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Head & Neck > 11) The Pharynx & Larynx > Flashcards

11) The Pharynx & Larynx Flashcards

1
Q

What is the location of the pharynx?

A

Cranial base to inferior border of cricoid cartilage anteriorly
Inferior border of C6 (past larynx) posteriorly

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2
Q

Where is the widest part of the pharynx?

A

Widest - Opposite hyoid

Narrowest - Inferior end, continuous with oesophagus

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3
Q

What 3 parts is the pharynx divided into?

A

Nasopharynx
Oropharynx
Laryngopharynx

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4
Q

Describe the location and function of the nasopharynx

A

Posterior to nose, superior to soft palate
Respiratory function
Contains the adenoids (lymphoid tissue)

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5
Q

Describe the location and function of the oropharynx

A

Posterior to mouth
Soft palate to superior border of epiglottis
Digestive function

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6
Q

Describe the location and function of the laryngopharnyx

A

Posterior to larynx
Superior border of epiglottis to inferior border of cricoid cartilage
Continuous with oesophagus

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7
Q

What types of epithelium line the pharynx?

A

Nasopharynx - Pseudostatified ciliated ep. with goblet cells
Oropharynx - Stratified squamous non-keratinised ep.
Laryngopharynx - Stratified squamous non-keratinised ep.

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8
Q

What are the layers of muscle and fascia that cover the pharynx?

A 
Wall of pharynx:
Incomplete outer circular muscle layer
Inner longitudinal muscle layer
Pharyngobasilar fascia
Mucous membrane
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9
Q

The outer circular muscular layer of the pharynx is made up of which 3 muscles?

A 
Superior constrictor
Middle constrictor
Inferior constrictor (lower horizontal fibres known as Cricopharyngeus)
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10
Q

What is the function of the outer pharyngeal muscles during swallowing?

A

Muscles constrict to propel bolus of food downwards
Outer muscle layer attaches posteriorly at midline raphe
Muscles overlap, incomplete anteriorly

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11
Q

Which 3 muscles make up the inner longitudinal muscle layer of the pharynx?

A

Stylopharyngeus
Palatopharyngeus
Salpingopharyngeus

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12
Q

What is the function of the inner pharyngeal muscles during swallowing?

A

Shorten & widen the pharynx

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13
Q

Which nerves innervate the pharynx?

A

Pharyngeal plexus of nerves:
Branches of glossopharyngeal & vagus nerve
Superior cervical ganglion

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14
Q

What is the sensory innervation to the pharynx?

A 
Glossopharyngeal nerve (CN IX)
Nasopharynx - Ophthalmic & Maxillary divisons of Trigeminal
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15
Q

What is the motor innervation to the pharynx?

A 
Vagus nerve (CN X)
Except stylopharyngeus muscle - glossopharyngeal nerve
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16
Q

What are the 3 stages of swallowing?

A
  1. Voluntary phase
  2. Pharyngeal phase
  3. Oesophageal phase
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17
Q

Which actions occurs during the voluntary phase of swallowing?

A

Tongue moves bolus back onto pharynx

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18
Q

Which actions occurs during the pharyngeal phase of swallowing?

A 
Involuntary
Inhibition of breathing
Pharynx widens & shortens
Larynx raised - suprahyoid & longitudinal muscles
Closure of glottis
Opening of upper oesophageal 'sphincter'
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19
Q

Which actions occurs during the oesophageal phase of swallowing?

A

Upper 1/3 - voluntary striated muscle (somatic control)
Lower 2/3 - smooth muscle (parasymp. control)
Wave of peristalsis
Bolus propelled to stomach in ~9secs
Lower oesophageal ‘sphincter’ opens

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20
Q

Which arteries supply the pharynx?

A

Branches of ECA:

  • ascending pharyngeal a.
  • lingual a.
  • facial a.
  • maxillary a.
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21
Q

Which veins provide venous drainage of the pharynx?

A

Pharyngeal plexus of veins > IJV

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22
Q

What is the gag reflex?

A

Tests pharyngeal innervation & musculature
Touch back of oropharynx - reflex of gagging
Afferent pathway - CN IX
Efferent pathway - CN X

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23
Q

What are the adenoids?

A

Sub-epithelial collection of lymphoid tissue (ring)
Junction of roof & posterior wall of nasopharynx
Largest 3-8yrs
Enlarge with viral/bacterial infections
Recurrent infections - chronically enlarged

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24
Q

What are the clinical features of enlarged adenoids?

A 
Nasal obstruction
Mouth breathing, nasal speech
Feeding difficulty
Snoring/ Obstructive sleep apnoea
Block opening of Eustachian tube
25
Q

What are the palatine tonsils?

A

Lymphoid tissue covered by squamous ep.
Lie in tonsillar fossa between:
Anterior - Palatoglossal arch
Posterior - Palatopharyngeal arch

26
Q

What is the lymphatic drainage of the palatine tonsils?

A

Jugulo-digastric (tonsillar) node

angle of mandible

27
Q

What dangers are associated with a tonsillectomy?

A

Bleeding - palatine tonsils very vascular
Often external palatine vein
ICA & CN IX lie just lateral to tonsillar fossa

28
Q

What is quinsy?

A

Peritonsillar abscess
Infection spread to peritonsillar tissue & abscess formation
Uvula pushed to other side
Requires abscess drainage

29
Q

Which common sites can food become stuck in the pharynx?

A

Oropharynx:
Vallecula - mucosal pouch between base of tongue & epiglottis

Laryngopharynx:
Piriform Fossa - Mucosal recess between central part of larynx & lateral lamina of thyroid cartilage

30
Q

Describe the location of the larynx

A

Connects oropharynx to trachea
Laryngeal inlet to inferior border of cricoid cartilage
Continuous with trachea

31
Q

What is the function of the larynx?

A

Guard the air passages especially during swallowing

Contains the voice box

32
Q

What is the laryngeal skeleton make up of?

A

Hyoid bone

9 cartilages

33
Q

Which 9 cartilages are part of the laryngeal skeleton?

A 
3 unpaired cartilages:
 - Epiglottis
 - Thyroid cartilage
 - Cricoid cartilage
3 paired cartilages:
 - Arytenoid cartilage(s) (important!)
 - Corniculate cartilage(s)
 - Cuneiform cartilage(s)
34
Q

Describe the epiglottis

A

Leaf shaped fibro-cartilage

Attached by ligaments to back of hyoid bone & thyroid cartilage

35
Q

Describe the thyroid cartilage

A

Laryngeal prominence ‘Adam’s Apple’
Upper surface used to mark level of C4
2 Lamina
2 Horns (superior & inferior thyroid horns)

36
Q

Describe the cricoid cartilage

A

Signet ring shaped
2 articular facets on each side (articulate with inferior horn of thyroid cartilage & arytenoid cartilage)
Surface marking for C6 level

37
Q

Describe the arytenoid cartilage

A

Pyramid shaped
Concave base articulating with cricoid
Anterior - vocal process
Lateral - muscular process

38
Q

Why is the arytenoid cartilage so important?

A

Crucial in vocal cord movement

39
Q

What is the cricovocal membrane/ligament?

A

a.k.a conus elasticus/ lateral cricothyroid ligament
mainly elastic fibres
lower border attached to cricoid cartilage
Upper free border - Vocal ligament

40
Q

What are the 3 spaces that the internal cavity of the larynx is divided into?

A

Supraglottic space
Glottis
Subglottic space

41
Q

Where is the supraglottic space?

A

Laryngeal inlet to Vestibular folds (false vocal cords)

42
Q

Where is the glottis space?

A

Vocal cords & rima glottis

Space between vocal cords

43
Q

Where is the subglottic space?

A

Below vocal cords to lower border of cricoid cartilage

44
Q

What is the function of the extrinsic laryngeal muscles?

A

Move entire larynx

  • Infrahyoid muscles depress larynx
  • Suprahyoid muscles elevate larynx
45
Q

What is the function of the intrinsic laryngeal muscles?

A

Act on

  • vocal folds to open & close glottis
  • aryepiglottic folds, help to close the laryngeal inlet
46
Q

Which nerve supplies the intrinsic laryngeal muscles?

A

Recurrent laryngeal nerve
except
Cricothyroid muscle - External laryngeal nerve

47
Q

What are the layers of the vocal cords?

A

Stratified squamous epithelium
Vocal ligament
Vocalis muscle

48
Q

The mucosa of the vocal cords is firmly adherent to the vocal ligament, with no submucosa. What consequences does this have?

A

Vocal cords look pearly white on laryngoscopy
No oedema during infections
Delayed spread of carcinoma of vocal cords

49
Q

Which muscles provide movement of the vocal cords?

A

Intrinsic muscles of larynx
Abduction - Posterior cricoarytenoid
Adduction - Lateral cricoarytenoid

50
Q

What is the importance of the cricothyroid muscle?

A

Only intrinsic muscle on the outside - increases vocal cord tension
Only intrinsic muscle supplied by External Laryngeal nerve

51
Q

Which nerve innervates the larynx?

A

Branches of the vagus nerve CN X

52
Q

What does the superior laryngeal nerve innervate?

A

Internal laryngeal nerve - Sensory to larynx above true vocal cord
External laryngeal nerve - motor to cricothyroid muscle

53
Q

What does the recurrent laryngeal nerve innervate?

A

Sensory below the true vocal cord

Motor to all intrinsic laryngeal muscles (except cricothryoid)

54
Q

Damage to which nerve causes hoarseness of the voice?

A

Recurrent laryngeal nerve palsy

Intrinsic laryngeal muscle weakness

55
Q

Name some of the causes of hoarseness of voice

A 
Infection - Laryngitis
Overuse of the voice
GORD
Benign nodules on vocal cords
Apical lung tumour - both sides
Bronchial carcinoma - Left side (right doesn't go low enough)
56
Q

Which arteries supply the larynx?

A

ECA > Superior thyroid artery > Superior laryngeal artery

Subclavian artery > Inferior thyroid artery > Inferior laryngeal artery

57
Q

Describe the venous drainage of the larynx

A

Superior Laryngeal vein > Superior Thyroid vein > IJV

Inferior Laryngeal vein > Inferior Thyroid vein > Left Brachiocephalic vein

58
Q

What may cause an upper airway or laryngeal obstruction?

A

Laryngeal oedema - infection (croup, acute epiglottitis)
Inhalation of a foreign body
Tumours

59
Q

If the upper airway of larynx is blocked what interventions are required?

A

Emergency: Cricothyroidotomy
Opening made through the cricothyroid membrane

Less urgent: Tracheostomy
Opening into the trachea

Head & Neck (12 decks)

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