ENT Flashcards
What is oral vestibule
The area located between the internal surface of the lips and external surface of the teeth
What is the oral cavity proper
The area located between the internal surface of teeth and the oropharynx
Boundaries of oropharynx
soft palate -> epiglottis
2 parts of palate
Hard palate - bone (maxilla)
Soft palate - muscle fibres covered by mucous membrane
What structures pass through the incisive foramen
Nasopalatine nerve
Greater palatine artery
Nasopalatine nerve is a branch of
CN V2 Maxillary division of trigeminal nerve
Name A-E
A- incisive foramen
B- Palatine bone
C- Lesser palatine foramen
D- Greater palatine foramen
E- minor salivary glands in palatal mucosa
The soft palate is made of
5 muscles
What are the muscles of the soft palate
Tensor veli palatini
Levator veli palatini
Palatopharyngeus
Palatoglossus
Muscle of the uvula
Function of the soft palate
Elevates and tenses when swallowing to prevent the passage of food into nasal cavity
Function of tensor veli palatini
Tenses palatine aponeurosis
Function of levator veli palatini
Elevates palatine aponeurosis
Function of palatopharyngeus muscle
Elevates the pharynx and depresses soft palate
Function of palatoglossus muscle
Depress the soft palate
Elevate the posterior portion of the tongue
Function of muscle of uvula
Shortens the uvula
Innervation of the soft palate muscles
All innervated by CN X EXCEPT tensor veli palatini
Tensor veli palatini - CN V3
Name A-E
A- tensor veli palatini
B- levator veli palatini
C- palatine tonsil
D- Palatopharyngeus
E- palatoglossus
Name A-D
A- tensor veli palatini
B- levator veli palatini
C- palatine aponeurosis
D- Eustachian tube
name A-D
A- levator veli palatini
B- muscle of uvula
C- tensor veli palatini
D- palatopharyngeus
Describe the sensory innervation of the palate
Hard palate - Nasopalatine nerve
Soft palate - Lesser palatine nerve
Describe the secretomotor innervation of the glands in hard palate
Facial nerve CN VII
What does the greater palatine nerve innervate
Sensory innervation of glands of hard palate
Describe the innervation of anterior 2/3 of tongue
General sensory - lingual nerve of CN V3
Special sensory - chorda tympani CN VII
Describe the innervation of posterior 1/3 of tongue
General sensory and special sensory - glossopharyngeal nerve CN IX
Name A-D
A- foliate papillae
B- vallate papillae
C- fungiform papillae
D- filiform papillae
Which papillae of the tongue have taste buds
Foliate
Vallate
Fungiform
Function of filiform papillae
For touch, temperature
Function of the saliva
Moisten food for swallowing
Initiate digestion of carbohydrates
Control bacterial flora
Provide a medium for dissolved food to stimulate taste buds
Name A-D
A- parotid gland
B- submandibular gland
C- submandibular duct
D- sublingual gland
Where is the parotid duct opening located at
Upper 2nd molar teeth
Where does the submandibular drain into
drains into the floor of mouth via sublingual caruncle
Where does the sublingual gland drain into
Floor of the mouth via several ducts
Name A-F
A- sublingual ducts
B- sublingual gland
C- submandibular duct
D- submandibular gland
E- parotid duct
F- Parotid gland
The parotid gland is innervated by
glossopharyngeal nerve CN IX
The sublingual and submandibular glands are innervated by
Chorda tympani branch of CN VII and lingual branch of CN V3
What are the secretory units of salivary gland called
serous acinus - secretes enzymes
mucous acinus - secretes mucin
Describe the difference in staining of the acini
Serous acinus - dark staining
Mucous acinus - clear grey staining
Which salivary gland has the most serous acinus (darkest stained in histology)
Parotid
Which salivary gland has the most mucous acinus (lightest stained)
Sublingual
What are the extrinsic muscles of the tongue
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
Name A-E
A- palatoglossus
B- styloglossus
C- hyoglossus
D- geniohyoid
E- genioglossus
Describe the innervation of the extrinsic muscles of the tongue
Hypoglossal nerve CN XII
Except palatoglossus - CN X
Describe the innervation of the intrinsic muscles of the tongue
Hypoglossal nerve CN XII
Name A-D
A- opening of the Eustachian tube
B- Adenoid tonsils
C- Palatine tonsil
D- lingual tonsil
Describe the relation between palatine and lingual tonsils
Palatine tonsils are continuous inferiorly with the lingual tonsil
The point of attachment = plica triangularis
What must be removed in tonsillectomy
Plica triangularis
What may occur in tonsillectomy due to extensive hypertrophy of the tonsils
Bleeding at the base of the tongue due to extensive tissue taken
Function of the tonsils
Trap bacteria and viruses on inhalation to expose these to the immune system
What are the outer circular muscles of the pharynx
Superior pharyngeal constrictor
Middle pharyngeal constrictor
Inferior pharyngeal constrictor
Function of constrictor muscles of the pharynx
sequential contraction from the superior to inferior to force the bolus of food down
What are the inner longitudinal muscles of the pharynx
stylopharyngeus
salpingopharyngeus
palatopharyngeus
Function of the inner longitudinal muscles of the pharynx
Elevate the larynx and shorten the pharynx
Why is it important to elevate the larynx while swallowing
So it closes the larynx to prevent inhaling the food and also opens the upper esophageal sphincter
Which nerve innervates the inner pharyngeal muscles
Vagus nerve CN X
EXCEPT stylopharyngeus - CN IX glossopharyngeal
Name A-F
A- stylopharyngeal
B- superior pharyngeal constrictor
C- middle pharyngeal constrictor
D- inferior pharyngeal constrictor
E- salpingopharyngeus
F- palatopharyngeus
What is the parapharyngeal space
triangular area between the base of skull and hyoid bone
What structures lie in the parapharyngeal space
Pharyngeal plexus formed by CN IX and CN X
What infection may spread to parapharyngeal space
tonsillitis
Name this space
Retropharyngeal space
Stimuli of the pharyngeal gag reflex is presented to which parts to trigger it
Posterior 1/3 of. tongue
Palatine tonsils
Wall of oropharynx
Which nerve senses a stimuli to trigger the gag reflex
CN IX
Which muscles are involved in the gag reflex
Constrictors of the pharynx
Longitudinal muscles of the pharynx
Tongue
Soft palate
Which nerves innervate the muscles of the gag reflex
Constrictors of the pharynx - CN X
Longitudinal muscles of the pharynx - CN X and CN IX (stylopharyngeus)
Tongue - CN XII except palatoglossus CN X
Soft palate - CN X and CN V3 (tensor veli palatini)
Name B-I
B- arytenoid cartilage
C- hyoid bone
D- epiglottitis
E- laryngeal promience
F- cricoid cartilage
G- thyrohyoid membrane
H- superior horn of thyroid cartilage
I- inferior horn of thyroid cartilage
Name A-F
A- vestibular ligament
B- vocal ligament
C- quadrangular membrane
D- conus elasticus
E- vocal process
F- muscular process
Describe the borders of quadrangular membrane
From epiglottitis -> vestibular ligament
Describe the borders of conus elasticus
From vocal ligament -> cricoid cartilage
Name A-D
A- laryngeal inlet
B- false vocal cord (vestibular ligament)
C- Vocal ligament
D- laryngeal ventricle
The laryngeal vestibule and laryngeal ventricle are infra/supraglottis
supra glottis - above the vocal cords
What are the extrinsic muscles of the larynx
Suprahyoid muscles (Digastric, mylohyoid, geniohyoid, stylohyoid)
Infrahyoid muscles (thyrohyoid, omohyoid, sternohyoid)
Stylopharyngeus
Function of the extrinsic muscles of the larynx
suprahyoid and stylopharyngeus muscles move the larynx superiorly
infrahyoid muscles move the larynx inferiorly
Name A-J
A- mylohyoid
B- Anterior belly of digastric
C- posterior belly of digastric
D- hyoid bone
E- Omohyoid
F- sternohyoid
G- sternocleidomastoid
H- thyrohyoid
I- stylohyoid
J- geniohyoid
Function of the intrinsic muscles of the larynx
Control the shape of rima glottidis
Sound production
What are the intrinsic muscles of the larynx
Cricothyroid
Thyroarytenoid
Lateral cricoarytenoid
Posterior cricoarytenoid
Arytenoid (transverse and oblique)
Name A-E
A- transverse arytenoid
B- posterior cricoarytenoid
C- cricothyroid
D- thyroarytenoid
E- lateral cricoarytenoid
Function of thyroarytenoid muscle
Relaxes the vocal ligament -> decreases the pitch
Function of lateral cricoarytenoid muscle
Adducts vocal ligament = closes the rima glottidis
Function of arytenoid muscles
Adducts the arytenoid cartilages
Function of the posterior cricoarytenoid muscle
Abduction of the vocal cord = widens the rima glottidis
Function of the cricothyroid muscle
Stretches and tenses the vocal ligament -> increases the pitch
Describe the innervation of the intrinsic muscles of the larynx
All by recurrent laryngeal nerve, branch of CN X
EXCEPT cricothyroid - superior laryngeal nerve, branch of CN X
What surgery can damage the recurrent laryngeal nerve
Thyroidectomy
Symptoms of recurrent laryngeal nerve damage
Hoarseness
Dysphonia
Dyspnoea
Describe the cough reflex
- sensory stimuli in supra glottis conveyed to brainstem via superior laryngeal nerve CN X
- glottic closure by lateral cricoarytenoid and arytenoid muscles
- Intercostal muscles and diaphragm muscles contract to increase body cavity pressure
- glottic release air at high velocity
What are the blood vessels that supply the larynx
Superior laryngeal artery
inferior laryngeal artery
Superior laryngeal artery is a branch of
superior thyroid artery, a branch from external carotid artery
Inferior laryngeal artery is a branch of
Inferior thyroid artery
Name A-I
A- superior thyroid artery
B- superior laryngeal artery
C- Inferior laryngeal artery
D- Inferior thyroid artery
E- Right subclavian artery
F- Brachiocephalic trunk
G- Left recurrent laryngeal nerve
H- superior laryngeal nerve (internal branch)
I- Vagus nerve
Describe the course of facial nerve
- Arise from the pons beginning as 2 roots - sensory and motor
- The 2 roots then travel through internal acoustic meatus to enter the temporal bone
- Enters the facial canal
- The 2 roots fuse to form the facial nerve
- then forms the geniculate ganglion and give rise to its branches
- the facial nerve then exits the facial canal via stylomastoid foramen and give off its motor branches
What are the branches of facial nerve formed after it enters the internal acoustic meatus
Greater petrosal nerve
Nerve to stapedius
Chorda tympani
Which branch of the facial nerve is formed in the facial canal
Chorda tympani
Where does the greater petrosal nerve arise from
at geniculate ganglion
Function of greater petrosal nerve
parasympathetic fibres to lacrimal gland and mucous glands (pharynx, palate and nasal cavity)
Function of nerve to stapedius
motor fibres to stapedius muscle of the middle ear
Function of chorda tympani
Special sensory fibres to anterior 2/3 of tongue
Parasympathetic fibres to submandibular and sublingual glands
Name A-G
A- nerve to stapedius
B- geniculate ganglion
C- mastoid air cells
D- stylomastoid foramen
E- chorda tympani
F- pterygopalatine ganglion
G- facial canal
How does chorda tympani leave the cranium
via petrotympanic fissure
What are the motor branches of facial nerve
Nerve to stapedius (given off at facial canal)
Posterior auricular nerve
Nerve to posterior belly of digastric muscle
Nerve to stylohyoid muscle
5 motor branches for muscles of facial expression
Nerve to posterior belly of digastric muscle, posterior auricular nerve, nerve to stylohyoid muscle all arise at
between stylomastoid foramen and parotid gland
Where do the 5 branches for muscles of facial expression arise at
within the parotid gland
Name A-G
A- temporal branch
B- Zygomatic branch
C- Buccal branch
D- Marginal branch
E- Cervical branch
F- posterior auricular branch
G- parotid gland
The chorda tympani combines with _____ nerve to form the _____
Combine with lingual nerve to form the submandibular ganglion
Where does chorda tympani join with lingual nerve
Infratemporal fossa
Lingual nerve is a branch of
mandibular division of trigeminal nerve CN V3
Function of lingual nerve
General sensory to anterior 2/3 of tongue
What happens if facial nerve is damaged due to intracranial lesions
Dry eyes
Dry mucous membranes
Dry mouth
Loss of taste
Facial paralysis
Describe the route of greater petrosal nerve
- Branches off from facial nerve before entering the facial canal
- Goes along the hiatus for greater petrosal nerve and carries presynaptic parasympathetic fibres to the pterygopalatine ganglion
- Deep petrosal nerve joins with the greater petrosal nerve and travels to the ganglion but does not synapse there
- Parasympathetic nerve fibres from greater petrosal nerve synapses at the ganglion
- Post synaptic parasympathetic fibres travel to the lacrimal gland and mucosa
What type of nerve fibres synapse at the pterygopalatine ganglion
Parasympathetic nerve fibres
Where do the parasympathetic nerve fibres of greater petrosal nerve go to
lacrimal gland
Pharynx
Palate
Nasal mucosa
What nerve fibres does deep petrosal nerve carry
Post-synaptic SYMPATHETIC nerve fibres to the pharynx, palate and nasal mucosa
Which nerves pass through the pterygopalatine ganglion but do not synapse
Deep petrosal nerve
CN V2 (only sensory)
