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ENT > Anatomy of the palate, pharynx and larynx > Flashcards

Anatomy of the palate, pharynx and larynx Flashcards

1
Q

Where is the oral vestibule located?

A

Between the lips and teeth

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2
Q

What level is the hyoid bone found at?

A

C3

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3
Q

What drains into the sublingual caruncle?

A

Submandibular glands (mixed secretions)

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4
Q

What drains into the sublingual fold?

A

Sublingual glands (mucus secretions)

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5
Q

What innervates the mylohyoid?

A

Innervated by CN V3

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6
Q

What innervates the geniohyoid?

A

C1 via the hypoglossal nerve

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7
Q

What is the function of the mylohyoid?

A

The mylohyoid elevates the hyoid and the tongue

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8
Q

What is the function of the geniohyoid?

A

As the geniohyoid muscle contracts it pulls the hyoid bone and with it the attached larynx upwards and forwards during swallowing

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9
Q

What are the 3 salivary glands?

A

Parotid
Submandibular
Sublingual

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10
Q

Where does the parotid gland drain?

A

Upper 2nd molar via the parotid duct/ stensen duct

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11
Q

Where does the submandibular gland drain?

A

Enters the floor of the mouth and secretes via the lingual caruncle via whartons duct

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12
Q

Where does the sublingual gland drain?

A

Lays in the floor of the mouth via several ducts in the sublingual folds

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13
Q

What is the innervation of the parotid gland?

A 
Parasympathetic innervation (secretomotor) from CN IX, where it hitches a ride on branches of CN V3
CN IX will synapse in the optic ganglion
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14
Q

What is the innervation of the submandibular and sublingual glands?

A

CN VII via the chorda tympani branch which runs along with the lingual nerve

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15
Q

Where will CN VII leave the middle ear?

A

Stylomastoid foramen

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16
Q

What separates the anterior tongue from the posterior tongue?

A

Sulcus terminalis

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17
Q

What nerves supply the anterior 2/3rd of the tongue?

A

General sensory is CN V3 - lingual

Taste is via CN VII - chorda tympani

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18
Q

What nerves supply the posterior 1/3rd part of the tongue?

A

Taste and general: CN IX

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19
Q

What are the 4 different papillae on the tongue?

A

Tastebuds: foliate, vallate and fungiform

Touch and temp: filiform

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20
Q

Where does the thyroid gland originate?

A

Pharynx and descends through the foramen caecum of the tongue
Thyroid swellings will move superiorly then inferiorly on swallowing due to the attachment of the larynx

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21
Q

What is the role of the extrinsic muscles of the tongue?

A

To change the position of the tongue during mastication, swallowing and speech

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22
Q

What is the role of the intrinsic muscles of the tongue?

A

Modify the shape of the tongue during function

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23
Q

What are the extrinsic muscles of the tongue?

A

Palatoglossus
Styloglossus
Genioglossus
Hyoglossus

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24
Q

What is the innervation to the extrinsic muscles of the tongue?

A

All hypoglossal except palatoglossus which is the vagus nerve

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25
Q

Where does the hypoglossal nerve originate?

A

Via many rootlets that attach to the medulla oblongata

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26
Q

Where can the hypoglossal canal be found?

A

Anterior wall of the foramen magnum

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27
Q

What is the course of the hypoglossal canal?

A

Descends in the neck lateral to the carotid sheath
At the level of the hyoid bone (C3) it passes anteriorly towards the lateral aspect of the tongue
Supplies most of the muscles of the tongue

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28
Q

How is the hypoglossal nerve tested?

A

If both CN XII are functional, the tongue tip will be in the midline
In unilateral CN XII damage, the tongue tip will point TOWARDS the side of the injured nerve

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29
Q

What is the blood supply to the tongue?

A

Lingual artery a branch of the external carotid artery
The arteries pass medial to the hyoglossus
The nerves pass lateral to the hyoglossus

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30
Q

What epithelium is found at the palate?

A

Non-keratinized squamous epithelium of the soft palate

Keratinised stratified squamous epithelium of the hard palate

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31
Q

What makes up the hard palate?

A

Palatine process of the maxilla
Palatine bone
Pterygoid hamulus of the sphenoid bone

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32
Q

What are the 5 muscles of the soft palate?

A 
Tensor veli palatini
Palatopharyngeus
Musculus uvulae
Palatoglossus
Levator veli palatini
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33
Q

What is the innervation of the muscles of the soft palate?

A

All CN X EXCEPT the tensor veli palatini which is via CN V3

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34
Q

What is the function of the tensor veli palatini?

A

Tenses palatine aponeurosis

Opens eustachian tube

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35
Q

What is the function of the palatopharyngeus?

A

Lifts the pharynx and thyroid cartilage

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36
Q

What is the function of the palatoglossus?

A

Brings the tongue and soft palate together

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37
Q

What is the function of the levator veli palatini?

A

Lift the palatine aponeurosis Closes the eustachian tube

38
Q

What is the function of the soft palate?

A

Stops food entering the nose during swallowing
Directs air into the nose OR mouth during speech, sneezing, coughing and vomiting
Helps to close off the entrance to the oropharynx during the gag reflex

39
Q

What is the function of the musculus uvulae?

A

Shortens the uvula

40
Q

How can CN X be tested?

A

If nerves are functioning correctly, the uvula should lift striah in the midline hen the patient says “ah”
If there is a unilateral nerve pathology, the uvula will be pulled AWAY FROM the non-functioning side by the normal side

41
Q

What is the function of the constrictor muscles of the pharynx?

A

During sequential contraction, they will push food inferiorly
Include the superior, middle and inferior pharyngeal constrictor

42
Q

What is the function of the inner longitudinal layer of muscles?

A

Skeletal

During contraction, pulls the larynx superiorly shortening the pharynx during swallowing

43
Q

What innervates the muscles of the pharynx?

A

All CN X
EXCEPT
Stylopharyngeus by IX

44
Q

What runs in the “gateway to the mouth”?

A

CN IX
Lingual artery
Stylopharyngeus artery

45
Q

What structure do all the circular muscles of the pharynx insert onto?

A

The midline raphe

46
Q

What is the only muscle to be supplied by the glossopharyngeal nerve?

A

Stylopharyngeus

47
Q

What are the longitudinal muscles of the pharynx?

A

Stylopharyngeus (CN IX)
Palatopharyngeus
Salpingopharyngeus (cartilage of eustachian tube)

48
Q

Where do the longitudinal muscles of the pharynx all insert onto?

A

The posterior border of the thyroid cartilage

49
Q

What is waldeyer’s tonsillar ring?

A

Defence against invading pathogens
Within the mucosa of the nasopharynx and oropharynx
Adenoid, tubal tonsil, palatine tonsil and lingual tonsil

50
Q

What do regional lymph nodes receive?

A

The group of lymph nodes that FIRST receives lymph from a given drained structure

51
Q

What drains the palatine tonsil?

A

Jugulo-digastric node

52
Q

What is the difference between the lymph nodes in infection and cancer?

A

Infection: swollen, painful, soft, smooth, not fixed, improve rapidly with treatment
Cancer: swollen, not painful, hard, irregular, fixed, do not improve

53
Q

Where do midline structures of the head and neck drain?

A

Can be bilateral

54
Q

What are the functions of the larynx?

A

Voice box

Sphincter of respiratory tract - regulates airflow, protects aspirated objects

55
Q

Where is the larynx located?

A

Between the pharynx and trachea
Anterior to the laryngopharynx
Between the carotid sheath structures
Between C4-C6 vertebral bodies

56
Q

What is enclosed within the pretracheal fascia of the neck?

A 
Strap muscles
Thyroid gland
Trachea and larynx
Oesophagus and pharynx
Recurrent laryngeal nerves (6th arch)
57
Q

What cartilages are contained within the larynx?

A

Thyroid
Cricoid
Arytenoid (vocal and muscular process)

58
Q

What type of cartilage are the thyroid and cricoid cartilages?

59
Q

What type of cartilage is the epiglottis?

60
Q

What is special about the cricoid cartilage?

A

Only circular cartilage in the resp tract

61
Q

What is cricoid pressure used for?

A

Compress oesophagus against C6 to straighten up the larynx and assist ventilation

62
Q

What are the 3 parts to the larynx?

A 
Laryngeal vestibule (contains vestibular folds/false vocal cords) 
Laryngeal vestibule
Infraglottic cavity (contains vocal fold/ true vocal cords)
63
Q

Where can the true vocal cords be found?

A

Vocal process of arytenoid cartilage to the thyroid cartilage

64
Q

Where can the false vocal cords be found?

A

Arytenoid cartilage to epiglottis

65
Q

What is the rima glottidis?

A

Space between the true vocal cords

66
Q

What are the 4 functions of the intrinsic muscles of the larynx?

A 
Tension = increase pitch
Relaxation = decrease pitch
Adduction = quieter
Abduction = louder
67
Q

What innervated the intrinsic muscles of the larynx?

68
Q

What is the tensor intrinsic muscle of the larynx?

A

Cricothyroid muscle
Attaches from the cricoid cartilage to the inferior horn of the thyroid cartilage
INCREASES PITCH

69
Q

What is the relaxor muscle of the larynx?

A

Thyroarytenoid muscle
Attaches from the posterior to the anterior arytenoid cartilage
DECREASES PITCH

70
Q

What are the adductor muscles of the larynx?

A

Lateral cricoarytenoid muscle:
Attaches from the muscular process of the arytenoid to the anterior cricoid cartilage
Arytenoid muscle:
Attaches from one arytenoid cartilage to another cricoid cartilage (looks like the Scottish flag)
QUIETENS VOICE

71
Q

What is the abductor muscle of the larynx?

A

Posterior cricoarytenoid muscle
Attaches from the posterior cricoid cartilage to the muscular process of the arytenoid cartilage
LOUDENS VOICE

72
Q

What shape should the rima glottidis be in for normal resting position?

A

Laryngeal muscle relaxed

73
Q

What shape should the rima glottidis be in for forced respiration?

A

Posterior cricoarytenoids contracted to open rima glottidis

74
Q

What shape should the rima glottis be in for phonation?

A

Arytenoid contract, assisted by the lateral cricoarytenoid to close it completely

75
Q

What shape should the rima glottis be in for whispering?

A

Lateral cricoarytenoids contracted

76
Q

Where will supraglottic tumours drain to?

A

The superior deep cervical nodes

77
Q

Where will glottis tumours drain to?

A

Present on the cords
Stays on cords
Presents with voice changes/ airway obstruction

78
Q

Where will sub-glottic tumours drain to?

A

Paratracheal nodes

Presents with voice/airway obstruction

79
Q

Where is the laryngeal buzz amplified?

A

Pharynx
Oral cavity
Nasal cavity

80
Q

How are oral sounds produced?

A

Soft palate tenses (CN V3) and elevates (CN X) to close off entrance to nasopharynx
Directs air through oral cavity
Sound interrupted by tongue (CN XII) and the teeth/lips (CN VII) to produce vowels and consonants

81
Q

How are nasal sounds produced?

A

Soft palate tenses (CN V3) and descends (CN X) to close off the entrance into the oropharynx
Directs stream through nasal cavities
Produces M, N or ING depending on position of tongue (CN XII) and teeth/ lips (CN VII)

82
Q

What structure does the tensor veli palatini wrap around?

A

The pterygoid hamulus

83
Q

What supplies the intrinsic muscles of the larynx?

A

Inferior laryngeal nerve except the cricothyroid which is supplied by the external laryngeal nerve

84
Q

What is the mucosa above the vocal folds supplied by?

A

Interal laryngeal nerve

85
Q

What is the mucosa below the vocal folds supplied by?

A

Inferior laryngeal nerve

86
Q

What nerve becomes the inferior laryngeal nerve?

A

Left recurrent laryngeal nerve

87
Q

How is the pharynx tested?

A

Ask patient to swallow a sip of water - does the larynx move up and down? Do they splutter?

88
Q

How is the larynx tested?

A

Listen to speech

Is is hoarse?

89
Q

Why can the cough reflex be a good test?

A

Requires a functioning larynx
Requires a functioning diaphragm
requires phrenic nerves
Requires abdominal wall

90
Q

Where does the inferior horn of the thyroid cartilage insert?

A

Onto the cricoid at the cricothyroid joint

ENT (20 decks)

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