ENT Anatomy Flashcards
1
Q
Function of nasal cavity? (5)
A
Acts as a patent conduit for air to be transported to the nasopharynx
Filters air of particulate material (vibrissae = small hairs)
Humidifies air (glands)
Warms inspired air in the nasal passage (blood)
Sense of smell as air passes over the olfactory epithelium
2
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A
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3
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4
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5
Q
Ethmoid bone relation to nasal cavity?
A
Ethmoid bone forms parts of the roof, lateral walls and septum of the nasal cavity
6
Q
A
Arrow pointing to sella turcica (hypophyseal fossa contains pituitary gland)
7
Q
What splits the left and right nasal cavities?
A
Vomer
8
Q
Which fractures can disrupt the cribiform plate of the ethmoid?
S/s? (2)
A
Le fort II and III fractures
* Anosomia (loss of smell) - however, olfactory nerve can regerate so can get sense of smell back
* Facilitate spread of infection
9
Q
Nasal mucosa? (3)
A
Nasal vestibule
* stratified squamous epithelium (keratinsied to non-keratinised)
Nasal cavity
* respiratory epithelium
* olfactory epithelium
10
Q
How are olfactory nerves described?
Which nerve?
A
hairs of toothbrush coming down through cribiform plate
* CN I - olfactory nerve
11
Q
Olfactory pathway? (5)
A
- Receptor cells in the olfactory epithelium
- Pass up through cribriform plate
- Synapse with olfactory bulb (ganglion)
- Then neurons pass along olfactory tract
- To Temporal lobe and olfactory areas
12
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A
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13
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A
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14
Q
Somatic sensory to nasal cavity?
A
CN V1 - opthalmic division of trigeminal nerve (upper half)
CN V2 - maxillary division of trigeminal nerve (lower half)
15
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A
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16
Q
Explain course of anterior ethmoidal nerve (CN V1) and nasopalatine nerve (CN V2)?
Function?
A
Anterior ethmoidal nerve is a branch of CN V1. It passes through the anterior ethmoidal foramen.
Nasopalatine nerve is a branch of CN V2, passing through the sphenopalatine foramen.
Function = somatic sensory
* temperature, pain, touch
17
Q
Blood supply to face? (3)
Origins?
A
Opthalmic artery - internal carotid artery
Facial artery - external carotid
Maxillary artery - external carotid
18
Q
blood supply to nasal cavity?
A
* Anterior + posterior ethmoidal artery - from opthalmic artery
* sphenopalatine + greater palatine artery - from maxillary artery
* lateral nasal and septal branches - facial artery
19
Q
What is Kiesselbach’s (Little’s) area? (2)
What occurs there?
A
Site where anastomosis occurs between nasal arteries
Located anteroinferiorly on nasal septum
* EPITAXIS - nose bleed
20
Q
What conchae project from lateral nasal wall?
A
* Superior nasal concha
* Middle nasal concha
* inferior nasal concha
21
Q
A
a) sphenoethmoidal recess
b) superior meatus
c) middle meatus
d) inferior meatus
1,2,3 = nasal concahe
22
Q
A
Inserted below inferior concha
* need anaesthetic or can cause gag reflex
23
Q
What is the sensory nerve supply of inferior nasal concha?
A
CN V2
24
Q
What are conchae often referred to as? Why?
What can airflow through nose be impacted by?
Explain
A
Turbinates - they cause turbulent airflow thru nasal cavity
* airflow thru nose impacted by engorgement of nasal mucosa
* one side will be engorged then change to other side every 1-5 hours
25
is this worrying?
No - just engorgement of nasal mucosa on one side
26
What are paranasal sinuses?
Explain arrangement within nasal cavity? (4)
What are they lined with?
Open spaces within bone
4 bilateral pairs assoctaed with nasal cavity
\* frontal sinuses
\* ethmoidal air cells
\* maxillary sinuses
\* sphenoid sinuses
Each sinus lined with respiratory epithelium
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Paranasal sinuses = dark because they have air
(maxillary sinus on floor of orbit)
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paranasal sinuses
30
Drainage of paranasal sinuses? (5)
\* Sphenoid sinus = sphenoethmoidal recess
\* Postrior ethmoidal air cells = superior meatus
\* frontal sinus, maxillary sinus + anterior ethmoidal air cells = middle meatus (semilunar hiatus)
\* Middle ethmoidal cair cells = middle meatus (ethmoidal bulla)
\* Nasolacrimal duct = inferior meatus
31
Where do paranasal sinuses drain eventually?
GI system
32
Lacrimal fluid drainage?
Lacrimal fluid drains inferomedially to the nasolacrimal duct which drains to inferior meatus
33
Sinusitits?
Inflammation of mucosa in 1 or more of the paranasal sinuses
34
Complications of sinusitis?
Ifected mucous can cause increased pressure in ethmoid and break the medial wall of the orbit and impact the eye/spread infection to optic nerve
35
What is painful sensation in sinusitis caused by?
CN V1 and V2 - may be referred to teeth
36
Which sinus is predisposed to infection?
Why?
Maxillary sinus
\* ostium of maxillary sinus is superior in relation to cavity - cilia must work against gravity
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What is the ora-antral fistula? (remeber antrum is another name for maxillary sinus)
Complications of this? (2)
Communication between maxillary sinus and tooth socket
\* tooth infection can lead to sinus infections
\* sinusitis can be referred to teeth
39
Divisions of the ear? (2)
Where are these divisions located?
Anatomical divisions
\* external ear
\* middle ear
\* inner ear
Functional divisions
\* hearing (auditory system)
\* balance (vestibular system)
ALL LOCATED IN TEMPORAL BONE
40
What is tympanic membrane?
Eardrum
41
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42
What does temporal bone contain? (2)
\* organs of hearing and balance (special sensory)
\* contains facial and vestibulocochlear nerves (CN VIII)
43
What is the pterion?
Complications of pterion?
H-shaped structure
\* made up of frontal, parietal, temporal and sphenoid
\* THINNEST part of skull
Because it is so thin, it can break and rupture middle meningeal artery
44
Processes of temporal bone?
\* zygomatic process - gives rise to zygomatic arch (CN 7 + 8 pass thru)
\* styloid process
\* mastoid process
(also eternal acoustic meatus!)
45
Petrous = rock-like
Ethmoid bone in pink
Facial nerve exits through **stylomastoid foramen**
46
What does facial nerve exit thru?
Stylomastoid foramen
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48
Which cranial nerves pass thru internal acoustic meatus?
CN VII
\* motor to face + stapedius
\* taste to ant. 2/3rds tongue
\* secretomotor to lacrimal + salivary glands
\* sensation to external ear
CN VIII (vestibulocochlear nerve)
\* balance
\* hearing
49
What vasculature passes thru internal acoustic meatus?
Labyrinthe artery + vein
\* branch of anterior inferior cerebellar artery
\* from circle of willis
50
External ear function?
\* auricle to tympanic membrane
\* external acoustic meatus
\* **collects and conveys sound waves to tympanic membrane**
51
Middle ear function?
\* tympanic membrane to oval window
\* also Eustachian tube
\* **amplifies and conducts sound waves to internal ear**
52
Function of internal ear?
\* oval window to internal acoustic meatus
\* **converts special sensory information:** into fluid waves, then APs to brain
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Where does ear canal begin?
Made up of?
What does it produce?
Begins at external acoustic meatus
\* composed of outer 1/3 elastic cartilage, inner 2/3 bony
\* produces **earwax** via **ceruminous glands**
57
What is the auricle (pinna)?
Label parts of ear
Visible part of the ear
58
Innervation of auricle
tympanic membrane - 2/3rds is CNV3, 1/3rd CN X
\* CNV3 = superior parts of EAM + tympanic membrane
\* CN X = infrior parts of EAM + tympanic membrane
59
Lymphatic drainage of auricle?
\* lateral surface of superior half to parotid lymph nodes
\* cranial surface of superior half to mastoid lymph nodes (and deep cervical)
\* rest of auricle to supeifical cervical lymph nodes
ALL EVENTUALLY DRAIN INTO DEEP CERVICAL NODES
then thoracic duct or right lymphatic duct at venous angles
60
Otoscopic examination?
Explain process
Examination of EAM and tympanic membrane
\* in child = EAM is short and straight. Careful not to damage tympanic membrane when gently pull auricle **posteroinferiorly**
\* •In an adult – EAM is curved. Gently pull auricle **posterosuperiorly**
61
What is the pars flaccida?
Pars tensa?
Flaccida = thin part of the tympanic membrane (superiorly)
Para tensa = thick part of the tympanic membrane (posteroinferiorly)
62
What is umbo?
the most inwardly depressed part of the tympanic membrane
63
Internal surface of tympanic membrane supplied by?
CN IX
64
Glossoparyngeal nerve (CN IX) provides sensory innervation to? (5)
* Middle ear cavity
* Eustachian tube
* Nasopharynx
* Oropharynx
* Tonsils
65
Middle ear contains? (3)
3 bones
\* malleus
\* incus
\* stapes
2 muscles
\* stapedius
\* tensor tympani
Nerve branches from
\* facial nerve
\* glossopharyngeal nerve
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69
Eustachian tube?
Function?
Complications?
Auditory tube, pharyngotympanic tube
\* connects anterior wall of middle ear cavity to nasopharynx
\* comps: bacteria and viruses can spread between the 2 i.e from pharynx/tonsils, reuslting in pain and hearing loss
(CN IX is common sensory nerve supply - pain from tonsilitis can mimic earache)
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71
Nasopharynx/oropharynx sensory innervation?
Laryngopharynx?
\* naso/oro = CN IX
\* laryngo = CN X
72
Facial nerve composed of? (4)
Explain course
Special sensory, sesnory, motor and parasympathetic
\* comes from pontomedullary junction
\* passes through internal acoustic meatus
\* splits and passes through stylomastoid foramen
73
What connects the internal acoustic meatus to the stylomastoid foramen?
**facial canal of the temporal bone** - so CN VII passes through here to get to stylomastoid foramen
74
What is the stapedius?
Function?
Smallest skeletal muscle in the body
\* reduces stapes movement to protect the internal ear from excessive noise
75
What is chorda tympani?
Function? (2)
Branch of CN VII
\* taste buds of the anterior 2/3rds of tongue
\* parasympathetic supply to submandibuar and sublingual salivary glands (connects to lingual nerve branch of CN V3)
76
Frontalis - raises eyebrows
Puff out and tap cheeks - obicularis oculi
77
Function of inner ear?
Innervation?
Converts special sensory information
CN VIII in 2 parts (vestiulocochlear nerve)
\* cochlear nerve (hearing)
\* vestibular nerve (balance)
78
where is otic capsule found?
What is it?
What does it contain?
Inner ear
\* densest bone in body
\* contains bony labyrinth (contains perilymph fluid) and communicating sacs and ducts (contain endolymph fluid)
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81
Vestibular apparatus? (3)
Explain
\* ampullae
\* urticle
\* saccule
\* hair cells stimulated by movement of endolymph
\* clusters of hair cells in regions maculae
\* semicircular ducts detect angular **movement change**
**\*** utricle and saccule detect **linear** movement change
\* utricle (horizontal)
\* saccule (verticle)
82
Explain sound transmission in internal ear
83
Cochlear apparatus?
84
Explain cochlear apparatus function
receptor cells in organ corti detect auditory stimuli (located on basilar membrane of cochlear duct)
\* cochlae duct is suspected by spiral ligaent and divded cochlaer canal into 2 parts
\* scala vestibuli
\* scala tympani
85
Explain route of vestibulocochlear nerve?
\* CN VIII comes from ponmedullary junction
\* exits at internal acoustic meatus
\* splits into cochlear and vestibular nerve axons
\* vestibular nerve axons from the semicircular ducts (+ the saccular + utricle)
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What is middle ear lined with?
What openings does it contain? (2)
columnar lined mucosa
\* contains openings to eustachian tube and mastoid cavity
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91
What is respiratory epithelium?
pseudostratified ciliated columnar
92
what is throat lined with?
respiratory and squamous epithelium depending on site
93
Components of salivary glands? (3)
\* Serous cells - darkly staining (contain digestive enzymes including amylase)
\* Mucinous component - clear grey staining
\* Peripheral myoepithelial cells - have contractile properties
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Serous cells (right) -darker, most likely parotid gland
Mucinous cells (left) - sublingual mostly mucinous
Submandibular - both
95
Pathology of the ear?
\* otitis media
\* cholesteatoma
\* tumours - bestibular schwannoma
96
What organisms can cause CHRONIC otitis media (middle ear inflammation)? (3)
Pseudomonas auerginosa, staph aureus, fungal
97
Cholesteatoma?
Where is it found?
Ax?
Not a tumour and doesn't contain cholesterol
\* superior posterior middle ear and/or petrous apex
\* Ax = chronic otitis media and perforted typanic membrane (acquired)
98
Pathogenesis cholesteatoma?
Normal lining of middle ear is cuboidal/columnar epithelium
\* turns into squamous epithelium and produces lots of keratin
\* associated inflammation
99
Keratin production
Cholesteatoma in suprior aspect, below that is tympanic membrane
100
What is vestibular schwannoma associated with?
Associated with vestibular portion of vestibulocochlear nerve (VIII)
\* MOST COMMON tumour of **temporal bone**
101
vestibular schwannoma
\* white tumour, temporal bone, well-defined margin
102
Ax vestibular schwannoma?
Most are unilateral and sporadic
\* if bilateral and young - consider neurofibromatosis type 2
103
Appearance vestibular schwannoma?
tan, white, yellow mass
104
vestibular shwannoma - looks like a tiger
105
Ax nasal polyps?
Allergy, infection, asthma, nickel exposure
\* if young, consider **cystic fibrosis**
106
nasal polyps
107
Granulomatosis with polyangitis (GPA)?
* Wegner’s granulomatosis
* Autoimmune disorder of unknown aetiology characterised by a small vessel vasculitis and necrosis, usually limited to respiratory tract and kidneys
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Dx GPA?
* Characterised by high frequency of anti-neutrophil antibody levels – ANCA +ve
* cANCA – GPA
* pANCA – microscopic polyangiitis
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GPA
multineucleate giant cells
Inflammatory cells
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Nasal tumours?
\* benign - squamous papillomas, “Schneiderian” papillomas. Angiofibromas
\* malignant - squamous cell carcinoma, also less commonly: adenocarcinoma, nasopharyngeal carcinoma, neuroblastoma, lymphoma
111
Types of schneiderian papilloma?
Ax? (3)
•Inverted, exophytic or oncocytic
\* HPV, smoking, organic solvents
112
s/s Schneiderian papilloma?
Blocked nose
113
Where are schneiderian papillomas?
•Inverted and oncocytic on lateral walls and paranasal sinuses,
\* exophytic on nasal septum
114
Inverted subtype of schneiderian papilloma
(can become malignant SCC)
115
Nasopharyngeal carcinoma associated with?
EBV and volatile nitroasamines in food
116
What malignancies in EBV associated with?
Why?
B cell lymphomas + Hodgkin's
\* mimics helper T cells, leading to proliferatin and survival of B cells
117
Ax laryngeal polyps?
Change in laryngeal mucosa secondary to vocal abuse (singers), infection and smoking
118
Laryngeal polyps
\*dilated blood vessels
\* stroma - fibrinous
119
Contact ulcer throat?
Ax? (4)
Posterior vocal cord
\* chronic throat clearing, voice abuse, GORD, intubation
120
laryngeal contact ulcer
121
Squamous papilloma associated with?
groups affected?
HPV
\* in children it is far more aggressive!!
122
Squamous papilloma
123
Paraganglioma?
How to differentiate?
Tumours arising in clusters of neuroendocrine cells throughout body
\* Chromaffin positive = adrenal medulla (phaeochromocytoma, chromaffin associated with catecholamines)
\* Non-chromaffin = nose + throat
124
What are paragangliomas associated with?
Multiple endocrine neoplasia 2
125
Risk factors SCC?
Smoking, alcohol + HPV (esp. in oropharynx)
126
Pathology of salivary glands? (3)
\* Sialolithiasis - stones
\* infection
\* tumours (parotid is the most common site)
General rule = if young and painful mass, think malignant
127
Most common tumour of salivary glands?
Risk?
Pleomorphic adenoma
\* can turn malignant
128
pleomorphic adenoma
\* stroma - myxoid
\* made up of epithelial cells
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What is second most common benign tumour of salivary glands?
Characteristics?
Warthin's tumour
\* bilateral and multicentric
130
Warthin's tumour
131
Malignant tumours of salivary glands? (2)
\* most common worldwide = mucoepidermoid carcinoma
\* in UK = adenoid cystic carcinoma
132
from salivary gland
mucoepidermoid carcinoma = mucinous cells, squamous cells + intermediate cells
133
where is cholesteatoma found?
middle ear
134
Larynx lined with?
respiratory epithelium
pseudostratified columnar epihelium
135
from salivary gland
adenoid cystic
\* punched-out, cribiform pattern
\* perineural invasion
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what divides oropharynx and nasopharynx?
soft palate
138
where is hyoid bone found?
bone—level C3. in line with inferior aspect of mandible
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What are the muscles of the floor of the mouth?
Geniohyoid - C1 (spinal nerve), piggybacks on hypoglossal
Mylohyoid - CN V3
141
Types salivary glands?
Major glands
\* parotid
\* submandibular
\* sublingual
Minor glands
\* 1000s
\* function = keep mouth moist
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Submandibular and sublingual
144
Nerve supply to parotid gland?
Submandibular?
Sublingual?
\* parotid = Glossopharyngeal
\* submandibular = CN VII by piggybacking on CN V3
\* sublingual = CN VII by piggybacking on CN V3
145
Where does chorda tympani run?
Between malleus and incus in middle ear then joins with CN V3 (lingual nerve)
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Innervation to tongue?
Posterior 1/3rd
\* taste + general sensory = CN IX
Anterior 2/3rds
\* General sensory = CN V3
\* Taste = CN VII
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Where does thyroid originate (during development)?
Examples of thyroid swellings?
Clinical sign?
Thyroid originates in the pharynx and descends through the foramen caecum of tongue
\* Thyroglossal duct cysts or ectopic thyroid tissue
\* thyroid swellings move superiorly then inferiorly on swallowing due to attachment to larynx
(thyroglossal duct cyst - when stick tongue out?)
150
Extrinsic muscles of the tongue? (4)
Function?
Palatoglossus, styloglossus, hyoglossus, genioglossus
\* function: change position of tongue during mastication, swallowing or speech
151
Intrinsic muscles of the tongue?
Function?
4 **pairs** - located posteriorly
\* function = modify shape of tongue
152
Course of hypoglossal nerves (CN XII)?
What do they lack?
Medulla oblangata -\> thru hypoglossal canal (anterior wall of foramen magnum) -\> descends in neck -\> at level of hyoid (C3), passes anteriroly towards laterla aspect of tongue -\> supplie smost of the muscles of the tongue
Lack sensory component
153
Innervation of tongue?
Most supplied by CN XII
154
Tongue injury?
if both CN XII's are functional, tongue tip remains in middle when patient sticks tongue out
\* if unilaterla CN XII damage, tongue tip will point **TOWARDS** side of injured nerve
155
Blood supply to tongue?
Lingual artery from external carotid
(hypoglossal nerve runs **laterally** alongside artery)
156
Where do tongue arteries pass in relation to hyoglossus?
Tongue nerves?
Arteries = pass **medial** to hyoglossus
Nerves = pass **lateral** to hyoglossus
157
colour change between hard palate and soft palate
158
What is hard palate made up of?
Bones
\* palatine bones
Misc
\* palatal rugae
\* duct openings of palatine glands
\* minor salivary glands
159
What passes through grater and lesser palatine foramina of hard palate?
Branches of CN V2
Branches of maxillary artery
160
Hard palate
161
Muscles of the soft palate? (5)
\* Tensor veli palatini (CN V3) - tenses palatine aponeurosis
\* musculus uvuvlae (CN X) - shortens uvula
\* levator veli palatini (X) - elevates palatine aponeurosis
\* palatoglossus (X) - extrinsic muscle of tongue
\* palatopharyngeus (X) - lifts pharynx and thyroid cartilage
**all innvertaed by vagus nerve except tensor veli palatini - CN V3**
162
Soft palate function?
Functions as a “trapdoor”:
1. Stops food entering the nose during swallowing
2. Directs air into the nose or the mouth during speech, sneezing, coughing & vomiting
3. Helps to close off the entrance into the oropharynx during the gag reflex
163
Clinical testing on CN X?
Ask patient to say "Aahh"
\* if nerves functioning normally, uvula should lift straight up in the midline
\* if unilateral nerve pathology, uvula will be pulled **away from** non-functioning side by normal side
(different from tongue cause goes tongue goes towards non-functioning side)
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Muscles of the pharynx?
Outer circular layer
\* 3 constirctor muscles
\* skeletal (voluntary) - pushes food bolus into oesophagus
Inner longitudinal layer
\* 3 paired vertical muscles
\* skeletal - pulls larynx superiorly during swallowing
166
What are muscles of the pharynx innervated by?
All innervated by CN X
**except stylopharyngeus**
\* innervated by **glossopharyngeal**
167
Where are circular consrictors of pharynx found?
Superior
\* from pterygoid hamulus to mylohyoid line
Middle
\* greater horn of hyoid)
Inferior
\* from thyroid cartilage to cricoid cartilage
168
Feature of superior constrictor of pharynx?
Pterygomandibular raphe
169
What is the gap between constrictor muscles of the pharynx called?
Function?
Gateway to mouth
Allows:
\* CN IX
\* Lingual artery]\* stylopharyngeus muscle
to pass thru
170
What are circular muscles of pharynx supplied by?
Vagus CN X
171
Where do all circular muscles of the pharynx insert into?
Midline raphe
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Example of longitudinal muscle?
What is it attached to?
Supplied by?
What is significant about it?
Stylopharyngeus
\* attached to styloid process
\* passes through "gateway to mouth" with Cn IX (glossopharyngeal)
**only pharynx muscle supplied by CN IX**
174
Longitudinal muscles? (3)
Where do they insert?
Innervation?
Stylopharyngeus, palatopharyngeus, salpingopharyngeus
\* all insert into posterior border of thryoid cartilage
All innervated by CN X except stylopharyngeus (CN IX)
175
longitudinal muscles of pharynx
176
Waldeyer's tosilar ring?
Where is it found?
Function?
Pharyngela tonsil, tubal tonsil, palatine tonsil, lingual tonsil
\* found in mucosa of nasopharynx and oropharynx
\* Function = defence against invading pathogens
177
Waldeyer's ring
\* tubal tonsil surrounds eustachian tube
178
Lymphatic drainage of face and neck?
179
Lymph nodes in illness?
Infection
\* swollen
\* painful
\* smooth
\* soft
\* not fixed
\* improves with antibiotics
Cancer
\* swollen
\* not painful
\* hard
\* irregular
\* fixed
\* do not improve
180
lymph node examination
181
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Where is larynx located?
Between pharynx and trachea
183
where is larynx enclosed within?
Along with?
pretracheal fascia
## Footnote
\* ‘strap’ muscles
\* Thyroid gland
\* Trachea & larynx
\* Oesophagus & pharynx
\* Recurrent laryngeal nerves
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Which wall of septum are nasal conchae found in?
lateral
189
explain structure of larynx
function (3)
composed of cartilages suspended from hyoid bone
\* Maintaining patency of URT
\* Cartilages help prevent entry of foreign bodies into LRT
\* Vocal cords and cough reflex produce sound
190
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epiglottis is leaf shaped
192
what is important for preventing both regurgitation and aspiration during **ventilation**?
Press on the cricoid cartilage
Lamina of the cricoid cartilage compresses the oesophagus
Presses it against the C6 vertebral body
Oesophagus is closed but the larynx/airway is open
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pairs of vocal cords?
2 pairs
\* true vocal cords = vocal processes of arytenoid cartilage + thyroid cartilage
**MOVEMENT IMPACTS SOUND**
\* false vocal cords = arytenoid cartilage to epilgottis
196
where is laryngoscope placed?
into the vallecula (space between epiglottis and tongue)
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intrinsic muscles of the larynx?
Function?
Innervation?
skeletal muscle - cause movement of vocal cords
\* tension (increase pitch)
\* relaxation (decreaes pitch)
\* adduction (quieter)
\* abduction (louder)
**all innervated by CN X (vagus nerve)**
199
tensors of the larynx?
function?
attachments?
cricothyroid muscles
\* increases pitch
\* attachments - anterolateral cricoid cartilage to inferior horn of thyroid cartilage
200
relaxors of larynx?
function?
attachments?
Thyroarytenoid muscles
\* decreases pitch
\* posterior thyroid to anteriorarytenoid cartilage
201
adductors of the larynx?
function?
attachments?
Arytenoid muscles
\* Makes voice quieter by closing rima glottidis
\* one arytenoid cartilage to another cricoid cartilage (cross)
202
abductors of the larynx?
function?
attachments?
Posterior Crico-arytenoid muscles
\* make voice louder by opening rima glottidis
\* posterior cricoid cartilage to muscular process of arytenoid cartilage (horseshoe)
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where do supra-glottis tumours drain to?
Drain to superior deep cervical nodes
205
glottic tumours found?
S/s?
On the cords
\* voice changes/airway obstruction
206
sub-glottic tumour features? (2)
- Spread to paratracheal nodes
- Present with voice/airway obstruction
207
is larynx sufficient to produce a loud sound?
No, Laryngeal ‘buzz’ is amplified by the pharynx, oral and nasal cavities
208
explain how oral sounds are produced?
* Soft palate tenses (CN V3) and elevates (CN X) to close off entrance into nasopharynx
* Directs stream of air through oral cavity
* Sound interrupted by the tongue (CN XII) and the teeth/lips (CN VII) to produce most vowels and consonants in English language
209
explain how nasal sounds are created?
* Soft palate tenses (CN V3) and descends (CN X) to close off entrance into oropharynx
* Directs stream of air through nasal cavities
* Produces one of three sounds: “m”, “n” or “ing” depending on position of tongue (CN XII), teeth and lips (CN VII).
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innervation of the larynx?
\* **all intrinsic muscles** apart from **cricothyroid** innervated by **inferior laryngeal nerve** (cricothyroid is superior LN)
\* mucosa above the folds is supplied by internal laryngeal nerve
\* mucosa below the folds is supplied by inferior laryngeal nerve
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vagus nerves supply?
Clinical test?
Vagus nerves are sensory and motor supply to palate, pharynx and larynx
PHARYNX
Ask patient to swallow small sip of water
* Watch larynx move up and down
* Do they ‘splutter’?
LARYNX
Listen to patient speak
* Is voice hoarse?
* Are the intrinsic muscles of larynx functioning normally to move the vocal cords
Ask patient to cough
* Is cough normal and powerful?
* Also requires functioning diaphragm, phrenic nerves, abdominal wall etc.
216
normal ear drum
it's the left ear (hammer of malleous slopes backwards)
217
otitis externa
(inflammation of the ear canal)
218
acute otitis media
219
otitis media with effusion
yellow is the colour of fluid
220
myringotomy
| (relieve pressure from otitis media)
221
retraction of pars tensa due to cholesteatoma
222
cholesteatoma
(note loss of ossicles e.g. incus - can see stapes head)
223
mastoiditis (left ear abnormally projected)
complication of cholesteatoma
224
cholesteatoma
(middle ear space should be filled with air so should be black)
225
brain abscess (outside ring enhanced on scan)
complication of cholesteatoma
226
presbycusis
227
nose-induced hearing loss
| (classical dip at 4 kHZ)
228
vestibular schwannoma
229
Meniere's disease
(low frequency sensorinerual hearing loss)
230
Battle's sign - suggests base of skull fracture
231
skull base fracture
bilateral air depositis - bilateral hearing loss
232
Left = acute otitis media
Right = cholesteatoma
233
menieres disease
Low frequency hearing loss in one ear
sensoryneural not conductive
234
rhinitis - should see air in sinuses (however, no air visible)
235
Orbital cellulitis
| (complication of acute sinusitis)
236
Pinna haematoma
237
Battle sign - temporal lobe fracture
238
deep neck space infection
239
orbital blowout fracture - **tear drop sign**
CT sinuses
(remember a blowout fracture is medial wall + floor!)
240
know where tonsils are
241
peritonsilar abscess
\* medial displacement of tonsil and uvula
\* concavity of palate lost
242
glandular fever
\* Tonsillar enlargement with membranous exudate
\* petechial haemorrhages on palate
243
Eustachian tube dyfunction
\* severely retratced TM
\* altered TM colour
\* fluid/bubbles
244
AOM
\* red, inflammed
\* no cone of light
