Why the roof of your mouth hurts: causes, treatment and prevention. Hard and soft palate Anatomy of the human palate

The palate is a horizontal partition that is located in the oral cavity and separates it from the nasal cavity.

The two-thirds of the roof of the mouth at the front of the mouth has a bony base. These bone processes in the form of a concave plate are located in a horizontal position in the upper jaw.

Therefore, here the palate is hard to the touch, however, from below it is covered with thin mucous membrane, where its continuation is the palatine curtain. It is represented by a muscular formation with a fibrous membrane and covered with mucous membrane.

The soft part of the palate is a barrier between the oral cavity and the pharynx, on the posterior edge of which the uvula is located.

These two sections make up the upper wall of the oral cavity. The palate is involved in the process of chewing, the generation of speech and voice sounds, and therefore is an integral part of the articulatory apparatus.

Causes of the inflammatory process

There are enough reasons that cause inflammation of the palate:

Primary and secondary inflammation

Primary inflammation of the palate is caused by the appearance of etiological factors and the formation of biologically active substances - mediators at the site of action of the damaging agent.

During primary inflammation, a change in structure occurs, destruction of cell membranes, disruption of reactions that occur in the mucous membrane of the palate. Moreover, such a violation has different effects on the vital activity of cellular organisms located on the surface of the palate.

As a result of exposure to decay products of the primary stage of inflammation, circulatory disturbances and nervous regulation disorders occur. The action of inflammatory mediators leads to the destruction of trophic and plastic factors.

Secondary inflammation is stronger in terms of the severity of the factors and leads to consequences, as a result of which the effect of negative agents is aggravated. The area of action of the mediator becomes the periphery, i.e. area around the primary lesion.

Factors of the secondary stage of inflammation are present in cell membranes and determine the subsequent pattern of development of the inflammatory process. At the same time, the activity of some cells is activated and they begin to produce active substances in relation to other cells, so an accumulation of under-oxidized products occurs.

The photo shows inflammation of the palate caused by stomatitis

Features of the clinical picture

Depending on the etiology of inflammation, the symptoms of palate diseases vary. An injury or scratch causes a tingling sensation that makes eating uncomfortable.

In the case of fungal infection, white erosion occurs, which is located not only on the palate, but also on the inner surface of the cheeks. A yellowish tint to the mucous membrane indicates problems with the liver, and inflammation of the tonsils and simultaneous redness of the palate indicates a sore throat.

In most cases, the disease affects areas of the palate and the tongue, which becomes swollen, intensifies.

In addition, there is a painful condition of the damaged areas, burning or redness, which in some cases is accompanied by elevated temperature.

Why does the sky hurt?

To find out why the palate hurts, you should consult a specialist and undergo a comprehensive examination, since inflammation can also be caused by diseases of the internal organs.

A bacterial infection in some cases is accompanied by a fever, pain when swallowing increases, as the infection provokes redness and swelling of the pharynx. There is also an increase in lymph nodes and a sore throat.

Pathological changes in blood composition and intoxication of inflammatory products at the cellular level contribute not only to the formation of plaque on the mucous membrane, but also provoke the appearance of pustular lesions. To demonstrate a protective reaction, the body begins to produce additional amounts of protein.

Therefore, the main causes of pain in the palate are:

violation of its mucous membrane;
metabolic disorder;
action of phlogogenic enzymes;
activation of the body's defenses.

Therapy for the disorder

Inflammatory processes are not only dangerous, but also bring significant discomfort to a person. In order to get rid of inflammation of the palate, you need to find out the cause of this disease. In this case, the doctor will be able to decide on the goals and method of treatment.

What can be done if the palate is inflamed and hurts:

In addition, doctors recommend avoiding irritating factors - rough food, cold or hot drinks. Diet during inflammation should be gentle, without sweets or spicy foods. You should also give up bad habits - smoking and alcohol.

How to help yourself at home?

At home, rinsing with infusions and decoctions of medicinal herbs: oak bark, chamomile, sage, calendula and sea buckthorn can help get rid of pain.

The healing process can be accelerated by rinsing with propolis tincture or lubricating the damaged areas with rosehip and sea buckthorn oils.

For prevention purposes

Following simple hygiene rules is the main method of preventing unwanted processes in the oral cavity. For this It is necessary at least 2 times a day and it is advisable to use it.

You should adhere to proper nutrition in order to reduce the risk of damaging the sensitive surface of the palate. Enrich your body with vitamins and microelements.

Avoid stress, maintain the functioning of your immune system, strengthen yourself, take care of the health of your internal organs and visit the dentist periodically.

Inflammation of the palate is not a simple problem. In some cases, it can be caused by serious illnesses. To determine the goals and methods of treatment, it is necessary to understand the nature of the disease, find out the symptoms and determine the causes of the disease.

To cope with the inflammatory process, you need to seek help from a specialist who will not only help in solving the problem, but also introduce you to preventive measures.

Most of it hangs down freely and is called the velum palatinum. Only a small section of it is adjacent to the upper wall. The soft palate, depending on its functional state, can take on different positions: when swallowing, it rises and gains a horizontal position, thereby separating the oral cavity from the nasal cavity. When breathing, the soft palate is in a relaxed state and hangs down.
The soft palate consists of a fibrous plate, the muscles of the soft palate and the mucous membrane that covers it on all sides. The posterior edge of the soft palate has a small protrusion called the uvula. On both sides of the uvula, the soft palate forms two folds in which muscles are located, forming two brackets: the anterior palatoglossus, arcus palatoglossus, and the posterior velopharyngeus, arcus palatopharyngeus. Between these there is a depression - the tonsil fossa, fossa tonsillaris, which contains the palatine tonsils, tonsilla palatina. Above it is the supratonsillar fossa, fossa supratonsillaris.
The soft palate consists of the following muscles:- Muscle-tensor velum palatini, m. tensor veli palatini;
- Levator veli palatine muscle, m. levator veli palatini;
- Velopharyngeal muscle, m. palatopharyngeus;
- Palatoglossus muscle, m. palatoglossus,
- Muscles of the uvula, m. uvulae.
1. Tensor palatine muscle, m. tensor veli palatini - originates from the external base of the skull - the scaphoid fossa of the pterygoid process, the auditory tube and the spine of the greater wing. The muscle fibers spread over the hook of the pterygoid process and are divided into two parts - external and internal. The outer part passes into the buccal-pharyngeal fascia and is partially attached to the posterior surface of the alveolar process. The inner surface expands and passes into the palatine aponeurosis.
Function: when the right and left muscles contract, the velum and palatine aponeurosis are stretched, and at the same time the lumen of the auditory tube expands.
2. Levator palati muscle, m. levator velipalatini - originates from the lower surface of the petrous part of the temporal bone and the cartilaginous part of the auditory tube. The levator velum palati muscle passes between the layers of the velopharyngeal muscle in the transverse direction and is divided into three bundles: anterior, middle and posterior. The anterior fascicle passes into the palatine aponeurosis, the middle fascicle connects with such a fascicle on the opposite side and forms the posterior edge of the soft palate. The back bun is woven into the tongue.
Function: raises the soft palate, and also, together with other muscles of the palate, is involved in separating the nasal cavity from the oral part of the pharynx.
3. Velopharyngeal muscle, m. palatopharyngeus - originates from the posterior wall of the pharynx and the posterior edge of the thyroid cartilage, has a triangular shape and consists of two layers: anterior and posterior. The fibers of the anterior muscle layer are located in front of the levator velum palati muscle, m. levator veli palatini, and the posterior one - behind this muscle. The anterior layer passes into the glossopharyngeal fascia, connects with the fibers of the muscle of the same name on the opposite side, part of it passes into the palatine aponeurosis. The posterior layer of the muscle is woven into the soft palate and attached to the lower surface of the auditory tube, the hook of the pterygoid process and passes into the posterior part of the levator velum palatine muscle.
Function: raises the pharynx, tongue, larynx; pulls the soft palate down and back; expands the lumen of the auditory tube; brings the palatine arches closer together.
4. Palatoglossus muscle, m. palatoglossus - originates from the transverse muscle of the tongue, passes through the anterior palatoglossus arch and enters the palate.
Function: lowers the soft palate and narrows the pharynx.
5. Uvula muscle, m. uvulae - originates from the nasal spine and mucous membrane of the nasal cavity, reaches the posterior edge of the soft palate and enters the uvula.
Function: raises and contracts the tongue.
Blood supply the palate is carried out by the large and small palatine arteries, as well as by the ascending palatine artery, a. palatina accendens. Venous outflow is carried out through the veins of the same name, which drain venous blood into the pterygoid plexus and pharyngeal veins.
Lymph drainage carried out in the retropharyngeal, upper deep cervical and submandibular lymph nodes.
Innervation The soft palate is carried out by the branches of the pharyngeal nerve plexus, plexus pharyngeus, and the small palatine nerves, nn. palatini minores, and nasopalatine nerve, n. tiasopalatini (from the second branch of the trigeminal nerve).

Before we begin to consider the anatomy of the human oral cavity, it is worth noting that in addition to the initial digestive functions, this part of the anterior gastrointestinal tract is directly involved in such important processes as breathing and speech formation. The structure of the oral cavity has a number of features; you will learn about the detailed characteristics of each of the organs of this section of the digestive system below.

Oral cavity ( cavitas oris) is the beginning of the digestive system. The lower walls of the oral cavity are the mylohyoid muscles, which form the diaphragm of the mouth (diaphragma oris). Above is the palate, which separates the oral cavity from the nasal cavity. The oral cavity is limited on the sides by the cheeks, in the front by the lips, and at the back it communicates with the pharynx through a wide opening - the pharynx (fauces). The oral cavity contains the teeth and tongue, and the ducts of the major and minor salivary glands open into it.

General structure and features of the oral cavity: lips, cheeks, palate

When talking about the anatomy of the human oral cavity, it is important to distinguish between the vestibule of the mouth (vestibulum oris) and the oral cavity itself (cavitas oris propria). The vestibule of the mouth is limited in front by the lips, on the sides by the cheeks, and from the inside by the teeth and gums, which are the alveolar processes of the maxillary bones covered with mucous membrane and the alveolar part of the lower jaw. Posterior to the vestibule of the mouth is the oral cavity itself. The entrance to the vestibule of the oral cavity, limited above and below by the lips, is the oral fissure (rima oris).

Upper lip and lower lip ( labium superius et labium inferius) They are skin-muscle folds. In the thickness of the structure of these oral organs there are fibers of the orbicularis oris muscle. The outside of the lips are covered with skin, which on the inside of the lips turns into a mucous membrane. The mucous membrane forms folds along the midline - the frenulum of the upper lip (frenulum labii superiors) and the frenulum of the lower lip (frenulum labii inferioris). In the corners of the mouth, where one lip meets the other, there is a labial commissure on each side - a commissure of the lips (commissure labiorum).

Cheeks ( buccae) , right and left, limiting the oral cavity on the sides, are based on the buccal muscle (m. buccinator). The outside of the cheek is covered with skin, the inside with mucous membrane. On the mucous membrane of the cheek, on the eve of the mouth, at the level of the second upper molar, there is an elevation - the papilla of the duct of the parotid salivary gland (papilla parotidea), on which the mouth of this duct is located.

Sky ( palatum) forms the upper wall of the oral cavity; its structure includes the hard palate and the soft palate.

Solid sky ( palatum durum) , formed by the palatine processes of the maxillary bones and horizontal plates of the palatine bones, covered below with mucous membrane, occupies the anterior two-thirds of the palate. Along the midline there is a suture of the palate (raphe palati), from which several transverse folds extend in both directions.

Soft sky ( palatum molle) , located posterior to the hard palate, is formed by a connective tissue plate (palatal aponeurosis) and muscles covered with mucous membrane above and below. The posterior section of the soft palate hangs freely down in the form of a palatine curtain (velum palatinum), ending at the bottom with a rounded process - the uvula palatina.

As can be seen in the photo of the structure of the oral cavity, the palatoglossus, palatopharyngeal and other striated muscles participate in the formation of the soft palate:

Palatoglossus muscle ( m. palatoglossus) steam room, begins in the lateral part of the root of the tongue, rises upward in the thickness of the palatoglossal arch, and is woven into the aponeurosis of the soft palate. These muscles lower the palate and narrow the opening of the pharynx. The palatopharyngeus muscle (m. palatopharyngeus), paired, begins in the posterior wall of the pharynx and on the posterior edge of the plate of the thyroid cartilage, goes up in the palatopharyngeus and is woven into the aponeurosis of the soft palate. These muscles lower the curtain and reduce the opening of the pharynx. The muscle that strains the velum palatini (m. tensor veli palatini) in the structure of the oral cavity is also paired. It begins on the cartilaginous part of the auditory tube and the spine of the sphenoid bone and goes from top to bottom.

Then the muscle goes around the hook of the pterygoid process, goes to the medial side and is woven into the aponeurosis of the soft palate. This muscle pulls the velum palatine in the transverse direction and expands the lumen of the auditory tube. The muscle that lifts the velum palatini (m. levator veli palatini), paired, begins on the lower surface of the pyramid of the temporal bone, anterior to the opening of the carotid canal, and on the cartilaginous part of the auditory tube. The structure of the human oral cavity is such that this muscle goes down and is woven into the aponeurosis of the soft palate. Both muscles elevate the soft palate. The uvula muscle (m. uvulae) begins on the posterior nasal spine and on the palatine aponeurosis, goes posteriorly and is woven into the mucous membrane of the uvula. The muscle raises and shortens the uvula. The muscles of the soft palate, which lift the velum palatine, press it against the back and side walls of the pharynx, separating the nasal part of the pharynx from its oral part. The soft palate limits the opening at the top - the pharynx (fauces), which connects the oral cavity with the pharynx. The lower wall of the pharynx is formed by the root of the tongue, and the palatoglossal arches serve as the side walls.

In the general structure of the oral cavity, several more muscles are distinguished. From the lateral edges of the soft palate, two folds (arches) extend to the right and left sides, in the thickness of which there are muscles (palatoglossus and palatopharyngeal).

Anterior fold - palatoglossus arch ( arcus palatoglossus) - descends to the lateral surface of the tongue, the posterior - palatopharyngeal arch (arcus palatopharyngeus) - is directed down to the lateral wall of the pharynx. In the recess between the anterior and posterior arches, in the tonsil fossa (fossa tonsillaris), on each side there is a tonsil (tonsilla palatina), which is one of the organs of the immune system.

These photos show the structure of the human oral cavity:

Features of the structure of the oral cavity: anatomy of the tongue

The tongue (lingua) plays an important role in the structure of the human oral cavity. formed by several muscles, takes part in mixing food in the mouth and in swallowing, in articulating speech, and contains taste buds. The tongue is located on the lower wall (bottom) of the oral cavity; when the lower jaw is raised, it completely fills it, while coming into contact with the hard palate, gums, and teeth.

In the anatomy of the oral cavity, the tongue, which has an oval-elongated shape, is divided into a body, a root and an apex. The anterior, pointed part of the tongue forms its apex (apex linguae). The posterior part, wide and thick, is the root of the tongue (radix linguae). Between the apex and the root is the body of the tongue (corpus linguae). The structure of this organ of the oral cavity is such that the convex back of the tongue (dorsum linguae) faces upward and backward (towards the palate and pharynx). On the sides to the right and left is the edge of the tongue (margo linguae). The median beard of the tongue (sulcus medianus linguae) runs along the back. Posteriorly, this groove ends in a fossa, called the blind foramen of the tongue (foramen caecum linguae). To the side of the foramen cecum, a shallow boundary groove (sulcus terminalis) runs to the edges of the tongue, which serves as the boundary between the body and the root of the tongue. The lower side of the tongue (facies inferior linguae) lies on the mylohyoid muscles, which form the floor of the oral cavity.

Speaking about the anatomy of the oral cavity, it is worth noting that the outside of the tongue is covered by the mucous membrane (tunica mucosa), which forms numerous elevations of varying sizes and shapes of the tongue papillae (papillae linguales), containing taste buds. Filiform and cone-shaped papillae (papillae filiformes et papillae conicae) are located over the entire surface of the back of the tongue, from the apex to the border groove. Mushroom-shaped papillae (papillae fungiformes), having a narrow base and an expanded apex, are located mainly at the apex and along the edges of the tongue.

Vallate papillae (surrounded by a shaft, papillae vallatae), in the amount of 7-12, located on the border of the root and body of the tongue. One of the features of the structure of the oral cavity is that in the center of the papilla there is an elevation bearing taste buds (bulbs), around which there is a groove separating the central part from the surrounding ridge. Leaf-shaped papillae (papillae foliatae) in the form of flat vertical plates are located on the edges of the tongue.

The mucous membrane of the root of the tongue does not have papillae; the lingual tonsil (tonsilla lingualis) is located under it.. On the underside of the tongue, the mucous membrane forms two fringed folds (plicae fimbriatae), oriented along the edges of the tongue, and a frenulum of the tongue (frenulum linguae), lying along the midline. On the sides of the frenulum of the tongue there is a paired elevation - the sublingual papilla (caruncula sublingualis), on which the excretory ducts of the submandibular and sublingual salivary glands open. Posterior to the sublingual papilla there is a longitudinal sublingual fold (plica sublingualis), corresponding to the sublingual salivary gland lying here.

The anatomical structure of the oral cavity includes several lingual muscles. Muscles of the tongue ( musculi linguae) paired, formed by striated (striated) muscle fibers. The longitudinal fibrous septum of the tongue (septum linguae) separates the muscles of the tongue on one side from the muscles on the other side. The tongue is divided into its own muscles, which begin and end in the thickness of the tongue (upper and lower longitudinal, transverse and vertical), and skeletal muscles, which begin on the bones of the head (genioglossus, hypoglossus and styloglossus).

Superior longitudinal muscle (m. longitudinals superior) located directly under the mucous membrane from the epiglottis and the sides of the tongue to its apex. This muscle shortens the tongue and raises its tip. The lower longitudinal muscle (m. longitudinals inferior), thin, is located in the lower parts of the tongue, from its root to the apex, between the hypoglossal (outside) and genioglossus (inside) muscles. The muscle shortens the tongue and lowers its top. The transverse muscle of the tongue (m. transversus linguae) runs from the septum of the tongue in both directions to its edges. The muscle narrows the tongue and raises its back. The vertical muscle of the tongue (m. verticals linguae), located between the mucous membrane of the back and the underside of the tongue, flattens the tongue. The genioglossus muscle (m. genioglossus) is adjacent to the septum of the tongue, begins on the mental spine of the lower jaw and goes upward and backward and ends in the thickness of the tongue, pulling the tongue forward and down.

Hyoglossus muscle (ll. hyoglossus) begins on the greater horn and on the body of the hyoid bone, goes upward and anteriorly and ends in the lateral parts of the tongue. This muscle pulls the tongue back and down. The styloglossus muscle (m. styloglossus) originates on the styloid process of the temporal bone, goes obliquely down and enters the thickness of the tongue from the side, pulling the tongue back and up. The muscles of the tongue form a complex intertwined system within its thickness, which ensures greater mobility of the tongue and variability of its shape.

SKY [palatum(PNA, J NA, BNA)] - a formation of bone and soft tissue that separates the oral cavity itself from the nasal cavity and pharynx; makes up the upper and posterior walls of the oral cavity.

Embryology

The formation of the palate begins at the 6-7th week of intrauterine development with the formation of lamellar projections - palatine processes - on the inner surface of the maxillary processes (see Face). The latter are initially directed downward, later taking a horizontal position (Fig. 1, a, b). At the end of the 8th week. During intrauterine development, the edges of the palatine processes fuse with each other and with the nasal septum. Fusion begins from the anterior parts of the palatine processes and gradually spreads posteriorly. In the posterior part of the oral cavity, the palatoglossal and velopharyngeal arches are formed from the palatine processes.

Anatomy

The palate is divided into the anterior section - the hard palate (palatum durum) and the posterior section - the soft palate (palatum molle).

Solid sky It is represented by the bony palate (palatum osseum), covered with a mucous membrane with a submucous base, the severity of the cut in different parts of the solid N. is different. The bony palate is formed by the palatine processes of the upper jaws (processus palatinus maxillae) and the horizontal plates of the palatine bones (laminae horizontales ossis palatini). The right and left halves of the bone N. are connected by a median palatine suture (sutura palatina mediana), along which a palatine ridge (torus palatinus) protruding towards the oral cavity often runs. At the anterior end of this suture there is an incisive fossa (fossa incisiva), into which the incisive canal (canalis incisivus) opens. In the posterolateral areas of the bone N., at the junction of the upper jaw and palatine bone, a large palatine opening (foramen palatinum majus) is formed. In the horizontal plate of the palatine bone next to the greater one there are small palatine foramina (foramina palatina minora). All openings lead into the greater palatine canal and further into the pterygopalatine fossa (see). The palatine grooves (sulci palatini), separated by the palatine spines (spinae palatinae), run forward from the greater palatine foramen.

Along the midline of the mucous membrane of the hard N. there is a suture of the palate (raphe palati), on which behind the incisors, corresponding to the incisive fossa, is the incisive papilla (papilla incisiva). On the sides of the anterior section of the suture there are transverse palatine folds (plicae palatinae transversae), more pronounced in children.

The submucosa is present in the lateral sections of the N., on the border with the soft N.; in the area of the suture and at the transition of the N. mucous membrane to the gum, it is absent. In the anterior sections of the N., the submucosa contains a small amount of adipose tissue, penetrated by thick tufts of dense fibrous connective tissue, between which vessels and nerves pass. In the posterior sections of the solid N., this layer is occupied by the mucous palatine glands. The shape of the bone N. is related to the shape of the skull and face.

Soft sky It is represented by the palatine aponeurosis, into which the muscles of the soft palate and pharynx are woven. With calm breathing and muscle relaxation, the soft palate hangs vertically, forming the so-called. palatine curtain (velum palatinum). In the middle of its rear edge there is a protrusion - a tongue (uvula). Soft N. includes the following muscles (Fig. 2): the muscle that strains the velum palatini (m. tensor veli palatini), the muscle that lifts the velum palatini (m. levator veli palatini), and the muscle of the uvula (m. uvulae). The terminal parts of the palatoglossus muscle (m. palatoglossus) and the velopharyngeal muscle (m. palatopharyngeus) are woven into the soft N. The muscle that strains the velum palatine is a pair, it begins with wide muscle bundles from the spine of the sphenoid bone (spina ossis sphenoidalis), from the membranous part of the Eustachian (auditory, T.) tube (tuba auditiva), from the scaphoid fossa (fossa scaphoidea) and the medial plate of the pterygoid process (lamina med. processus pterygoidei). The muscle bundles, converging, descend vertically downwards, the resulting tendon is thrown over the pterygoid hook (hamulus pterygoideus). Then, taking a horizontal direction, these tendon bundles, together with the tendon bundles of the opposite side, form the palatine aponeurosis, which is attached to the posterior edge of the hard N.

The muscle that lifts the velum palatine, also paired, starts from the lower surface of the pyramid of the temporal bone, anterior and medial from the external opening of the carotid canal (canalis caroticus) and the cartilaginous part of the Eustachian tube; approaching the midline, it intertwines with bundles of the muscle of the same name on the opposite side.

The uvula muscle is a paired muscle that starts from the N. aponeurosis and ends at the tip of the uvula; shortens and raises the tongue. The palatine muscle is a continuation of part of the bundles of the transverse muscle of the tongue (m. transversus linguae), at the root of the tongue it rises along the posterior part of the side wall of the mouth and is woven into the soft palate; the muscle forms the thickness of the palatine arch (areus palatoglossus), when contracted, it lowers the palatine curtain and reduces the diameter of the pharynx.

The velopharyngeal muscle is a steam muscle, located in the lateral wall of the pharynx, starting from the posterior wall of the pharynx and the thyroid cartilage of the larynx and, moving upward, is woven into the lateral sections of the velum palatine. The muscle forms the velopharyngeal arch (areus palatopharyngeus) and, when contracted, lowers and pulls back the palatine curtain and narrows the pharynx. Between the arches are the palatine tonsils (see).

Soft N. is covered with a mucous membrane, which has a submucosa containing mucous and mucoserous glands.

Blood supply the palate (Fig. 3) is carried out by the maxillary artery (a. maxillaris) and the facial artery (a. facialis). The descending palatine artery (a. palatina descendens) departs from the maxillary artery, and from it to the hard nerve through the greater palatine foramen - the greater palatine artery (a. palatina major). This artery lies in the groove at the site of the transition of the hard N. to the base of the alveolar process, gives off branches to the mucous membrane of the hard N., and its terminal branches anastomose with the incisive artery (a. incisiva), emerging from the incisive canal. The incisive artery is terminal. It is formed from the posterior nasal lateral and septal arteries of the nose (aa. nasales post, laterales et septi), extending from the maxillary artery.

In addition, the small palatine arteries (aa. palatinae minores) - branches of the descending palatine artery - exit onto the hard N. from the small palatine foramina, located posterior to the greater palatine foramen. The soft N. is supplied with blood through the ascending palatine artery (a. palatina ascendens), which extends from the facial artery.

Venous outflow occurs through the palatine vein (vena palatina), which originates in the thickness of the soft tissue, passes through the bed of the palatine tonsil and most often flows into the facial vein. Other veins drain into the pharyngeal venous plexus.

Innervation carried out by the second branch of the trigeminal nerve due to the greater palatine nerve (n. palatinus major), emerging from the greater palatine foramen, and the small palatine nerves (nn. palatini minores), emerging through the small palatine foramina, as well as the nasopalatine nerve (n. nasopalatinus), exiting through the incisive foramen. The motor innervation of the soft nerve is carried out by the branches of the IX and X pairs of cranial nerves. The muscle that strains the velum palatine is innervated by the mandibular nerve (n. mandibularis).

Lymphatic drainage occurs to the deep cervical lymph nodes (nodi lymphatici cervicales profundi), retropharyngeal nodes (nodi lymphatici retropharyngei), as well as to the submandibular lymph nodes (nodi lymphatici submandibulares).

Histology

The mucous membrane of solid H. is covered with stratified squamous keratinizing epithelium. In the epithelial layer, the basal, spinous, granular and stratum corneum are clearly distinguished. The stratum corneum is formed by several rows of completely keratinized cells (without nuclei). Glycogen is not normally detected in the epithelium of solid N., but it can accumulate here when the process of keratinization is weakened (for example, when wearing laminar dentures for a long time). The basal and spinous layers are characterized by high activity of redox enzymes. The connective tissue basis of the mucous membrane of solid N. consists of fairly dense connective tissue; Some of the bundles of its collagen fibers are directly woven into the periosteum of the palatine bones, especially in those areas where there is no submucosa, due to which the mucous membrane is tightly fixed to the bone. In the area of the palatal suture and when the N. passes into the gum, the submucosa is absent; throughout the rest of the solid N., a clearly defined submucosa is revealed in the mucous membrane. In the anterior section of the N., on the sides of the palatal suture, the submucosa is represented by an accumulation of adipose tissue, and in the posterior section by an accumulation of small mucous glands.

The mucous membrane of the anterior surface of soft N. is covered with multilayered squamous non-keratinizing epithelium. The cells of the spinous layer of the epithelium contain a large amount of glycogen; They are also characterized by high activity of enzyme systems. The lamina propria of the mucous membrane consists of relatively thin interwoven bundles of collagen fibers; At the border with the submucosa there is a massive layer of elastic fibers. The submucosa is represented by loose connective tissue, which contains the end sections of small mucous glands. The posterior surface of the soft N. is covered with multirow ciliated epithelium, characteristic of the respiratory tract. Both surfaces of the uvula in adults are covered with stratified squamous non-keratinizing epithelium, rich in glycogen. In newborns, on the posterior surface of the uvula there is a multi-row ciliated epithelium, which is replaced by multi-layered epithelium during the first month of life.

Physiology

The muscular apparatus of the soft N., when pronouncing sounds and the act of swallowing (see), carries out complex movements, separating the oral cavities and nasopharynx. When the velum palatine is lifted, a roller (Passavan roller) is formed on the back wall of the pharynx due to contraction of the muscle of the superior pharyngeal constrictor; It is believed that this cushion is formed only during swallowing.

Research methods

To detect patol, processes that have arisen in N., in addition to clarifying the anamnesis, examination, palpation, rentgenol, research, biopsy and certain other methods used in dentistry, examination of patients are carried out (see Examination of the patient).

Pathology

Developmental defects. The most common of these is congenital cleft of the upper lip (outdated name “cleft palate”), often in combination with a congenital cleft of the upper lip. Congenital underdevelopment of the soft N. or uvula is also observed. According to M.D. Dubov (1960), per 1000 newborns, at least one is born with a cleft lip or cleft. The causes of congenital facial clefts, including the palate, are not well understood; Various assumptions have been made about the influence of unfavorable factors on the development of the fetus during the period of facial formation.

In the USSR, according to the accepted classification of malformations of the N., proposed by M. D. Dubov, clefts of the N. are divided into two main groups: through clefts passing through the alveolar process, hard and soft N., and non-through clefts of the N., with The loose alveolar process is developed normally.

Through clefts are unilateral (to the right or left of the midline) and bilateral (Fig. 4, a, b), when the connection of the premaxillary bone with the nasal septum and maxillary bones is absent on both sides. With a unilateral cleft, the nasal septum and premaxillary bone are connected to the palatine plates on only one side. With bilateral through clefts of the N. and upper lip, the premaxillary bone moves forward, which complicates surgical treatment.

Non-through clefts of the N. are divided into complete (the apex of the cleft begins at the alveolar process and passes through the hard and soft N.) and partial clefts (the cleft of the soft and part of the hard N.). Partial ones include hidden, or submucosal, clefts, in which the cleft of the muscles of the soft N. or the cleft of the uvula, and sometimes part of the hard N. is covered with a mucous membrane.

With N.'s clefts, especially with through ones, the respiratory and nutritional functions of newborns are sharply impaired; when sucking, part of the milk is poured out through the nasal passages, it is aspirated into the respiratory tract, and nasal breathing is disrupted (with this malformation, there is a high mortality rate in newborns). With age, children with cleft N. have speech disorders - dysarthria (see) and nasality (see), in which children become withdrawn and lag behind in their studies. The development of the upper jaw is often disrupted - narrowing of the upper dental arch, changing the shape of the face, retraction of the upper lip, etc. As a rule, due to the lack of a normal muscular apparatus, an expansion of the middle part of the nasopharynx is formed.

Treatment of the cleft is surgical. If surgery for a lip defect is indicated in early childhood (see Lips), then it is recommended to begin surgery for cleft N. at the age of 4-7 years. Ensuring proper nutrition and breathing is achieved by using devices for separating the oral cavity and nose - obturators (see Obturators). Children with N. clefts are under medical supervision from a number of specialists: pediatrician, dentist, otolaryngologist, speech therapist. The prognosis for N. clefts, especially through ones, in newborns is not always favorable; high mortality is observed.

A malformation is also a narrow high N. - hypsistaphylia; It is believed that this defect occurs as a result of mouth breathing with hypertrophy of the pharyngeal tonsil (see Adenoids). Treatment is carried out using orthodontic methods (see Orthodontic methods of treatment).

In the absence of positive results, surgical treatment is possible, usually ending successfully.

Sometimes there is congenital isolated underdevelopment of the soft N., mainly the uvula, as well as the palatine arches, which negatively affects the act of swallowing, and subsequently the pronunciation of certain sounds. Surgical treatment is lengthening of the soft N. (staphyloplasty). The results are favorable.

In adults, an impacted tooth may be found in the area of the transition of the alveolar process into the palatine process of the upper jaw. Surgical treatment: removal of an unerupted tooth using a chisel.

Damage. In everyday conditions, N. can be injured by sharp objects (fork, bone, pencil, etc.). Treatment consists of suturing the wound of soft N.

Burns are often observed - from hot food or chemicals. substances, but they do not reach a large extent.

Treatment - antiseptic and protein rinses.

Gunshot wounds of N., as a rule, occur in combination with wounds of the nasal cavity, maxillary sinus, and upper jaw. Surgical treatment of the wound of the N. is carried out with sutures on the detached flaps of the mucous membrane of the hard N. and on the soft N. To protect the surgical field and maintain the dressing, an individual protective plate is made of quick-hardening plastic.

In the vast majority of cases, outcomes for N. injuries are favorable. Staged treatment - see Face.

Diseases. The mucous membrane of N. is usually affected by stomatitis (see). In newborns and weakened children of the first year of life, so-called N. may be observed. aphthae of newborns (see Aphthae), as well as thrush (see Candidiasis). Oral candidiasis often develops in older people, especially those who wear dentures. The mucous membrane of soft N. is involved in the pathological process in scarlet fever, measles, especially in diphtheria. Inflammatory infiltrate and swelling of the soft tissue often accompany tonsillitis and phlegmon of the pterygomaxillary and peripharyngeal space.

The source of the purulent process in the area of hard N. is usually an infection emanating from the upper lateral incisors or first upper premolars; less commonly, the inflammatory process is associated with periodontitis of the palatal roots of molars. Pus usually accumulates under the periosteum, forming a hard N. abscess (Fig. 5, a and b). The mucous membrane in this area becomes hyperemic. Swelling and hyperemia sometimes spread to soft N. Pain is noted, eating is difficult, and body temperature rises. Fluctuation is determined 2-3 days after the onset of the disease. With a periosteal abscess, due to the detachment of soft tissue from the bone within the abscess, necrosis of the bone tissue may form.

More often, the purulent process in the area of the hard N. is purulent periostitis (see) or osteomyelitis (see) of the palatine process of the upper jaw; when making a diagnosis, it is necessary to differentiate it from an abscess due to periodontal disease (see), with a dental cyst (see), emanating from the apex of the root of the second incisor. Surgical treatment: an incision is made to the bone along the N. parallel to the alveolar edge. It is advisable to excise a small triangular section of the mucous membrane along with the periosteum for a more reliable drainage of pus and to prevent bone necrosis.

In cases of severe diphtheria or with damage to the vagus nerve, paralysis of the soft muscles of the N. may develop.

Tuberculosis of the mucous membrane of N., as well as its other localization in the oral cavity, is observed with active pulmonary tuberculosis. Small infiltrates or small tubercles of gray-yellow color appear on the mucous membrane. They can disintegrate, resulting in the formation of superficial (less often deep) ulcerations of irregular shape, with undermined edges; their bottom is covered with small flaccid pink-yellowish granulations or a grayish purulent coating, surrounded by miliary tubercles. Ulcerations are significantly painful. At the same time, damage to the submandibular or submental lymph nodes is observed. Anti-tuberculosis treatment (see Tuberculosis).

Hard chancre, or primary syphiloma, localized on soft N., has the appearance of a limited superficial ulcer. In the secondary period of syphilis, the mucous membrane is affected, tubercles appear, located focally in the form of a semiring. The mucous membrane thickens and turns red. Tuberous syphilide of the mucous membrane can resolve, leaving tender scars, or form ulcerations of irregular shape, the bottom of which is covered with gray disintegrated tissue.

The development of gumma is rare. With gumma, a diffuse, dense, slightly painful swelling with blurred boundaries is determined in the periosteum; the mucous membrane is swollen, hyperemic, and sometimes there is intense night pain. Subsequently, the swelling increases in diameter to 3-4 cm or more, gradually softens and opens into the oral cavity. In some cases, perforation of the solid N. may occur (Fig. 6). With the development of gumma in the thickness of bone tissue (gummy osteomyelitis), extensive bone destruction is often observed. There is severe pain and impaired sensitivity in the area innervated by the nasopalatine nerve. Often a communication is formed between the oral cavity and the nasal cavity or maxillary sinus. When healing occurs, radiant scars remain on the N.

The results of serol tests are important for diagnosis. The main one is general antisyphilitic treatment (see Syphilis). Surgical intervention to close the bone defect is indicated only after general treatment of syphilis.

Actinomycosis can sometimes develop under the mucous membrane on the alveolar process of the upper jaw. In this case, the infection usually spreads from the inflammatory-changed area of the mucous membrane, the edges in some cases forming a canopy over the not completely erupted upper wisdom tooth (so-called pericoronitis). A persistent inflammatory infiltrate is formed. The course, diagnosis and treatment are the same as for other localizations of actinomycosis in the maxillofacial region (see Actinomycosis). In the vast majority of cases, N.'s diseases (with the exception of untreated syphilis) end successfully.

Tumors. In the area of hard and soft N., benign and malignant neoplasms are observed, emanating from soft tissues, and in some cases growing from the bone tissue of the alveolar and palatine processes of the upper jaw, maxillary sinus, nasal cavity, and nasopharynx. Sometimes tumors developing from the soft tissues of N. cause secondary changes in bone tissue (usures) or grow into the bone.

Fibroma of hard and soft N. usually protrudes above the surface; sometimes it, like a polyp, is located on a short and thick stalk. When wearing a plate denture, this neoplasm may have a flattened shape.

In the area of hard and soft N., especially on the uvula, cavernous hemangioma (see) and lymphangioma (see) are found, neurofibroma (see) is rare, neuroma (see) is even more rare.

Papilloma is observed relatively often; usually it is localized on the uvula, palatine arches, and less often on the hard palate. Often papilloma is multiple.

In the area where the mucous (small serous) glands are located, benign tumors develop - adenoma (see), adenolymphoma (see), mixed tumors and malignant ones (mucoeidermoid, cylindroma, sometimes glandular cancer). As they grow, neoplasms can cause thinning of bone tissue, and malignant ones can destroy bone, growing into the maxillary sinus and nasal cavity.

After enucleation of benign tumors, one or two sutures are usually applied. For malignant neoplasms, radiation therapy is performed followed by excision of the tumor within healthy tissue. According to indications, lymph nodes and neck nodes are removed.

For the first time, the method of N. plastic surgery for congenital clefts, including an incision in the lateral sections of the hard N., detachment of mucoperiosteal flaps, their displacement to the midline and suturing of the cleft, was proposed and justified in 1861 by B. Langenbeck. This method of uranostaphyloplasty (plasty of hard and soft N.) remains the basis of modern plastic surgery on N.

The most important aspects of N. plastic surgery, in addition to closing the defect, are reducing the tension of the soft palate muscles, narrowing the lumen of the nasopharynx and lengthening the soft palate. To reduce the tension of the muscles of the soft palate, A. A. Limberg proposed performing an interlaminar osteotomy - a longitudinal dissection of the pterygoid process with an inward displacement medial plate together with the muscle that strains the soft N. For the purpose of mesopharyngoconstriction (narrowing the lumen of the pharynx), incisions are made parallel to the pterygomandibular fold and, having stratified the tissue with a tampon, the side wall of the pharynx is pressed inward.

To lengthen the soft N. (retrotransposition) and restore its function (in case of incomplete clefts), P. P. Lvov (1925) proposed, taking into account the sufficient blood supply to the flaps, to perform retrotransposition in one stage. For this purpose, in the anterior section of the hard palate, a triangular flap is cut out with a posterior apex, which remains motionless, and the lateral flaps from the hard palate are shifted back, fixed to the apex of the flap and stitched together.

In 1926, A. A. Limberg developed an operation of radical uranostaphyloplasty, which combines retrotransposition, mesopharyngoconstriction, resection of the posterointernal edge of the greater palatine foramen (to reduce the tension of the neurovascular bundle), interlaminar osteotomy and fissurorrhaphy (suturing the gap). This operation was the basis for the further development of plastic methods for all forms of clefts N.

In 1958, F. M. Khitrov proposed to perform plastic surgery in two stages for bilateral through clefts: first, to close the defect of the anterior part of the hard nerve, and then to close the remaining cleft of the hard and soft muscle.

Subsequently, less traumatic methods of intervention were developed, without damaging the bones. In 1973, Yu. I. Vernadsky proposed to carry out mesopharyngeal constriction without incisions along the pterygo-submandibular folds. L. E. Frolova in 1974 developed the plastic surgery of soft palate in the first years of life by suturing the palatine arches, and in 1979 she proposed closing the defect in the area of hard palate using a transfer flap from one of the fragments of the palate.

Methods of surgical treatment of acquired N. defects depend on the location and shape of the defect. Small defects located along the midline of the hard N. are covered with contiguous bridge-like mucoperiosteal flaps on both sides of the defect. The hole on the lateral surface of the hard N. is closed with a mucoperiosteal flap on a pedicle facing the greater palatine foramen (providing nutrition to the flap from the palatine artery). For median defects involving hard and soft N., the operation is performed in the same way as for congenital clefts. To eliminate large defects in N., plastic surgery with a Filatov stem according to Zausaev is used.

In cases of shortening of the soft N., if objective data on its size is necessary, the method proposed by V.I. Zausaev (1972) is used: the length of the soft N. is measured from the incisors to the tip of the tongue and the height of the tongue above the line of closure of the teeth.

In the postoperative period, before the first dressing, patients are not allowed to speak in order to avoid the dressing shifting and vomiting; within 2-3 weeks. patients receive liquid food. The first dressing is done on the 8-10th day.

To prevent deformation of the upper jaw, which often occurs with congenital and acquired N. defects, orthodontic treatment is of great importance.

Bibliography: Vernadsky Yu. I. Traumatology and reconstructive surgery of the maxillofacial region, Kyiv, 1973, bibliogr.; Buria N. Atlas of plastic surgery, trans. from Czech., vol. 2, p. 86 and others, Prague - M., 1967; Gemonov V.V. and Roshchina P.I. Activity of some enzyme systems in the epithelium of the human oral cavity with hyperkeratosis, Dentistry, v. 55, no. 2, p. 22, 1976; Gutsan A. E. Congenital clefts of the upper lip and palate, Chisinau, 1980, bibliogr.; Dmitrieva V. S. and Lando R. L. Surgical treatment of congenital and postoperative palate defects, M., 1968, bibliogr.; Dubov M.D. Congenital cleft palate, L., 1960, bibliogr.; 3ausaev V.I. Modification of the operation to close congenital cleft palates, Dentistry, No. 1, p. 59, 1953; aka, The use of the Filatov stem for repeated surgical interventions after unsuccessful operations for clefts of the hard and soft palate, ibid. No. 2, p. 26, 1958; same, Objective analysis of remaining palate deformations after previous surgical interventions and assessment of the results of uranostaphyloplasty, ibid., vol. 51, no. 2, p. 51, 1972; Clinical operative maxillofacial surgery, ed. M. V. Mukhina, L., 1974, bibliogr.; Falin L.I. Human embryology, p. 179, M., 1976; Khitrov F. M. On the issue of treatment of congenital cleft palate, Dentistry, No. 4, p. 33, 1958; A x h a u s e n G. Tech-nik und Ergebnisse der Spaltplastiken, Miinchen, 1952; Baxter H. a. Cardoso M. A method of minimizing contracture following cleft palate operations, Plast. reconstruct Surg., v. 2, p. 214, 1947; Berndorfer A. Die Geschichte der Operationen der angeborenen Missbildun-gen, Zbl. Chir., S. 1072, 1955; L u h- m a n n K. Die Angeborenen Spaltbildun-gen des Gesichtes, Lpz., 1956; O b 1 a k P. New guiding principles in the treatment of clefts, J. max.-fac. Surg.% v. 3, p. 231, 1*975; Schonborn, tiber eine neue Methode der Staphylorraphie, Verh. dtsch. Ges. Chir., Bd 4, S. 235, 1875; S i s h e r H. Oral anatomy, St Louis, 1960.

V. I. Zausaev; A. G. Tsybulkin (an.).

Palatum - the upper wall of the oral cavity itself. It is divided into hard and soft palates.

Front of the palate solid sky, palatum durum, has a bone base - palatum osseum, which is formed by the palatine processes of the upper jaws and the horizontal plates of the palatine bones. The back of the palate - the soft palate, palatum molle, is mainly formed by muscles, an aponeurosis and the mucous membrane in which the palatine glands are located.

The mucous membrane, closely adjacent to the hard palate, is smooth, passes in front and from the sides into the gum, behind - into the soft palate, into its uvula, uvula palatina, and arches of the palate. In the middle of the mucous membrane of the palate there is a narrow whitish strip - the suture of the palate, raphe palati, near the medial incisors, there is a small fold - the incisive papilla, papilla incisva, which corresponds to the incisive canal, canalis incisivus.

Several (or one) weakly defined transverse palatal folds, plicae palatinae transversae, extend from the suture in the transverse direction. In the area of the suture, the mucous membrane of the palate is thinner than at the edges. Between it and the periosteum there is a thin layer of mucous palatine glands, glandulae palatinae. Forming two oblong clusters, they fill the space between the bony palate and the alveolar processes.

The layer of glands of the hard palate thickens towards the back and without a noticeable border passes into the layer of glands of the soft palate.

Soft sky, palatum molle, formed mainly by muscles. It distinguishes between the anterior horizontal part, which is a continuation of the hard palate, and the posterior part, directed obliquely backward and downward. The soft palate is also called the velum palatinum. Together with it, it limits the isthmus of the pharynx. The velum palatine is covered with a mucous membrane, which fuses with a well-developed palatine aponeurosis, aponeurosis palatina, the attachment point for the muscles of the soft palate. The soft palate in the middle is extended into a small conical uvula, uvula palatina; on its front surface a continuation of the palate suture is visible.

On each side, the velum palatine passes into two arches. One - the anterior - palatoglossus arch, amis palatoglossus - goes to the root, the other - the posterior - passes into the mucous membrane of the lateral wall of the pharynx - the velopharyngeal arch, arcus palatopharyngeus. From above, as a result of the connection of the posterior surface of the palatoglossal arch and the anterior surface of the velopharyngeal arch, a semilunar fold, plica semilunaris, is formed, limiting the supratonsillaris fossa from above.

Between the palatine arches and the soft palate there is a space through which the oral cavity communicates with the cavity - the isthmus of the pharynx, isthmus faucium, and its anterior rounded edge is clinically called the pharynx, fauces.

From the posterior surface of the palatoglossal arch extends a thin triangular fold, plica triangularis, of the mucous membrane, partially covering the inner surface of the palatine tonsil. Narrow at the top, it is attached to the lateral edge of the root with its wide base. Between its posterior edge and the palatine lingual arch in front, and the velopharyngeal arch in the back, a triangular tonsil fossa, fossa tonsillaris, is formed, at the bottom of which is the palatine tonsil, tonsilla palatina, which fills the entire fossa in adults.

Innervation: nn. palatini majores et minores, incisivi.

Blood supply: aa. palatina descendens, palatina ascendens; v. palatina externa, plexus pterygoideus, plexus pharyngeus.

Palatine tonsil, tonsilla palatina, is a paired bean-shaped formation. The tonsils are located on each side between the palatoglossus and velopharyngeal arches in the tonsil fossa. On the outside, the tonsil has a fibrous lining - the tonsil capsule, capsula tonsillaris, and borders on the buccal-pharyngeal part of the m. constrictor pharingis superior. Its inner surface is uneven, with numerous round or oval almond dimples, fossulae tonsillares, corresponding to almond crypts, criptae tonsillares. The latter are depressions in the epithelial lining and lie in the substance of the palatine tonsil. The walls of the pits and crypts contain numerous lymph nodes, noduli lymphatici.

In a normal state, the tonsil does not extend beyond the fossa and there is free space above it - the supratonsillaris fossa.

Innervation: nn. palatini, n. nasopalatinus, plexus palatinus.

Blood supply: a. palatina ascendens (a. facialis), a. palatina descendens (a. maxillaris), r. tonsillaris a. facialis. Venous blood from the palate is directed to v. facialis. Lymph flows into the nodi lymphatici submandibulares et submentales.

Muscles of the palate and pharynx.

1. Muscle that strains the velum palatine, m. tensor veli palatini, flat, triangular, located between and the muscle that lifts the velum palatine. With its wide base, the muscle starts from the scaphoid fossa, fossa scaphoidea, sphenoid bone, membranous plate of the cartilaginous part of the auditory tube and the edge of its bony groove, reaching the spine of the sphenoid bone. Heading downwards, it passes into a narrow tendon, which, going around the groove of the pterygoid hook of the pterygoid process and the mucous bursa on it, then crumbles into a wide bundle of tendon fibers in the aponeurosis of the soft palate. Some bundles are attached to the posterior edge of the horizontal plate of the palatine bone, partially intertwined with the bundles of the muscle of the same name on the opposite side.

Function: stretches the anterior part of the soft palate and the pharyngeal part of the auditory tube.

Innervation: n. tensoris veli palatini.

2. Muscle that lifts the velum palatine, m. levator veli palatini, flat, located medially and posterior to the previous one. It starts from the lower surface of the petrous part of the temporal bone, anterior to the external opening of the carotid canal, and from the cartilaginous part of the auditory tube, from its inferomedial surface.

The bundles are directed downward, inward, forward and, expanding, enter the soft palate, intertwining with the bundles of the muscle of the same name on the opposite side. Some of the bundles are attached to the middle part of the aponeurosis of the palate.

Function: raises the soft palate, narrows the pharyngeal opening of the auditory tube.

3. Muscles of the uvula, mm. uvulae are two muscle bundles converging towards the midline of the uvula. A gradual decrease in the number of muscle bundles determines its conical shape. The muscles originate from the posterior nasal spine of the hard palate, spina nasalis posterior, from the palatine aponeurosis and are directed to the midline, woven into the mucous membrane of the uvula. Most of the muscle bundles attached to the palatine aponeurosis reach the midline, resulting in a thickened midline called the palatine suture.