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ENT > Anatomy of Palate, Pharynx and Larynx > Flashcards

Anatomy of Palate, Pharynx and Larynx Flashcards

Also incl. salivary glands, tongue Use Cameron's cards too; you kind of gave up at larynx

1
Q

Define the boundaries of the oral cavity

A

Superior Border: Hard and soft palates

Inferior Border: Muscles of the floor of the mouth

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2
Q

What can be seen on the “floor of the mouth”?

A
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3
Q

What muscles make up the floor of the mouth?

A

They form a muscular diaphragm

  • Geniohyoid
    • C1 via hypoglossal nerve
  • Mylohyoid
    • Innervated by CN V3
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4
Q

What are the three major salivary glands and where can they be found?

A
  1. Parotid Gland
    • duct crosses face and secretes into mouth by upper 2nd molar
  2. Submandibular Gland
    • duct enters floor of mouth and secretes via lingual caruncle
  3. Sublingual Gland
    • lays in floor of mouth secretes via several ducts superiorly
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5
Q

How many minor saliva glands do humans have?

A
  • 1000s in oral mucosa
  • basal secretion (background and continuous) to keep mouth moist
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6
Q

What stimulates for salivation?

A
  1. Thought, sight, smell of food or presence of food in mouth
  2. Painful oral conditions e.g. teething or fractured mandible
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7
Q

Describe the innervation of salivary glands?

A
  • Supplied by presynaptic parasympathetic secretomotor fibres converyed from the facial nerve…
  • to the lingual nerve by the chorda tympani nerve, ….
  • whcih synpase with postsynaptic neurons in the submandibular ganglion
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8
Q

Where is the foramen caecum found?

A

At the tip of the terminal groove

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9
Q

Where are the vallate papillae found?

A

In the anterior 2/3 of the tongue

along with foliate papillae & fungiform papillae

All 3 types have taste buds

Filiform papillae can also be found in anterior 2/3 but are for touch, temperature etc

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10
Q

Describe the thyoglossal duct cysts/ ectopic thyroid tissue

A

Thyroglossal duct cysts or ectopic thyroid tissue can be located at any position in the MIDLINE migratory path

  • thyroid swellings move superiorly then inferiorly on swallowing due to attachment to the larynx
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11
Q

What are the extrinsic muscles of the tongue?

A
  1. Palatoglossus
  2. Styloglossus
  3. Genioglossus
  4. Hyoglossus
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12
Q

Which nerve supplies motor function to the tongue?

A

Hypoglossal Nerves (CN XII)

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13
Q

Describe the pathway of the hypoglossal (CN XII) nerve?

(connection to CNS; base of skull foramen; extracrainal part)

A

Connection to the CNS

  • _​_via many rootlets that attach to the medulla oblongata

Base of Skull Foramen Part of Course

  • occipital bone
  • hypoglossal canal (anterior wall of foramen magnum)

Extracranial Part of Course

  • descends in neck lateral to carotid sheath
  • at level of hyoid bone it passes anteriorly towards lateral aspect of the tongue
  • supplies most of the muscles of the tongue
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14
Q

How would you test the motor function of the tongue?

A

Ask the patient to STICK THEIR TONGUE OUT STRAIGHT

  • if both CN XII’s are functional the tongue tip remains in the midline upon protrusion
  • in unilateral CN XII damage the tongue tip will point towards the side of the injured nerve
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15
Q

What can be seen when someone opens their mouth?

A
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16
Q

Describe the osteological anatomy of the hard palate

A
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17
Q

Summarise the functions of the soft palate

A

functions as a trapdoor

  1. Stops food entering the nose during swallowing
  2. Directs air into the nose or the mouth during:
    • speech
    • vomiting
    • coughing
    • vomiting
  3. Helps to close off the entrance into the oropharynx during the gag reflex
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18
Q

List the 5 pairs of skeletal muscles of the soft palate

A
  1. Tensor veli palatini
  2. Levator veli palatini
  3. Palatopharyngeus
  4. Palatoglossus
  5. Musculus uvulae
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19
Q

What is the function and innervation of tensor veli palatini?

(a muscle of the soft palate)

A

CN V3

Tenses palatine aponeurosis

*skeletal muscles of the soft palate are all supplied by CN X except tensor veli palatini*

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20
Q

What is the function and innervation of Levator veli palatini?

(a muscle of the soft palate)

A

CN X

Lifts palatine aponeurosis

*skeletal muscles of the soft palate are all supplied by CN x except tensor veli palatini*

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21
Q

Describe the function and innervation of musculus uvulae

(a muscle of the soft palate)

A

CN X

Shortens uvula

*skeletal muscles of the soft palate are all supplied by CN X except tensor veli palatini*

22
Q

What is the function and the innervation of Palatoglossus?

(a muscle of the soft palate)

A

CN X

Brings tongueand soft palate together

*skeletal muscles of the soft palate are all supplied by CN X except tensor veli palatini*

23
Q

What is the function and the innervation of the palatopharyngeus?

(a muscle of the soft palate)

A

CN X

Lifts pharynx and thyroid cartilage

*skeletal muscles of the soft palate are all supplied by CN X except tensor veli palatini*

24
Q

How would you test the function of the soft palate?

A

Ask the patient to say “Aaaah”

  • if the nerves are functioning normally the uvula should lift straight up in the midline
  • if there is unilateral nerve pathology the uvula will be pulled away from the non-functioning side by the normal side
25
Q

What 2 muscles layers are seen in the pharynx?

A

Outer circular layer

Inner longitudinal layer

26
Q

How many muscles are in each muscle layer of the pharynx?

By which nerve are the muscles of the pharynx innervated?

What is the function of the muscles of the pharynx?

A

Outer Circular Layer

  • 3 constrictor muscles
  • skeletal (voluntary)
  • function: during sequential contraction, pushes food bolus inferiorly

​Inner Longitudinal Layer

  • 3 paired vertical muscles
  • skeletal (voluntary)
  • function: during contraction, pulls larynx superiorly shortening pharynx during swallowing

ALL innervated by CN X

except stylopharyngeus

27
Q

Which is the external layer of muscles on the pharynx?

A

the circular muscles

28
Q

Describe and explain Waldeyer’s ring

A

Waldeyer’s tonsilar ring refers to the lymphatic tissue that surrounds the superior pharynx.

It is made up of:

  1. Pharyngeal (adenoid) tonsil
  2. Tubal tonsil
  3. Palatine tonsil
  4. Lingual tonsil
29
Q

Define regional nodes

A

Regional nodes are the group of lymph nodes that FIRST receive the lymph that has drained from a given structure

30
Q

What are the regional nodes for the tip of the tongue

A

Submental nodes

(found in the neck posterior to the mental process of the mandible)

31
Q

Into which node does the palatine tonsil drain?

A

The jugulo-digastric node

32
Q

Why is important that a lymph node examination in clinic is bilateral?

A

midline structures often drain bilaterally

e.g. the tip of the tongue may drain to the left or right submental nodes

33
Q

How might an infected lymph node be described?

A
  • swollen
  • painful
  • soft
  • smooth
  • not fixed (stuck to) adjacent structures
  • improve rapidly with antibiotics etc
34
Q

How might a lymph node that is swollen due to cancer be described?

A
  • swollen
  • not painful
  • hard
  • irregular
  • fixed
  • does not improve
35
Q

Between what vertebral levels does the larynx sit?

36
Q

What are the functions of the larynx?

A
  • “voice” box
  • sphincter of respiratory tract
    • regulates airflow
    • protection of aspirated objects
37
Q

List the cartilages found in the larynx

A
  • epiglottis
  • thyroid cartilage
  • cricoid cartilage
  • 1st tracheal ring
    *
38
Q

What are the 2 processes found on arytenoid cartilages?

A

muscular process

vocal process

39
Q

Why is the cricoid cartilage important clinically?

A
  1. Press on the cricoid cartilage
  2. Lamina of the cricoid cartilage compresses the oesophagus
  3. Presses it against the C6 vertebral body
  4. Oesophagus is closed but the larynx/airway is open
  5. Prevents regurgitation
  6. Allows ventilation
40
Q

List some of the features of the larynx

A
  1. Laryngeal inlet (aditus)
  2. Laryngeal vestibule
  3. False vocal cord (vestibular fold)
  4. Laryngeal ventricle
  5. True vocal cord (vocal fold)
  6. Infra-glottic cavity
41
Q

Define vocal cords

A

Vocal cords are the free borders of mucosa covered connective tissue in the larynx

42
Q

How many vocal cords do you have?

A
  • 2 pairs of vocal cords:
    • true vocal cords; movement impacts sound
      • vocal process of arytenoid cartilage to thyroid cartilage
    • false vocal cords
      • arytenoid cartilage to epiglottis
43
Q

Define “intrinsic muscles of the larynx”

A

They’re all skeletal muscle

Found between cartilages causing movement of the vocal cords

All innervated by CN X

44
Q

Which intrinsic muscle of the larynx increases pitch?

How?

A

Cricothyroid muscles

By tensing vocal ligament

‘Nods’ thyroid cartilage

45
Q

Which intrinsic muscle of the larynx decreases pitch?

How?

A

Thyroarytenoid muscles

By relaxing vocal ligament

Attachments: posterior thyroid to anterior arytenoid cartilage

46
Q

Which intrinsic muscles of the larynx make voice quieter?

How?

A

Lateral crico-arytenoid muscles

Adducts/brings vocal ligaments together

Attachments: muscular process of the arytenoid to anterior cricoid cartilage

Arytenoid muscles

Adducts/brings vocal ligaments closer together

Closing rima glottidis

Attachments: one arytenoid cartilage to another cricoid cartilage

47
Q

What intrinsic muscle of the larynx make the voice louder?

A

Posterior crico-arytenoid muscles

Abducts vocal cords (people with abs love themselves and talk louder)

Opening rima glottidis

Attachments: posterior cricoid cartilage to muscular process of arytenoid cartilage

48
Q

What are the differences between supra-glottis, glottic and subglottic tumours ?

A

Supra-glottis Tumours

drain to superior deep cervical nodes

Glottic Tumours

present on the cords

95% stay on the cords

presents with voice changes/airway obstruction

Sub-glottic Tumours

spread to paratracheal nodes

present with voice/airway obstruction

49
Q

Explain subglottal pressure threshold?

A

Once subglottal pressure threshold is reached then air crosses vocal cords causing vibration

50
Q

Is the larynx sufficient to produce a loud sound?

A

No

the laryngeal “buzz” is amplified by the pharynx, oral and nasal cavities

Funnel shaped pathway from larynx to mouth

ENT (4 decks)

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