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CD 663 > Anatomy & Physiology of the Aerodigestive Tract: A Lifespan Perspective > Flashcards

Anatomy & Physiology of the Aerodigestive Tract: A Lifespan Perspective Flashcards

1
Q

Aerodigestive Tract

A

¥ Shared muscles and structures of the aerodigestive Tract

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2
Q

Deciduous/Primary dentition (20 teeth)

A

Ð 5 teeth per quadrant

Ð Erupt at 6-­‐24 months

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3
Q

¥ Adult Dentition (32 teeth)

A

Ð 8 teeth per quadrant
Ð Appear 5-­‐6 yrs
Ð Full set by 13 yrs

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4
Q

¥ Mandible elevators
Ð Close/raise the lower jaw
Ð Lateralize the mandible
Includes:

A

¥ Temporalis
¥ Masseter
¥ Medial/internal pterygoid

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5
Q

¥ Mandible depressors
Ð Open/lower the jaw
Includes:

A

¥ Lateral/external pterygoid

–With assistance of suprahyoids (a group of muscles)

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6
Q

Two major facial muscles (CN VII) involved in mastication

A

¥ Orbicularis oris muscles

¥ Buccinator muscles

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7
Q

Major Muscles of Chewing:

A

Internal (Medial) Pterygoid
External (Lateral) Pterygoid (open jaw)
-Affecting TMJ movement

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8
Q

The Temporomandibular Joint TMJ

A

¥ Joint between the maxilla and the mandible
¥ Joint contains an intra-­‐articular disk which facilitates movement between the two bones
¥ Sensory innervation of the joint is by the mandibular nerve (branch of the trigeminal nerve, CN. V)

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9
Q

Suprahyoids that assist in jaw opening (depressors)

A 
Refer to a group of muscles above hyoid bone
Ð	Diagstric (CN V, VII)
Ð	Stylohyoid (CN VII)
Ð	Mylohyoid (CN V)
Ð	Geniohyoid (CN XII)
¥	Elevators: to larynx
Depressors: to mandible
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10
Q

Orbicularis Oris & Buccinator:

A

Containing bolus in the mouth while chewing

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11
Q

Major Muscles of during Chewing

A
  1. Temporalis (CN V)
  2. Masseter (CN V)
  3. Buccinator (CN VII)
  4. Orbicularis Oris (CN VII)
    AND
    (Not shown in the graph)
    ¥ Medial pterygoid
    ¥ Lateral pterygoid
    ¥ Suprahyoids
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12
Q

Oral Transport:

Oropharynx: 1. Oropharyngeal propulsion

A
  1. Oropharyngeal propulsion
    a. Tongue seals around bolus with tip anchored at alveolar ridge
    b. Midline of tongue forced upward (mylohyoid, geniohyoid, digastric)
    c. Root of tongue pressed against velum (styloglossus, hyoglossus)
    d. Propels bolus upward and backward toward faucial arches
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13
Q

Oral Transport:

Oropharynx: 2. Velopharyngeal function (VP port remains open)

A

a. Velum: elevates as tongue propels

b. VP port remains open

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14
Q

Tongue

Landmarks

A 
Ð	Tip/apex
¥	anterior of the tongue
Ð	Blade
¥	below the alveolar ridge
Ð	Front
Ð	Back
Ð	Dorsum
¥	Superior surface
Ð	
Root/Base
¥	Lingual base
¥	Lying close to the pharynx
Ð	Body
¥	Major mass of tongue
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15
Q

¥ Valleculae

A

Space btw base of tongue and epiglottis

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16
Q

Tongue Muscles: Intrinsic

A

Superior longitudinal M.I
nferior longitudinal M.
Transverse M.
Vertical M.

Overall shaping of the tongue and fine movements of tongue tip

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17
Q

Tongue Muscles: Extrinsic

A

1) Genioglossus
2) Hyoglossus
3) Palatoglossus
4) Styloglossus

¥Gross movements of tongue (Position)

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18
Q

Tongue: Innervation

Sensory

A

Ð General sensation
¥ Anterior 2/3 of tongue
–CN V trigeminal
¥ Posterior 1/3 of tongue

Ð	Taste
¥	Anterior 2/3
–CN VII facial
¥	Posterior 1/3
–CN IX
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19
Q

Tongue: Innervation

Motor

A

Ð ** CN XII Hypoglossal
¥ Innervates all intrinsic and extrinsic muscles
except for palatoglossus

¥ Palatoglossus is innervated by CN X (Vagus nerve) or CN XI (Accessory nerve)

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20
Q

Pharyngeal Stage

A

¥ Velar muscles contraction to close the VP port
¥ Base of tongue (BOT) retraction
¥ Sequential contraction of the pharyngeal constrictors
¥ Laryngeal/hyoid elevation & ant movement
¥ Epiglottis retraction/inversion
¥ Constriction of the laryngeal vestibule
¥ Vocal fold adduction
¥ Opening/relaxation of the cricopharyngeus
¥ Cricopharyngues muscle aka pharyngeal-­‐esophageal (PE) segment

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21
Q

Pharyngeal Stage

Hypopharynx (Laryngopharynx):

A

Hypopharynx (Laryngopharynx):

  1. Muscular propulsion
    a. Pharyngeal constriction/squeeze
    b. Pyriform sinuses
    c. Cricopharyngeal function
22
Q

Pharyngeal Stage Larynx

A
  1. Larynx
    a. Closure: glottis, ventricular folds, epiglottis
    b. Hyoid elevation (-> -> elevation of the larynx)
23
Q

The Pharynx

A

¥

Nasopharynx

¥ Oropharynx
Ð Epiglottis
Ð Valleculae

¥	Laryngopharynx
Ð	Aka. “Hypopharynx”
¥	btw epiglottis and larynx/ esophagus
Ð	Contains pyriform sinuses
¥	Space btw interior constrictor and larynx/ thyroid cartilage
24
Q

Pharyngeal Muscles (CN X)

A

¥ Stylopharyngeus

Constrictors
Ð	Superior
Ð	Middle
Ð	Inferior
¥	*Part of UES w/ Cricopharyngeus

The pharyngeal constrictor muscles make up the external circular layer of the pharynx.
Ð

Function: narrow the pharynx

25
Q

Larynx landmarks 1

A 
Thyroid cartilage
Ð	Thyroid notch
Vestibule
Ð	Area above the ventricle
Ventricle
Ð	Space btw vestibule folds and true vocal folds
26
Q

Larynx landmarks 2

t

A 
Vestibule/Inlet
Ð	Ventricular folds/false vocal folds
Ð	Ventricle
Ð	True vocal folds (“vocal folds”)
Ð	Glottis
Ð	Infraglottic cavity
¥	When using the true vocal folds as a boundary:
Ð	SupragloXs
¥	Area above the true vfs
¥	Ventricle+ventricle folds+vestibule
Ð	SubgloXs
¥	Infraglottic cavity
¥	Area below the true vfs
27
Q

Cartilages of larynx

A 
thyroid
epiglottis
corniculate
arytenoid
criocoid
trachael ring
28
Q

Important Landmarks

A

¥ Epiglottis
Important Landmarks
¥ Pharyngeal recesses
Ð Aka. “side pockets”, into which food may fall and reside before or aGer the swallowing reflex triggers
¥ Valleculae
– The wedge-­‐shaped space formed between the base of the tongue and epiglottic
¥ Pyriform sinuses
– Spaces located in the pharynx, beside the larynx
– The most inferior structures of the pharynx
¥ Aryepiglottic folds
¥ False vocal folds

29
Q

Five [5] Intrinsic Muscles of the Larynx

A

1.Posterior cricoarytenoid muscle (PCA =Vocal fold abductor

2.Interarytenoid muscles (IA)= Vocal fold adductors
Ð Transverse arytenoid m.
Ð Oblique arytenoid m.
3. Lateral cricoarytenoid muscle (LCA)

  1. Cricothyroid muscle (CT) =Pitch controller/tensors
  2. Thyroarytenoid (TA)
30
Q

Suprahyoids

Extrinsic laryngeal muscles

A 
¥	Suprahyoid muscles
[laryngeal elevators]
Ð	Run to hyoid from above
¥	mandible & temporal bone
Ð	Elevate larynx
¥	Digastric
¥	Mylohyoid
¥	Geniohyoid
¥	Stylohyoid
  Also, depress the mandible
31
Q

Infrahyoids

Extrinsic laryngeal muscles

A 
¥	Infrahyoid muscles
[laryngeal depressors]
Ð	Attach to hyoid from below
¥	Sternum & scapula
Ð	Depress/lower larynx
¥	Sternohyoid
¥	Omohyoid
¥	Sternothyroid
¥	Thyrohyoid
32
Q

Normal Aerodigestive Track Infrahyoids

A 
Lower hyoid and larynx
Ð	Sternohyoid
Ð	Sternothyroid
Ð	Thyrohyoid
¥	Pulls hyoid down but thyroid up
¥	Responsible for epiglottic inversion during pharyngeal phase
Ð	Omohyoid
33
Q

Esophageal Stage

A

¥ Esophagus
Ð Consists of a hollow muscular tube 20 to 25 cm long with a sphincter at each end.
Ð Upper esophageal sphincter (UES)
Ð Lower esophageal sphincter (LES)

¥ AFer entrance of bolus into the esophagus, the food is carried to the stomach via gravity and esophageal peristalsis

¥ Peristalsis: the involuntary constriction and relaxation of the muscles of the intestine or another canal, creating wavelike movements that push the contents of the canal forward.

34
Q

Esophageal Stage

A

A. Esophagus:

  1. Upper esophageal sphincter opening
  2. Primary/Secondary peristaltic wave
  3. Lower esophageal sphincter opening
35
Q

Esophagus

A

¥ 20-­‐25 cm in length for adults
¥

Striated and smooth muscles

¥	Upper Esophageal Sphincter
(UES; striated muscles)
Ð	Inferior pharygeal constrictor
Ð	Cricopharyngeal muscle
Ð	Proximal esophagus

¥ Lower Esophageal Sphincter
(LES; smooth muscles)

36
Q

Upper Esophageal Sphincter (UES)

A

¥ aka. Pharyngeal-­‐esophageal (PE) segment
¥ Cricopharyngeus Muscle (major muscle)
Ð It separates the pharynx from the esophagus.
Ð At the end of the pharyngeal stage of the swallow, it must relax to allow the bolus to enter the esophagus.
¥ (It is normally closed to prevent the reflux of food and to keep air out of the digestive system.)
Ð If the P.E. segment does not relax, food will build up in the pharynx and eventually spill over the top of the larynx into the airway.

¥ The cricopharyngus is innervated by the CN X Vagus.

37
Q

AFer esophageal stage,

A

breathing resumes & all components return to rest position.

38
Q

Salivary Glands

A

¥ Submandibular glands
Ð 65% of saliva
Ð Behind point of chin

¥ Parotid glands
Ð 25% of saliva
Ð Side of face near ear

¥ Sublingual glands
Ð 15% of saliva
Ð Anterior floor of mouth near mandibular canine/cuspids

¥ Dysfunction results in Xerostomia
Ð Oral dryness

39
Q

Neural Control: CNS
¥ Frontal lobe cortex
Ð Primary motor cortex (PMC)

A

¥ Frontal lobe cortex
Ð Primary motor cortex (PMC)
Face tongue, jaw movements for oral stage facilitates initiation of swallowing

¥ Anterior to PMC
Ð Stimulation swallowing associated with chewing

¥ Central Pattern Generator (CPG)

40
Q

Neural Control: CNS, Anterior to PMC

A

¥ Anterior to PMC

Ð Stimulation swallowing associated with chewing

41
Q

Neural Control: Central Pattern Generator (CPG)

A

Ð Bilaterally arranged groups (nucleus tractus solitarius; NTS) of neurons in brainstem that are interconnected
Ð Involved in swallow, respiration, cardiovascular reflexes, and possible other functions.
¥ “Swallowing center”
Ð “Swallowing CPG” or
Ð “Swallow program generator (SPG)”
Ð Located in medulla oblongata

42
Q

Neural Control: PNS (Sensation)

A

¥ Sensation via Cranial nerves
Ð VII, IX, X (Taste)

Ð V, VII, IX, X (general sensation)
¥ Glossopharyneal nerve (IX) responsible for sensing bolus at faucial pillars and thus for “trigger” the pharyngeal phase of the swallow

43
Q

Neural Control: PNS (Motor)

A

¥ Motor/Efferent signals via Cranial Nerves
Ð V, VII, IX, X (XI), XII

¥ Motor/Efferent signal via Spinal Nerves
– C1-­‐C4

¥ Motor/Efferent signals to Esophagus
Ð CN X (Vagus)
Ð Enteric nerves (control function of GI system)
Ð Parasympathetic/Sympathetic Extrinsic nerves of esophagus

44
Q

¥ CN V

¥ CN X

A

Sensory/motor innervation to face

Important in chewing

45
Q

CN VII

A

Sensory/motor fibers

Sensation of oropharynx & taste to ant. 2/3 of tongue

46
Q

CN IX Glossopharyngeal Nerve

A

Ð Sensory/motor fibers

Ð Taste to posterior of tongue, sensory/motor innervation to the pharynx

47
Q

CN X

A

Provides motor/sensory innervation to the palate, pharynx, esophagus, stomach and respiratory tract
¥ Recurrent laryngeal nerve (RLN)
¥ Superior laryngeal nerve (SLN)
Ð Taste to oropharynx, and sensation/motor function to larynx and laryngopharynx

48
Q

CN XI

A

Support CN X

49
Q

CN XII

A

Motor fibers that primarily innervate the tongue

50
Q

Neural Regulation of Swallowing

A

sensory impulses transmitted as a result of stimulation of receptors on the fauces, soF palate, base of the tongue, and posterior pharyngeal wall.

51
Q

Neural Regulation of Swallowing: Sensory impulses reach…

A

the brainstem primarily through the 5th, 7th, 9th, and 10th cranial nerves, while the efferent (motor) function is mediated through the 5th, 7th, 9th, 10th (11th), 12th cranial nerves.

52
Q

Neural Regulation of Swallowing: Cricopharyngeal sphincter opening

A

is reflexive, relaxation occurring at the time when the bolus reaches the posterior pharyngeal wall prior to reaching this sphincter.

CD 663 (4 decks)

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