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Phase 1 - Anatomy > Anatomy - The Internal Larynx and Pharynx > Flashcards

Anatomy - The Internal Larynx and Pharynx Flashcards

1
Q

What nerve(s) are related to the superior thyroid arteries?

A

The external laryngeal nerves.

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2
Q

What nerve(s) are related to the inferior thyroid arteries?

A

The recurrent laryngeal nerve crosses the inferior thyroid artery.

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3
Q

How many parathyroid glands are there?

A

4.

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4
Q

Where are the parathyroid glands located?

A

Posterior surface of thyroid glands.

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5
Q

How are the parathyroid glands developed?

A

From the pharyngeal pouches.

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6
Q

Name 3 functions of the larynx.

A
  1. Phonation. 2. Cough reflex. 3. Protection of the lower respiratory tract.
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7
Q

What is the epithelium of the vocal folds? and why?

A

Stratified squamous epithelium. This is more robust and can withstand the vibrations and wear and tear.

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8
Q

What is the blood supply to the larynx?

A

Superior and inferior laryngeal arteries (branches of the thyroid arteries).

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9
Q

What does the recurrent laryngeal nerve supply?

A

Motor innervation to intrinsic muscles of the larynx (except cricothyroid).

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10
Q

What does the internal branch of the superior laryngeal nerve supply?

A

Sensory innervation to laryngopharynx and larynx.

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11
Q

What does the external branch of the superior laryngeal nerve supply?

A

Motor innervation to the cricothyroid muscle.

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12
Q

Name the 3 unpaired cartilages in the larynx.

A
  1. Epiglottis (elastic cartilage). 2. Thyroid (hyaline cartilage). 3. Cricoid (hyaline cartilage).
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13
Q

What do the two sheets of thyroid cartilage form in the midline?

A

The laryngeal prominence (Adam’s apple).

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14
Q

What do the inferior horns of the thyroid cartilage articulate with?

A

They form a synovial joint with the cricoid cartilage.

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15
Q

What do the superior horns of the thyroid cartilage articulate with?

A

The hyoid bone.

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16
Q

What vertebral level is the inferior border of the larynx at?

A

C6.

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17
Q

Name the 3 paired cartilages in the larynx.

A
  1. Arytenoid. 2. Cuneiform. 3. Corniculate.
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18
Q

What do the arytenoid cartilages articulate with?

A

The base articulates with the cricoid cartilage and the apex articulates with the corniculate cartilages.

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19
Q

Where are cuneiform cartilages located?

A

Within the ary-epiglottic folds. They strengthen the folds.

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20
Q

What is the space between the vocal cords called?

A

Rima glottidis.

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21
Q

What is the superior vestibular folds also known as?

A

False vocal folds.

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22
Q

What are the extrinsic muscles of the pharynx?

A

The suprahyoids, infrahyoids and stylopharyngeus.

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23
Q

What is the function of the extrinsic muscles of the larynx?

A

They move the larynx superiorly and inferiorly during swallowing.

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24
Q

Name the 4 infrahyoid muscles.

A
  1. Omohyoid (scapula to hyoid). 2. Sternohyoid (sternum to hyoid). 3. Sternothyroid (sternum to thyroid). 4. Thyrohyoid (thyroid to hyoid).
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25
Q

What is the function of the intrinsic muscles of the larynx?

A

They control the shape of the rima glottidis, and the length and tension of the vocal folds.

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26
Q

What is the innervation of the intrinsic laryngeal muscles?

A

Recurrent laryngeal nerve.

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27
Q

What intrinsic laryngeal muscle is not innervated by the recurrent laryngeal nerve?

A

Cricothyroid.

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28
Q

What is the innervation of the cricothyroid muscle?

A

External branch of the superior laryngeal nerve.

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29
Q

What is the function of the cricothyroid muscles?

A

Stretches and tenses the vocal cords. Important for the creation of speech.

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30
Q

What is the function of the thyroarytenoid muscles?

A

Relaxes the vocal ligament, allowing for a softer voice.

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31
Q

What is the function of the posterior cricoarytenoid muscles?

A

Abduction of the vocal cords; the only muscles capable of widening the rima glottidis.

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32
Q

What is the function of the lateral cricoarytenoid muscles?

A

Adduction of the vocal folds; narrow the rima glottidis.

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33
Q

What is the function of the transverse arytenoids muscles?

A

Adduction of the arytenoid cartilages, narrows the laryngeal inlet.

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34
Q

What nerve passes through the parotid gland?

A

The facial nerve - Cn 7.

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35
Q

What are the 5 branches of Cn 7.

A
  1. Temporal. 2. Zygomatic. 3. Buccal. 4. Mandibular. 5. Cervical.
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36
Q

Where does the pharynx extend from and to?

A

The base of the skull to the cricoid cartilage (C6).

37
Q

What are the 3 sections of the pharynx called?

A
  1. Nasopharynx. 2. Oropharynx. 3. Laryngopharynx.
38
Q

What is the function of the pharyngeal constrictor muscles?

A

They contract sequentially to propel food into the oesophagus.

39
Q

What is the origin of the superior constrictor?

A

Pterigoid plate and pterygomandibular raphe.

40
Q

What is the origin of the middle constrictor?

A

Hyoid bone.

41
Q

What is the origin of the inferior constrictor?

A

Thyroid and cricoid cartilages.

42
Q

What is the innervation of the pharyngeal constrictors?

A

The pharyngeal branch of the Vagus nerve.

43
Q

What is the function of the longitudinal pharyngeal muscles?

A

They shorten and widen the pharynx. They also elevate the pharynx during swallowing.

44
Q

What are the 3 longitudinal pharyngeal muscles called?

A
  1. Stylopharyngeus. 2. Salpingopharyngeus. 3. Palatopharyngeus.
45
Q

What is the origin of the stylopharyngeus and what is its innervation?

A

Origin: Styloid process of temporal bone. Innervation: Glossopharyngeal, Cn 9.

46
Q

What is Killian’s dehiscence?

A

The weakest part of the pharyngeal wall. Located inferiorly in the midline. It is the commonest site for a pharyngeal diverticulum.

47
Q

What vessels are found in the carotid sheath?

A
  1. Common carotid artery. 2. Vagus nerve. 3. Internal jugular vein.
48
Q

Where is the carotid sinus located?

A

At the bifurcation of the common carotid artery.

49
Q

Where does the glossopharyngeal nerve exit the cranial cavity?

A

Through the jugular foramen.

50
Q

What nerve supplies sensory and taste innervation to the posterior 1/3 of the tongue.

A

The glossopharyngeal nerve.

51
Q

What does elevation of the soft palate do?

A

It closes the orifice between the nasopharynx and oropharynx. This occurse during swallowing to prevent food refluxing into the nose. It also occurs in phonation.

52
Q

What nerve supplies sensory sensation to the anterior 2/3 of the tongue?

(different than taste)

A
  • The trigeminal nerve, Cn 5.
  • Lingual nerve of the mandibular branch
53
Q

What nerve supplies taste sensation to the anterior 2/3 of the tongue?

A

The facial nerve, Cn 7. (chorda tympani)

54
Q

What are the functions of the larynx?

A
  • phonation
  • cough reflex
  • protection of the lower respiratory tract
55
Q

Describe the positioning of the larynx?

A
  • in the anterior compartment of the neck
  • suspended from hyoid bone
  • spanning between C3 and C6
  • continuous inferiorly with the trachea
  • open superiorly into laryngeal part of the pharynx
56
Q

What lines the anterior and lateral borders of the larynx?

A
  • anteriorly by the infrahyoid muscles
  • laterally by the lobes of the thyroid gland
  • major blood vessels ascends laterally
57
Q

What is the clinical relevance of its position in relation to the oesophagus?

A
  • posterior to the larynx as the oesophagus
  • emergency intubation
    • pressure is applied on the cricoid cartilage
    • occludes the oesophagus
    • preventing regurgitation of gastric contents
    • known as cricoid pressure or Sellick’s maneuver
58
Q

The internal cavity allowance can be divided into which three sections?

A
  • supraglottis - From the inferior surface of the epiglottis to the false vocal cords (vestibular folds)
  • Glottis - contain the vocal cords and 1 cm below them, the opening between the vocal cords is known as the rima glottidis (its size altered by the muscles of phonation)
  • Subglottis - From the inferior border of the glottis to the inferior border of the cricoid cartilage
59
Q

Describe the histology of the interior surface of the larynx? what is the exception?

A
  • All lined by pseudo-stratified ciliated columnar epithelium
  • the true vocal cords are lined by stratified squamous epithelium
60
Q

Describe the two arterial supplies to the larynx?

A
  • superior laryngeal artery - branch of the superior thyroid artery (derived from the external carotid), Follows internal branch of the superior laryngeal nerve to the larynx
  • inferior laryngeal artery - branch of the inferior thyroid artery (derived From the thyrocervical trunk), Follows the recurrent laryngeal nerve to the larynx
61
Q

Describe the venous drainage of the larynx?

A
  • superior Laryngeal vein - drains into the internal jugular vein via the superior thyroid
  • inferior laryngeal vein - drains into the left Brachiocephalic vein via the inferior thyroid vein
62
Q

Describe the motor and sensory innovation by the branches of the vagus nerve to the larynx?

A
  • recurrent laryngeal nerve - sensory innovation to the infraglottis, motor innovation to all the internal muscles of the larynx (except the cricothyroid)
  • Superior laryngeal nerve - internal branch provide sensory innovation to the supraglottis, external branch provides motor innovation to the cricothyroid muscle
63
Q

What is the difference between Extrinsic ligaments and intrinsic ligaments in terms of their functions?

A
  • Extrinsic ligaments attached the larynx to external structures
  • intrinsic ligaments are responsible for holding the cartilage of the larynx together
64
Q

Name and describe the attachment of the extrinsic ligaments?

A
  • thyro-hyoid membrane - Spines between the superior aspect of the thyroid cartilage and the hyoid bone, pierced laterally by the superior laryngeal vessels and internal laryngeal nerve
    • medial thyroid hyoid ligament - anteriomedial thickening of membrane
    • Lateral thyrohyoid ligament - posteriolateral thickening of the membrane
  • Hyo-Epiglottic ligament - Connects the hyoid bone to the anterior aspect of the epiglottis
  • cricotracheal ligament - Connects the cricoid cartilage to the trachea
  • Medial cricothyroid ligament - Anteriomedial thickening of the cricoid thyroid ligament, connects the thyroid and cricoid cartilage
65
Q

Name and describe the attachments of the intrinsic ligaments?

A
  • cricothyroid ligament - From the cricoid cartilage and extends superiorly terminating with a free upper margin ( forms the vocal ligament), attached anteriorly to the thyroid cartilage and posteriorly to the arytenoid cartilage
  • Quadrangular membrane - spans between the anteriolateral arytenoid cartilage and the lateral aspects of the epiglottis, has free upper margin and lower margin, lower margin is thickened to become the vestibular ligament
66
Q

What is the clinical relevance of the cricothyroid ligament?

A
  • Cricothyroidotomy
  • Temporary airway when there is an obstruction at or above the larynx
  • palpate the thyroid cartilage make a small incision at the midline of the depression
  • insert an endotracheal tube to secure the airway
67
Q

What happens to the vocal folds to control phonation?

A

abduction, adduction, relaxed and tensed

68
Q

Describe the histology of the vocal fold?

A
  • non-keratinised stratified squamous epithelium
  • Reinke’s space - amorphous layer rich in glycosaminoglycans, vibrates freely to create sound
  • Vocal ligaments - lies at the free upper edge of the cricothyroid ligament
  • vocalis muscle - exceptionally fine muscle fibres that lie laterally to the vocal ligaments
  • spaces between the vocal cords is known as rima glottidis
69
Q

Describe the positioning of the vestibular folds in relation to the true vocal cords?

A
  • the vestibular folds lie superior in each of the true vocal cords
70
Q

What does the vestibular forwards consist of? What is their function?

A
  • Consist of the vestibular ligament - lower free edge of the quadrangular membrane
  • covered by mucous membrane, pink in colour
  • provide protection to the larynx
71
Q

How do the functions of the external and internal muscles of the larynx differ?

A
  • the external muscles act to elevate or depress the larynx during swallowing
  • the internal muscles act to move the individual components of the larynx - playing a vital role in breathing and phonation
  • Change the shape of the rima glottidis, and the length and tension of the vocal cords
72
Q

Name the three groups of the extrinsic muscles?

A
  • superhyoid
  • infrahyoid - Attached are the hyoid bone, Depresses the larynx
  • stylopharyngeus (pharynx) - Elevates the larynx
73
Q

What innovates all intrinsic muscles of the larynx what is the exception?

A
  • Inferior laryngeal nerve ( terminal branch of the recurrent laryngeal nerve( branch of the vagus nerve itself))
  • cricothyroid is innovated by the external branch of the superior laryngeal nerve (derived from the vagus nerve)
74
Q

Describe the cricothyroid muscle? attachment? actions?

A
  • Originates from the anterior aspect of the cricoid cartilage
  • attaches to the inferior margin and inferior horn of the thyroid cartilage
  • Stretches and tenses the vocal cords
75
Q

Describe the thyroarytenoid muscle? attachment? actions?

A
  • Originates from the inferior posterior aspect of the angle of the thyroid cartilage
  • attaches to the anterior lateral part of the arytenoid cartilage
  • relaxes the vocal cords allowing for a softer voice
76
Q

Describe the posterior cricoarytenoid muscle? attachment? actions?

A
  • Sole abductors of the vocal folds, only muscle capable of widening the rima glottidis
  • Originates from the posterior surface of the cricoid cartilage
  • attaches to the muscular process of the arytenoid cartilage
77
Q

Describe the lateral cricoarytenoid muscle? attachment? actions?

A
  • major adductor of vocal folds, narrowing the rima glottidis - modulating the tone and volume speech
  • originates from the arch of the cricoid cartilage
  • attaches to the muscular process of the arytenoid cartilage
78
Q

Describe the transverse and oblique arytenoid muscles?

A
  • adduct the arytenoid cartilages, closing posterior portion of rima glottidis, Narrowing the laryngeal inlet
  • Spans from one arytenoid cartilage to another
79
Q

What marks the laryngeal inlet?

A
  • aryepiglottic folds
  • posterior is the hypopharynx (sometimes called laryngo-pharynx)
80
Q

What is the clinical relevance of the piriform fossa?

A
  • Slit like gap lateral to the superior and inferior horns of the thyroid cartilage
  • Malignant tumours may be silent as it can grow in the fossa before symptoms develop
81
Q

What nerve supplies the muscles of the tongue?

A

the hypoglossal nerve (CN XII)

Phase 1 - Anatomy (29 decks)

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