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14. Head and Neck > 9. The Pharynx and Larynx > Flashcards

9. The Pharynx and Larynx Flashcards

1
Q

What is the pharynx?

A

The superior, expanded part of the alimentary system posterior to the nasal and oral cavities and extending inferiorly past the larynx.

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2
Q

Where does the pharynx run from and to?

A

From cranial base to inferior border of the cricoid cartilage anteriorly and inferior border of C6 vertebra posteriorly.

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3
Q

Where is the pharynx at its widest and narrowest?

A

Widest 5cm opposite hyoid.

Narrowest 1.5cm inferior end where it is continuous with oesophagus.

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4
Q

What and where are the three parts of the pharynx?

A

Nasopharynx posterior to nose and superior to soft palate, oropharynx posterior to mouth, laryngopharynx posterior to larynx.

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5
Q

Where are the functions of the parts of the pharynx?

A

Naso - respiratory function.
Oro - digestive function.
Laryngo - n/a.

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6
Q

What are the different epithelial linings of the pharynx?

A

Naso - pseudostratified ciliated epithelium with goblet cells.
Oro - stratified squamous epithelium non-keratinised.
Laryngo - stratified squamous epithelium non-keratinised

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7
Q

How are the adenoids formed?

A

Lymphoid tissue forms a tonsillar ring around the superior part of the nasopharynx.

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8
Q

Where does the oropharynx run from and to?

A

Soft palate to the superior border of the epiglottis.

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9
Q

Where does the laryngopharynx run to?

A

Superior border of epiglottis to the inferior border of the cricoid cartilage, continuous with oesophagus.

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10
Q

What is the wall of the pharynx like?

A

Incomplete outer circular muscle layer and inner longitudinal muscle layer. Muscle layer covered internally by pharyngobasilar fascia, covered with mucous membrane.

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11
Q

What are the muscles in the pharynx outer circular muscle layer?

A

Superior constrictor, middle constrictor, inferior constrictor.

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12
Q

What does the outer circular muscle layer of the pharynx do?

A

Constrict in swallowing to propel the bolus of food downwards in an involuntarily swallowing reflex.

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13
Q

What are the muscles in the pharynx inner longitudinal muscle layer?

A

Stylopharyngeus, palatopharyngeus, salpingopharyngeus.

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14
Q

What does the inner longitudinal muscle layer of the pharynx do?

A

In swallowing they shorten and widen pharynx.

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15
Q

Generally, what innervates the pharynx?

A

Pharyngeal plexus of nerves formed by branches of vagus CN X and glossopharyngeal CN IX along with sympathetic fibres from superior cervical ganglion.

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16
Q

What is the sensory innervation of the pharynx?

A

Glossopharyngeal nerve. Nasopharynx via opthalmic and maxillary divisions of trigeminal nerve CN V.

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17
Q

What is the motor innervation to the pharynx?

A

Vagus nerve CN X, except to stylopharyngeus nerve - from glossopharyngeal nerve CN IX.

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18
Q

What are the three phases of swallowing?

A

Voluntary, pharyngeal phase, oesophageal phase.

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19
Q

What is the voluntary phase of swallowing?

A

Tongue moves bolus back onto the pharynx.

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20
Q

What is the pharyngeal phase of swallowing?

A

Afferent information from pressure receptors in palate and anterior pharynx reach swallowing centre in brain stem -> inhibition of breathing + raising of larynx + closure of glottis + opening of upper oesophageal sphincter.

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21
Q

What is the oesophageal phase of swallowing?

A

Muscle in upper third of oesophagus is voluntary striated so somatic control, lower thirds is smooth muscle so PSANS control. Wave of peristalsis sweeps down so bolus is in stomach in 9 seconds. Lower oesophageal sphincter opens.

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22
Q

What is the blood supply to the pharynx?

A

Branches of external carotid artery: ascending pharyngeal artery, lingual artery, facial artery, maxillary artery.

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23
Q

What is the venous drainage of the pharynx?

A

Pharyngeal venous plexus -> internal jugular vein.

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24
Q

What is the gag reflex?

A

Tests innervation and musculature of the pharynx by touching the back of the oropharynx -> reflex contraction of pharyngeal muscles.

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25
Q

What are the afferent and efferent pathways involved in the gag reflex?

A

Afferent - glossopharyngeal nerve CN IX.

Efferent - vagus nerve CN X.

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26
Q

What are the adenoids?

A

Sub-epithelial collection of lymphoid tissue at junction of rood and posterior wall of nasopharynx.

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27
Q

What are the clinical features of enlarged adenoids?

A

Nasal obstruction, mouth breath and nasal speech, feeding difficulty especially in infants, snoring, block opening of Eustachian tube.

28
Q

Where are the palatine tonsils?

A

In tonsillar fossa between two arches: anterior - palatoglossal arch (boundary between mouth and oropharynx) and palatopharyngeal arch (contains palatopharyngeus muscle that blends with wall of phaynx).

29
Q

What is the lymphatic drainage of the palatine tonsils?

A

Jugulo-digastric node at angle of the mandible.

30
Q

Why does tonsillectomy lead to bleeding often?

A

Very vascular. External palatine vein causes bleeding, internal carotid artery and glossopharyngeal nerve lie just lateral to tonsillar fossa.

31
Q

What is quinsy?

A

Peritonsillar abscess from infection spread: peritonsillar tissue -> abscess formation.

32
Q

Where does the uvula move in quinsy?

A

It is pushed to the other side to the abscess.

33
Q

What are the common sites for food to become stuck?

A

Oropharynx - vallecula, base of tongue, region of palatine tonsil.
Laryngopharynx - piriform fossa, cricopharyngeus.

34
Q

What is the vallecula?

A

Mucosal pouch between the base of the tongue and epiglottis.

35
Q

What is the piriform fossa?

A

Mucosal recess between the central part of the larynx and lateral lamina of the thyroid cartilage.

36
Q

Where does the larynx run from and to?

A

From the laryngeal inlet to the level of the inferior border of the cricoid cartilage, here it’s continuous with the trachea.

37
Q

What is the main function of the larynx?

A

Guard air passages, especially during swallowing, acts as a sphincter/valve of the lower respiratory tract to maintain the airway.

38
Q

What is the laryngeal skeleton made up of?

A

Hyoid bone and 9 cartilages.

39
Q

What are the nine cartilages of the laryngeal skeleton?

A

3 unpaired cartilages: epiglottis, thyroid cartilage, cricoid cartilage.
1 important set of paired cartilages: arytenoid cartilages.
2 other sets of paired cartilages: corniculate cartilage, cuneiform cartilage.

40
Q

What and where is the epiglottis?

A

Lead shaped fibro cartilages attached by ligaments to the back of the hyoid bone and thyroid cartilage.

41
Q

What and where is the thyroid cartilage?

A

Laryngeal prominence. Upper surface if at C4 level.

42
Q

Why is the position of the thyroid cartilage clinical relevant?

A

Its upper surface is level with C4 which is where the carotid artery bifurcates and the level of the carotid body.

43
Q

What makes up the thyroid cartilage?

A

Two lamina.

Two horns - superior thyroid horn -> ligament -> hyoid bone, inferior thyroid horn -> synovial joint with cricoid.

44
Q

What is the cricoid cartilage?

A

Signet ring shaped. Two articular facets on each side - inferior horn of thyroid cartilage and artyenoid cartilage.

45
Q

What is the relevance of the position of the cricoid cartilage?

A

It’s at C6 level.

46
Q

What is the arytenoid cartilage?

A

Pyramid shaped cartilage important for vocal cord movement. Anterior - vocal process, lateral - muscular process.

47
Q

What is the cricovocal membrane/ligament?

A

Elastic fibres whose lower border attaches to cricoid cartilage and upper border is the vocal ligament.

48
Q

What and where is the vocal ligament?

A

Attached to deep surface of angle of thyroid cartilage and it’s the vocal process of arytenoid cartilage.

49
Q

What are the three spaces of the internal cavity of the larynx?

A

Supraglottic space, glottis, subglottic space.

50
Q

Where does the supraglottic space run from and to?

A

Laryngeal inlet to vestibular folds.

51
Q

Where does the glottis run from and to?

A

Vocal cords and rima glottis.

52
Q

Where does the subglottic space run from and to?

A

Below vocal cords to lower border of cricoid cartilage.

53
Q

What are the extrinsic muscles of the larynx and their actions?

A

Infrahyoid muscles - depress larynx.

Suprahyoid muscles - elevate larynx.

54
Q

What do the intrinsic muscles of the larynx act on and what are their actions?

A

Vocal folds - open and close glottis.

Aryepiglottic folds - help to close the laryngeal inlet.

55
Q

What is the innervation to the intrinsic muscles of the larynx?

A

Recurrent laryngeal nerve, except to cricothyroid muscle - external laryngeal nerve.

56
Q

What are the layers of the vocal cord?

A

Stratified squamous epithelium, vocal ligament, vocalis muscle.

57
Q

What is the result of no submucosa on the vocal cords?

A

They look pearly white on laryngoscopy, no oedema in infection, delayed spread of carcinoma of vocal cords.

58
Q

What are the movements of the vocal cords and by which muscles?

A

Intrinsic muscles of the larynx move them.
Abduction - posterior cricoarytenoid.
Adduction - lateral cricoarytenoid.
Cricothyroid - intrinsic muscles on outside increase vocal cord tension.

59
Q

What is the innervation of the larynx?

A

Branches of the vagus nerve (CN X).
Superior laryngeal nerve - internal laryngeal nerve sensory to larynx above true vocal cord, external laryngeal nerve motor to cricothyroid muscle.
Recurrent laryngeal nerve - sensory below true vocal vords, motor to rest of intrinsic laryngeal muscles.

60
Q

What are the routes of the left and right recurrent laryngeal nerves?

A

Arises from vagus nerve (CN X).
Right: descends to T2 then curves around the subclavian artery.
Left: descends to T4 then curves around the arch of the aorta.
Nerves move up to larynx and then lies between trachea and oesophagus.

61
Q

What is the pathophysiology for hoarseness of the voice from pathology in the neck and chest?

A

Recurrent laryngeal nerve palsy leading to intrinsic laryngeal muscle weakness.

62
Q

What are some causes of hoarseness of the voice?

A

Infection (laryngitis), overuse of the voice, GORD, benign nodules on vocal cords, apical lung tumour, bronchial carcinoma (left only).

63
Q

What is the blood supply to the larynx?

A

Superior and inferior laryngeal arteries, branches of the superior and inferior thyroid arteries respectively.

64
Q

What is the venous drainage of the larynx?

A

Superior and inferior laryngeal veins.
Superior laryngeal -> superior thyroid -> interneal jugular.
Inferior laryngeal -> inferior thyroid -> left brachiocephalic vein.

65
Q

What can cause upper airway/laryngeal obstruction?

A

Laryngeal oedema from infection, inhalation of foreign bodies, tumours.

66
Q

What is a cricothyroidotomy?

A

Opening the airway though the cricothyroid membrane.

67
Q

What is a tracheostomy?

A

Opening the airway through the trachea.

14. Head and Neck (11 decks)

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