ORAL MUCOSA 王文岑 助理教授 高醫大附設醫院 S 棟 2 樓 口腔病理影像診斷科...

ORAL MUCOSAORAL MUCOSA

王文岑 助理教授 高醫大附設醫院 S 棟 2 樓 口腔病理影像診斷科 07-3208284 wcwang@kmu.edu.tw

口腔黏膜

WenChen Wang

學習目標• 口腔黏膜的分類、定義與功能• 口腔黏膜的細胞組成及顯微構造

學習資源及主要圖片引用 : 1. Nanci A: Ten Cate’s Oral Histology, Develop

ment, structure, and function 6th ed. p.329-75 2. Orban BJ :Orban’s oral histology and embryology,9th ed. p.261-3343. Avery JK: Essentials of Oral Histology and Emb

ryology: A clinical approach. 2nd ed. p.164-83

WenChen Wang

MUCOUS MEMBRANEDefinition:

-Moist lining of the intestinal tract, nasal passages and other body cavities that communicate with the exterior

Oral mucosa

Oral mucosa: Oral mucous membrane

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各部位的口腔黏膜

上下唇－唇紅緣 vermillion border唇黏膜 labial mucos

a唇繫帶 labial frenum前庭區 vestibule

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頰－頰黏膜 buccal mucosa

頰繫帶 buccal frenum

咬合線 occlusal line

腮腺開口 orifice of Stenson’s duct

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舌－ 口底－舌背 唾液腺開口

dorsal surface

舌腹ventral surfrace

舌繫帶lingual frenum

舌側緣tongue border

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牙齦－齒間牙齦interdental papilla固著牙齦attached gingiva黏膜牙齦mucogingiva前庭區

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顎部－硬顎 hard palate

軟顎 soft paalte

懸雍垂 uvula 　

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FUNCTIONS OF ORAL MUCOSA

• Protection

• Sensation

• Secretion

• Thermal regulation

Oral mucosa

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STRUCTURE OF ORAL MUCOSA

• Epithelium………………

..epidermis

• Lamina propria………

..dermis• Submucosa……………

..subcutaneous

* Epithelial ridges, rete pegs

Oral mucosa

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Oral mucoperiosteum

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EPITHELIUM

…stratified squamous cell

Keratinized Nonkeratinized basal basal prickle prickle granular intermediate keratinized superficial

Oral mucosa

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KeratinizationBasal cell prickle granular keratinized layer

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Basal cell layer

• Cuboid or columnar shape• Containing bundles of tonofibril

s and cell organs• Synthesize DNA, protein• Most cell divisions

Oral mucosa

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Prickle cell layer (spinous cell layer)

• Irregularly polyhedral shape• Conspicuous tonofibril bundles• Membrane-coating granules in uppe

r part• Intercellular bridge- Desmosome• Most active in protein synthesis

Oral mucosa

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Granular cell layer

• Flatter & wider• Keratohyaline granules• Tonofibrils• Membrane-coating granules• Synthesis protein

Oral mucosa

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Keratin layer• Flattened & dehydrated• Lost all organelles• Cell filled with packed fibrillar material

Oral mucosa

orthokeratin parakeratin

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Intermediate layer of nonkeratinized epi. • Flattened cells • Tonofilaments & glycogen

Superficial layer of nonkeratinized epi.• Flattened cells • Tonofilaments

& glycogen• Fewer organells• Nuclei persist

Oral mucosa

WenChen Wang

Nonkeratinocytes in the oral epi.• Melanocyte melanin, premelanosome, melanosome• Langerhan’s cell regulatory, antigen trap• Merkel’s cell tactile sensory• Lymphocyte inflammatory response

**Clear cells: Melanocyte, Langerhan’s cell, Merkel’s cell

Oral mucosa

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Intercellular Junctions• Desmosome (Hemide

smosome)• Tight junction• Gap junction

Oral mucosa

Intercelluar bridge

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FUNCTIONAL CLASSIFICATION

OF ORAL MUCOSAKeratinized areas• Masticatory mucosa-hard palate & gingiva• Vermilion border

Nonkeratinized areas…Lining or reflecting mucosa• lip, cheek, alveolar mucosa, vestibular fornix, m

outh floor, soft palate, ventrum of tongue

Specialized mucosa• dorsum of the tongue

Oral mucosa

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Hard Palate1.different zones of palatine mucosa

gingival region, palatine raphae, fatty zone, glandular zone(mucous gland)

Oral mucosa

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2. tight fixed to the underlying periosteum

* No submucous layer: gingiva region and palatin raphe (mucoperiosteum)

3. epithelium uinform in form, well-keratinized

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Gingiva

1. Parakeratinized 75%, orthokeratinized 15%, nonkeratinized 10%

2. often showing stippled surface

Oral mucosa

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3. Free gingiva, free gingiva groove, attached gingiva, interdental gingiva, mucogingival junction

4. “col”…depressed part of interdental papilla, thin nonkeratinized epi.

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Vermilion border of lip• Transitional zone between skin

of lip and lip mucosa

• No gland

Oral mucosa

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Nonkeratinized Areas

… Lining or reflecting mucosa

• lip,cheek, alveolar mucosa, vestibular fornix, mouth floor, soft palate, ventrum of tongue

• Thick nonkeratinized epi. and varied amount of loose textured submucosa (containing fat & gland) movably attached to the deep structure

Oral mucosa

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Fordyce’s spots (granule)

• Isolated sebaceous gland

• buccal mucosa near mouth angle and opposite the molars

Oral mucosa

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Fordyce’s granule

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Specialized Mucosa

… Dorsal lingual mucosa

• Lingual PapillaeFiliform papilla: entire an

t part of tongue, no taste bud

Fungiform papilla: tongue tip

Foliate papilla: lateral border of post. Tongue

Oral mucosa

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Circumvallate papilla: before V-shape terminal sulcus, 8-10 in number

• von Ebner’s glands, main source of salivary lipase

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Foliate papilla

Fungiform papilla

Circumvallate papilla

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Taste Buds1. Ovoid or barrel-shaped intraepi. organ2. Taste pore3. Supporting cells4. 10-12 neuroepithelial cells (receptors of taste)

Oral mucosa

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Taste Sensation

• Sweet-fungiform papilla

• Salty-fungiform

• Bitter -circumvallate

• Sour- foliate

Oral mucosa

WenChen Wang

SummaryORAL MUCOSA

• STRUCTURE OF ORAL MUCOSAKeratinized vs. NonkeratinizedKeratinocytes in the oral epiNonkeratinocytes in the oral epi

• FUNCTIONAL CLASSIFICATIONKeratinized areasNonkeratinized areasSpecialized mucosa

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SALIVARY GLANDSALIVARY GLAND

Salivary gland

唾 液 腺

WenChen Wang

學習目標• 唾液腺的分類、組織與細胞組成及功能

學習資源及主要圖片引用 :1. Avery JK. Oral development and histology. 2nd e

dition, Chapter 21, p. 352-812. Berkovitz BK, Holland GR, Moxham BH. 2nd editio

n, p.215, 2203. de Almeida PDV, et al.. Saliva Composition and F

unctions: A Comprehensive Review. J Contemp Dent Pract 2008 3:72-80

WenChen Wang

CLASSIFICATION OF SALIVARY GLAND

1. By location

2. By sizeMajor Salivary Gland

Parotid gland Submandibular gl. Sublingual gland

Minor Salivary Gland Labial and buccal, palatine, lingual……

Salivary gland

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CLASSIFICATION OF SALIVARY GLAND

3. By structure:Mucous glandSerous glandMixed gland

Salivary gland

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STRUCTURE OF SG

• Acinus cells• Duct system • Connective tissue:

fibrous septa and capsule

blood vesselsnerves

Salivary gland

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• acinic cellsmucous cell , serous cell or mixed acin

i

• Terminal tubule:

acinic cell +

myoepithelial cell• Terminal secretory units:

Terminal tubule+

intercalated duct cell

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Mucous cell

• pale• Low-protein, high c

arbohydrate• Mucin: glycoprotei

n, sialic acid• Viscous• Lubrication

Salivary gland

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Serous cell

• Dark stain• High -protein, low car

bohydrate• rER, lysosome, mitoc

hondria, secretory granule, zymogen granules (amylase)

• Watery consistency• Digestion

Salivary gland

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Myoepithelial cell

• Surrounding the acinic cell and intercalated duct

• Long process• like smooth m. in ult

rastructure• Contractile function,

helping to extraction

Salivary gland

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• Demilunes: mixed acini muco

us cells (inner) + serous cells

• Cell Junctions:• Tight junction

Intermediate junction

Desmosome characteristics of ectodemal origin

Salivary gland

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SALIVA produced by terminal secretory units

striated duct

interlobular duct

excretory duct

main duct (ex. Stensen’s duct)

ORAL CAVITY

Salivary gland

MAJOR SALIVARY GLAND

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Parotid gland• Size largest• Location retromandibular fossa,

infra-auricular• Main duct Stensen’s duct• Opening buccal mucosa respect to 2nd

molar• Acini serous acini• Saliva Vol. 25-30%

Salivary gland

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Submandibular gland

• Size intermediate

• Location submandibular triangle,

below mylohyoid m.

• Main duct Warton’s duct

• Opening Caruncula sublingualis,

mouth floor

• Acini mixed acini, serous

predominate

• Saliva Vol. 60%

Salivary gland

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Sublingual gland

• Size smallest ( a main gland and

several small glands)• Location mouth floor,

above mylohyoid m.• Main duct Bartholin’s duct• Opening sublingual fold• Acini mixed acini, mucous

predominate• Saliva Vol. 5%

Salivary gland

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MINOR SALIVARY GLANDS

about 7% of total saliva

• Labial and buccal (mixed)

• glossopalatine (pure mucous)

• palatine (pure mucous)

• lingual (mixed)

Salivary gland

WenChen Wang

SALIVA : COMPOSITION AND FUNCTION

• 750ml produced daily, pH 6.7-7.4

• 99% or more: WATER

• 1% or less: inorganic ions,

secretory glycoproteins,

serum constituents, and

others

Salivary gland

SALIVA : COMPOSITION AND FUNCTION

• Lumbrication ...mucins, proline-rich proteins• Buffering ………………………….bicarbonate• Remineralization ………...calcium , phosphate• Digestion……………amylase, lipase, proteases• Antimicrobial property ...proline-rich proteins,

lysozyme, histatins, lactoperoxidase, IgA• Protection………………………. water, mucins• Wound healing………………... growth factors

Homeostasis of Oral Cavity

Salivary gland

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COMMON CAUSES of salivary dysfunction

• Aging• Infection, inflammation, obstructio

n• Side effects of drugs• Autoimmune disease (ex. Sjögren’s

syndrome)• Diabetes Mellitus, alcoholism• Neoplasm• Head and neck Radiotherapy

Salivary gland

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DENTAL COMPLICATIONS related to salivary dysfunction

• Xerostomia

• Rampant caries

• Periodontitis

• Secondary infection

Salivary gland

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Summary

SALIVARY GLAND• CLASSIFICATION

By location, size & structure

• STRUCTUREConnective tissueDuctsTerminal secrectory units

• SALIVA : COMPOSITION AND FUNCTION

• CLINICAL CONSIDERATION