turtleneck around it and it's a free space of gingiva and that free gingiva is what you're going to measure that's how we assess for gum disease it's how we assess for inflammation for bone loss and it's really important in terms of peronal um diagnosis and classification the gingival sulcus then is just the space it's the space between the marginal gingiva and the tooth within that there's a space and that's physically where your probe will go your your probe will go in the sulcus and measure how deep that connection goes the palette I said we were going to come back to the palette and talk about the vibrating line the vibrating line is a very light line you can see it on yourself in the mirror if you want to or look in a partner's mouth the vibrating line is a line that separates the hard and soft palette it's called the vibrating line because if you were to open your mouth and say ah you might see that soft palette go like that and that's why it's called the vibrating line fobia palatini are two little indentations right behind the vibrating line and we already talked about the uula on the pet then we have right behind the max anterior teeth the incisive pill star highlight just like the terago mandibular fold and just like the Alla of the nose the incisive pill is a local anesthesia Landmark please memorize this please remember this the incisive papilla covers the incisive fmen and the incisive foramen is where that nerve comes through that you're going to anesthetize so it covers that so that incop Mill is really important to remember I will say that in terms of variations of normal some patients have very pronounced easy to see incisive Pilla and some patients have very subtle incisive pillas the the anatomy is not very distinct or pronounced so it's hard to see the Palatine rug on the sides are just sort of these um extensions of thicker keratinized tissue there the median Palatine RAF is very specific though the palatin rug are not as specific some are defined some are not the median palatin RAF is the only line that goes down the center okay so it's an extension it's a seam it's it's um significant and every patient essentially has one it's just that some patients have really distinct ones and some patients do not so a lot of the times um just sort of make a note on this a lot of the times early on in clinics some students can get the median Palatine RAF mixed up with a maxillary um Taurus or Tori Tori is plural but um essentially what I'm saying is there's a variation of normal and that's called Tori and so sometimes times that Medium Palatine rafay students feel that it's very pronounced and thick and they'll put that that's a torai and and sort of get those mixed up so if it's all the way down the midline and it's a ridge almost or very pronounced line more than likely it's not a t t are very bulbous shaped um they're kind of look like little mushrooms but they're hard and so the people that are down in clinic with you learning clinical skills will help you work through that if you're not sure just ask but sometimes those do get mixed up every now and then next I said I was going to talk about the maxillary tuberosity again as well and this is it right between the maxillary tuberosity and the hamular process which we'll talk about when we get to the bones is a Groove called the hamular Notch and so this I believe is way easier to feel than the max tuberosity because it's more significantly different than all of the other bone right so if you put your tongue back up to where that maxillary tuberosity would be this is the notch that your tongue can kind of go up into if that makes sense hamular Notch tongue so on the tongue we have a few different um words to describe the surfaces the dorsal surface is going to be on the top there you can see on the picture the laterals are the sides and then the vental is underneath the Apex is is always going to be the tip of your tongue and then on the sides of your tongue or the lateral surface of your tongue you have something called foliate pilla foliate pilla are named that because of foliage foliage is um a term used to describe leaves or leaflike structures and that's why these are called this because these Pilla on the tongue look like little leaves they're they're um long and sort of oblong shape so they they're like leaf-like extensions and you can really see this on um a partner's tongue so if as you're doing some of these early ones in clinic just kind of keep that in mind keep looking for these things the other types of Pilla we have are on the next picture the filor pill are kind of like the tongues carpet they're very widely dispersed they're um the ones that you're probably used to looking at right the ones that kind of if you took a probe or an Explorer and kind of ran it along the tongue it would move almost like carpet wood or or really nicely mowed grass uh in terms of the fungiform these look like small little red round shaped mushrooms that's why they're called fungiform um and some people have really prominent ones and some people don't so again as you're looking for these variations of normal look for these some patients might not have Min fungiform and some patients might have really pronounced ones behind the tongue or behind the body of the tongue we have the base of the tongue most of this you cannot see you may be able to see some Circ valent lingual Pella maybe if that patient really can you know kind of spread open their mouth really wide and and stick their tongue out maybe you can see the circum valent pill I know I can on me but um that's another thing but you might not be able to see it on everybody is is what I'm trying to say the circum valent lingual pill right behind that there's a sulcus terminalis which is kind of like a Groove and then right at the center at the base of the tongue we have the fan seeum on the lateral sides we have some Palatine tonsils which we talked about which were between the fal pillars and then very at the back we have our epig latus next is the floor of the mouth so in the floor of the mouth we have a few different things that we can really see on the right picture I'm going to start with the top right picture I'm going to talk about two things here the first one is the Deep lingual veins these are pretty easy to see because the tissue there on the floor or sorry the vental surface of your tongue the tissue there is just really thin and you can really see those veins pretty significantly um you can see them running down along the sides what what you're going to notice then is right as those veins are coming down you're going to see this like kind of like a curtain of tissue and uh I guess curtain is the best way I can describe it but it but it does they look like little wings if your tongue at the bottom of your tongue had little wings following those veins those are called P fmria so those are coming down those wings on the side and then when you open your tongue like that you're going to see the left picture the Retro miloy curtain is sort of towards the back and again it's like a little fold of tissue or like a wing um the sublingual Carles and the submandibular duct are essentially at the same spot so if you're like Katie I think those lines are going to the same spot yes they are the reason for that is because the within the car unles is the duct right so you have your sublingual fold you can see there on that side you have these sublingual folds that sort of kind of come together and then right at the Middle where that lingual freenom is on either side you're going to have these two little round they look like little round BBS of tissue okay those are your sub sublingual car unes and then within those car unes you have your submandibular duct or your Wharton's duct I have seen on board's prep content I've seen some mandibular duct and won stuff used interchangeably so try to memorize both um but anyway that's where the car uncles are and then the alval lingual sulcus again just a space right so alval alular bone on the mandible lingual lingual tissue it's the space between your alular bone and your lingual tissue so if you think about it I'm not going to do it right now but you could put your finger under your tongue and your tongue would be technically in that alval lingual Solus because there's that space between the bone and the tongue and then mandibular taus um again that's an extension of bone it's round it's bulbous but that is a variation of normal you will not find a mandibular Taurus on everybody last we have the FAX this is a review from anatomy and physiology but we do have it in here because it could be um fair game for boards testing so in the fax region we just want to remember that it goes naso Oro lingo fairings right and in that order as air comes in it bleeds through either one of those things if it comes in the nasal cavity it's going to go from the nasal fings all the way down versus if it comes in the oral cavity it's going to come in the oral Fairing and down so that is just a review essentially um if you have questions definitely reach out but that is the module for today so thank you for listening [Music] he