Craniovertebral Joints and Pharynx

Question 1

What type of joint is the atlanto-occipital joint?

Answer 1

synovial (condyloid) between occipital condyles and facets on superior surfaces of the lateral atlas

Question 2

Occipital condyles are _____ with complementary _____ facets on the atlas

Answer 2

convex; concave

Question 3

What type of movement does the atlanto-occipital joint allow?

Answer 3

flexion and extension with slight rotation and lateral flexion (yes movement - 45 degrees in each direction)

Question 4

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

Answer 4

3; 1

Question 5

Inferior articular facets of the atlas and superior articular facets of the axis form the two ____ atlanto-axial joints.

Answer 5

lateral

note: these facets are large and transversely oriented, allowing for a large amount of mobility

Question 6

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

Answer 6

odontoid process (dens); anterior arch; transverse

note: “no” movement (shake head 45 degrees in each direction)

Question 7

This is a continuation of the anterior longitudinal ligament. It connects the anterior arch of the atlas and anterior margin of foramen magnum.

Answer 7

anterior atlanto-occipital membrane

Question 8

This is in the same relative position as the ligamentum flavum. It connects the posterior arch of atlas and poster margin of foramen magnum.

Answer 8

Posterior atlanto-occipital membrane

Question 9

What artery perforates the inferior margin of the posterior atlanto-occipital membrane?

Answer 9

vertebral

Question 10

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.

Answer 10

tectorial membrane

Question 11

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.

Answer 11

Cruciate ligament

Question 12

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.

Answer 12

alar ligament

Question 13

This ligament provides a weak interconnection between the tip of the dens and the margin of foramen magnum

Answer 13

apical ligament

Question 14

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.

Answer 14

Jefferson’s (Burst) fracture

Question 15

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.

Answer 15

Hangman’s fracture

Question 16

The fracture of the dens is displacement with or without rupture of what ligament?

Answer 16

transverse ligament

Question 17

The pharynx extends from the base of the skull at the ____ ___ to the ____

Answer 17

sphenoidal body; esophagus

note: esophagus and trachea start at same level (C6)

Question 18

The pharynx consists of an outer ____ muscle and an inner ____ muscle and is guarded by a ring of ____ tissue

Answer 18

circular; longitudinal; lymphoid

Question 19

The pharynx has motor innervation primarily by the ____ nerve and sensory innervation via branches of the ____, ____, and ____ nerves

Answer 19

vagus; maxillary, glossopharyngeal, vagus

Question 20

The superior constrictor muscle arises anteriorly from the pterygoid ___ and pterygomandibular ____, where it is continuous with the _____

Answer 20

hamulus; raphe; buccinator

Question 21

The superior constrictor is attached posteriorly to the ____ tubercle at the base of the skull to the ____ ____ at the midline

Answer 21

pharyngeal; pharyngeal raphe

Question 22

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?

Answer 22

phayrgobasilar; 1. levator veli palatini, 2. pharyngotympanic tube 3. ascending palatine artery

Question 23

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.

Answer 23

middle constrictor

Question 24

Posteiorly, the upper fibers of the middle constrictor overlap the lower fibers of the superior constrictor, like stacked cups. True or false?

Answer 24

true

Question 25

Anteriorly, there is a gap between the middle and superior constrictors allowing for the passage of what 3 structures?

Answer 25

stylopharyngeus, stylohyoid ligament, glossopharyngeal n.

Question 26

This muscle arises anteriorly from the oblique line of the thyroid cartilage and from the cricoid cartilage and attaches posteriorly to the pharyngeal raphe.

Answer 26

inferior constrictor

Question 27

Anteriorly, the gap between the middle and inferior constrictors permits the passage of what 2 structures

Answer 27

internal laryngeal nerve and superior laryngeal artery

Question 28

The lower fibers of the inferior constrictor form the ____ that acts as a sphincter between the pharynx and esophagus

Answer 28

cricopharyngeus

Question 29

What nerve and artery enter at the lower border of cricopharyngeus?

Answer 29

recurrent laryngeal nerve and inferior laryngeal artery

Question 30

This internal muscle of the pharynx arises from the pharyngotympanic tube and blends in with the posterior wall of the pharynx

Answer 30

salpingopharyngeus

Question 31

This internal muscle of the pharynx arises from the hard palate and aponeurosis. It blends with the side of the pharyngeal wall.

Answer 31

palatopharyngeus

Question 32

This internal muscle of the pharynx arises from the styloid process and attaches inferiorly to the upper border of the thyroid cartilage

Answer 32

stylpharyngeus

Question 33

Sylopharyngeus is the only muscle of the pharynx that in not innervated by the ___ nerve. It is innervated by the ____ nerve.

Answer 33

vagus; glossopharyngeal

Question 34

This is a thin layer of loose CT that forms the outer covering of the pharynx. The pharyngeal plexus of nerves is embedded here.

Answer 34

buccopharyngeal fascia

Question 35

This fascia fills in the gap between the upper borders of the superior constrictors and the base of the skull

Answer 35

pharyngobasilar fascia

Question 36

For the following artery, name the branch that comes off of it to supply the pharynx and tonsillar regions: ECA

Answer 36

ascending pharyngeal artery

Question 37

For the following artery, name the branch that comes off of it to supply the pharynx and tonsillar regions: Facial artery

Answer 37

ascending palatine artery and tonsillar artery

Question 38

For the following artery, name the branch that comes off of it to supply the pharynx and tonsillar regions: maxillary artery

Answer 38

descending palatine artery and a pharyngeal branch

Question 39

For the following artery, name the branch that comes off of it to supply the pharynx and tonsillar regions: inferior thyroid artery

Answer 39

pharyngeal branches

Question 40

Do branches of the superior thyroid artery supply the pharynx/tonsillar regions?

Answer 40

yes

Question 41

Veins of the pharynx form a minor plexus that drains into the ____ plexus

Answer 41

pterygoid

Question 42

This vein is the source of much of the bleeding in the removal of the palatine tonsils

Answer 42

external palatine vein

Question 43

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

Answer 43

maxillary nerve: upper part glossopharyngeal nerve: lower part, gag reflex (sensory) vagus: gag reflex (motor)

Question 44

Most lymphatic drainage from the pharynx, including the tonsils is mostly to the _____ nodes

Answer 44

jugulodigastric

Question 45

What are the superior and inferior boundaries of the nasopharynx?

Answer 45

superior: body of sphenoid inferior: soft palate note: continuous with nasal cavities via choanae

Question 46

In the nasopharynx, the cartilage of the pharyngotympanic tube forms a bulge called what?

Answer 46

torus tubarius

Question 47

The salpingopalatine fold overlies the tensor veli palatini muscle. What does this muscle do and and what ganglion sits on it?

Answer 47

modifies the auditory tube for air exchange; hooks under pterygoid hamulus where otic ganglion sits on it

Question 48

This is an elevation between the salpingopharyngeal and salpingopalatine folds. It is formed by the underlying LVP

Answer 48

torus levatorius

Question 49

What are the attachments of LVP

Answer 49

between petrous temporal and auditory tube to palatine aponeurosis

Question 50

This is a slit-like space that extends posteriorly and laterally behind the torus tubarius

Answer 50

pharyngeal recess

Question 51

The roof and posterior wall of the nasopharynx contain what?

Answer 51

pharyngeal tonsils

Question 52

What are the boundaries of the oropharynx?

Answer 52

1. separated form the oral cavity by the tongue and palatopharyngeal/palatoglossal arches 2. superior - soft palate 3. inferior - epiglottis

Question 53

In regards to the oropharynx, the space between the palatoglossal arch and palatopharyngeal arch form the tonsillar cleft and contains what?

Answer 53

palatine tonsils

Question 54

In regards to the oropharynx, the tonsillar bed is formed by the ____ fascia and the ____ constrictor muscle

Answer 54

pharyngobasilar; superior

Question 55

In regards to the oropharynx, the base of the tongue facing the pharynx contains a large accumulation of lymphoid tissue forming the ____ _____

Answer 55

lingual tonsils

Question 56

What are the boundaries of the laryngopharynx?

Answer 56

posterior: larynx superior: inferior border of cricoid cartilage inferior: superior border of epiglottis

Question 57

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)

Answer 57

piriform

Question 58

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

Answer 58

Waldeyer's

Question 59

Degulation is the act of swallowing and has three stages. Describe each.

Answer 59

1. voluntary: food is compressed 2. involuntary: the soft palate is elevated to seal nasopharynx, the larynx is elevated, forcing the epiglottis posterior 3. involuntary: contraction of constrictors propel food down to esophagus

Question 60

Where is the deglutition center located?

Answer 60

medulla

Question 61

What is the tensor veli palatini innervated by?

Answer 61

trigeminal nerve