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ACEM Primary Written > Anaesthetics: Anatomy - Larynx, pharynx and oral cavity > Flashcards

Anaesthetics: Anatomy - Larynx, pharynx and oral cavity Flashcards

1
Q

Which is the largest of the laryngeal cartilages?

A

Thyroid cartilage

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2
Q

What is the vertebral level of the superior border of the thyroid cartilage?

A

C4

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3
Q

What are some of the features and connections of the thyroid cartilage?

A

Laryngeal prominence (fusion of inferior 2/3 of laminae in median plane)
Superior and inferior thyroid notches

Superior horns connected to hyoid superiorly via thyrohyoid membrane
Connected to cricoid cartilage anteriorly via cricothyroid membrane, and inferior horns articulate directly with cricoid cartilage posteriorly (cricothyroid joints)

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4
Q

What structures pierce the thyrohyoid membrane?

A

Superior laryngeal vessels
Branch of superior laryngeal nerve

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5
Q

What cartilage forms the only complete ring around the larynx?

A

Cricoid cartilage (“signet ring” shaped, broader posteriorly)

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6
Q

How is the cricoid cartilage connected to other laryngeal structures?

A

To thyroid cartilage via cricothyroid membrane anteriorly
Articulates directly with inferior horns of thyroid cartilage posteriorly
To first tracheal ring via cricotracheal ligament

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7
Q

What are the nine laryngeal cartilages?

A

Unpaired: thyroid cartilage, cricoid cartilage, epiglottic cartilage
Paired: arytenoid cartilages x2, corniculate cartilages x2, cuneiform cartilages x2

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8
Q

What are the three processes of the arytenoid cartilages and what does each articulate with? What does the base articulate with?

A

Apical process: articulates with corniculate cartilage superiorly (attaches to aryepiglottic fold)
Vocal process: provides attachment for vocal ligament
Muscular process: provides attachment for posterior and lateral crico-arytenoid muscles
Base: articulates with superior border of cricoid cartilage (cricoarytenoid joints: for movement of vocal folds)

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9
Q

Describe the attachments of the epiglottic cartilage

A

Leaf-shaped plate of elastic cartilage with “stalk” attached to posterior surface of anterior thyroid cartilage

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10
Q

What is the function of the epiglottic cartilage?

A

Flattens and moves posteriorly during swallowing to close off and protect larynx

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11
Q

Where are the corniculate cartilages located?

A

On apices of arytenoids

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12
Q

Where are the cuneiform cartilages located?

A

Within aryepiglottic folds (act to strengthen folds)

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13
Q

What do the cuneiform cartilages articulate with?

A

No direct attachments, located within aryepiglottic folds

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14
Q

What vertebral levels does the larynx span?

A

C3-6

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15
Q

What are the three sections of the larynx (and their respective interior laryngeal aspects)? What are their boundaries?

A
  1. Supraglottis (laryngeal vestible): from inferior epiglottis to vestibular folds
  2. Glottis (laryngeal ventricle and middle part of laryngeal cavity): vocal cords and 1cm below
  3. Subglottis (infraglottic cavity): from inferior glottic to inferior border of cricoid
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16
Q

What are the false cords?

A

Vestibular folds

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17
Q

What kind of epithelium lines the larynx?

A

All except the vocal cords are lined by respiratory epithelium (ciliated pseudostratified columnar)
Vocal cords are simple squamous

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18
Q

What are the six intrinsic muscles of the larynx?

A
  1. Cricothyroid
  2. Thyro-arytenoid
  3. Posterior crico-arytenoids
  4. Lateral crico-arytenoids
  5. Oblique and transverse arytenoids
  6. Vocalis
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19
Q

What nerve innervates the intrinsic muscles of the larynx?

A

All except cricothyroid are innervated by the inferior laryngeal nerve (branch of the recurrent laryngeal nerve from CN X)
Cricothyroid innervated by external laryngeal nerve (branch of superior laryngeal nerve from CN X)

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20
Q

What is the “singer’s muscle”?

A

Cricothyroid

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21
Q

Describe the origin, insertion and actions of the cricothyroid

A

Origin: anterolateral cricoid
Insertion: inferior horn of thyroid
Actions: stretches and tenses vocal ligament

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22
Q

Describe the origin, insertion and actions of the thyro-arytenoid

A

Origin: posterior surface of thyroid laminae, cricothyroid ligament
Insertion: anterolateral arytenoid
Actions: relaxes vocal ligament

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23
Q

Describe the origin, insertion and actions of the posterior crico-arytenoid

A

Origin: posterior surface of cricoid lamina
Insertion: vocal process of arytenoid
Actions: abducts vocal cords

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24
Q

Describe the origin, insertion and actions of the lateral crico-arytenoid

A

Origin: arch of cricoid
Insertion: vocal process of arytenoid
Actions: adducts vocal cords

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25
Describe the origin, insertion and actions of the oblique and transverse arytenoids
Origin: one arytenoid Insertion: contralateral arytenoid Actions: adducts vocal cords
26
Describe the origin, insertion and actions of vocalis
Origin: vocal process of arytenoid Insertion: ipsilateral vocal ligament Actions: relaxes posterior vocal ligament while maintaining or increasing tension in anterior part
27
What vocal change does vocal cord adduction produce?
Allows phonation
28
What vocal change does vocal cord abduction produce?
Allows whispering
29
What vocal change does vocal cord relaxation produce?
Decreases pitch
30
What vocal change does vocal cord tension produce?
Increases pitch
31
What is the primary vocal cord adductor?
Lateral crico-arytenoid
32
What is the primary vocal cord abductor?
Posterior crico-arytenoid
33
What is the primary vocal cord tensor?
Cricothyroid
34
What is the primary vocal cord relaxer?
Thyro-arytenoid
35
Which three laryngeal muscles help protect the laryngeal inlet during swallowing?
1. Lateral crico-arytenoids 2. Oblique and transverse arytenoids 3. Aryepiglottic muscles
36
Four extrinsic laryngeal ligaments
1. Thyrohyoid: with median and lateral thyrohyoid ligaments (thickenings of membrane) 2. Hyo-epiglottic 3. Cricotracheal 4. Median crico-thyroid (thickening of the cricothyroid ligament)
37
Two intrinsic laryngeal ligaments
1. Cricothyroid 2. Quadrangular membrane
38
What structure forms the vocal ligament?
The free superior margin of the cricothyroid ligament
39
What structure forms the vestibular ligament?
The free inferior margin of the quadrangular membrane
40
What structure forms the aryepiglottic ligament?
The free superior margin of the quadrangular membrane
41
What are the attachments for the quadrangular membrane?
Anterolateral arytenoid to lateral epiglottis
42
Between what vertebral levels does the pharynx run?
From base of skull to inferior border of cricoid cartilage (C6)
43
What are the three sections of the pharynx and what are the boundaries of each?
1. Nasopharynx: from base of skull to soft palate 2. Oropharynx: from soft palate to superior border of epiglottis 3. Laryngopharynx: from superior border of epiglottis to inferior border of cricoid cartilage (C6)
44
What four structures are contained within the oropharynx?
1. Posterior 1/3 of tongue 2. Lingual tonsils (at base of tongue) 3. Palatine tonsils (in tonsillar fossa between palatoglossal and palatopharyngeal arches) 4. Superior constrictor muscle
45
What is Waldeyer's ring?
Ring of lymphoid tissue in the naso- and oro-pharynx formed by the paired palatine tonsils, adenoid tonsils, and lingual tonsils
46
Where are the piriform fossae?
Lateral to laryngeal inlet
47
What is a pharyngeal diverticulum and how does it occur?
Inferior pharyngeal constrictor has two parts: thyropharyngeus and cricopharyngeus, with weak area in between When muscle action is dyssynchronous, weak area can form a pharyngeal diverticulum (or pouch) and cause dysphagia
48
What are the three circular and three longitudinal pharyngeal muscles?
Circular: 1. Superior pharyngeal constrictor (in oropharynx) 2. Middle pharyngeal constrictor 3. Inferior pharyngeal constrictor Longitudinal: 1. Stylopharyngeus 2. Palatopharyngeus 3. Salpingopharyngeus
49
Origin and insertion of the superior pharyngeal constrictor
Origin: mandible and pterygoid plate Insertion: pharyngeal tubercle on occiput and pharyngeal raphe
50
Origin and insertion of the middle pharyngeal constrictor
Origin: stylohyoid ligament and horn of hyoid Insertion: pharyngeal raphe
51
Origin and insertion of the inferior pharyngeal constrictor
Origin: cricoid and thyroid cartilages Insertion: pharyngeal raphe
52
What is the function of the circular vs longitudinal pharyngeal muscles?
Circular: contract sequentially to propel food Longitudinal: shorten and widen pharynx, elevate when swallowing
53
Origin and insertion of the stylopharyngeus
Origin: styloid process of temporal bone Insertion: pharyngeal wall
54
Origin and insertion of the palatopharyngeus
Origin: hard palate Insertion: pharyngeal wall
55
Origin and insertion of the salpingopharyngeus
Origin: Eustachian tube Insertion: pharyngeal wall
56
Which of the pharyngeal muscles also help to equalise the middle ear?
Salpingopharyngeus
57
Which nerve innervates the pharyngeal muscles?
All except stylopharyngeus are innervated by CN X Stylopharyngeus innervated by CN IX
58
What four nerves form the pharyngeal plexus?
1. Pharyngeal branches of CN IX 2. Pharyngeal branch of CN X 3. Branches from external laryngeal nerve (of CN X) 4. Sympathetic fibres from superior cervical ganglion
59
What provides the motor and sensory innervation of the oro- and laryngo-pharynx?
Pharyngeal plexus
60
What provides the sensory supply to the nasopharynx?
Anterior and superior aspect of nasopharynx supplied by CN V2
61
Describe arterial supply and venous drainage of the pharynx
Arterial supply by ascending pharyngeal artery, and branches of the lingual, facial and maxillary arteries (all from the external carotid artery) Venous drainage by pharyngeal venous plexus which empties to the internal jugular vein
62
Where does the root of the tongue attach?
Between mandible, hyoid, and posterior surface of dorsum of tongue
63
What structure separates the anterior and posterior parts of the tongue?
Terminal sulcus
64
What are the four types of lingual papillae and where are they found?
1. Vallate: just anterior to sulcus 2. Fungiform: at apex and margins of tongue 3. Filiform: sensitive to touch, found throughout tongue 4. Foliate: poorly developed in humans
65
Three structural features of the inferior surface of the tongue
Frenulum Lingual vein on either side of frenulum Sublingual caruncle on either side at base of frenulum: opening of submandibular duct
66
Four extrinsic and four intrinsic muscles of the tongue
Extrinsic: 1. Genioglossus 2. Hyoglossus 3. Styloglossus 4. Palatoglossus Intrinsic: 1. Superior longitudinal 2. Inferior longitudinal 3. Transverse 4. Vertical
67
Describe the arterial supply and venous drainage of the tongue
Both arterial supply and venous drainage are unilateral (separated by lingual septum) Arterial supply via lingual artery from external carotid artery: splits into dorsal and deep lingual arteries Venous drainage by dorsal and deep lingual veins: deep forms sublingual, may drain directly to internal jugular vein or join to form lingual vein first
68
Describe the lymphatic drainage of four regions of the tongue. Where do they all ultimately drain to?
Apex and frenulum: submental lymph nodes (medial portion drains bilaterally) Root: bilaterally to superior deep cervical lymph nodes Lateral body: submandibular lymph nodes on ipsilateral side Medial body: bilaterally to inferior deep cervical lymph nodes All ultimately drains to deep cervical lymph nodes which then empty into the jugular venous trunks at the right and left venous angles
69
What nerve supplies the extrinsic and intrinsic muscles of the tongue?
All except palatoglossus supplied by CN XII Palatoglossus by pharyngeal plexus
70
Describe the sensory innervation of the anterior and posterior parts of the dorsum of the tongue
Anterior 2/3: touch and temperature by lingual nerve (from CN V3, trigeminal ganglion), special sensation (except vallate papillae) by lingual nerve (from chorda tympani of CN VII, geniculate ganglion) Posterior 1/3: touch, temperature and special sensation by lingual branch of CN IX (glossopharyngeal ganglion)
71
What nerve provides sensory innervation to the small area of lingual mucosa that forms the anterior wall of valleculae? What other fibres are carried by this nerve?
Internal laryngeal nerve (from CN X, inferior vagal ganglion) Also carries parasympathetic secretomotor fibres to serous glands
72
What nerve provides proprioceptive sensation to the tongue?
Lingual nerve
73
What are the salivary glands?
Parotid, submandibular and sublingual glands Small accessory salivary glands
74
Describe the arterial supply and venous drainage of the submandibular glands
Arterial supply by submental arteries Venous drainage by veins accompanying the arteries
75
Describe the arterial supply and venous drainage of the sublingual glands
Arterial from sublingual and submental arteries (respectively from lingual and facial arteries)
76
Describe the innervation of the submandibular and sublingual glands
Presynaptic parasympathetic secretomotor fibres conveyed from facial nerve to lingual nerve via chorda tympani, which synapse with postsynaptic neurons to submandibular ganglion
77
What are the four muscles of mastication?
1. Masseter 2. Temporalis 3. Medial pterygoids 4. Lateral pterygoids
78
Origin, insertion and actions of the masseter
Origin: superficial part from maxillary process of zygomatic bone, deep part from zygomatic arch of temporal bone Insertion: ramus of mandible Actions: elevates mandible (closes mouth)
79
Origin, insertion and actions of the temporalis
Origin: temporal fossa Insertion: coronoid process of mandible Actions: elevates (closes mouth) and retracts mandible
80
Origin, insertion and actions of the lateral pterygoids
Origin: superior head from greater wing of sphenoid, inferior head from lateral pterygoid plate of sphenoid Insertion: heads form tendon which inserts to neck of mandible Actions: bilateral action protracts mandible and depresses chin, unilateral action moves jaw side-to-side
81
Origin, insertion and actions of the medial pterygoids
Origin: superficial head from maxillary tuberosity and pyramidal process of palatine, deep from lateral pterygoid plate of sphenoid Insertion: ramus of mandible (near angle) Actions: elevates mandible (closes mouth)
82
What is the most powerful muscle of mastication?
Masseter
83
What is the most superficial muscle of mastication?
Masseter
84
Which is more superior: lateral or medial pterygoid?
Lateral
85
Fascia from which muscle can be used for tympanic membrane repair (myringoplasty)?
Temporalis
86
What is the major protractor of the jaw?
Lateral pterygoid (due to horizonal orientation of fibres)
87
What shape is the lateral pterygoid? What shape is the medial pterygoid?
Lateral: triangular Medial: quadrangular
88
Which muscles are responsible for depression (mouth opening) at the TMJ?
Lateral pterygoids Suprahyoid muscles Infrahyoid muscles
89
Which muscles are responsible for elevation (mouth closing) at the TMJ?
Masseter Temporalis Medial pterygoids
90
Which muscles are responsible for jaw protrusion?
Lateral pterygoids Medial pterygoids Masseter
91
Which muscles are responsible for jaw retrusion?
Temporalis Masseter
92
Which muscles are responsible for lateral movements of the jaw?
Temporalis on same side Pterygoids on opposite side Masseter
93
What are the surface boundaries of the parotid gland?
Extends from zygomatic arch to upper part of neck Overlaps posterior belly of digastric and anterior border of sternocleidomastoid Anteriorly overlaps masseter Extends below external acoustic meatus posteriorly onto mastoid process Enclosed within parotid sheath
94
What encloses the parotid gland?
Parotid sheath (extension of investing layer of deep cervical fascia)
95
What nerve supplies the fascia and overlying skin of the parotid?
Great auricular nerve (C2)
96
What muscle arises from the external surface of the parotid fascia?
Risorius
97
Describe anteromedial surface of parotid
Grooved by posterior border of mandibular ramus, related to masseter and medial pterygoid (attached to ramus) Gland wrapped around capsule of TMJ Parotid duct and facial nerve emerge from anteromedial surface Further back, superficial temporal and maxillary arteries (terminal branches of external carotid) leave this surface
98
Which surface does the external carotid enter the parotid through?
Lowest part of posteromedial surface
99
Between which structures does the facial nerve enter the gland?
Between mastoid and styloid processes
100
What important structures are located within the parotid, from superficial to deep?
Branches of facial nerve (form a plexiform arrangement) Retromandibular vein (formed from confluence of superficial temporal and maxillary veins) External carotid artery Superficial temporal artery Branches of great auricular nerve Maxillary artery Preauricular group of lymph nodes lie on or deep to fascial capsule of parotid
101
How long is the parotid duct?
~5cm
102
Describe the course of the parotid duct
Passes forward across masseter before turning around its anterior border and piercing buccinator (palpable on clenched masseter) Lies on middle 1/3 of a line between intertragic notch of auricle and midpoint of philtrum Opens on mucous membrane of cheek opposite 2nd upper molar
103
Describe the arterial supply of the parotid gland
Branches of external carotid: posterior auricular and superficial temporal
104
Describe the venous drainage of the parotid gland
Retromandibular vein: from superficial temporal and maxillary veins
105
Describe the lymphatic drainage of the parotid gland
To preauricular (parotid) lymph nodes, then to upper group of deep cervical lymph nodes
106
Describe the nerve supply of the parotid gland
Parotid sheath and overlying skin (and sensory to gland) by auriculotemporal nerve (from CN V3) and great auricular nerve (branch of cervical plexus for C2 and C3) Parasympathetic to gland (increases secretion): presynaptic fibres from CN IX -> tympanic branch -> tympanic plexus -> lesser petrosal -> otic ganglion -> postsynaptic fibres conveyed by auriculotemporal nerve (from CN V3) Sympathetic to gland (decreases secretion): derived from cervical ganglia through the external carotid nerve plexus
107
Describe the five boundaries of the parotid gland
Superior: zygomatic arch Posterior: external ear and anterior SCM Medial: ramus of mandible Anterior: anterior border of ramus Inferior: angle and inferior border of mandible
108
Five important contents of the parotid region
1. Parotid gland and duct 2. Parotid plexus of facial nerve (CN VII) 3. Retromandibular vein 4. External carotid artery 5. Masseter

ACEM Primary Written (150 decks)

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