2. GI Tract Pharynx and Swallowing.pptx

Question 1

What is the difference between the piriform fossa and the larnygeal inlet?

Answer 1

Piriform fossa – between the quadrangular membrane of the larynx and the side wall of the pharynx

The laryngeal inlet is between the aryepiglottic folds

Question 2

What makes up the pharyngobasilar fascia? 4

Answer 2

Superior, middle and inferior constrictors

+ Elevators

Question 3

What are the 4 points of pharyngeal attachment?

Answer 3

1. Medial pterygoid plate of sphenoid
2. Pharyngobasilar fascia attaches to the cartilage of the auditory tube
3. Levator Palati arises from the apex of the petrous temporal bone, inside is the pharyngeal attachment
4. The fascia, and the posterior, midline pharyngeal raphe formed by the constrictors attaches to the pharyngeal tubercle

Question 4

3 structural features of the hyoid bone?

Answer 4

Body
Greater horn
Lesser horn

The stylohyoid ligament attaches to the lesser horn to suspend the hyoid from the styloid process of the skull

Question 5

What are the attachments of the pharyngobasilar fascia and the 3 constrictors?

Answer 5

1. Pharyngobasilar fascia attaches to the medial pterygoid plate (posterior nasal choanae), internal to the attachment of
2. Superior constrictor, which continues to form the pterygo-mandibular raphe with buccinator
3. Middle constrictor attaches to the hyoid bone (greater and lesser horns) and stylohyoid ligament
4. Inferior constrictor attaches to the oblique line of the thyroid cartilage (thyropharyngeus), the cricoid cartilage (cricopharyngeus) and to the fascia on cricothyroid

Question 6

The free, lower edge of which structure contributes to the palatopharyngeal sphincter that separates the naso from the oropharynx during swallowing?

Answer 6

The superior constrictor

Question 7

What structure fills the gap above superior constrictor and then lies internal to it?

Answer 7

The pharyngobasilar fascia

Question 8

What seals the “Gap” below the superior constrictor?

Answer 8

“Gap”, sealed by tongue muscles, fascia and mucous membrane, but allowing neurovascular structures to enter the oral cavity

Question 9

What structure is between Buccinator and Superior constrictor?

Answer 9

Pterygomandibular raphe

Question 10

What nerve supplies:

• Cricothyroid
• Larynx
• Sensation to larynx above vocal folds

Answer 10

External laryngeal nerve to cricothyroid

Recurrent laryngeal nerve passing deep to inf constrictor to reach the larynx

Internal laryngeal nerve – sensation to larynx above the vocal folds

Question 11

_____ fascia lies externally, all around the muscular pharynx and blends with the pretracheal fascia

Answer 11

Buccopharyngeal fascia lies externally, all around the muscular pharynx and blends with the pretracheal fascia

Question 12

What prevents air being drawn into the stomach during inhalation?

Answer 12

The inferior constrictor has a lower, circular part, crico-pharyngeus that forms a spinster around the upper oesophagus

Question 13

What nerve supplies all the pharyngeal constrictors?

Answer 13

The pharyngeal branch of the vagus (X)

Question 14

What is a potential consequence of uncoordinated contraction of cricopharyngeus?

Answer 14

May excessively raise pressure in the pharynx

Question 15

At which point does the superior constrictor layer end?

What is it’s importance?

Answer 15

The cricopharyngeal sphincter (which leaves only 2 layers, the middle and inferior constrictor)

This allows a potential weakness (The dehiscence of Killian) through which a pharyngeal diverticulum may occur, particularly in cricopharyngeal incoordination

Question 16

What are the points of insertion of the pharyngeal elevators?

Importance?

Answer 16

From skull to fan out into the inner surface of the pharynx. May send some fibres to the thyroid cartilage as well.

** ensures simultaneous elevation of the pharynx and larynx

Question 17

Name the pharyngeal elevators?

Answer 17

Palatopharyngeus
Stylopharngeus
Salpingopharyngeus

All on internal pharynx aspect

Question 18

Function of palatopharyngeus?

Answer 18

Elevates the pharynx and larynx
Draws the soft palate downwards and brings the palatopharyngeal arch towards the midline to help palatoglossus (the pillars of the fauces) separate the oral cavity from the pharynx

Main function: Pharyngeal elevator

Question 19

Stylopharyngeus:
Attachments
Innervation
Main function

Answer 19

Stylopharyngeus descends from the styloid process to the internal pharyngeal surface

It is the only muscle supplied by the glossopharyngeal nerve (IX)

Main function: Pharyngeal elevator

Question 20

Salpingopharyngeus:
Attachments?
Function?
Innervation?

Answer 20

From cartilage of auditory tube

Function: Elevator of pharynx and larynx. Opens auditory tube during swallowing for pressure equalisation in middle ear

Innervation: Vagus nerve

Question 21

Nervous supply of palatine tonsil?

Lymph drainage?

Answer 21

Glossopharyngeal nerve

Lymph drainage to Jugulodigastric node

Question 22

Swelling of which two tonsils may cause obstruction of the airway and auditory tube and why?
Causing…

Answer 22

The pharyngeal tonsil/ adenoid on the roof of the nasopharynx,
and also the tubal tonsil as they are at the opening of the auditory tube
Causing?
-Mouth breather
-Middle ear infection

Question 23

What is the vallecula?

Answer 23

The vallecula is a pit or fossa between the tongue and epiglottis, waiting for foreign bodies!

Question 24

Arterial supply of the upper and lower pharynx?

Answer 24

Upper pharynx - branches of the external carotid artery

Lower pharynx – branches of the inferior thyroid branch of thyrocervical from subclavian

Question 25

Venous drainage of the pharynx?

Answer 25

Include pterygoid plexus but essentially converges on the facial and internal jugular veins

Question 26

Lymph drainage of pharynx?

Answer 26

Includes:

• Retropharyngeal nodes
• Paratracheal nodes
• Infrahyoid nodes

To converge on the deep cervical nodes

Question 27

Which parts of the pharynx receive their sensory supply by the following nerves:

• Glossopharyngeal (IX)
• Vagus (X)
• Maxillary (V2)

Answer 27

Oropharynx, palatine tonsil, inferior aspect of soft palate and posterior 1/3 tongue – Glossopharyngeal (IX)
[Referred pain to middle ear]

Laryngopharynx, vallecula and epiglottis - Vagus (X)

Nasopharynx – Maxillary (V2)

Question 28

Motor supply of the pharynx?

Answer 28

PS, secretomotor- Vagus(X) and Facial (VII)

Musculature- Vagus except stylopharyngeus which is glossopharyngeal

Question 29

5 stages of swallowing

Answer 29

1. The bolus is pushed towards the back of the oral cavity by raising the tip and body of the tongue upwards towards the palate – mylohyoid and tongue intrinsic muscles
2. Styloglossus pulls the tongue upwards and backwards to tip the bolus through the oropharyngeal isthmus and into the pharynx
3. The soft palate is tensed (tensor palati) and elevated (levator palati) to sit within Passavant’s ridge and separate the naso from the oropharynx
   The palatoglossal and palatopharyngeal arches relax and move laterally
4. The pharynx and larynx have already been elevated by the longitudinal muscles - stylopharyngeus, salpingopharyngeus and palatopharyngeus; stylohyoid and digastric may also help
5. Relaxation of the elevators allows the pharynx and bolus to descend, while sequential contraction of the constrictors pushes the bolus towards the oesophagus