《医学英语》五年制教学课件

医学英语五年制教学课件,医学英语,医学,英语,五年制,教学,课件 OralCavityandPharynxHOSPITAL:China-JapanUnionHospitalDEPARTMENT：RheumatologyImmunologyNAME：ZhaoFengLooktothymouth,diseasesenterthere.GeorgeHerbertThe mouth and oral cavity are used by individuals to express the entire range of emotions.As early as infancy,the mouth provides gratification and sensory pleasure.General Considerationsinfancy婴儿期婴儿期初期（初期（prime）同根词：同根词：infantinfantileinfantilismvocabularygratification满足感，喜悦之情。满足感，喜悦之情。近义词：近义词：satisfaction同根词：同根词：gratifygratifyingvocabularysensory感觉的、知觉的。感觉的、知觉的。同根词：同根词：sensesensationsensationalsensorsensorialvocabularyApproximately 20%of all visits to primary care physicians are related to problems of the oral cavity and throat.Most patients with these problems present with throat pain,which may be acute and associated with fever or difficulty in swallowing.A sore throat may be the result of local disease,or it may be an early manifestation of a systemic problem.General ConsiderationsIt has been estimated that more than 90%of patients infected with human immunodeficiency virus(HIV)have at least one oral manifestation of the disease.It appears that as further immunologic impairment develops,the risk of oral lesions increases.There are several important oral manifestations that are strongly associated with early HIV infection.The presence of any of them mandates HIV testing.General Considerationsimmunodeficiency免疫缺陷。免疫缺陷。同根词：同根词：immuneimmunizationimmunologyimmunoglobulinimmunohistochemistryvocabularymandate授权；命令；委托管理。授权；命令；委托管理。同根词：同根词：mandatory同近义词：同近义词：empowervocabularyOral cancer represents about 3%of all cancers.Cancer of the oral cavity and pharynx was responsible for 7550 deaths in 2007,killing approximately 1 person per hour,24 hours per day.The rate of death from oral cancer is higher than those from cervical cancer;Hodgkins disease;cancer of the brain,liver,testis,kidney,or ovary;or malignant melanoma.General Considerationscervical（宫）颈的（宫）颈的词组：词组：cervicalcancercervicalvertebra同根词：同根词：cervixvocabularytestis睾丸睾丸testes（复数）（复数）ovary子房（植物）；卵巢子房（植物）；卵巢近义词近义词germen同根词同根词ovariectomyvocabularycervical宫颈的宫颈的词组：词组：cervicalcancercervicalvertebra同根词：同根词：cervixvocabularymalignantbenignmelanoma同根词：同根词：melanosisvocabularyOne of the reasons for this high death rate is that the cancer is routinely discovered late in its development,with metastases to other areas or invasion deep into local structures.Oral cancer is also particularly dangerous because it has a high risk of producing second primary tumors.This means that patients who survive a first encounter with the disease have up to a 20 times higher risk for development of a second cancer.General Considerationsmetastasismtstssmetastases（pl）同根词：同根词：metastasize同近义词：同近义词：transfer/diversionvocabularyThere is a 2:1 male-to-female incidence ratio and a 2:1 African-Americantowhite death rate ratio.It is estimated that a man has a 1:72 lifetime risk for development of oral cancer.The American Cancer Society estimates that approximately 34,360 new cases of oral cancer were diagnosed in 2007 in the United States,with 24,180 cases occurring in men and 10,180 in women.General ConsiderationsWorldwide,the problem is much greater:More than 350,000 to 400,000 new cases are diagnosed each year.Although the exact cause of tongue cancer remains unknown,it most often occurs in people who use tobacco products(cigarettes,cigars,pipes,and smokeless tobacco),consume alcohol(especially when combined with tobacco use),or chew betel nuts.Chewing of betel nuts is not a common practice in the United States,but it is a widespread habit in many parts of the world,especially in Taiwan.General Considerationsconsume同根词：同根词：consumptionconsumerbetelbetelnutvocabularyRed staining of teeth in a betel nut user.Many physician visits for oral problems are associated with psychiatric disturbances.Psychosomatic disease symptoms often center on the mouth.Patients with psychosomatic disease may complain of“burning”or“dryness”of the mouth or tongue.General Considerationspsychiatric精神病的精神病的词根：词根：psycho同根词：同根词：psychicpsychiatristpsychoanalysispsychosomatic心身疾病心身疾病vocabularyBruxism,or grinding of the teeth other than for chewing,occurs especially during sleep.This overuse of the muscles of mastication has often been interpreted as a manifestation of rage or aggression that is not overtly displayed;it may also be an infantile response to reduce psychic tension.General Considerationsbruxism=teethgrindingmasticationmasticatevocabularyBruxism can produce facial pain,which causes further spasm of the muscles and continued bruxism,resulting in a vicious circle.Individuals who habitually have something in their mouths,such as a pipe,a thumb,or a pencil,may cause damage to their oral cavities.General Considerationsvicious词根：词根：psycho同根词：同根词：viciouslyviciousness近义词：近义词：infamousvocabularyAlthough it is often thought that the oral cavity is examined only by dentists,other healthcare professionals must have competency in evaluating this important region of the body.The healthcare provider must be able to accomplish the following:1.Appraise oral hygiene2.Recognize dental caries and periodontal diseaseGeneral Considerationshygienehygienicsperiodontal词根：词根：periodonticperiodontistperiodontitisvocabulary3.Recognize the presence of oral lesions,as well as disorders of the regional lymph nodes,salivary glands,and bony structures4.Recognize oral manifestations of systemic disease5.Recognize systemic problems caused by oral disease and procedures6.Assess physical findings concerning the range and smoothness of jaw motion7.Identify dental appliances8.Know when a dental consultation is required or should be postponed because of a medical problemGeneral ConsiderationsThe oral cavity consists of the following structures:Buccal mucosa Lips Tongue Hard and soft palates Teeth Salivary glandsStructure and Physiology Oral Cavitypalate腭腭同根词同根词palatablesalivary词根：词根：saliva同根词同根词salivatevocabularyStructure and Physiology Oral CavityThe oral cavity extends from the inner surface of the teeth to the oral pharynx.The hard and soft palates form the roof of the mouth.The soft palate terminates posteriorly at the uvula.The tongue lies at the floor of the mouth.At the most posterior aspect of the oral cavity lie the tonsils,between the anterior and posterior pillars.Structure and Physiology Oral CavityThe buccal mucosa is a mucous membrane that is continuous with the gingivae and lines the insides of the cheeks.The linea alba,or bite line,is a pale or white line along the line of dental occlusion.It may be slightly raised and show impressions of the teeth.gingivadndav同根词：同根词：gingivaegingivalvocabularyStructure and Physiology Oral CavityLips are red as a result of the increased number of vascular dermal papillae and the thinness of the epidermis in this area.An increase in desaturated hemoglobin,cyanosis,is manifested as blue lips.The common blue discoloration of the lips in a cold environment is related to the decreased blood supply and increased extraction of oxygen.desaturate减少饱和度；稀释。减少饱和度；稀释。saturate浸透；使饱和。浸透；使饱和。saturationcyanosisvocabularyStructure and Physiology Oral CavityThe tongue lies at the floor of the mouth and is attached to the hyoid bone.It is the main organ of taste,aids in speech,and serves an important function in mastication.The body of the tongue contains intrinsic and extrinsic muscles and contains the strongest muscle of the body.The tongue is supplied by the hypoglossal,or 12th cranial,nerve.hyoidintrinsicextrinsicglossalhypoglossalvocabularyStructure and Physiology Oral CavityThe dorsum of the tongue has a convex surface with a median sulcus.At the posterior portion of the sulcus is the foramen cecum,which marks the area of the origin of the thyroid gland.Behind the foramen cecum are mucin-secreting glands and an aggregate of lymphatic tissue called the lingual tonsils.The texture of the tongue is rough as a result of the presence of papillae,the largest of which are the circumvallate papillae.dorsum同根词：同根词：dorsalconvex凸凸concave凹凹sulcusforamencecum同根词：同根词：cecalvocabularyThe tongue viewed from above.epiglottis会厌会厌tonsil同根词：同根词：tonsillectomylingual舌；语言。舌；语言。同根词：同根词：linguistcircumvallate城墙围住；轮廓状地。城墙围住；轮廓状地。fungiformfiliformvocabularyStructure and Physiology Oral CavityThere are approximately 10 of these round papillae,which are located just in front of the foramen cecum and divide the tongue into the anterior two thirds and the posterior one third.Filiform papillae are the most common papillae and are present over the surface of the anterior portion of the tongue.The fungiform papillae are located at the tip and sides of the tongue.These papillae can be recognized from their red color and broad surface.Structure and Physiology Oral CavityThe taste buds are located on the sides of the circumvallate and fungiform papillae.Taste is perceived from the anterior two thirds of the tongue by the chorda tympani nerve,a division of the facial nerve.The glossopharyngeal,or ninth cranial,nerve perceives taste sensation from the posterior third of the tongue.chordak:d索；腱索；腱tympani定音鼓定音鼓chordatympani鼓索神经鼓索神经glossopharyngealvocabularyStructure and Physiology Oral CavityThere are four basic taste sensations:sweet,salty,sour,and bitter.Sweetness is detected at the tip of the tongue.Saltiness is sensed at the lateral margins of the tongue.Sourness and bitterness are perceived at the posterior aspect of the tongue and are carried by the glossopharyngeal nerve.Structure and Physiology Oral CavityWhen the tongue is elevated,a mucosal attachment,the frenulum,may be seen underneath the tongue in the midline connecting the tongue to the floor of the mouth.frenulumfrinjlm系带系带freunla（pl）vocabularyStructure and Physiology Oral CavityThe hard palate is a concave bone structure.The anterior portion has raised folds,or rugae.The soft palate is a muscular,flexible area posterior to the hard palate.The posterior margin ends at the uvula.The uvula aids in closing off the nasopharynx during swallowing.rugaru皱襞皱襞rugae（pl）rudiuvulanasopharynxvocabularyStructure and Physiology Oral CavityTeeth are composed of several tissues:enamel,dentin,pulp,and cementum.Enamel covers the tooth and is the most highly calcified tissue in the body.The bulk of the tooth is the dentin.Under the dentin is the pulp,which contains branches of the trigeminal,or fifth cranial,nerve and blood vessels.The cementum covers the root of the tooth and attaches it to the bone.Cross-sectional view through a molar tooth.enamelnm()l釉质釉质dentin本质本质pulp髓质髓质cementumsmentm骨质骨质trigeminalvocabularyStructure and Physiology Oral CavityThe primary dentition,or the deciduous teeth,consists of 20 teeth that erupt from the ages of 6 to 30 months.The primary dentition per quadrant of jaw consists of two incisors,one canine,and two premolars.These teeth are shed from the ages of 6 to 13 years.The secondary dentition,or the permanent teeth,consists of 32 teeth that erupt from the ages of 6 to 22 years.The secondary dentition per quadrant of jaw consists of two incisors,one canine,two premolars,and three molars.deciduousdeciduoustreepermanentinciseincisorcaninekenan犬科的犬科的molarpremolarvocabularyStructure and Physiology Oral CavityAlthough not part of the oral cavity proper,the salivary glands are considered part of the mouth.There are three major salivary glands:the parotid,the submandibular,and the sublingual glands.The parotid gland is the largest of the salivary glands.It lies anterior to the ear on the side of the face.The facial,or seventh cranial,nerve courses through the gland.The duct of the parotid gland,Stensens duct,enters the oral cavity through a small papilla opposite the upper first or second molar tooth.Structure and Physiology Oral CavityThe submandibular gland is the second largest salivary gland.It is located below and in front of the angle of the mandible.The duct of the submandibular gland,Whartons duct,terminates in a papilla on either side of the frenulum at the base of the tongue.The sublingual gland is the smallest of the major salivary glands.It is located in the floor of the mouth,beneath the tongue.There are numerous ducts of the sublingual gland,some of which open into Whartons duct.In addition to these major salivary glands,there are hundreds of very small salivary glands located throughout the oral cavity.Structure and Physiology PharynxThe pharynx is divided into the nasopharynx,the oropharynx,and the hypopharynx.The nasopharynx lies above the soft palate and is posterior to the nasal cavities.On its posterolateral wall is the opening of the eustachian tube.The adenoids are pharyngeal tonsils and hang from the posterosuperior wall near the opening of the eustachian tube.The oropharynx lies below the soft palate,behind the mouth,and superior to the hyoid bone.Posteriorly,it is bounded by the superior constrictor muscle and the cervical vertebrae.eustachianjusten咽鼓管；咽鼓管；欧斯塔奇（意大利解剖学家）欧斯塔奇（意大利解剖学家）eustachiantubevocabularyStructure and Physiology PharynxBelow the oropharynx is the area known as the hypopharynx(or laryngopharynx).The hypopharynx is surrounded by three constrictor muscles,which are innervated by the glossopharyngeal and vagus nerves.The hypopharynx ends at the level of the cricoid cartilage,where it communicates with the esophagus through the upper esophageal sphincter.laryngolaryngopharynxinnervate同根词：同根词：innervationvagus迷走神经迷走神经cricoid环状的环状的sphincter括约肌括约肌vocabularyFunctional parts of the pharynx.Structure and Physiology PharynxThe muscular walls of the pharynx are formed by the constrictor muscles,which function during the act of swallowing.The blood supply is derived from the external carotid artery.Structure and Physiology PharynxLymphatic tissue is abundant in the pharynx.The lymphoid tissue consists of the palatine tonsils,the adenoids,and the lingual tonsils.These tissues form Waldeyers ring.The palatine tonsils lie in the tonsillar fossa,between the anterior and posterior pillars.The palatine tonsils are almond-shaped and vary considerably in size.Structure and Physiology PharynxThe adenoids lie on the posterior wall of the nasopharynx,and the lingual tonsils are located at the base of the tongue.The upper portion of the pharynx drains to the retropharyngeal nodes,and the lower part drains to the deep cervical lymph nodes.Structure and Physiology PharynxThe functions of the pharynx are as follows:Enable swallowing Enable speech Provide an airwayStructure and Physiology PharynxSwallowing,or deglutition,is divided into three stages.The voluntary stage occurs when a bolus of food is forced by the tongue past the tonsils to the posterior pharyngeal wall.The second stage is involuntary constriction by the pharyngeal muscles,propelling the bolus from the pharynx to the esophagus.Structure and Physiology PharynxThe third stage is also involuntary,in which the esophageal muscles push the bolus down into the stomach.The larynx is first raised and then closed during the first two stages of swallowing.The eustachian tubes open during swallowing when the nasopharynx closes.Structure and Physiology PharynxThe pharynx also acts as a structure of resonation and articulation.Resonation refers to the vibration of a structure.Articulation is the change in shape of a structure to produce speech.Contracting the pharyngeal muscles causes a change in the acoustic quality of speech.Changes in the size and shape of the pharynx affect resonance.The soft palate affects resonance by opening and closing the partition between the oral and nasal cavities.If closure is incomplete,nasal speech results.resonation同根词：同根词：resonateacoustic同根词：同根词：acousticsacousticalvocabularyStructure and Physiology LarynxThe larynx is located at the superior margin of the trachea and below the hyoid bone,which is located at the base of the tongue.The larynx is at the level of the fourth to sixth cervical vertebrae.The larynx functions as a guard against the entrance of solids and liquids into the trachea,as well as being the organ of voice production.Structure and Physiology LarynxThe epiglottis is attached above the larynx.The function of the epiglottis is generally believed to be protection of the airway during swallowing.Structure and Physiology LarynxThe body of the larynx consists of a series of cartilaginous structures:the thyroid,the cricoid,and the arytenoid cartilages.The thyroid cartilage forms the bulk of the structure of the larynx and produces the prominence in the neck known as the Adams apple.Toward the top of the thyroid cartilage is the thyroid notch.Farther down on the thyroid cartilage,there is a space,the cricothyroid space and membrane,that separates the thyroid cartilage from the cricoid cartilage.arytenoid,rtind杓状杓状notch切迹切迹vocabularyStructure and Physiology LarynxThe cricoid cartilage articulates with the cricothyroid membrane superiorly and the trachea inferiorly.It is the only complete ring of cartilage in the larynx.The paired arytenoid cartilages provide an important area for attachment of the vocal cords.Laryngeal cartilages.Laryngeal skeleton.Structure and Physiology LarynxThe vocal cords vibrate to generate speech.Sound is produced by the rapid vibration of the vocal cords excited by the exhaled stream of air.The vocal cords are brought together,and their tension is changed,by the action of various laryngeal muscles.The nerve supply to the larynx is derived from the superior and recurrent laryngeal branches of the vagus,or 10th cranial,nerve.Voice produced at the larynx is modified by the pharynx and oronasal cavity.Review of Specific Symptoms Oral CavityAll patients should be asked the following:“When did you last see a dentist?”“What did the dentist do?”“Do your gums bleed?”“Have you any pain,sores,or masses on your lips or in your mouth that do not heal?”“Have you had any problems after extraction of a tooth?”(If the patient wears dentures)“Have you noticed any change in the way your dentures fit?”Review of Specific Symptoms Oral CavityCancers of the oral cavity are most often found in people who are older than 45 years of age.Cancer of the lip is more common in men than in women and is more likely to develop in people with light-colored skin who have spent extensive time in the sun.Cancer of the oral cavity is more common in people who chew tobacco or smoke pipes.A possible sign of a cancer of the mouth or gums is when dentures no longer fit well.Review of Specific Symptoms Oral CavityThe most important symptoms of disease of the oral cavity are as follows:Pain Ulceration Bleeding Mass Halitosis(bad breath)Xerostomia(dry mouth)Review of Specific Symptoms Oral Cavity painWhen a patient complains of oral pain,it is important to ask the following:“Where is the pain?”“Describe the pain.”“Do you feel the pain anywhere else?”“What brings the pain on?”“What makes it better?worse?”“When you have the pain,do you have any other symptoms?”Review of Specific Symptoms Oral Cavity painTooth pain may be a symptom of underlying gingival disease.A history of dental procedures and recent dental work should be documented.Pain in the teeth may sometimes be referred from the chest.Patients with angina may actually complain of pain in their teeth associated with exertion.Careful and thoughtful questioning is indicated.Review of Specific Symptoms Oral Cavity ulcerationOral ulcerative lesions are common and may be manifestations of local or systemic disease of immunogenic,infectious,malignant,or traumatic origin.The patients history is important because it indicates whether the lesions are acute or chronic,single or multiple,and primary or recurrent.Review of Specific Symptoms Oral Cavity ulcerationOral pain is frequently related to ulceration of the lips or tongue.Cancer is not the most common cause of oral cavity ulceration,but it must always be considered.When a patient complains of ulceration,ask the following questions:“Have you had a lesion like this before?”“Are there multiple lesions?”“How long have the lesions been present?”Review of Specific Symptoms Oral Cavity