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H&N 11 Flashcards

1
Q

how does the post. lobe of pituitary arise?

A

from developing brain: downgrowth from diencephalon forms in midline= infundibulum, and extends down towards roof of oral cavity,

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2
Q

name given to downgrowth of diencephalon from which P lobe of pituitary arises?

A

infundibulum

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3
Q

how is floor of hypothalamus formed?

A

from part of diencephalon giving rise to infundibulum

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4
Q

what name is given to connection between floor of hypothalamus and infundibulum forming P lobe of pituitary?

A

pituitary stalk

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5
Q

name given to outpushing from roof of oral cavity which grows up to meet forming infundibulum?

A

Rathke’s pouch

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6
Q

what may form from persitent remnants of Rathke’s pouch in the roof of the pharynx from where it split off from the ectoderm from which it was derived?

A

cysts

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7
Q

how do the tongue and thyroid gland arise from pharyngeal arches?

A

from where they meet as they curve around lateral walls of mouth and pharynx, meeting in the midline ventrally

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8
Q

which 3 components form the anterior 2/3 of the tongue?

A

median tongue bud from floor of pharynx at level of 2nd pharyngeal arch- facial nerve
paired distal tongue buds form in front of median bud and eventually overgrow and absorb it. originate from 1st pharyngeal arch- trigeminal nerve

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9
Q

which 2 components form posterior 1/3 of tongue?

A

copola- forms in midline from 2nd pharyngeal arch
hypobranchial eminence- forms from 3rd and 4th arches behind copola. Expands and absorbs copola, forming post 1/3 tongue (3rd arch- glossopharyngeal nerve) and epiglottis (4th arch)

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10
Q

what is seen in adult at site of fusion of A and P parts of tongue?

A

sulcus terminalis

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11
Q

muscles of tongue are NOT derived from pharyngeal arches. where do they arise from?

A

small somites (paraxial mesoderm) which arise in occipital region and migrate into developing tongue

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12
Q

name given to site of origin of thyroid?

A

foramen cecum

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13
Q

name of epithelial outgrowth in 4th wk that gives rise to thyroid?

A

thyroid diverticulum

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14
Q

where is the foramen cecum?

A

between 1st and 2nd pharyngeal arches, behind median tongue bud

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15
Q

on descent, how does the thyroid remain attached to the foramen cecum?

A

via the thyroglossal duct

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16
Q

what may form as a remanant of the distal end of the thyroglossal duct?

A

pyramidal lobe of thyroid

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17
Q

the foramen cecum closes off, but how is it seen in adult?

A

indentation on dorsum of tongue

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18
Q

calcitonin producing cells of thyroid originate from where?

A

4th pharyngeal pouch-ventral part

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19
Q

most common site for thyroglossal cysts?

A

base of tongue and just inferior to hyoid

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20
Q

most common site of ectopic thyroid tissue due to failure of thyroid to descend normally?

A

tongue

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21
Q

when might the isthmus of the thyroid need to be incised?

A

during a tracheostomy to expose the trachea to keep the airway patent

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22
Q

what is the nasopharynx attached to superiorly?

A

base of skull

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23
Q

the wall of the pharynx has an outer incomplete circular muscle layer, and an inner longitudinal layer, what 3 muscles comprise the inner layer?

A

stylopharyngeus-from 3rd arch
palatopharyngeus
salpingopharyngeus

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24
Q

the 3 named tonsils comprising the incomplete ring of lymphoid tissue in the pharynx?

A

palatine- between palatoglossal and palatopharyngeal ridges
adenoids (pharyngeal)- near roof of nasopharynx close to ET entry
lingual- beneath mucosa of P 1/3 of tongue

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25
how is food forced into oesophagus?
by automatic contraction of the 3 pharyngeal constrictor muscles
26
which muscles contract to elevate the larynx during swallowing?
suprahyoid muscles | longitudinal pharyngeal muscles= stylopharyngeus, palatopharyngeus, salpingopharyngeus
27
2 important structures vulnerable to injury in tonsillectomy?
ICA | glossopharyngeal nerve
28
arterial b.supply to tonsil?
tonsillar branch of facial artery
29
common site where FBs entering pharynx may become lodged?
piriform fossa
30
what does the posterior wall of the pharynx lie against?
prevertebral layer of deep cervical fascia
31
what does the nasopharynx lie superior to?
soft palate
32
what may a pharyngeal pouch (diverticulum of zenker) in the pharynx cause?
dysphagia regurgitation of food halitosis-bad breath
33
what nerve plexus supplies the pharynx and what does it comprise?
pharyngeal | pharyngeal branches of vagus, glossopharyngeal, and sympathetoc branches from S.cervical ganglion
34
sensory innervation to nasopharynx?
maxillary division of trigeminal
35
how does the uvula look if tonsillitis?
central and inflamed
36
how does the uvula look if peritonsillar abscess?
pushed to 1 side
37
what is the anatomical location of the pituitary gland?
sits in the pituitary (hypophyseal) fossa in the sella turcica= a saddle shaped depression in the sphenoid bone
38
where does Rathke's pouch arise?
out-pocketing of ectoderm of the stomatodeum, evagination of roof of oropharynx, grows dorsally towards developing forebrain
39
how is the tongue capable of being highly mobile?
due to the lingual frenulum= short cord attaching tongue to oral cavity
40
importance of tongue being highly mobile?
necessary for mastication and speech
41
what do the intrinsic and extrinsic muscles of tongue allow?
tongue can change its shape and position
42
what does the tongue develop from?
components of each of the pharyngeal arches
43
what swellings does the 1st pharyngeal arch give rise to which contribute to the tongue
2 lateral lingual swellings | 1 median lingual swelling= tuberculum impar
44
the copula/hypo-branchial eminence, a second median swelling, is formed from the mesoderm of what?
the 2nd, 3rd and 4th pharyngeal arches
45
how does the 4th pharyngeal arch contribute to tongue development?
contributes to the formation of 2 of the 3 median lingual swellings: the copula, and the epiglottal swelling which will form the epiglottis
46
how does the tongue become freed from the floor of the oral cavity?
extensive degeneration occurs by apoptosis: programmed cell death, but the tongue still retains a connection to the oral cavity via the lingual frenulum
47
what happens as the lateral lingual swellings increase in size?
they overgrow the tuberculum impar and merge, forming the anterior 2/3 of the tongue
48
why is sensory innervation to the posterior 1/3 of the tongue mainly from the glossopharyngeal nerve based in development?
the 3rd pharyngeal arch component of the copula overgrows the 2nd arch component
49
what is the innervation to the extreme posterior part of the tongue and the epiglottis?
superior laryngeal branch of vagus nerve due to development from the 4th pharyngeal arch which forms the epiglottal swelling and small contribution to the copula
50
most tongue musculature develops from occipital somites, hence what is its innervation?
hypoglossal nerve
51
general sensory innervation to anterior 2/3 of tongue and why?
mandibular division of trigeminal (lingual nerve) as mucosa originates from 1st pharyngeal arch (gave rise to 2 lateral lingual swellings which overgrow the tuberculum impar- a median lingual swelling)
52
how does taste sensation of anterior 2/3 of tongue come to derive from the chorda tympani nerve?
the nerve passes into the 1st pharyngeal arch from the second, passing through the 1st pharyngeal pouch and hence travels through the middle ear
53
between which 2 swellings of the developing tongue does the primordium of the thyroid gland appear between?
the tuberculum impar and the copula
54
from where does the thyroid gland descend into the neck?
floor of the pharynx
55
where are the follicular cells of the thyroid gland derived from?
the thyroid diverticulum: an epithelial proliferation in the floor of the pharynx between the tuberculum impar and the copula which descends in front of the pharyngeal gut., the hyoid bone and laryngeal caritlages, and stays connected to tongue on migration by thyroglossal duct
56
what part of the 4th pharyngeal pouch gives rise to the parafollicular cells of the thyroid?
ventral part, the ultimobranchial body
57
in what region of the neck do thyroglossal cysts occur, in contrast to branchial cysts?
midline of neck | branchial occur more laterally along SCM
58
why does CATCH22 occur with Di-George syndrome?
deletion on chromosome 22 responsible for disruption of neural crest cells C- cardiac abnormalities- neural crest cells contribute to devlopment of CVS e.g. endocardial cushions and separation of PA and aorta? A- abnormal facies- neural crest cells populate mesenchyme forming prominences giving rise to face T- thymic hypoplasia/aplasia- thymus derived from 3rd pharyngeal pouch and neural crest cells contribute the mesenchyme into which the endoderm from pharyngeal pouches migrates, the mesenchyme makes the CT necessary for gland differentiation C- cleft palate- failure of 1 or both palatal shelves to grow towards the midline and/or fuse with its partner H- hypocalcaemia- absence of PT glands which secrete PTH which stimualtes Ca2+ release from bone, reabsorption by kidneys and absorption from gut via calcitriol
59
boundaries of nasopharynx?
superior=skull base inferior= level of soft palate anterior= posterior choanae posterior= adenoids= C1
60
vertebral level of oropharynx?
C2-C3
61
vertebral level of laryngopharynx?
C4-C6
62
boundaries of oropharynx?
``` superior= level of soft palate inferior= superior edge of epiglottis anterior= oral cavity posterior= C2-C3 ```
63
boundaries of laryngopharynx?
``` superior= superior edge of epiglottis inferior= lower border of cricoid cartilage anterior= larynx posterior= C3-C6 vertebrae ```
64
contents of nasopharynx?
adenoids | opening of eustachian tube
65
contents of oropharynx?
palatine tonsils | anterior and posterior tonsillar pillars (palatoglossal and palatopharyngeal arches)
66
lymphatic drainage of palatine tonsils?
``` lymphatics pierce superior constrictor muscle of outer incomplete circular layer of pharyngeal muscles pass to nodes along IJV (terminal LNs) jugulodigastric node (angle of mandible) ```
67
how are constrictor muscles of pharynx attached posteriorly (open anteriorly) ?
median raphe
68
importance of soft palate elevation in swallowing?
closes off nasopharynx so food not regurgitated through nose
69
indications for a tonsillectomy?
recurrent tonsillitis (5 per yr for at least 2 yrs) previous peritonsillar abscess (quinsy) suspected cancer (unilateral enlargement/ulcertation) OSA syndrome
70
risks during tonsillectomy?
GA bleeding infection
71
vertebral level of hard palate?
C1
72
vertebral level of angle of mandible?
C2
73
vertebral level of hyoid bone?
C3
74
vertebral level of upper and lower borders of thyroid cartilage?
C4 and C5
75
vertebral level of cricoid cartilage?
C6
76
muscle which must relax for food to enter oesophagus?
cricopharyngeus
77
describe the mechanism of swallowing
Pushing food from oral cavity to oropharynx: tongue and suprahyoid muscles (mylohyoid, geniohyoid, digastric and stylohyoid) pull hyoid and larynx up, soft palate elevates closing off nasopharynx and superior constrictor pharyngeal muscles contract. Food bolus passes into hypopharynx by aid of middle an d inferior constrictors cricopharyngeus relaxes, allowing food to enter oesophagus after being funneled into upper part by piriform fossa
78
what is the larynx protected by in swallowing?
overhanging tongue epiglottis vocal cords
79
lining of oropharynx and laryngopharynx?
stratified squamous non-keratinized epithelium
80
how is peristalsis aided by arrangement of pharyngeal musculature?
constrictor muscles overlap each other and so contract in a downward fashion
81
pharyngeal arterial b.supply?
ECA: branches of lingual, facial and maxillary arteries, ascending and descending palatine artery, ascending pharyngeal artery, superior thyroid artery
82
venous blood drainage pharynx?
pharyngeal venous plexus to IJV
83
motor nerve supply to pharynx?
facial nerve glossopharyngeal vagus hypoglossal
84
sensory supply to laryngopharynx?
glossopharyngeal nerve
85
presentation of patient with enlarged adenoids?
``` mouth breathing hyponasal speech- high pitched feeding difficulty snoring/OSA recurrent acute otitis media- earache chronic otitis media with effusion- glue ear- reduced hearing ```
86
reasons for pharyngeal pouch formation between inferior constrictor and cricopharyngeus (laryngopharynx)?
weaker area incoordination of pharyngeal phase of swallowing cricopharyngeal spasm

ESA 4 (24 decks)

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