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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
What are the palatine tonsils?
Lymphoid tissue covered by squamous ep. Lie in tonsillar fossa between: Anterior - Palatoglossal arch Posterior - Palatopharyngeal arch
26
What is the lymphatic drainage of the palatine tonsils?
Jugulo-digastric (tonsillar) node | angle of mandible
27
What dangers are associated with a tonsillectomy?
Bleeding - palatine tonsils very vascular Often external palatine vein ICA & CN IX lie just lateral to tonsillar fossa
28
What is quinsy?
Peritonsillar abscess Infection spread to peritonsillar tissue & abscess formation Uvula pushed to other side Requires abscess drainage
29
Which common sites can food become stuck in the pharynx?
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
Describe the location of the larynx
Connects oropharynx to trachea Laryngeal inlet to inferior border of cricoid cartilage Continuous with trachea
31
What is the function of the larynx?
Guard the air passages especially during swallowing | Contains the voice box
32
What is the laryngeal skeleton make up of?
Hyoid bone | 9 cartilages
33
Which 9 cartilages are part of the laryngeal skeleton?
``` 3 unpaired cartilages: - Epiglottis - Thyroid cartilage - Cricoid cartilage 3 paired cartilages: - Arytenoid cartilage(s) (important!) - Corniculate cartilage(s) - Cuneiform cartilage(s) ```
34
Describe the epiglottis
Leaf shaped fibro-cartilage | Attached by ligaments to back of hyoid bone & thyroid cartilage
35
Describe the thyroid cartilage
Laryngeal prominence 'Adam's Apple' Upper surface used to mark level of C4 2 Lamina 2 Horns (superior & inferior thyroid horns)
36
Describe the cricoid cartilage
Signet ring shaped 2 articular facets on each side (articulate with inferior horn of thyroid cartilage & arytenoid cartilage) Surface marking for C6 level
37
Describe the arytenoid cartilage
Pyramid shaped Concave base articulating with cricoid Anterior - vocal process Lateral - muscular process
38
Why is the arytenoid cartilage so important?
Crucial in vocal cord movement
39
What is the cricovocal membrane/ligament?
a.k.a conus elasticus/ lateral cricothyroid ligament mainly elastic fibres lower border attached to cricoid cartilage Upper free border - Vocal ligament
40
What are the 3 spaces that the internal cavity of the larynx is divided into?
Supraglottic space Glottis Subglottic space
41
Where is the supraglottic space?
Laryngeal inlet to Vestibular folds (false vocal cords)
42
Where is the glottis space?
Vocal cords & rima glottis | Space between vocal cords
43
Where is the subglottic space?
Below vocal cords to lower border of cricoid cartilage
44
What is the function of the extrinsic laryngeal muscles?
Move entire larynx - Infrahyoid muscles depress larynx - Suprahyoid muscles elevate larynx
45
What is the function of the intrinsic laryngeal muscles?
Act on - vocal folds to open & close glottis - aryepiglottic folds, help to close the laryngeal inlet
46
Which nerve supplies the intrinsic laryngeal muscles?
Recurrent laryngeal nerve except Cricothyroid muscle - External laryngeal nerve
47
What are the layers of the vocal cords?
Stratified squamous epithelium Vocal ligament Vocalis muscle
48
The mucosa of the vocal cords is firmly adherent to the vocal ligament, with no submucosa. What consequences does this have?
Vocal cords look pearly white on laryngoscopy No oedema during infections Delayed spread of carcinoma of vocal cords
49
Which muscles provide movement of the vocal cords?
Intrinsic muscles of larynx Abduction - Posterior cricoarytenoid Adduction - Lateral cricoarytenoid
50
What is the importance of the cricothyroid muscle?
Only intrinsic muscle on the outside - increases vocal cord tension Only intrinsic muscle supplied by External Laryngeal nerve
51
Which nerve innervates the larynx?
Branches of the vagus nerve CN X
52
What does the superior laryngeal nerve innervate?
Internal laryngeal nerve - Sensory to larynx above true vocal cord External laryngeal nerve - motor to cricothyroid muscle
53
What does the recurrent laryngeal nerve innervate?
Sensory below the true vocal cord | Motor to all intrinsic laryngeal muscles (except cricothryoid)
54
Damage to which nerve causes hoarseness of the voice?
Recurrent laryngeal nerve palsy | Intrinsic laryngeal muscle weakness
55
Name some of the causes of hoarseness of voice
``` 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
Which arteries supply the larynx?
ECA > Superior thyroid artery > Superior laryngeal artery Subclavian artery > Inferior thyroid artery > Inferior laryngeal artery
57
Describe the venous drainage of the larynx
Superior Laryngeal vein > Superior Thyroid vein > IJV Inferior Laryngeal vein > Inferior Thyroid vein > Left Brachiocephalic vein
58
What may cause an upper airway or laryngeal obstruction?
Laryngeal oedema - infection (croup, acute epiglottitis) Inhalation of a foreign body Tumours
59
If the upper airway of larynx is blocked what interventions are required?
Emergency: Cricothyroidotomy Opening made through the cricothyroid membrane Less urgent: Tracheostomy Opening into the trachea

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