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(4) Head & Neck - Sessions > (12.1+2) Pharynx & Larynx > Flashcards

(12.1+2) Pharynx & Larynx Flashcards

1
Q

Describe how the Pharynx is subdivided.

A
  • Nasopharynx: base of cranium - soft palate
  • Oropharynx: soft palate - superior border of Epiglottis
  • Laryngopharynx: superior border of Epiglottis - Inferior border of Cricoid cartilage (anteriorly) & C6 (posteriorly)
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2
Q

Describe how the epithelium of Nasopharynx adapt to its function?

A

Pseudostratified columnar ciliated + Goblet cells

  • Goblet cells secrete mucus catching foreign materials
  • Cilia trap and swipe the mucus down to oropharynx to be swallowed
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3
Q

Describe how the epithelium of Laryngopharynx adapt to its function.

A

Stratified squamous non-keratinised

- Against abrasion during swallowing

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4
Q

The pharyngeal muscles are seperated in two layers, name the muscles and describe their functions.

A

Outer circular
- Superior & Middle & Inferior Constrictors
- Inferior has two fibres, Thyropharyngeal (upper) & Cricopharyngeal (lower)
- Constrict to push food down
Inner longitudinal
- Stylopharyngeus & Palatopharyngeus & Salpingopharyngeus
- Contract to shorten & widen the pharynx

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5
Q

Describe the phases of swallowing.

A

1 Voluntary: Tongue pushes food back to oropharynx
2 Pharyngeal: Respiration inhibited + Epiglottis closes glottis + Upper Oesophageal Sphincter relaxed
3 Oesophageal: Peristalsis + Lower Oesophageal Sphincter relaxed

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6
Q

Describe the innervation to the pharynx.

A

Pharyngeal Plexus: Glossopharyngeal & Vagus & SNS fibres from Superior Cervical Ganglion

Sensory

  • Maxillary (CN Vii) -> Nasopharynx
  • Glossopharyngeal (CN IX) -> Oropharynx
  • Vagus (CN X) -> Laryngopharynx

Motor

  • Vagus (CN X) -> all Pharyngeal muscles except
  • Glossopharyngeal (CN IX) -> Stylopharyngeus
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7
Q

What arteries supply the Pharynx?

A

Branches from External Carotid A:

  • Ascending pharyngeal
  • Lingual
  • Facial
  • Maxillary
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8
Q

Describe the venous drainages of the Pharynx.

A

Pharyngeal Venous Plexus -> Internal Jugular Vein

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9
Q

Describe the Lymphoid tissues in the Pharynx

A

Aggregate become tonsils, forming Tonsillar (Waldeyer’s) Ring at Nasopharynx

  • Adenoid tonsil (superior part)
  • Tubular tonsils x2
  • Palatine tonsils x2
  • Lingual tonsil
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10
Q

Recurrent infection may cause chronic enlargement of Adenoid tonsil, suggest some complications of this.

A
  • Breathing difficulties
  • Speaking difficulties
  • Feeding difficulties
  • Blockage of Eustachian tube -> Otits media
  • Snoring / Sleep Apnoea
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11
Q

Where does the Palatine tonsils drain into? Where do they locate?

A
  • Jugulo-digastric (Tonsillar) lymph nodes

- Angle of mandible

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12
Q

Suggest why may a Tonsillectomy of the Palatine tonsil be risky.

A
  • Haemorrhage from Internal Jugular Vein

- Internal Carotid A & Glossopharyngeal N pass laterally to Palatine tonsils

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13
Q

A patient came with a viral infection, you found his uvula shifted to the left side. What happened?

A
  • Quinsy = peritonsillar abscess, infection spread from the right Palatine tonsil
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14
Q

Suggest some common sites of where food is likely to be sucked.

A
  • Vallecula = in Oropharynx, region of palatine tonsils

- Piriform fossa = in Laryngopharynx, between epiglottis & tongue

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15
Q

Name 5 important bony structures in the Larynx.

A
  • Hyoid Bone
  • Epiglottis
  • Thyroid Cartilage
  • Cricoid Cartilages
  • Arytenoid x2
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16
Q

Describe the movement of Epiglottis.

A

Contraction of Suprahyoid & Longituidinal Pharyngeal muscles -> elevate Hyoid bone & Larynx -> Epiglottis become horizontal -> closes Glottis

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17
Q

Describe the shape and clinical importance of its bony marking of Thyroid cartilage.

A
  • Laryngeal prominence marks C4
    = Bifurcation of Common Carotid A, Carotid Body & Sinus locate
    = superior border of larynx
18
Q

Describe the shape and clinical importance of its bony marking of Cricoid cartilage.

A
  • Signet ring shape
  • Marks C6
    = inferior border of Hyoid bone
    = Junction of Pharynx & Oesophagus
    = Junction of Larynx & Trachea
19
Q

Describe the shape and function of Arytenoid cartilage.

A
  • Pyramid shape

- Attachments for Vocal cords

20
Q

Where are the vocal cords attached?

A

Arytenoid Cartilage

21
Q

Where does the vocal ligament arise from?

A

Upper free border of the Cricovocal Ligament (Conus Elasticus)

22
Q

What is the Glottis?

A

Vocal cords x2 + Rima Glottis

23
Q

Draw and label a simple diagram showing:

  • Epiglottis
  • Arytenoid Cartilage
  • True Vocal Folds
  • False Vocal Folds (What’s another name?)
  • Glottis
  • Rima Glottis
  • Aryepiglottic Folds
  • Base of the tongue
A

http://imgarcade.com/1/intrinsic-muscles-of-the-larynx-superior-view/

False vocal fold = vestibular fold

24
Q

When are the vocal cords adducted and which muscles are responsible for it? Which nerves innervate this action?

A

Adduction (closes Rima Glottis) during phonation

  • Lateral Cricoarytenoid muscle, Recurrent Laryngeal N
  • Cricothyroid muscle, Inferior Laryngeal N
25
Q

When are the vocal cords abducted and which muscles are responsible for it? Which nerve innervates this action?

A

Abduction (opens Rima Glottis) during respiration

- Posterior Cricoarytenoid muscle, Recurrent Laryngeal N

26
Q

Name and describe the function of each intrinsic Laryngeal muscle.

A
  • Aryepiglottic muscle -> Aryepiglottic Folds -> close Laryngeal inlet
  • Posterior Cricoarytenoid muscle -> abduct (open) Rami Glottidis -> respiration
  • Lateral Cricoarytenoid & Cricothyroid muscles -> adduct (close) Rami Glottidis -> phonation
27
Q

Describe the innervations of the Larynx.

A
  • External Laryngeal -> motor of Cricothyroid
  • Recurrent Laryngeal -> motor of all Intrinsic laryngeal muscles except ^ + sensory below Vocal cords
  • Internal Laryngeal -> sensory above Vocal cords
28
Q

Suggest some reasons causing hoarseness in voice.

A
  • Overuse of voice / benign nodules
  • Infection (viral/Streptococcus)
  • GORDS
  • Apical lung tumour (both sides affected)
  • Aortic Aneurysm / Brachial Carcinoma (only left side affected)
29
Q

Describe the level of descending and looping of Recurrent Laryngeal Nerves on both sides.

A
  • Right: descends to T2 -> loops around R. Subclavian A

- Left: descends to T4 -> loops around Aortic Arch

30
Q

Describe the arterial supplies to the Larynx.

A
  • External Carotid A -> Superior Thyroid A -> Superior Laryngeal A
  • Subclavian A -> Inferior Thyroid A -> Inferior Laryngeal A
31
Q

Describe the venous drainages of the Larynx.

A
  • Superior Laryngeal V -> Superior Thyroid V -> Internal Jugular V
  • Inferior Laryngeal V -> Inferior Thyroid V -> Left Brachiocephalic V
32
Q

Suggest two ways to manage upper laryngeal obstruction.

A
  • Cricothyroidotomy = opening Cricothyroid membrane in emergency for airways
  • Tracheostomy = opening in Trachea
33
Q

What is a Pharyngeal diverticulum? Why can it be an issue?

A
  • A weak point in the Inferior Constrictor, between Cricopharyngeus & Thyropharyngeus)
  • Food builds up in the pouch -> Dysphagia
34
Q

Describe how the two muscles of the Inferior constrictor of the Pharynx work to prevent intrapharyngeal pressure rising?

A
  • Thyropharyngeus contracts as Cricopharyngeus relaxes
  • Allows food bolus to be propelled into the oesophagus
  • Prevents trapping of bolus
35
Q

Which part of the tongue is contained with the Oropharynx? Which nerve receives its sensory information?

A
  • Posterior 1/3

- Glossopharyngeal (CN IX)

36
Q

Describe the Gag reflex.

A

Touch back of Oropharynx -> Glossopharyngeal afferents -> Vagus efferents -> pharyngeal muscles contract

37
Q

Describe how the larynx is divided into three sections.

A
  • Supraglottic space = laryngeal inlet to Vestibular folds
  • Glottis = true vocal folds & rima glottis
  • Subglottic space = true vocal folds to inferior border of cricoid cartilage
38
Q

Why does the vocal cords appear pale?

A

It lacks of submucosa layer, mucosa attaches directly to the vocal ligaments

39
Q

What bony structure does the Thyroid gland attached to? By what structure?

A
  • Hyoid bone

- Attached by Levator Glandulae Thyroideae at the Isthmus

40
Q

Why does the Thyroid gland move during swallowing?

A
  • Pretracheal fascia attach to Thyroid & Cricoid cartilages & encloses Thyroid gland
  • Suprahyoid muscles elevate Laryngeal skeletons, moving the Thyroid gland with it
41
Q

Describe the shape of Inferior Thyroid Artery and explain the importance of this shape.

A
  • Tortuous

- Allow elongation as the Thyroid Gland moves during swallowing

42
Q

Describe the blood supplies to the Thyroid glands.

A
  • Superior Thyroid A

(4) Head & Neck - Sessions (11 decks)

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