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Anatomy Head And Spine > Ear, Airways and Larynx > Flashcards

Ear, Airways and Larynx Flashcards

1
Q

what is the outer ear made of?

A

auricle

external acoustic meatus (EAM)

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2
Q

what is the function of the EAM?

A

collects vibrations and mediates their passage to the middle ear

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3
Q

what are the depressions, eminences and folds of the auricle?

A

Helix and lobule: Folded outer margin of the auricle
Antihelix: Parallel inner margin
Tragus and antitragus: Eminences anterior and inferior to the EAM respectively
Concha: The auricle’s hollow centre

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4
Q

within which bone does the middle and inner ear lie in?

A

petrous part of the temporal bone

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5
Q

from which structure does the middle ear conduct sound from to the oval window?

A

tympanic membrane

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6
Q

what are the 3 ossicles?

A

Malleus
Incus
Stapes

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7
Q

malleus muscle

A

Tensor tympani muscle (V3): Pulls the handle of the malleus medially. This tenses the tympanic membrane, reducing the force of vibrations in response to loud noises

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8
Q

stapes muscle

A

Stapedius (VII): Pulls the stapes posteriorly to prevent excessive oscillation

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9
Q

what is the function of the pharyngotympanic (Eustachian) tube connection the internal ear to the nasopharynx?

A

Equalises barometric pressure between the middle ear and the external environment

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10
Q

functions of the facial nerve?

A

Motor:

  • Muscles of facial expression and posterior suprahyoid muscles
  • Stapedius
  • Parasympathetic to lacrimal gland, salivary glands, mucous membranes of nasal cavity

Sensory:

  • Taste anterior 2/3 tongue
  • General sensation to external auditory meatus and auricle
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11
Q

nerves of the facial nerve

A 
Extracranial component of facial nerve
Posterior auricular nerve*
Greater petrosal nerve*
Chorda-tympani
Nerve to stapedius
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12
Q

journey of CNVIII in ear

A

Enters the middle ear through the internal acoustic meatus (along with VII) and then splits into the vestibular and cochlear nerves (both SSA).

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13
Q

branches of vestibular nerve

A

1) Upper branch, SSA fibres to the semi-circular canals and utricle
2) Lower branch, SSA fibres to the saccule

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14
Q

where are the vestibulocochlear nuclei located?

A

pons/medulla

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15
Q

VIII nuclei and branches

A

1) cochlear nucleus- cochlea

2) vestibular nuclei- semicircular canals and utricle (upper) + saccule (lower)

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16
Q

features of EAM and tympanic membrane

A 
pars flaccida
lateral process of malleus
posterior malleolar fold
handle of malleus
umbo
cone of light
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17
Q

what is the URT lined with?

A

resp epithelium

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18
Q

what are the two functions of respiratory epithelium?

A

1) removed trapped particles

2) warms and humidifies air

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19
Q

where does the larynx come from in the upper resp tract?

A

in the lower part of the tract

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20
Q

what are the two functions of the larynx?

A

1) sphincter of the lower resp tract

2) specialised for phonation in humans

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21
Q

how is the nose the first line of defence? [3]

A
  • Nasal mucosa and conchae, warm and humidify inhaled air
  • Hairs trap large particles
  • Cilia move rubbish laden mucus to the back to be swallowed
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22
Q

what are the four mechanisms that prevent aspiration?

A

1) gag reflex
2) swallowing
3) sneezing
4) coughing

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23
Q

what are the sensory and motor components of the gag reflex?

A

sensory: soft palate and back of tongue predominantly IX
motor: pharyngeal constrictors (X)

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24
Q

the three phases of swallowing

A

1) oral (voluntary)
2) pharyngeal (reflex)
3) oesophageal

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25
Q

oral phase nerves

A

V, VII, IX, X, XII

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26
Q

pharyngeal phase nerves

A

IX, X, XII

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27
Q

oesophageal phase nerves

A

IX, X

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28
Q

phase 1 of swallowing process

A

1) Food is chewed by the muscles of mastication (V3). Bolus is held on tongue.
2) Elevation of soft palate, tensor and levator palatini (Mandibular V3 and Vagus X, respectively).
3) Bolus into oropharynx, done by the tongue (XII). Airway is still OPEN.

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29
Q

phase 2 of swallowing process

A

1) Triggered when bolus hits pharyngeal arch, tongue (XII) retracts pushing bolus into pharynx
2) Airway CLOSED – action of pharyngeal muscles (X)
3) Bolus propelled through pharynx (pharyngeal constrictors, X)

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30
Q

phase 3 of swallowing process

A

Oesophagus opened, airway closed, breath held. Bolus propelled through oesophagus

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31
Q

afferents and efferents of coughing

A

afferent: X
efferent: V3 and X

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32
Q

afferents and efferents of sneezing

A

afferent: V2 and I
efferent: X

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33
Q

what are the conchae?

A

superior, middle and inferior from 3 recesses

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34
Q

what are the sinuses?

A

frontal
sphenoidal
maxillary
ethmoidal cells

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35
Q

where does the sphenoidal recess drain?

A

sphenoethmoidal recess

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36
Q

where do the posterior ethmoidal cells drain?

A

lateral wall of the superior meatus

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37
Q

where do the middle ethmoidal cells drain?

what also drains here?

A

middle meatus

frontal sinus, anterior ethmoidal cells, maxillary sinuses

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38
Q

where does the lacrimal duct drain?

A

inferior meatus

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39
Q

which sinuses does the ophthalmic (V1) nerve supply?

A

Frontal, sphenoid + ethmoid sinuses

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40
Q

which sinuses does the maxillary (V2) supply?

A

maxillary sinus

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41
Q

frontal sinus innervation

A

Supraorbital branch of Frontal branch of V1

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42
Q

sphenoid sinus innervation

A

Post Ethmoidal branch of Nasociliary of V1

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43
Q

ethmoid sinus innervation

A

Ant and Post Ethmoidal branches of Nasociliary of V1

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44
Q

maxillary sinus innervation

A

Infraorbital branch of V2

45
Q

frontal sinus

A

Superior to the orbit in the frontal bone
Triangular; base parallel to midline and apex 1/3 along orbit
- drains into middle meatus
- innervated by supraorbital branch of V1
- blood supply: Anterior ethmoidal artery (branch of ophthalmic artery

46
Q

sphenoidal sinuses

A

Within the body of sphenoid

  • drains into sphenoethmoidal recess
  • innervated by Posterior ethmoidal branches (of the nasocillary) of V1
  • blood supply: Pharyngeal arteries (maxillary artery)
47
Q

maxillary sinuses

A

Completely fill the bodies of their respective maxillae
Largest paranasal sinus and is pyramidal
- drains into Middle of semilunar hiatus of the middle meatus
- innervated by Infraorbital and alveolar branches of V2
- blood supply: infra-orbital and superior alveolar branches of the maxillary arteries

48
Q

what are the 3 parts of the ethmoid bone?

A

Cribriform plate
Perpendicular plate
Ethmoidal labyrinth

49
Q

ethmoidal sinuses

A

Fill the ethmoidal labyrinth
variable individual air cells (divided into anterior, middle and posterior)
- drains into:
1) Anterior: Nasofrontal duct (15%) or ethmoidal infundibulum
2) Middle: Ethmoidal bulla (directly into the middle meatus)
3) Posterior: Superior meatus (directly)
- innervated by: Anterior and posterior ethmoidal branches (of the nasocillary) of V1 (opthalmic division of trigeminal)
- blood supply: Anterior and posterior ethmoidal (opthalmic)

50
Q

summary of paranasal sinuses:

1) which ones are there?
2) where do most of them drain?
3) innervation?

A

frontal, sphenoidal, ethmoid air cells and maxillary

Mostly drain into the middle meatus
Except for the sphenoid sinus which drains into the sphenoethmoidal recess

Frontal, sphenoid and ethmoid: Ophthalmic division of trigeminal (V1)

Maxillary: Maxillary division of trigeminal (V2)

51
Q

how can infection travel down the Eustachian tube?

A

to the mastoid antrum and air cells and then erode the temporal bone

52
Q

infection from root of teeth

A

reach the maxillary sinuses due to proximity

53
Q

how can pituitary tumours be accessed?

A

surgical route through the sphenoidal sinuses via the nose

54
Q

two functions of larynx?

A

1) protects lower airways

2) phonation

55
Q

where is the larynx located?

A

under the hyoid bone and above the trachea

56
Q

what is the innervation to the larynx?

A

X entirely

57
Q

vagus branches that innervate the larynx

A

1) Superior Laryngeal

2) Recurrent Laryngeal - sensation below vocal folds and all other muscles

58
Q

superior laryngeal innervation of the larynx

A

Internal – sensation above vocal folds

External – one muscle, the cricothyroid

59
Q

what is damage to the recurrent laryngeal associated with?

A

Damage to recurrent laryngeal is associated with hoarseness and deepening voice. Bilateral damage can be life-threatening.

60
Q

what are the 3 unpaired cartilages of the larynx?

A

Cricoid
Thyroid
Epiglottis

61
Q

what are the 3 paired cartilages of the larynx?

A

Arytenoid
Corniculate
Cuneiform

62
Q

what are the 2 extrinsic membranes of the larynx?

A

Thyrohyoid membrane

Cricotracheal ligament

63
Q

what are the 2 instrinsic membranes of the larynx?

A

Cricothyroid

Quadrangular

64
Q

4 main muscles of the larynx

A

1) transverse arytenoid muscle
2) thryoarytenoid muscle
3) posterior cricoarytenoid muscle
4) lateral cricoarytenoid muscle

65
Q

which is the lowest unpaired cartilage in the larynx?

A

cricoid (the only complete cartilaginous ring in all air passages)

66
Q

thryoid angle

A

90-120 degrees

67
Q

what does anterior movement of the thyroid result in?

what joint facilities this?

A

stretching of the vocal ligament

cricothryoid joint

68
Q

what does the cricoid ligament connect?

A

cricoid to thyroid cartilages

69
Q

what does the cricoid ligament form at the superior border?

A

vocal ligament (thickened)

70
Q

what does the vocal ligament attach to?

A

vocal process of the arytenoid cartilage

71
Q

what does the cricoarytenoid joint enable?

A

allows abduction and adduction of the vocal ligaments (and also vestibular, to a smaller degree)

72
Q

what is the space between the vocal ligaments called?

A

rima glottides

73
Q

how is the epiglottis attached to the thyroid?

A

thyroepiglottic ligament

74
Q

what motion of the epiglottis carries out its function?

A

Retroflexes over the pharyngeal isthmus to protect it during swallowing

75
Q

superior and inferior attachments of quadrangular membrane?

A

It is superiorly connected to epiglottis and inferiorly to the thyroid and arytenoids

76
Q

what does the quadrangular membrane form at the inferior border?

A

vestibular ligament (thickened)

77
Q

membranes and the ligament they form

A

cricothyroid ligament forms the vocal ligament (superior)

quadrangular membrane forms the vestibular ligament (inferior)

78
Q

which nerve innervates the larynx?

what are there main branches

A

vagus

  • superior laryngeal nerve
  • recurrent laryngeal nerve
79
Q

what are the branches of the superior laryngeal nerve and what do they provide?

A

Internal laryngeal nerve:
All sensation above the vocal folds

External laryngeal nerve:
Cricothyroid muscle only

80
Q

what is the function of the recurrent laryngeal nerve?

A

All sensation below the vocal folds

All muscles of the larynx except cricothyroid

81
Q

what is the effect of movement of the cartilages?

A

the movement of the thyroid and arytenoid will cause movement of the vocal ligaments and results in altered phonation

82
Q

what does the movement of the arytenoid also caused alongside movement of the vocal ligament?

A

movement of the vestibular ligament

this provides the protective function of the airway

83
Q

what will the movement of the epiglottis cover?

A

cover the pharyngeal isthmus

serves as protection

84
Q

what innervates the cricothyroid muscle?

A

external laryngeal nerve (inferior to the internal)

85
Q

the movement of the cricothyroid muscle?

A

forward and downward movement of thyroid cartilage along cricothyroid joint
(made of straight and oblique parts)
increases tension on vocal ligaments

86
Q

what muscle adjusts tension on the vocal ligaments?

A

vocalis

87
Q

movement go the posterior crico-arytenoid?

what is the purpose of this movement?

A

Abduction of the vocal ligaments

Increased air flow = increased volume of sound

88
Q

movement of the lateral crico-arytenoid?

A

Adduction of the vocal ligaments

89
Q

movement of the transverse arytenoid?

A

adduction of the arytenoid cartilages

90
Q

movement of thyroid-arytenoid and oblique arytenoid muscles?

A

Sphincter of laryngeal inlet

Narrows the laryngeal inlet by pulling arytenoid cartilages forward while pulling the epiglottis toward the arytenoid cartilages

Contraction occurs as part of pharyngeal phase of swallowing

91
Q

what is the effect of damage to the vagus before branching to the superior laryngeal nerve?

A

complete paralysis

92
Q

what is the effect of lesion of the internal laryngeal nerve?

A

loss of sensation above the vocal folds

93
Q

what is the effect of lesion of the external laryngeal nerve?

A

paralysis of the cricothyroids

94
Q

what is the effect of lesion of the recurrent laryngeal nerve?

A

paralysis of all muscles of the larynx except cricothyroid

loss of sensation below the vocal folds

95
Q

which artery does the superior laryngeal nerve travel alongside?

what is this artery a branch of?

what is an effect of a lesion of this artery?

A

superior thyroid artery

branch of the external carotid artery

can affect action the cricothyroid

96
Q

which artery does the recurrent laryngeal nerve travel past upwards then behind?

how is this relevant in surgery?

A

inferior thyroid artery

the nerve is vulnerable in surgery that involves ligating the inferior thyroid artery

97
Q

what can cause compression of the recurrent laryngeal?

what is the effect of this compression?

A

a bronchial/oesophageal tumour
mediastinal lymphadenopathy

results in hoarseness, breathlessness or both

(inferior thyroid artery supply superior oesophagus and trachea)

98
Q

sneeze reflex

A

via afferents via maxillary division (V2)

inspiration
intrathoracic pressure increased by glottis closure, abdominal muscle contraction

soft palate depression against tongue via palatopharyngeus/palatoglossis (branch of X)

sudden abduction of the vocal folds to release the intrathoracic pressure via nose or mouth

99
Q

cough reflex

A

via afferents via vagus branches

inspiration
intrathoracic pressure increased by glottis closure, abdominal muscle contraction

soft palate raised and tensed against posterior wall of pharynx
via Levator veli palatine (X), tensor veli palatine (V3), superior constrictor (X)

sudden abduction of the vocal folds to release the intrathoracic pressure via nose or mouth

100
Q

how can the airways be managed in an emergency?

A
  • Chin lift/ Jaw thrust
  • Oropharyngeal/Nasopharygeal airway
  • Endotracheal intubation
  • Cricothyroidotomy (through the Cricothyroid membrane)
  • Tracheostomy
101
Q

where is a tracheostomy performed?

A

Between tracheal rings

skin –> superficial cervical fascia –> platysma –> Deep cervical fascia –> strap muscles –> pretracheal fascia –> thyroid isthmus –> stoma in 2nd , 3rd & 4th rings

102
Q

6 functions of the facial nerve

A

1) salivation
2) lacrimation
3) facial expression
4) taste
5) mastication and swallowing
6) general sensation

also provides tension to middle ear bones (innervation to stapedius)

103
Q

salivation via CNVII

A

VII provides GVE fibres from the superior salivary nucleus destined for submandibular and sublingual salivary glands via the SUBMANDIBULAR ganglion

104
Q

lacrimation via CNVII

A

VII provides GVE fibres from the superior salivary nucleus destined for LACRIMAL gland via PTERYGOPALATINE ganglion.

105
Q

taste via CNVII

A

SVA fibres from anterior two thirds of tongue to the solitary nucleus via the geniculate ganglion

106
Q

mastication and swallowing via CNVII

A

SVE fibres to the buccinator (mastication), raising larynx during swallowing, innervates stylohyoid and posterior belly of digastric

107
Q

nucleus for salivation, lacrimation, taste

A

superior salivatory nucleus

108
Q

nucleus for stapedius and facial expression

A

facial nucleus

Anatomy Head And Spine (5 decks)

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