Exam 2 Prep Flashcards
Cricoid cartilage
Ring like cartilage resting atop the trachea
Most inferior of the laryngeal cartilage
Higher in posterior than anterior
Thyrohyoid membrane
Stretches across the space between the greater Cornu of the hyoid and the lateral thyroid
See page 194 for anatomical location
Cartilages of the larynx
3 unpaired cartilages:
Cricoid
Thyroid
Epiglottis
3 paired cartilages:
2 arytenoids
2 corniculates
2 cuneiforms (in aryepiglottic folds)
Thyroid cartilage
Largest of the laryngeal cartilages
Articulates with the cricoid cartilage below by means of paired processes that let it rock forward and backward at that joint
Arytenoid cartilage
Rides on the high-backed upper surface of the cricoid cartilage
Forms the posterior point of attachment for the vocal folds
Paired
Corniculate cartilage
Rides on the superior surface of each Arytenoid
prominent landmarks in the aryepiglottic folds
Articulates with the apex or superior process of the Arytenoid cartilage
Cuneiforms cartilage
Resides within the aryepiglottic folds
Provides a degree of rigidity to the folds
Cricothyroid joint
Thyroid and cricoid cartilages articulate with this joint
Allows the two cartilages to come closer together
Muscles attach to laryngeal cartilage
See photos and pages 214, 216-223
Thyrovocalis
Attaches to Arytenoid VOCAL process
Tenses the vocal folds
Responsible for adduction of the membranous portion of the vocal folds
Originates from the inner surface of the thyroid cartilage near the thyroid notch
Contraction draws thyroid and cricoid cartilages further apart in front
Glottal tensor
Infrahyoid muscles
Depress the hyoid bone
Consists of sternohyoid and omohyoid muscles
Pressure during the open phase of phonation
Subglottal pressure is greater than supraglottal pressure
Cause of vocal folds to return to resting position after being blown apart
Negative pressure between the folds
Elasticity of the vocal folds
What happens to airflow when the vocal folds make contact?
Air flow is completely halted and the cycle of vibration is complete
Adduction
Act of bringing the vocal folds together for phonation
Abduction
Process of drawing the vocal folds apart to terminate phonation
Bernoulli principle
Given a constant volume flow or air or fluid
At point of constriction there will be a DECREASE in pressure perpendicular to the flow and an INCREASE in velocity of the flow
Bernoulli principle in relation to phonation
Low pressure created behind the fast moving air column produces Bernoulli effect which causes the bottom of vocal folds to close followed by the top
Air pressure flowing between the vocal folds is lower than the pressure outside so the vocal folds vibrate together
Systems want to move to a place of lower pressure
Closure of the vocal folds cuts off the air column and releases a pulse of air
Posterior cricoarytenoid
SOLE abductors of vocal folds
See pages 216 and 217 for picture
Origin: posterior cricoid lamina
Insertion: posterior aspect of the arytenoids
Myoelastic aerodynamic theory
Elasticity refers to elastic recoil
Aerodynamic refers to the Bernoulli priniciple
Vibration of vocal folds depends on the elements embodied in the name of the theory
Myoelastic element i the elastic component of muscle (myo)
Associated soft tissues of the larynx, and the aerodynamic component is that of the airflow and pressure through this constricted tube
Combination of tissue elasticity, which causes the vocal folds to return to their original position after being distended and the Bernoulli effect, which helps promote this return by dropping the pressure at the constriction, accounts for the sustained vibration
Nasoendoscopy
Fiber-optic, flexible scope that is inserted transnasally
Through the nose and velopharyngeal port
Fiberoptic bundle provides an image of the vocal folds and laryngeal structure in real time
Excellent tool for swallowing evaluation
Changeable elements of vocal folds, affects pitch
Tension - when increased the natural frequency of the vibration will increase
Length - as the vocal folds lengthen it lowers the fundamental frequency
Mass - as mass of the vibrating body decreases, frequency of vibration will increase
Type of pressure brings the vocal folds together
Negative pressure
Fundamental frequency
The lowest frequency of vibration of the vocal folds or of a harmonic series
Increased fundamental frequency means we are lengthening the vocal folds, decreased means we are shortening.
As frequency increases so does pitch
Intrinsic muscles of larynx
Adductors
Abductor
Glottal tensors
Relaxers
Auxiliary musculature
Adductors (Intrinsic Laryngeal)
OBLIQUE ARYTENOID MUSCLES
Lateral cricoarytenoid muscles
Transverse Arytenoid muscles
THESE MUSCLES TENSE DURING ADDUCTION..IDENTIFY ON A PHOTO(SEE PHOTO APP)
Abductor (Intrinsic Laryngeal)
Posterior cricoarytenoid muscles
THESE MUSCLES ROTATE AND ROCK ARYTENOIDS MEDIALLY (ID ON PHOTO APP)
Glottal tensors (Intrinsic Laryngeal)
Circothyroid muscles, pars recta and pars oblique
Thyrovocalis (medial Thyroarytenoid) muscles
Relaxers (intrinsic laryngeal)
Thyromuscularis (lateral thyroarytenoid) muscles
Auxiliary musculature (Intrinsic Laryngeal)
Thyroarytenoid muscles
Superior thyroarytenoid muscles
Aryepiglotticus muscles
Thryoepiglotticus muscles
Extrinsic muscles of larynx
Hyoid and laryngeal elevators (suprahyoid)
Hyoid and laryngeal depressors (infrahyoid)
Hyoid and laryngeal elevators (suprahyoid) - Extrinsic laryngeal
1Digastricus anterior and posterior
3StyloHYOID muscles
3MyloHYOID muscles
3GenioHYOID muscles
2HypoGLOSSUS muscles
2GenioGLOSSUS muscles
2ThyroPHARYNGEUS muscles
2Inferior PHARYNGEAL constrictor muscles
Hyoid and laryngeal depressors (infrahyoid) - Extrinsic laryngeal
1SternoTHYROID
3OmoHYOID
3SternoHYOID
3ThyroHYOID
Identify epiglottis, true vocal folds, trachea
See photos in photo app
Cricotracheal membrane (ligament)
The trachea attaches to the larynx bia the cricotracheal ligament (membrane)
Ligament between the cricoid cartilage of the larynx and the tracheal cartilage
ID ON A PHOTO
Cricothyroid ligament (membrane)
Membranous lining below the level of the vocal folds, lining the subglottal region, and attaching to the thyroid, cricoid, and Arytenoid cartilages
ID ON A PHOTO
Termination of phonation
Completion of the period during which vocal folds are vibrating for a given segment
Abdominal fixation
Process of impounding air within the lungs through inhalation and forceful vocal folds adduction that results in increased intra-abdominal pressure
Cough
Forceful evacuation through the respiratory passageway, entailing deep inhalation through widely abducted vocal folds, tensing and tight adduction of the vocal folds, and elevation of the larynx, followed by forceful expiration
Pitch
The psychological (perceptual) correlate of frequency of vibration
Frequency definition
Number of cycles of vibration per second
Breathy vocal attack
Vocal attack in which expiration occurs before the onset of vocal folds adduction
shimmer
Measures variability in amplitude
Increased shimmer can indicate a breathy or hoarse quality
Looking at loudness
Deals with sustained phonation - high shimmer if cannot sustain phonation
Intensity
Magnitude of sound expressed as the relationship between 2 pressures
Loudness, subglottal pressure increases, and medial compression
Vocal folds tighten
What is vocal shimmer
Measure of the cycle by cycle variation in intensity
Cricothyroid Innervation
X vagus and superior laryngeal nerve
All intrinsic laryngeal muscle Innervation MINUS Circothyroid
(Cricoarytenoid & lateral cricoarytenoid, thyromuscularis)
X vagus
Recurrence laryngeal nerve
Digastricus anterior Innervation
V Trigemnial nerve, mandibular branch, via the mylohyoid branch of the inferior alveolar nerve
Digastricus posterior Innervation
VII facial nerve, Digastric branch
Stylohyoid Innervation
Motor branch of the VII facial nerve
Geniohyoid Innervation
XII hypoglossal nerve and C1 spinal nerve
3 muscles that elevate the larynx
Thryopharyngeus
Cricopharyngeus
Thyrohyoid
When they elevate the larynx they change the shape of the vocal tract
Phonation occurs when the vocal folds do what?
Vibrate within the larynx
Vocal hygiene
- Hydration
- Avoid: caffeine, smoking, alcohol, throat clearing, habitual coughing
- Manage reflux
- Get plenty of rest
Intrinsic vs extrinsic muscles
Intrinsic make fine adjustments on vocal cords, extrinsic change the length of the vocal tract
Paired facial bones
- Maxillae
- Palatine
- Zygomatic
- Nasal
- Lacrimal
- Inferior nasal conchae bones
Immobile articulators
- Alveolar ridge
- Hard palate
- Teeth
Label facial muscles
Temporalis
Masseter
frontalis,
zygomatic minor
zygomatic major
risorious
depressor anguli oris
SEE PHOTO APP
Class I Occlusion
First molar of the mandibular arch is one-half tooth advanced of the maxillary molar
Normal relationship between the molars of the dental arches
Class II malocclusion
The first mandibular molars are retracted at least one tooth from the first maxillary molars
Mandible is retracted
Class III Malocclusion
First mandibular molar is advanced farther than one tooth beyond the first maxillary molar
Mandible is protruded
Class I malocclusion
Normal orientation of molars, but an abnormal orientation of the incisors
Nerve damage to VII facial nerve
Make it hard to say ooo
Lip rounding is effected
Innervates the orbicularis oris
Lavator veli palatini
Muscle of the velum
Elevates and retracts the posterior velum
Essential for swallowing
Makes up the bulk of the soft palate
Primary elevator of the soft palate
Function of the transverse muscle of the tongue
Provides a mechanism for narrowing the tongue
What happens with a nasal sound?
Velum lowers to allow air into the nasal cavity
Produces m, n, ŋ
How are vowels produced?
Without closure or narrowing in the vocal tract
Vowel chart
SEE PHOTO APP
/l/
Liquid and lateral b/c it is flat
Cognate pairs
Have the same place and manner but different voicing
Plosive cognate pairs
(P, b) (t,d) (k,g)
Fricative cognate pairs
(F,v) (θ, ð) think, them (s,z) (ʃ, ʒ) ship, beige
Affricate cognate pairs
tʃ chew, dʒ join
Glide cognate pair
ʍ,w why way
Apraxia
Deficit in programming of musculature for voluntary movement that is NOT attributable to muscular weakness or paralysis
Oral apraxia might have difficulty using the facial and lingual muscles of non speech acts
Verbal apraxia - deficit in planning the motor act and programming the articulators for speech sound production. Makes error in correct articulation of the sounds of speech, although the errors vary widely from one attempt to another
Cause: lesions in brain structure, damage to left hemisphere premotor region
What is the most important function of the mandible
mastication
Is the infant or adult larynx more elevated?
Infant
What reflex allows the infant to gain nutrition?
Rooting
Responds to tactile stimulation of lips or cheek
Turns toward stimulus and opens mouth
Respiratory center of the brain
Medulla oblongata
3 main stages of the swallow
- Oral (prep & transport) - voluntary…transport can be voluntary or involuntary
- Pharyngeal - involuntary
- Esophageal - involuntary
Main function of epiglottis
Cover the entrance of the larynx so food and liquid do not enter the windpipe and lungs
Oral transport stage
When bolus contacts faucies pharyngeal swallow is triggered
Glossopharyngeal nerves IX (9)
Responsible for taste on the posterior 1/3 of the tongue
Bitter taste
Facial nerve VII (7)
Taste: sweet, salty, sour
Anterior 2/3 of tongue
Palate
Does breathing cease during swallow?
Yes
General terms
- Mastication - chewing
- Deglutition - swallowing
- Dysphagia - difficulty swallowing
- Bolus - ball of liquid or food
- Gustation - sense of taste
- Papillae - taste buds
Deficits of oral prep stage
- Loss of sensation and awareness, coupled with weak baccalaureate musculature, lead to pocketing of food in the lateral or anterior dulcimer
- Weak muscles of mastication cause inadequately chewed food
- Weak lingual muscles may result in poor mixing of saliva with the food, inadequate bolus production, poor lip seal and posterior tongue elevation to impound the bolus, difficulty compressing the bolus onto the hard palate
- Muscles of soft palate are compromised velum may not be fully elevated and tongue may not be elevated back, permitting food to escape into the pharynx before initiation of the pharyngeal reflex (could cause aspiration pneumonia)
Deficits of oral transit stage
Center around sensory and motor dysfunction
1. Weakened movements cause reduced oral transit time of bolus to pharynx. Food may remain on tongue or hard palate following transit
2. Epiglottis may fail to invert over the laryngeal opening and to have limited elevation of the hyoid. Increased pooling of food or liquid in vallecuale
3. Difficulty initiating a reflexive swallow
Deficits of the pharyngeal stage
Sensory and motor deficit
1. Slowed velar elevation may result in nasal regurgitation (loss of food or liquid through the nose and loss of pharyngeal pressure
2. Reduced sensation at the faucets, posterior tongue, pharyngeal wall, or soft palate may result in elevated threshold for the trigger of the swallowing reflex
3. Reduced function of the pharyngeal constrictors may result in slowed pharyngeal transit time of the bolus, may prematurely reinitiate respiration
4. Weakened pharyngeal function may result in residue left in the valleculae
5. Failure of the hyoid and thyroid to elevate may result in the loss of airway protection, so that food may fall into the larynx and be aspirated on reinflation of the lungs
Deficits of the esophageal stage
- Gastoesophageal reflux disease (GERD) - acids from stomach refluxed into your esophagus or pharynx
Lower esophageal sphincter relaxes allowing gastric juices to enter esophagus
If upper sphincter is weaker acid reflows into pyriform sinus assaulting pharyngeal tissue
If happens during night when sleeping acid may flow into the airway resulting in aspiration - Hiatal hernia - stomach herniates through the esophageal hiatus
- Stenosis - fair congenital malformation of esophagus loss of nutrition for newborn
- Rare maldevelopment of the esophagus may even result in the esophageal contents directly entering the trachea
Fine and gross motor movements
Fine = intrinsic muscles
Gross = extrinsic
Tensor veli palantini muscle
Dilator of the auditory tube permitting aeration of the middle ear cavity
Lingual muscles of the tongue are innervated by what nerve?
XII Hypoglossal nerve
Masseter (mandibular muscle) Innervation
V Trigeminal - anterior trunk of the mandibular nerve arising form the V Trigeminal
Temporalis (mandibular muscle) Innervation
V Trigeminal - Temporal branches arising from the mandibular nerve of V trigeminal
Medial pterygoid (mandibular muscle) Innervation
V Trigeminal - mandibular division of the V trigeminal nerve
Lateral Pterygoid (mandibular muscle) Innervation
Mandibular branch of the V trigeminal nerve
Digastricus anterior (mandibular muscle) Innervation
Mandibular branch of the V trigeminal nerve
Via the mylohyoid branch of the inferior alveolar nerve
Digastricus posterior (mandibular muscle) Innervation
Digastricus branch of the VII facial nerve
Mylohyoid (mandibular muscle) Innervation
Alveolar nerve, arising from the V trigeminal nerve, mandibular branch
Geniohyoid (mandibular muscle) Innervation
XII hypoglossal nerve and spinal C1 nerve
Platysma (mandibular muscle) Innervation
Cervical branch of the VII facial nerve
Baby teeth (deciduous teeth) erupt
6-12 months
Superior longitudinal tongue muscle
Elevates, assists in retraction of, or deviates tip of tongue
Important in production of /t/, /d/, /s/, /z/, /n/, /l/ - alveolar phonemes
Inferior longitudinal tongue muscle
Pulls tip of the tongue downward, assists in retraction, deviates tongue
Cleft lip definition
Occurs along the premaxillary suture
Due to failure of embryonic facial and labial tissue to fuse during 4th and 7th weeks of pregnancy
Cleft palate
Can involve both hard and soft palates
Between 6th and 9th week
Tongue should drop away from the processes so maxilla can close along the suture line
Primary palate
Includes alveolar arch
Fistula
small channel formed from the infected area of the tooth, which usually coincides with the tip of the root, until the external surface area of the gum
Movement of mandible is much greater during speech or mastication ?
Mastication
Alveoli (dental)
sockets in the jaws in which the roots of teeth are held in the alveolar process with the periodontal ligament.
DIVA model
Include some forms of feedback about the accuracy of articulation
Feedback monitors output as well as auditory
DIVA model provides explanation for what?
Motor equivalence, contextual variability, speech rate effects and coarticulation
Feed forward in DIVA model
Sending a signal in anticipation of known cues
Feedback is used to create feedback forward
Allows for modifications of speech production
Areas of brain involved in feedback and feed forward
Pre motor cortex
Cerebellum
Auditory cortex
Somatosensory cortex
Condyloid process articulates with
Temporal bone in the mandibular fossa forming the TMJ
Dynamic/action theory
Think domino effect
Functionally defined group of muscles (coordination structures) and associated articulators are assigned a task, many ways to complete task
Explains co articulation b/c there’s overlapping. Perturbation or sudden unexpected force applied to another articulators
The motor act is accurately achieved within the bounds of variability
Motor equivalence states that a goal can be achieved through various means and systems
Dynamic/action theory account for
Dynamic aspects of the physical system required to achieve a specific target within the environment
Do gross motor movements develop before fine motor movements?
YES
Oral preparatory phase deficits
- Decreased awareness of food
- Difficulty holding food in mouth
- Pocketing food in cheeks
- Premature spillage of food into airway
Difficulty chewing and forming a bolus
May be a problem with dentition
Don’t have buckle or the orbicularis oris musculature is weak
Chewing but don’t swallow
Oral transport phase deficits
- Anterior spillage
- Premature spillage into airway
- Difficulty moving bolus back towards pharynx
No swallow trigger or delayed swallow response
Impaired coordination of oral and pharyngeal structures
Weak elevation of the velum
Inadequate closure of the vocal folds
Reduced high, low laryngeal elevation
Weak elevation of the tongue
Pharyngeal phase deficits
- Delayed swallow response
- Impaired coordination of oral and pharyngeal structures
- Weak elevation of velum
- Inadequate closure of vocal folds
- Reduced hyolaryngeal elevation
Esophageal phase deficits
- Upper esophageal sphincter does not open
- Slow or absent esophageal peristalsis
Can fix with proton pump inhibitor
