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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
Q

Describe the origin, insertion and actions of the oblique and transverse arytenoids

A

Origin: one arytenoid
Insertion: contralateral arytenoid
Actions: adducts vocal cords

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26
Q

Describe the origin, insertion and actions of vocalis

A

Origin: vocal process of arytenoid
Insertion: ipsilateral vocal ligament
Actions: relaxes posterior vocal ligament while maintaining or increasing tension in anterior part

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27
Q

What vocal change does vocal cord adduction produce?

A

Allows phonation

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28
Q

What vocal change does vocal cord abduction produce?

A

Allows whispering

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29
Q

What vocal change does vocal cord relaxation produce?

A

Decreases pitch

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30
Q

What vocal change does vocal cord tension produce?

A

Increases pitch

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31
Q

What is the primary vocal cord adductor?

A

Lateral crico-arytenoid

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32
Q

What is the primary vocal cord abductor?

A

Posterior crico-arytenoid

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33
Q

What is the primary vocal cord tensor?

A

Cricothyroid

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34
Q

What is the primary vocal cord relaxer?

A

Thyro-arytenoid

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35
Q

Which three laryngeal muscles help protect the laryngeal inlet during swallowing?

A
  1. Lateral crico-arytenoids
  2. Oblique and transverse arytenoids
  3. Aryepiglottic muscles
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36
Q

Four extrinsic laryngeal ligaments

A
  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)
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37
Q

Two intrinsic laryngeal ligaments

A
  1. Cricothyroid
  2. Quadrangular membrane
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38
Q

What structure forms the vocal ligament?

A

The free superior margin of the cricothyroid ligament

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39
Q

What structure forms the vestibular ligament?

A

The free inferior margin of the quadrangular membrane

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40
Q

What structure forms the aryepiglottic ligament?

A

The free superior margin of the quadrangular membrane

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41
Q

What are the attachments for the quadrangular membrane?

A

Anterolateral arytenoid to lateral epiglottis

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42
Q

Between what vertebral levels does the pharynx run?

A

From base of skull to inferior border of cricoid cartilage (C6)

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43
Q

What are the three sections of the pharynx and what are the boundaries of each?

A
  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)
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44
Q

What four structures are contained within the oropharynx?

A
  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
Q

What is Waldeyer’s ring?

A

Ring of lymphoid tissue in the naso- and oro-pharynx formed by the paired palatine tonsils, adenoid tonsils, and lingual tonsils

46
Q

Where are the piriform fossae?

A

Lateral to laryngeal inlet

47
Q

What is a pharyngeal diverticulum and how does it occur?

A

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
Q

What are the three circular and three longitudinal pharyngeal muscles?

A

Circular:
1. Superior pharyngeal constrictor (in oropharynx)
2. Middle pharyngeal constrictor
3. Inferior pharyngeal constrictor

Longitudinal:
1. Stylopharyngeus
2. Palatopharyngeus
3. Salpingopharyngeus

49
Q

Origin and insertion of the superior pharyngeal constrictor

A

Origin: mandible and pterygoid plate
Insertion: pharyngeal tubercle on occiput and pharyngeal raphe

50
Q

Origin and insertion of the middle pharyngeal constrictor

A

Origin: stylohyoid ligament and horn of hyoid
Insertion: pharyngeal raphe

51
Q

Origin and insertion of the inferior pharyngeal constrictor

A

Origin: cricoid and thyroid cartilages
Insertion: pharyngeal raphe

52
Q

What is the function of the circular vs longitudinal pharyngeal muscles?

A

Circular: contract sequentially to propel food
Longitudinal: shorten and widen pharynx, elevate when swallowing

53
Q

Origin and insertion of the stylopharyngeus

A

Origin: styloid process of temporal bone
Insertion: pharyngeal wall

54
Q

Origin and insertion of the palatopharyngeus

A

Origin: hard palate
Insertion: pharyngeal wall

55
Q

Origin and insertion of the salpingopharyngeus

A

Origin: Eustachian tube
Insertion: pharyngeal wall

56
Q

Which of the pharyngeal muscles also help to equalise the middle ear?

A

Salpingopharyngeus

57
Q

Which nerve innervates the pharyngeal muscles?

A

All except stylopharyngeus are innervated by CN X
Stylopharyngeus innervated by CN IX

58
Q

What four nerves form the pharyngeal plexus?

A
  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
Q

What provides the motor and sensory innervation of the oro- and laryngo-pharynx?

A

Pharyngeal plexus

60
Q

What provides the sensory supply to the nasopharynx?

A

Anterior and superior aspect of nasopharynx supplied by CN V2

61
Q

Describe arterial supply and venous drainage of the pharynx

A

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
Q

Where does the root of the tongue attach?

A

Between mandible, hyoid, and posterior surface of dorsum of tongue

63
Q

What structure separates the anterior and posterior parts of the tongue?

A

Terminal sulcus

64
Q

What are the four types of lingual papillae and where are they found?

A
  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
Q

Three structural features of the inferior surface of the tongue

A

Frenulum
Lingual vein on either side of frenulum
Sublingual caruncle on either side at base of frenulum: opening of submandibular duct

66
Q

Four extrinsic and four intrinsic muscles of the tongue

A

Extrinsic:
1. Genioglossus
2. Hyoglossus
3. Styloglossus
4. Palatoglossus

Intrinsic:
1. Superior longitudinal
2. Inferior longitudinal
3. Transverse
4. Vertical

67
Q

Describe the arterial supply and venous drainage of the tongue

A

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
Q

Describe the lymphatic drainage of four regions of the tongue. Where do they all ultimately drain to?

A

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
Q

What nerve supplies the extrinsic and intrinsic muscles of the tongue?

A

All except palatoglossus supplied by CN XII
Palatoglossus by pharyngeal plexus

70
Q

Describe the sensory innervation of the anterior and posterior parts of the dorsum of the tongue

A

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
Q

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?

A

Internal laryngeal nerve (from CN X, inferior vagal ganglion)
Also carries parasympathetic secretomotor fibres to serous glands

72
Q

What nerve provides proprioceptive sensation to the tongue?

A

Lingual nerve

73
Q

What are the salivary glands?

A

Parotid, submandibular and sublingual glands
Small accessory salivary glands

74
Q

Describe the arterial supply and venous drainage of the submandibular glands

A

Arterial supply by submental arteries
Venous drainage by veins accompanying the arteries

75
Q

Describe the arterial supply and venous drainage of the sublingual glands

A

Arterial from sublingual and submental arteries (respectively from lingual and facial arteries)

76
Q

Describe the innervation of the submandibular and sublingual glands

A

Presynaptic parasympathetic secretomotor fibres conveyed from facial nerve to lingual nerve via chorda tympani, which synapse with postsynaptic neurons to submandibular ganglion

77
Q

What are the four muscles of mastication?

A
  1. Masseter
  2. Temporalis
  3. Medial pterygoids
  4. Lateral pterygoids
78
Q

Origin, insertion and actions of the masseter

A

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
Q

Origin, insertion and actions of the temporalis

A

Origin: temporal fossa
Insertion: coronoid process of mandible
Actions: elevates (closes mouth) and retracts mandible

80
Q

Origin, insertion and actions of the lateral pterygoids

A

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
Q

Origin, insertion and actions of the medial pterygoids

A

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
Q

What is the most powerful muscle of mastication?

A

Masseter

83
Q

What is the most superficial muscle of mastication?

A

Masseter

84
Q

Which is more superior: lateral or medial pterygoid?

A

Lateral

85
Q

Fascia from which muscle can be used for tympanic membrane repair (myringoplasty)?

A

Temporalis

86
Q

What is the major protractor of the jaw?

A

Lateral pterygoid (due to horizonal orientation of fibres)

87
Q

What shape is the lateral pterygoid? What shape is the medial pterygoid?

A

Lateral: triangular
Medial: quadrangular

88
Q

Which muscles are responsible for depression (mouth opening) at the TMJ?

A

Lateral pterygoids
Suprahyoid muscles
Infrahyoid muscles

89
Q

Which muscles are responsible for elevation (mouth closing) at the TMJ?

A

Masseter
Temporalis
Medial pterygoids

90
Q

Which muscles are responsible for jaw protrusion?

A

Lateral pterygoids
Medial pterygoids
Masseter

91
Q

Which muscles are responsible for jaw retrusion?

A

Temporalis
Masseter

92
Q

Which muscles are responsible for lateral movements of the jaw?

A

Temporalis on same side
Pterygoids on opposite side
Masseter

93
Q

What are the surface boundaries of the parotid gland?

A

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
Q

What encloses the parotid gland?

A

Parotid sheath (extension of investing layer of deep cervical fascia)

95
Q

What nerve supplies the fascia and overlying skin of the parotid?

A

Great auricular nerve (C2)

96
Q

What muscle arises from the external surface of the parotid fascia?

A

Risorius

97
Q

Describe anteromedial surface of parotid

A

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
Q

Which surface does the external carotid enter the parotid through?

A

Lowest part of posteromedial surface

99
Q

Between which structures does the facial nerve enter the gland?

A

Between mastoid and styloid processes

100
Q

What important structures are located within the parotid, from superficial to deep?

A

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
Q

How long is the parotid duct?

A

~5cm

102
Q

Describe the course of the parotid duct

A

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
Q

Describe the arterial supply of the parotid gland

A

Branches of external carotid: posterior auricular and superficial temporal

104
Q

Describe the venous drainage of the parotid gland

A

Retromandibular vein: from superficial temporal and maxillary veins

105
Q

Describe the lymphatic drainage of the parotid gland

A

To preauricular (parotid) lymph nodes, then to upper group of deep cervical lymph nodes

106
Q

Describe the nerve supply of the parotid gland

A

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
Q

Describe the five boundaries of the parotid gland

A

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
Q

Five important contents of the parotid region

A
  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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