Head and Neck Flashcards
What are the borders of the posterior triangle of the neck?
Posterior SCM
Anterior trapezius
Clavicle
Nuchal line of occiput
What are the borders of the anterior triangle of the neck?
Inferior mandible
Imaginary midline
Jugular notch of sternum
Medial edge of SCM
What is the origin and insertion of trapezius?
Nuchal line of occiput
Lateral 1/3 of clavicle
What are the sub triangles of the anterior triangle?
Submental (medial to anterior belly of digastric, superior to hyoid)
Submadibular (between anterior and posterior belly of digastric)
Carotid (between posterior belly of digastic and omohyoid)
Muscular (medial to omohyoid)
What is found in the submental triangle?
Small lymph nodes
Origin of anterior jugular vein
What is found in the submandibular triangle?
Lymph nodes and submandibular gland
What is found in the carotid triangle of the neck?
Carotid artery in sheath with vagus nerve and ijv
Deep cervical lymph nodes
What is found within the muscular triangle of the neck?
Infrahyoid muscles
Vicera of the neck
At what level does the carotid artery bifurcate?
Superior thyroid cartilage (C4)
What are the actions of sternocleidomastoid
Bilateral contraction lifts chin
Unilateral contraction flexes neck laterally and rotates head so ear moves to ipsolateral shoulder
What is in the posterior triangle of the neck?
Ejv
Cnxi
Roots of brachial plexus
What is the subcutanious tissue of the neck also known as?
Superficial cervical fascia
What are the subdivisions of the deep cervical fascia?
Investing fascia
Prevertebral fascia
Pretrachial fascia
Carotid sheath
What muscles are found within the superficial cervical fascia and the investing cervical fascia?
Platysma
Scm and trapezius
Where does the pretracheal fascia extend from and too?
From the hyoid to the fibrous pericardium
How can the pretracheal fascia be subdivided?
Visceral and muscular
Visceral is continuous with the buccopharangeal fascia and contains oesophagus, trachea and thyroid
Muscular sits anteriorly containing the infrahyoid muscles.
Where does the preverterbral fascia run?
Encompasses the vertebral column and muscles, fixed to the cranial bone superiorly and is continuous with the thoracic fascia and axillary sheaths inferiorly
Where do the carotid sheaths blend?
With the pretracheal fascia medially, investing fascia laterally and the preveterbral fascia posteriorly
What are the functions of the cervical fascia?
Compartmentalise contents
Allow movement
Contain infection
What is more serious, a reteropnayngeal abscess or parapharangeal abscess? Why?
Reteropharyngeal - space opens directly into mediastinum whilst parapharyngeal space stops at level t2/3
Which is more common, reeteropharangeal abscess or parapharyngeal abscess?
Parapharyngeal
What tends to preceed retro and parapharyngeal abcesses?
Retro - urti
Para - tonsilitis
What fascia sits in the retropharyngeal space?
Alar fascia
What are the superficial and deep infrahyoid muscles?
What innervates them?
Superficial
Omohyoid - C1 to C3 branch of ansa cervicalis
Sternohyoid - C1 to C3 branch of ansa cervicalis
Deep
Sternothyroid - C1 via hypoglossal nerve
Thyrohyoid - C2 to C3 branch of ansa cervicalis
What are the functions of the infrahyoid muscles?
Depress the hyoid.
Thyrohyoid can elevate the larynx
Sternothyroid can depress the larynx
What are the suprahyoid muscles and their innervation?
Mylohyoid - n. to mylohyoid b.o. inferior alveolar n. b.o. CNV3
Geniohyoid - C1 via hypoglossal n.
Stylohyoid - stylohyoid branch of facial nerve
Anterior belly of digastric - nerve to mylohyoid
Posterior belly of digastric - digastric branch of facial nerve
What is the path and function of the olfactory nerve?
Special sense smell
Olfactory receptors, through cribiform plate into olfactory bulb, pass back down the olfactory tract to the cerebrum
Where do the optic tracts terminate (most fibres?)
Lateral geniculate nucleus of thalamus
Why does increased icp cause papilloedema?
The nerve is actually a tract covered in meningies and csf. Raised icp impairs drainage causing papilloedema
What is the autonomic nucleus of cn iii called?
Edinger westphal or accessory
Where do the three branches of the trigenminal nerve leave the cranium
V1 - superior orbial fissure
V2 - foramen rotundum
V3 - foramen ovale
What are the muscles of mastication?
Temporalis
Masseter
Medial and lateral pterygoids
Other than the muscles of mastication which other muscles does CNV3 supply?
Anterior digastric
Tensor tympani
Which nerves are associated with the cavernous sinus?
Cn 3 - 6
What is special about the abducens nerve?
Long intradural course
Which nerves pass through the superior orbital fissure?
Occulomotor
Trochlea
Parts of cnv1 (lacrimal, supra orbital, nasocilary)
Abducent
What areas of senation are provided by the facial nerve?
Anterior 2/3rds taste
General sensation around eam of external ear
What is the course of the facial nerve?
Motor and sensory/autonomic (intermediate nerve) roots leave the pons
Transverse the IAM before turning sharply in the temporal bone forming the geniculate ganglion
Pass through the bone giving off greater petrosal nerve, nerve to stapedius and chorda tympani.
Exits the stylomastoid foramen
Gives off posterior auricular nerve
Splits into 5 facial motor branches (temporal, zygomatic, buccal, mandibular, cervical)
What branch of the facial nerves are associated with which autonomic ganglions?
Greater petrosal to the pterygopalatine
Chorda tympani to the submandibular
What autonomic does the facial nerve provide (and from which ganglions?
Pterygopalatine - lacrimation, mucus membranes of sinuses and nasopharynx
Submandibular - SM and SL glands
By which nerve do postganglionic fibres travel from the pterygopalatine to the lacrimal glands?
The lacrimal branch of CNV2
Differentiate upper and lower motor neurone causes of facial paralysis - why?
Upper is forehead sparing as there is bilateral innervation to both facial nerve nuclei from the cerebral hemisphere (thus both umn tracts would have to be damamge)
Lower effects forehead as there is no collateral innervation from CNVII
What effect may a proximal facial nerve lesion have on hearing? What about distal?
May make you sensitive to low tones as reduced dampening from stapedius
Distal will have no effect on hearing
Which cranial nerves arise from which areas of the brain and brainstem?
Cerebral - i, ii Midbrain - iii, iv Pons - v, vi, vii, Pons/medulla - viii Medulla - ix, x, xii Medulla and spine - xi
What are the ganglia of the vestibulocochlea nerve?
Vestibular - vestibular ganglion
Cochlea - spiral ganglions
What are the tuning fork tests for hearing?
Rinne’s - is bone conduction louder than air (if so obstructive defect in that ear)
Weber’s - in which ear is a central vibration louder (if louder in ear with loss obstructive defect in that ear, if louder in ear without loss sensorineural defect in ear with loss)
What sensation is provided by the. Glossopharyngeal nerve?
Taste and sensation (posterior 1/3)
Sensation in euctachian tube and inner tympanic membrane
Baro and chemo receptors at arch of aorta
Sensation of oropharynx and throat
Gag reflex
What motor and autonomic innervation is. Provided by cnix (with ganglion)
Stylopharynegeus Parotid gland (otic)
Through which foramen does the glossopharyngeal nerve leave the cranium?
Jugular foramen
Which branch of the glossopharyngeal nerve goes to the otic ganglion?
Tympanic!
What are the four branches of the cranial nerves that supply sensation to the ear?
Auricular temporal - trigeminal
Posterior auricular - facial
Tympanic - glossopharyngeal
Auricular - vagus
What sensation is derived from the vagus nerve?
Inferior pharynx and larynx
Root of Tongue and epiglottis
Viceral sensation from thorax and abdomen
Aortic bodies and sinuses
What is the motor innervation of the vagus
Soft palate
Pharynx
Intrinsic laryngeal muscles
Palatoglossus
Through which foramen does the vagus exit the cranium
Jugular
What are the three branches of the vagus that supply the larynx? What do they do?
Superior laryngeal branches into external laryngeal (motor to cricothyroid) and internal laryngeal (sensation to internal larynx)
Recurrent laryngeal becomes inferior laryngeal (all intrinsic laryngeal muscles except cricothyroid)
What is the course of the acessory nerve?
Branches of c1-5 merge with cnx outside jugular foramen then seperate again crossing scm down to trapezeus
How does the hypoglossal nerve leave the cranium?
Hypoglossal canal
How do sympathetic fibres reach the head and neck?
Leave t1-l2 by the anterior root, travel through the white rami communicates, enter sympthetic trunk ganglia where they ascend to the cervical ganglion
What is innervated by the superior cervical ganglion? What arteries do these nerves follow?
Sweat glands, pulpils, levator palpebrae superioris, nasal glands, salivary glands
Via carotids
What do the nerves of the middle cervical ganglion innervate? What arteries do they follow?
Larynx, trachea, hypopharynx, oesophagus
Via the inferior thyroid artery
What is the clinical consequence of the close association between the sympathetic nerve nerve supply to han and arteries?
Aneurysm can damage them
What are the specific features of the cervical vertebra?
Stubby transverse process Triangular vertebral foramen Foramen for vertebral artery Bifid spine (c3-6) Horizontal articular processes
What is special about the atlas and axis?
What movements do they allow?
Atlas - no spinous process or body
Axis - ordontoid peg
Atlas and occiput joint allows nodding
Axis and atlas joint allows shaking
What are the parts of the neurocranium?
Calvaria
Base
What are the three sutures and two joins of the calvaria?
Coronal suture
Saggital suture
Lamboid suture
Bregma (coronal and saggital join)
Lambda (saggital and lamboid join)
What makes the cranial sutures strong?
Synathrotic fibrous sutures
Serrated edges allowing interlocking.
What is the middle layer of a skull bone termed?
Diploe
What are two weak areas of the cranium?
Pterion (joint of parietal, frontal, temporal and sphenoid)
Base (due to many foramen)
When do the fontanelles close? What do they form?
How can the adult form be useful clinically?
Anterior closes to bregma - closes by 18 months
Posterior closes to lambda - closes by 12 months
Used as radiological landmarks
What is the advantage of a baby having unfused sutures?
Allows skull compression on delivery
What are the two processes at the top of the madibular ramus from anterior to posterior?
Coronoid
Condylar
What are the 6 sections of the temporal bones?
Squamous Mastoid Tympanic Styloid Zygomatic process Petrous
Which parts of the ear are contained within the petrous temporal bone?
Tympanic cavity, eustachian tube, inner ear
What is located posterior to the tragus in the external ear?
Concha
Antitragus
What are the two ridges that make up the majority of the auricle?
Helix
Antihelix
What is the arterial supply to the external ear?
Superficial temporal
Posterior auricular
What is the nervous innervation to the external ear?
Great auricular nerve (C2/C3) to posterior auricle
Auricular temporal branch of CNV2 to anterior auricle, superior/inferior surface of EAM and external tympanic membrane
Auricular branch of CNX to concha and inferior posterior surface of EAM
Posterior auricular branch of CNVII to concha and antihelix
Tympanic branch of glossopharyngeal to internal tympanic membrane and eustachian tube
What are the different parts of the EAM made of?
External 1/3rd elastic cartilage with skin continuous with external skin
Inner 2/3rds within the temporal bone lined with skin continous with the tympanic membrane
What is earwax and where is it produced?
Specialised sweat produced in the outer third of the eam
Where does an auricular haemotoma form?
Between the elastic cartilage and the perichondrium
What is the usual cause of otis externa?
Bacteria or fungi
What are the two areas of the middle ear?
Epitympanic recess
Tympanic cavity
What are the borders of the tympanic cavity?
Lateral - tympanic membrane
Medial - labryinthine wall
Superior - tegmea tympni plate of bone (then meningies)
Inferior - layer of temporal bone
Anterior - carotid wall, contains eustachian tube and tensor tympani
Posterior - mastoid wall, contains aditus to mastoid antrum and swelling where facial nerve decends
Where do the muscles of the middle ear attach and. Origionate?
Tensor tympani - attaches to malleolus
Stapedius - embeded in posterior wall, tendon attaches to stapes
What is the angle of the tympanic membrane?
Oblique (closer superiorly when viewed by otoscope) and concave
What is visible on a healthy otoscope?
EAM should not be inflammed/pussy etc.
Tympanic membrane should be pearly grey with a cone of light reflecting anterioinferiorly
Handle of the malleolus passes posterioinferiorly ending at the umbo
What can cause tympanic membrane rupture?
Infection
Trauma
Pressure
What commonly proceeds otitis media? What is the usual cause? What appears on exam?
URTI
Virus
Swollen tympanic membrane as pus forces it out
What is a complication of otitis media effecting the eustachian tube? What is the pathology, appearance and treatment
Effusion
Blockage of eustachian tube by fluid - air absorbed by cells - pressure drops
Tympanic membrane retracted with fluid level visible
Grommit
What is a complication of otitis media with effusion?
Cholesteatoma - Chronic retraction of tympanic membrane causing pockets.
Skin cells gather and divide forming a lesion
Can damage and erode structures of the middle ear or progress to cause a meningitis
What are the vestibular apparatus?
What sort of movement does each bit respond to?
The semicircular canals (rotational acceleration)
The urtical and saccule (linear acceleration)
What contributes to balance?
Ventricular system
Vision
Muscle tone
Briefly, how do the vestibular apparatus work?
Hair cells extend cillia into otolithic membrane filled with otoliths
Membrane move as head moves pulling on hair cells
What is meniers disease?
Long lasting vertigo, hearing loss, tinnitus and vomiting caused by excessive endolymph
What causes BPPV?
Debris in endolymph that give the impression of continued movement even after movement has stopped
What is the general structure of the inner ear?
Bony labyrinth filled with perilymph
Membranous labyrinth filled with endolymph
Where does the condylar process of the mandibular ramus sit when the jaw is closed?
Mandibular fossa of the temporal bone
What is special about the tmj joint?
It has two cavities separated by a fibrous disc
What is the disc that separates the two cavities of the tmj joint made of?
Fibrocartilage
What cartilage is used around the tmj articular discs, why?
Fibrocartilage - very hard wearing
What two (reversible) movements are possible in the jaw?
Protrusion
Depression (opening)
How does the jaw protrude?
Movement occurs using the upper cavity. Lateral pterygoid pulls rami anterior moving the condylar process onto the articular tubercle. This protrudes and slightly depresses the jaw
Which muscles retrude the jaw?
Temporalis and masseter
What muscles open the mouth (depress jaw)?
Lateral pterygoids, supra and infra hyoids and GRAVITY
What muscles. Close the jaw?
Temporalis
Masseter
Medial pterygoid
How is the mandible moved from side to side?
Unilateral protraction
What supports the jaw?
Fibrous capsule
Extracapsular ligaments (tm ligament)
Accessory ligaments
Closed mouth
What bones form the boundaries of the orbit?
Roof - frontal, sphenoidal
Floor - maxilla, zygomatic
Lateral - zygomatic, sphenoid
Medial - ethamoid, lacrimal, maxilla
What is significant about the medial orbital wall?
Very thin and unsupported as overlays sinuses so easily fractured
What holes are there in the orbit?
Superior orbital fissure (motor nerves, lacrimal nerve, frontal nerve, opthalmic veins)
Inferior orbital fissure (infra orbital nerve, opthalmic artery)
Optic canal (optic nerve)
Fossa for lacrimal gland (lacrimal gland)
Fossa for lacrimal sac (nasolacrimal duct)
What is the term for a fracture where the contents of the eye are displaced into the sinus?
What is the risk
Blow out fractures
Risk of infection
How can a blow out fracture present?
Enophthalmos (sunken eye)
Exopthalmos (protruding eye) can be pulsetile if bleeding behind eye
Which of the external ocular muscles does not originate around the superior orbital fissure and optic canal?
Inferior oblique
What are the actions of superior and inferior oblique in adduction and abduction?
Adduction
SO depresses and IO elevates
Abduction
SO intorts, depresses and abducts
IO extorts, elevates and abducts
Which muscle elevates the eye when it is abducted?
Superior rectus
What is the effect of a third nerve palsy?
Dilated pupil (decreased parasympathetic stimulation)
Ptosis (no lps)
Eye abducted and depressed
What is the effect of a fourth nerve palsy?
Unable to move eye inferio medially
What provides arterial supply to the eye?
Ophthalmic artery, a branch of the internal carotid, becomes the central artery of the retina and several branches to the orbit
Blood to lower orbit from infraorbital artery (external carotid)
What is the venous drainage of the eye?
Superior and inferior ophthalmic veins to the cavernous sinus via the superior orbital fissure
Some drainage straight to the pterygoid venous plexus via the inferior orbital fissure
Central vein of the retina drains down the optic nerve before joining one of the opthalmic veins or direct to cavernous sinus
What is the opening between the eyelids called?
Palpebral fissure
What is the conjunctiva?
A layer that covers the inner of the eyelids and reflects back over the sclera but NOT the cornea
The conjunctiva over the sclera is the bulbar and over the eyelid is the palpebral
What are the muscles of the eyelid? How are they innervated?
LPS - CNIII
Tarsal - sympathetic stimulated smooth muscle
Orbicularis occuli - CNVIII
What eyelid muscle is the strongest opener of the eye?
LPs
What glands are found in the eyelid?
Meibonian glands - secrete oil that traps lacrimal fluid
Ciliary glands - secrete sebum
What problems are associated with eyelid glands?
Meibonian gland - meibonian cyst - internal surface, painless initially, not usually infection
Ciliary gland - stye - lower eyelid, painful, infective therefore red
What causes blinking?
Corneal dryness, irritation, expectation of contact.
Bilateral reflex
What is the process of lacrimation?
Fluid produced from lacrimal glands superiomedially under parasympathetic stimulation following sensation taken via CNV1
Fluid crosses eye, spread by blinking
Oil from meibomian glands keeps it within the eye
Collects at lacrimal lakes before draining through the lacrimal canal, lacrimal sac and finally nasolacrimal duct.
Emerges at the inferior meatus
What cartilages make up the external nose?
Septal Lateral Major alar Minor alar Greater alar
What line divides the nasal vestibule from the nasal cavity? What changes here?
Limen nasi
Skin to mucous membrane
What is the lining of the nasal cavity?
Psuedostratified ciliated with goblet cells
What is the opening from nasal cavity to the nasopharynx?
Choanae
What surfaces are involved in the floor and roof of the nasal cavity?
Floor - palatine process of maxilla, palatine bone
Roof - frontal, ethimoid, sphenoid
What bones and cartilages make up the nasal septum?
Ethymoid
Vomer
Septal cartilage
From which bone do the superior and middle conchae originate?
Ethymoid
What is the area above the superior conchae termed?
Spenoethamoidal recess
Where do the lacrimal apparatus and eustachian tubes open?
Lacrimal into inferior meatus
Eustachian into the nasopharynx at the level of inferior meatus
Where do the sinuses drain?
Maxillary - middle meatus
Frontal - frontonasal duct to ethmoid infundibulum to middle meatus
Anterior ethmoid - ethmoid infundibulum to middle meatus
Middle ethmoid - bulla into middle meatus
Posterior - direct to superior meatus
Sphenoid - drains into sphenoethymoidal recess
Which sinus is not present at birth?
Frontal
The expansion of which sinus contributes to face growth?
Maxillary
What blood vessels supply the nose?
Anterior and posterior ethmoidal (from opthalmic thus ICA)
Sphenopalatine (from maxillary thus ECA)
Greater palatine (from maxillary thus ECA)
Labial (from facial thus ECA)
Where do many of the blood vessels meet and anastamose?
Septal surface just posterior to the nares - littles area (kiesselbach’s)
How do the veins drain the nose?
To the cavernous sinus (following ethmoidal arteries)
To the facial vein (following labial artery)
To the pterygoid plexus (following sphenopalatine)
What is the line of divide in sensation between CNV1 and 2?
V1 does anterior superior internal nose and nasal bridge externally
V2 does posterior inferior internal nose and lateral nose externally
What are the functions of the nose?
Smell Filter Warm Humidify Drain secretions
What aids the nose in its functions?
Turbulent flow moves air to olfactory region, increases time for warmth humidity and filtering
Concha increase surface area increasing warmth, humidity and filtering
Very vascular so more warmth and humidity
Where do epistaxis usually occur? What happens if they don’t occur here?
90% from littles area
Posterior bloods very hard to stop as so far back (sphenopalatine artery)
What can cause nosebleeds?
Local trauma Systemic problems (coagulation, htn)
What is sinusitis?
When would you tx with abx?
Inflammation of the sinuses blocking drainage causing stagnation with secondary bacterial infection
Acute sinusitis is usually viral (98%)
Give abx if high temp, severe unilateral symptoms, marked deterioration after stable for a while (2ndry infection)
What are problems associated with nasal polyps?
Nasal obstruction causing obstructive sleep apneoa
What causes rhinitis?
Inflammation of nasal mucosa increasing volume of secretions
Can be allergic, infective, polyps
Where can nasal infections spread?
Anterior cranial fossa via cribiform plate
Middle ear via eustachian tube
Paranasal sinuses
Lacrimal apparatus via nasolacrimal duct
What is a complication of a nasal fracture?
Nasal septal necrosis
Nasal septal deviation (can block a nare)
What nerves supply the maxillary sinuses? What does this mean clinically?
Superior alveolar - this is the same as the molars thus sinusitis may present with toothache
When do the pharyngeal arches develop?
Weeks 4/5
What are the swellings around the stomatodeum?
Frontonasal prominence Maxillary prominences (of 1st arch) Mandibular prominences (of 1st arch)
What cranial nerves are associated with what pharyngeal arches?
V. 1
VII. 2
IX. 3
X. 4,6
What develops from the pharyngeal arches?
1 - muscles of mastication - mandible, malleus and incus
2 - muscles of facial expression - stapes, styloid process, upper hyoid bone
3 - stylopharyngeus - lower hyoid bone
4 - cricothyroid, pharyngeal constrictors, upper thyroid cartilage
6 - intrinsic muscles of the pharynx, lower thyroid and cricoid cartilage
What are the two cartilages associated with pharyngeal arches 1 and 2
Meckels
Reicherts
What do the pharyngeal pouches go on to form?
1st - tympanic cavity, iam
2nd - palatine tonsils
3rd - thymus, inferior parathyroid
4th - superior parathyroid, parafolicular cells
What do the pharyngeal clefts form?
1st forms eam
Rest fuse forming cervical sinus and close
What pathology arises from the pharyngeal clefts? How is it identified?
Branchial cysts or fistulae
Cysts along anterior edge of scm
What drives the movement of the components of embryonic head to their adult location?
The expansion of the maxillary prominences
What forms the nose during development?
Lateral and medial nasal prominences either side of nasal pit
What does the maxillary prominence fuse with during development? What happens then? What does this create?
Medial nasal prominence
Medial nasal prominences fuse on the midline
Creates the primary palate
How does the secondary palate form?
Palatal shelves descend from maxillary prominence
Mandible enlarges creating more space
Palatal shelves turn horizontally and fuse on the midline
What are the three grades of cleft palates? What do they involve?
Cleft lip - failure of fusion of medial nasal prominence with maxillary prominence
Lateral cleft lip and primary palate - as cleft lip but also failure of palatal shelf to fuse with primary palate
Cleft lip and secondary palate - as cleft lip and primary palate but also failure of palatal shelves to meet in midline
What are the symptoms of foetal alcohol syndrome? What causes it?
Effects ncc migration
- small head
- low nose bridge
- flat midface
- no philtrum
- small palpebral fissure
How does the pituitary form? Include name of developmental area.
Posterior is downgrowth from diencephalon
Anterior is outpouching from pharynx in a region called rathke’s pouch - growing sphenoid bone pinches off rathke’s pouch separating it from the pharynx
What anchors the tongue?
Lingual frenulum
What do the muscles of the tongue do?
Extrinsic - movement
Intrinsic - shape
What splits the anterior 2/3 of tongue from posterior 1/3
Sulcus terminalis
What swellings contribute to tongue development?
Lateral ligngual (pa1) Tuberculum ipar (pa1) Cupola (pa2,3,4) Epiglottal swelling (pa4,6)
How does development of the tongue occur?
Lateral lingual swellings overgrow tuberculum impar, middle of cupola overgrows top. Degeneration occurs freeing the tongue.
What clinical corrolation is there to the multi. Arch origins of the tongue?
Multiple nervous innervation
Why does chordae tympani pass through the middle ear?
It arises from the facial nerve (paii) and inserts into the first thus has to pass through p pouch 1 (the middle ear!)
Where does the thyroid gland develop?
The foramen cecum at the base of the sulcus terminalis
How does the thyroid decend?
As a bilobed diverticulum remaining connected to the foramen cecum by the thyroglossal duct
When it reaches its destination parafolicular cells and the parathyroid glands migrate in from the 3/4th pouches
What abnormality of the thyroids descent is there? How can it be differentiated from branchial cysts?
Thyroglossal duct cysts due to failure of closure of thyroglossal duct. They are midline and move with swallowing
What are the vertebral levels of the pharynx?
C1 naso
C2 C3 oro
C4 C5 C6 laryngo
What are the openings from the nasal cavity to the nasopharynx?
Choanae
What is the lining of the pharynx?
Naso - pseudostratifed ciliated
Oro and laryngo - stratified squamous
What is the ring of tonsils in the pharynx called?
Waldeyer’s ring
Where are the palatine tonsils located?
Between the anterior and posterior tonsillar arches in tonsillar fossa
On what muscle do the palatine tonsils sit?
Superior constrictor
What is the arterial supply to the pharyngeal tonsils?
Tonsillar branch of the facial artery and ascending palatine artery
What lymph nodes do the tonsils drain into?
Internal jugular vein associated nodes (deep cervical)
Jugulodigastic
What are the openings into the laryngopharynx, which locations are they found?
Superior - oropharynx
Inferior - oesophagus
Superior-anterior - larynx
What are the major muscles of the pharynx?
How are they arranged?
Under what control are they under?
The superior, middle and inferior constricters, overlap posteriorly, open anteriorly (act as circular muscles) VOLUNTARY Longitudinal muscles (stylopharyngeus, salpingopharyngeus, palatopharyngeus) CN ix and CN x
What are the actions of the muscles of the pharynx?
Circular muscles constrict
Longitudinal muscles shorten and widen
What are the stages of swallowing?
Tongue voluntarily pushes food bolus to back of oropharynx
Soft palate elevates closing nasopharynx, longitudinal muscles shorten and widen pharynx and also raise larynx (along with suprahyoid muscles)
Sequential contraction of constricter muscles push bolus into oesophagus
What prevents food entering the larynx?
Epiglottis, ventricular folds, tongue base.
What are the stages of swallowing?
Voluntary tongue motion to push food back
Elevation of soft pallate to block nasopharynx
Widening of pharynx using longitudinal pharyngeal muscles
Elevation of the larynx by the suprahyoid muscles
Sequential constraction of the constrictor muscles
Which nerve supplies the cricothyroid muscle?
The external branch of superior laryngeal nerve
What nerve supplies the majority of the intrinsic laryngeal muscles?
Inferior laryngeal as a branch of recurrent laryngeal nerve
What is the arterial supply to the larynx?
Superior thyroid branching to sup. laryngeal and cricothyroid
Inferior thyroid branching to inf. laryngeal
What are the folds and cords of the larynx?
Superior ventricular folds (false vocal cords)
Infeior vocal folds (true vocal cords)
What are the openings between the true and false vocal cords called?
Rima glottidis
Rima vestibuli
