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ENT Medicine > Clinical Anatomy of Speech and Swallow > Flashcards

Clinical Anatomy of Speech and Swallow Flashcards

1
Q

What does swallowing require?

A

Efficient and synchronised motor control

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2
Q

What are the three phases of swallowing?

A

Oral phase (voluntary), pharyngeal phase (involuntary), oesophageal phase (involuntary)

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3
Q

What occurs in the oral phase?

A

Mastication, bolus manipulation, labial seal

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4
Q

What occurs in the pharyngeal phase?

A

Hyolaryngeal elevation, sequential constrictor contraction

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5
Q

What occurs in the oesophageal phase?

A

Relaxation of the upper oesophageal sphincter (cricopharyngeal)

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6
Q

What nerve innervates the muscles of mastication?

A

CN V3

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7
Q

What is the role of the muscles of mastication in the oral phase of swallowing?

A

Break down food and allow it to mix with saliva

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8
Q

What is the involvement of the facial muscles in the oral phase of swallowing?

A

Create labial seal = orbicularis oris

Tightens cheek = buccinator

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9
Q

What nerve innervates the facial muscles involved in the oral phase of swallowing?

A

CN VII

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10
Q

What structures manipulate the bolus when it is in the oral cavity?

A

The intrinsic and extrinsic tongue muscles (CN XII) = manipulate bolus and align it between the dentition and push it against the hard palate

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11
Q

What does the soft palate do during the oral phase of swallowing?

A

Depresses to create an oropharyngeal seal = tongue also ripples bolus posteriorly

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12
Q

What nerve innervates the soft palate?

A

CN X = lesser palatine nerve

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13
Q

What nerves innervate the hard palate?

A

Branches of pterygopalatine ganglion = greater palatine nerve

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14
Q

What kind of modalities are supplied to the hard palate?

A

Secretomotor from CN VII, general sensation from CN V2

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15
Q

What structure do the nerves supplying the hard palate pass through?

A

Palatine canal

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16
Q

Where does the incisive branch of the nasopalatine nerve supply?

A

The area of the hard palate behind the front teeth

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17
Q

What covers the palatal rugae?

A

Mucosa = keratinised stratified squamous epithelium

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18
Q

What extrinsic muscles of the tongue does the facial nerve supply somatic innervation to?

A

Genioglossus, hyoglossus and styloglossus

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19
Q

What is the course of the facial nerve into the mouth?

A

Extends from medulla and passes through hypoglossal canal = descends close to carotid sheath, courses lateral to hyoglossus into floor of mouth

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20
Q

What initiates the pharyngeal phase of swallowing?

A

Delivery of the bolus to the oropharynx

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21
Q

What is the critical step in the pharyngeal phase of swallowing?

A

Switch from air channel to food channel (<1s)

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22
Q

What are the facilitators of the pharyngeal phase of swallowing?

A

Elevation of soft palate
Posterior pressure from tongue
Hyolaryngeal elevation
Pharyngeal constrictor contraction

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23
Q

What does the elevation of the soft palate during the pharyngeal phase cause?

A

Seals off the nasopharynx from the oropharynx

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24
Q

What does the posterior pressure from the tongue help during the pharyngeal phase?

A

Seals of laryngeal aditus = aided by epiglottis

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25
Q

What is the purpose of the hyolaryngeal elevation during the pharyngeal phase?

A

Protects airway and opens upper oesophageal sphincter

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26
Q

What muscles elevate the hyoid bone?

A

Suprahyoid and longitudinal pharyngeal muscles drag the hyoid bone superiorly and anteriorly

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27
Q

What is the elevation of the hyoid bone coupled with?

A

Posterior tongue pressure from the stylohyoid and hyoglossus

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28
Q

What does the elevation of the hyoid bone cause the epiglottis to do?

A

Forces epiglottis inferior to the tongue and covers the laryngeal aditus to protect the airway

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29
Q

What aids the movement of the bolus from the laryngopharynx to the oesophagus?

A

Tongue pressure, sequential contraction of pharyngeal constrictors (superior to inferior), relaxation of upper oesophageal sphincter (cricopharyngeus)

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30
Q

How long does the oesophageal phase last?

A

8-20s

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31
Q

When does the oesophageal phase begin?

A

Once the cricopharyngeal sphincter has opened = bolus is then passed to the stomach via peristaltic action

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32
Q

What nerve innervates the cricopharyngeus?

A

External laryngeal nerve (CN X)

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33
Q

What does the retropharyngeal space communicate with?

A

The mediastinum = allows spread of infection

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34
Q

What may be the symptoms of a parapharyngeal space tumour?

A

May be asymptomatic for some time = can present with symptoms of lower cranial nerve dysfunction

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35
Q

Where does the pharyngeal plexus supply?

A

Muscles of soft palate and pharynx (except tensor veli palatine), sensory component of mucosa

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36
Q

What cranial nerves make up the pharyngeal plexus?

A

CN IX and X

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37
Q

What is the sensory component of the gag reflex?

A

Stimuli present to posterior 1/3 of tongue, palatine tonsils and wall of oropharynx = innervated by CN IX

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38
Q

What is the aim of the motor component of the gag reflex?

A

Tries to close off the oropharynx by muscular contraction

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39
Q

What makes up the motor component of the gag reflex?

A

Constrictors of pharynx (CN X), longitudinal muscles of pharynx (CN IX and X), tongue (CN XII), soft palate (CN X)

40
Q

What are the gateways to the mouth and tonsillar bed?

A

The gaps between the superior and inferior pharyngeal constrictor muscles

41
Q

What do the gateways to the mouth and tonsillar bed allow?

A

Passage of CN IX, lingual artery and stylopharyngeus muscle

42
Q

What nerve may be damaged in a tonsillectomy?

A

CN IX

43
Q

What is the fundamental function of the larynx?

A

A sphincter = carries out airflow regulation and protection

44
Q

What happens to the vocal cords during forced expiration?

A

They abducts to allow passage of air

45
Q

What muscles causes the widening of the rima glottidis?

A

Contraction of the posterior crico-arytenoid muscles = causes lateral rotation of the crico-artytenoid joint

46
Q

How does the larynx carry out a protective role?

A

Through glottic closure and the cough reflex

47
Q

When is the rima glottidis closed firmly?

A

During swallowing to reduce passage of substances other than air into the lower respiratory tract

48
Q

What happens to the diaphragm and intercostal muscles during inspiration?

A

They contract and pull downwards

49
Q

What occurs during controlled expiration?

A

Contraction of the inspiratory muscles = helps build pressure in respiratory tree inferior to larynx (subglottal pressure)

50
Q

What does the pressure needed for phonation depend on?

A

Depends on the vocal task

51
Q

What must be adequate for phonation to occur?

A

Subglottal pressure threshold must be reached = Air crosses vocal cords causing vibration

52
Q

What dictates the pitch of the voice?

A

The length/tension of the vocal cords

53
Q

What kind of muscles are the intrinsic laryngeal muscles?

A

Skeletal = involuntary

54
Q

What effect does vocal cord tension have on vocal pitch?

A

Tension increase pitch, relaxation decreases pitch

55
Q

What effect does abduction and adduction of the vocal cords have on the volume of the voice?

A

Adduction makes the voice quieter, abduction makes the voice louder

56
Q

What nerve innervates the intrinsic muscles of the larynx?

A

All innervated by the inferior laryngeal branch of CN X (except cricothyroid)

57
Q

What is the function of the thyro-arytenoid muscle?

A

Relaxes vocal ligaments = decreases pitch

58
Q

Where is the thyro-arytenoid muscle located?

A

Attaches to posterior thyroid to anterior arytenoid cartilage

59
Q

What is the function of the cricothyroid muscle?

A

Tenses vocal ligaments = increase pitch

Nods thyroid cartilage

60
Q

Where is the cricothyroid muscle located?

A

Attaches to anterolateral cricoid cartilage to inferior horn of thyroid cartilage

61
Q

What is the normal state of the laryngeal muscles?

A

They are relaxed

62
Q

Which larynx muscles contract during forced expiration?

A

The posterior crico-arytenoid muscle = vocal cords

63
Q

Which muscle aid the lateral crico-arytenoid muscles in adducting the vocal cords during phonation?

A

Arytenoid muscle

64
Q

Which nerve supplies the mucosa of the larynx above the vocal folds?

A

Internal laryngeal nerve = branch of superior laryngeal nerve

65
Q

Which nerve supplies the mucosa of the larynx under below the vocal cords?

A

Inferior laryngeal nerve

66
Q

Where does the left recurrent laryngeal nerve become the inferior laryngeal nerve?

A

At the level of the cricothyroid joint

67
Q

Which nerve gives rise to the superior laryngeal nerve?

A

The vagus nerve = passes through jugular foramen to give superior laryngeal branch

68
Q

What structure does the vagus nerve descend through the neck in?

A

The carotid sheath

69
Q

Where does the recurrent laryngeal nerve branch off from the vagus nerve?

A

Branches off in the mediastinum

70
Q

What nerves connect in Galen’s anastomosis?

A

Internal laryngeal nerve (superior laryngeal nerve) and the recurrent laryngeal nerve

71
Q

What kind of reflex is the cough reflex?

A

It is involuntary

72
Q

Where are the sensory stimuli for the cough reflex detected?

A

Sensory stimuli in the supraglottis = then conveyed to the brainstem via the internal laryngeal nerve

73
Q

What occurs during the cough reflex once the sensory information has reached the brainstem?

A

Vocal cords contract to shut larynx and glottis closes to increase body cavity pressure = glottic release of high pressure air jet

74
Q

What modalities does the vagus nerve supply the pharynx, palate and larynx with?

A

Sensory and motor supply

75
Q

How do you test the function of the vagus nerve in the pharynx?

A

Ask patient to swallow = watch larynx move up and down, do they splutter?

76
Q

How do you test the function of the vagus nerve in the larynx?

A

Listen to the patient speak = is the voice hoarse?

77
Q

How may the function of the vagus nerve in the throat be tested?

A

Ask the patient to cough = is the cough normal and powerful?

78
Q

What is dysphonia?

A

Impaired ability to produce an appropriate level of phonation

79
Q

What are some causes of dysphonia?

A

Neoplasm, neuromuscular dysfunction, inflammation

80
Q

Where do supraglottic tumours drain lymph to?

A

The superior deep cervical lymph nodes

81
Q

Where do most glottic tumours form?

A

Present on the vocal cords = 95% stay on cords

82
Q

How do glottic and subglottic tumours present?

A

Voice change and airway obstruction

83
Q

Where can subglottic tumours spread to?

A

Paratracheal nodes

84
Q

Why does the sound produced in the larynx need to be amplified?

A

Larynx is insufficient to produce loud sound

85
Q

What shape is the pathway between the larynx and mouth that vocal sounds are transmitted through?

A

It is funnel shaped

86
Q

What structures amplify the vocal “buzz” produced by the larynx?

A

Pharynx, oral cavity, nasal cavity

87
Q

How are oral sounds produced?

A

Soft palate tenses (CN V3) and elevates (CN X) to close off the entrance to the nasopharynx = directs stream of air through oral cavity

88
Q

How are vowels and consonants produced?

A

Sound interrupted by tongue (CN XII) and teeth/lips (CN VII) to produce most vowels/consonants

89
Q

How are nasal sounds produced?

A

Soft palate tenses (CN V3) and descends (CN X) to close off entrance into oropharynx = directs stream of air through nasal cavities

90
Q

What are the three nasal sounds that can be produced?

A

m, n and ing = depends on position of tongue (CN XII), teeth and lips (CN VII)

91
Q

What are the muscles of the soft palate?

A

Tensor veli palatini, levator veli palatini, palatoglossus, palatopharyngeus, uvular

92
Q

What is the action of tensor veli palatini?

A

Tenses soft palate and opens Eustachian tube during swallowing

93
Q

What is the function of levator veli palatini?

A

Elevates soft palate during swallowing

94
Q

What does the palatoglossus muscle do?

A

Elevates posterior part of tongue and draws soft palate onto tongue

95
Q

What is the function of the palatopharyngeus muscle?

A

Tenses soft palate and pulls walls of pharynx superiorly/anteriorly/medically during swallowing

ENT Medicine (22 decks)

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