Anatomy and Physiology of the Throat Flashcards
what do patients ussually present with to do with the throat?
sore throat
something stuck in my throat
difficulty swallowing
painful swallowing
hoarseness
pain radiating from throat to ear
what is dysphagia?
Difficulty swallowing
what is odynophagia?
Painful swallowing
what is dysphonia?
Iām hoarse
what is referred otalgia?
Pain going from my throat to my ear
what are the different areas of the throat?
nasal cavity
oral cavity
larynx
nasopharynx
oropharynx
hypopharynx
what is the structure of the mouth/oral cavity?
Everything anterior to tonsils and soft palate.
Includes whole tongue except tongue base (oropharynx).
Contains teeth, tongue and salivary glands.
what is the function of the mouth/oral cavity?
Mastication
First part of swallow (oral phase)
Taste
Transform sound generated by the larynx into discernable words
(arthr = vocal articulation)
what are the primary muscles of mastication?
temporalis
masseter
medial pterygoid
lateral pterygoid
what are secondary muscles of mastication?
suprahyoid muscles
digastric muscle
mylohyoid muscle (oral diaphragm)
geniohyoid muscle
buccinator muscle is sometimes classed as one
what are primary and secondary muscles of mastication innervated by?
Mandibular branch of Trigeminal Nerve (CN V3)
What are the 2 parts of the tongue?
Anterior 2/3rds
From 1st branchial arch
Sensation by lingual nerve (CN V3)
Taste by chorda tympani (CN VII)
Posterior 1/3rd
From 3rd branchial arch
Supplied by CN IX
Innervation of the tongue?
Anterior 2/3rds
From 1st branchial arch
Sensation by lingual nerve (CN V3)
Taste by chorda tympani (CN VII)
Posterior 1/3rd
From 3rd branchial arch
Supplied by CN IX
What are the 2 categories of tongue muscles and what is their function?
Intrinsic muscles (after shape)
Extrinsic muscles (after position)
what are the intrinsic muscles of the tongue?
superior longitudinal
inferior longitudinal
transverse
vertical
what are the extrinsic muscles of the tongue?
genioglossus - chin to tongue
hyoglossus - hyoid bone to tongue
styloglossus - styloid to tongue
palatoglossus muscle (supplied by the vagus nerve (CN X)) - palatine bone to tongue
what are the boundaries of the floor of the mouth?
Superiorly - oral mucosal space
Inferiorly - mylohyoid muscle
Anteriorly - mandibular gingiva
Posteriorly - anterior tonsillar pillars
what glands are contained within the floor of the mouth?
Submandibular and subligual salivary glands
where does the parotid duct open into the the buccal mucosa?
Parotid duct opens into buccal mucosa opposite upper 2nd molar
what is the function of the nasopharynx\/
allows air into larynx
what is the function of the soft palate and uvula
prevent regurgitation of food into nasopharynx on swallowing by closing against the posterior pharyngeal wall (failure = veloplataine insufficiency)
what are the functions of oropharynx and hypopharynx?
Oropharynx & hypopharynx contribute to normal swallow
Allows passage of air and food
what does the epiglottis do?
Epiglottis closes airway during swallow
Resonating chamber during phonation
where does the hypopharynx lead to?
oesophagus
what is the sensation of the oropharynx and hypopharynx from?
Glossopharyngeal (CN IX) and Vagus (CN X) nerves
what are the pharyngeal constrictor muscles?
Superior, middle and inferior
Motor supply by Vagus nerve (CN X)
What are the boundaries of the oropharynx?
Lower border of soft palate to upper margin of epiglottis
Palatoglossal arch to posterior pharyngeal wall
Lateral is faucial pillars and palatine tonsils
What is the structure of the epithelium of the oropharynx?
Stratified, non-keratinised squamous
What is the nerve supply of the oropharynx?
Pharyngeal plexus (CN IX and X)
Where does the hypopharynx receive blood supply from?
Blood supply is the superior thyroid artery, lingual artery and the ascending pharyngeal artery
What are the boundaries of the hypopharynx?
Superior margin of epiglottis to lower border of cricoid cartilage
Continuous with oesophagus
Anterior wall back of pharynx
What are the 3 subunits of the hypopharynx?
Pyiform sinus
Post-cricoid area
Posterior pharyngeal wall
What is the nerve supply of the hypopharynx?
Pharyngeal plexus (CN IX and X)
where is the larynx located?
C3-6
what are the cartilages of the larynx
Epiglottis
Thyroid
Cricoid
Arytenoid
Corniculate
Cuneiform
what are the functions of the larynx?
Allow of air between trachea and mouth
Movements of vocal cords produce voice (phonation) and alter pitch and volume
(Mouth/oral cavity and pharynx also contribute to sound)
Protect the airway from aspiration
Epiglottic closure ā food directed to hypopharynx
Cough reflex
what are all muscles of the larynx innervated by?
Recurrent laryngeal nerve
what is the exeption of muscles of the pharynx which is instead innervated by superior lryngeal nerve?
cricothyroid muscle = Superior laryngeal nerve (external branch)
In the larynx sensation si carried via vagus nerve where is innervation from above and below the vocal chords?
Above vocal cords (glottis & supraglottis) = Superior laryngeal nerve
Below vocal cords (subglottic) = Recurrent laryngeal branch
function of cricothyroid muscle?
lengthen and tense the vocal cords
what is the function of posterior cricoartyenoid muscle?
abduct and externally rotate the arytenoid cartilages, resulting in abducted vocal cords.
what is the function of the lateral cricoartenoid muscles?
adduct and internally rotate the arytenoid cartilages, increase medial compression.
what is the function of trnasverse artyenoid muscles?
adduct the arytenoid cartilages, resulting in adducted vocal cords.
what are the functions of oblique artenoid muscles?
narrow the laryngeal inlet by constricting the distance between the arytenoid cartilages.
what is the function of thyoartyenoid muscles?
narrow the laryngeal inlet, shortening the vocal cords, and lowering voice pitch.
what three things must you have to produce a recognisable voice?
Air flow to the larynx (generated by the lungs & diaphragm).
Vibration / mucosal wave (eg. on the vocal fold in the larynx during vocal cord adduction).
Resonance in the upper aerodigestive tract & use of the pharynx, mouth, tongue and lips to manipulate the sound produced by the larynx into words and sounds.
what are the 3 parts of the larynx?
Supraglottis
Extends from the superior tip of the epiglottis to the floor of the ventricular fold (junction of respiratory and squamous epithelium)
Glottis
Begins superior at the true vocal fold and extends inferiorly to a horizontal plane 5mm inferior to the vocal cord
Subglottic
Begins 5mm below the free edge of the true vocal cord and proceeds to the inferior border of the cricoid cartilage
What are the segments of cartilage in the larynx?
7 segments of cartilages:
Cricoid cartilage
Thyroid cartilage
Epiglottis
Paired arytenoid cartilages (corniculate and cuneiform)
What are the muscles of the larynx?
Extrinsic
Infrahyoid, suprahyoid and thyrohyoid
Move the entire laryngeal complex
Intrinsic
Regulate movement of the vocal folds
Innervation of the larynx?
Motor innervation:
CN X
All intrinsic muscles supplied by recurrent laryngeal nerve except for cricothyroid muscle (external laryngeal)
Sensory innervation:
Supraglottic by internal laryngeal nerve
Glottic and subglottic by recurrent laryngeal nerve
What are intrinsic larynx muscles supplied by for motor innervation?
All intrinsic muscles supplied by recurrent laryngeal nerve except for cricothyroid muscle (external laryngeal)
What is the sensory innervation of:
supraglottic larynx
glottic larynx
subglotic larynx
Supraglottic by internal laryngeal nerve
Glottic and subglottic by recurrent laryngeal nerve
What are the different steps of speech?
Respiration
Source of energy, from air flow
Inhalation and exhalation
Phonation
Flow of air through different voice cord position, tension, vibration and length
Resonation
Oral/nasal speech balance
Depend on nasopharynx, nasal cavity and oral cavity
Articulation
Production of speech, determined by action of lips, tongue and jaw
Prosody
Production of syllable stress and emphasis
Provide effective speech tone
