Craniovertebral Joints and Pharynx Flashcards
What type of joint is the atlanto-occipital joint?
synovial (condyloid) between occipital condyles and facets on superior surfaces of the lateral atlas
Occipital condyles are _____ with complementary _____ facets on the atlas
convex; concave
What type of movement does the atlanto-occipital joint allow?
flexion and extension with slight rotation and lateral flexion (yes movement - 45 degrees in each direction)
In regards to the atlanto-axial joints, there are __ total synovial joints between the atlas and axis vertebrae plus __ ligamentous articulation which create a composite structure allowing rotation
3; 1
Inferior articular facets of the atlas and superior articular facets of the axis form the two ____ atlanto-axial joints.
lateral
note: these facets are large and transversely oriented, allowing for a large amount of mobility
The medial atlanto-axial joint is the articulation between the _____ ____ of the axis and the ___ ___ of the atlas and the _____ ligament of the atlas, completing the pivot joint with two joint cavities
odontoid process (dens); anterior arch; transverse
note: “no” movement (shake head 45 degrees in each direction)
This is a continuation of the anterior longitudinal ligament. It connects the anterior arch of the atlas and anterior margin of foramen magnum.
anterior atlanto-occipital membrane
This is in the same relative position as the ligamentum flavum. It connects the posterior arch of atlas and poster margin of foramen magnum.
Posterior atlanto-occipital membrane
What artery perforates the inferior margin of the posterior atlanto-occipital membrane?
vertebral
This is a continuation of the posterior longitudinal ligament. It connects the body of the axis and anterior margin of foramen magnum to clivus and covers the deeper cruciate, alar and apical ligaments.
tectorial membrane
This ligament has a strong transverse part attached to the lateral masses and anterior arch of atlas posterolateral to the dens. It helps form the medial atlanto-axial joint and has a weak vertical part that interconnects the boyd of the axis and the anterior margin of foramen magnum.
Cruciate ligament
This ligament provides strong connections between the lateral sides of the dens and the margin of the foramen magnum of the occipital bone. It minimizes rotation.
alar ligament
This ligament provides a weak interconnection between the tip of the dens and the margin of foramen magnum
apical ligament
In this type of fracture, the arches of the atlas are fractured and the lateral masses are displaced laterally due to excessive axial compression resulting in 2-4 fracture points or severe hyperextension resulting in posterior arch fractures. This can commonly occur when diving into shallow water.
Jefferson’s (Burst) fracture
This is a fracture of the pedicles of the axis. It is due to force when the neck is hyperextended. It makes up 20% of all spinal fractures and is commonly seen in automotive accidents and hangings.
Hangman’s fracture
The fracture of the dens is displacement with or without rupture of what ligament?
transverse ligament
The pharynx extends from the base of the skull at the ____ ___ to the ____
sphenoidal body; esophagus
note: esophagus and trachea start at same level (C6)
The pharynx consists of an outer ____ muscle and an inner ____ muscle and is guarded by a ring of ____ tissue
circular; longitudinal; lymphoid
The pharynx has motor innervation primarily by the ____ nerve and sensory innervation via branches of the ____, ____, and ____ nerves
vagus; maxillary, glossopharyngeal, vagus
The superior constrictor muscle arises anteriorly from the pterygoid ___ and pterygomandibular ____, where it is continuous with the _____
hamulus; raphe; buccinator
The superior constrictor is attached posteriorly to the ____ tubercle at the base of the skull to the ____ ____ at the midline
pharyngeal; pharyngeal raphe
There is a gap in the superior constrictor musculature at the base of the skull between its anterior and posterior attachment sites, filled in by ______ fascia and providing a site of passage for what three structures?
phayrgobasilar; 1. levator veli palatini, 2. pharyngotympanic tube 3. ascending palatine artery
This muscle arises anteriorly from the lesser and greater horns of the hyoid bone and the lower part of the stylohyoid ligament. It attaches posteriorly to the pharyngeal raphe.
middle constrictor
Posteiorly, the upper fibers of the middle constrictor overlap the lower fibers of the superior constrictor, like stacked cups. True or false?
true
Anteriorly, there is a gap between the middle and superior constrictors allowing for the passage of what 3 structures?
stylopharyngeus, stylohyoid ligament, glossopharyngeal n.
This muscle arises anteriorly from the oblique line of the thyroid cartilage and from the cricoid cartilage and attaches posteriorly to the pharyngeal raphe.
inferior constrictor
Anteriorly, the gap between the middle and inferior constrictors permits the passage of what 2 structures
internal laryngeal nerve and superior laryngeal artery
The lower fibers of the inferior constrictor form the ____ that acts as a sphincter between the pharynx and esophagus
cricopharyngeus
What nerve and artery enter at the lower border of cricopharyngeus?
recurrent laryngeal nerve and inferior laryngeal artery
This internal muscle of the pharynx arises from the pharyngotympanic tube and blends in with the posterior wall of the pharynx
salpingopharyngeus
This internal muscle of the pharynx arises from the hard palate and aponeurosis. It blends with the side of the pharyngeal wall.
palatopharyngeus
This internal muscle of the pharynx arises from the styloid process and attaches inferiorly to the upper border of the thyroid cartilage
stylpharyngeus
Sylopharyngeus is the only muscle of the pharynx that in not innervated by the ___ nerve. It is innervated by the ____ nerve.
vagus; glossopharyngeal
This is a thin layer of loose CT that forms the outer covering of the pharynx. The pharyngeal plexus of nerves is embedded here.
buccopharyngeal fascia
This fascia fills in the gap between the upper borders of the superior constrictors and the base of the skull
pharyngobasilar fascia
For the following artery, name the branch that comes off of it to supply the pharynx and tonsillar regions: ECA
ascending pharyngeal artery
For the following artery, name the branch that comes off of it to supply the pharynx and tonsillar regions: Facial artery
ascending palatine artery and tonsillar artery
For the following artery, name the branch that comes off of it to supply the pharynx and tonsillar regions: maxillary artery
descending palatine artery and a pharyngeal branch
For the following artery, name the branch that comes off of it to supply the pharynx and tonsillar regions: inferior thyroid artery
pharyngeal branches
Do branches of the superior thyroid artery supply the pharynx/tonsillar regions?
yes
Veins of the pharynx form a minor plexus that drains into the ____ plexus
pterygoid
This vein is the source of much of the bleeding in the removal of the palatine tonsils
external palatine vein
In regards to sensory innervation of the pharynx by the maxillary, glossopharyngeal, and vagus nerves, give the location or action that each nerve is involved in
maxillary nerve: upper part
glossopharyngeal nerve: lower part, gag reflex (sensory)
vagus: gag reflex (motor)
Most lymphatic drainage from the pharynx, including the tonsils is mostly to the _____ nodes
jugulodigastric
What are the superior and inferior boundaries of the nasopharynx?
superior: body of sphenoid
inferior: soft palate
note: continuous with nasal cavities via choanae
In the nasopharynx, the cartilage of the pharyngotympanic tube forms a bulge called what?
torus tubarius
The salpingopalatine fold overlies the tensor veli palatini muscle. What does this muscle do and and what ganglion sits on it?
modifies the auditory tube for air exchange; hooks under pterygoid hamulus where otic ganglion sits on it
This is an elevation between the salpingopharyngeal and salpingopalatine folds. It is formed by the underlying LVP
torus levatorius
What are the attachments of LVP
between petrous temporal and auditory tube to palatine aponeurosis
This is a slit-like space that extends posteriorly and laterally behind the torus tubarius
pharyngeal recess
The roof and posterior wall of the nasopharynx contain what?
pharyngeal tonsils
What are the boundaries of the oropharynx?
- separated form the oral cavity by the tongue and palatopharyngeal/palatoglossal arches
- superior - soft palate
- inferior - epiglottis
In regards to the oropharynx, the space between the palatoglossal arch and palatopharyngeal arch form the tonsillar cleft and contains what?
palatine tonsils
In regards to the oropharynx, the tonsillar bed is formed by the ____ fascia and the ____ constrictor muscle
pharyngobasilar; superior
In regards to the oropharynx, the base of the tongue facing the pharynx contains a large accumulation of lymphoid tissue forming the ____ _____
lingual tonsils
What are the boundaries of the laryngopharynx?
posterior: larynx
superior: inferior border of cricoid cartilage
inferior: superior border of epiglottis
The ____ recess is on either side of the larynx extending to the laminae of the thyroid cartilage (food can get trapped here and stimulate the recurrent and internal laryngeal nerves)
piriform
The pharyngeal tonsils, palatine tonsils, and lingual tonsils along with smaller lymphoid masses form a ring of lymphoid tissue called _____ ring that guards against infections
Waldeyer’s
Degulation is the act of swallowing and has three stages. Describe each.
- voluntary: food is compressed
- involuntary: the soft palate is elevated to seal nasopharynx, the larynx is elevated, forcing the epiglottis posterior
- involuntary: contraction of constrictors propel food down to esophagus
Where is the deglutition center located?
medulla
What is the tensor veli palatini innervated by?
trigeminal nerve
