Head & Neck Anat Flashcards
What are the boundaries of the neck?
Superior: Inferior border of mandible + mastoid process + superior nuchal line
Inferior: Thoracic inlet
Posterior: T1 vertebra
Anterior: 1st rib + costal cartilage + manubrium
Where is the thoracic outlet?
Space between clavicle and 1st rib
What bony landmarks are located adjacent to the occipital protuberance?
Superior nuchal line
The C3/4 vertebral level contains:
i) upper margin of ___________
ii) bifurcation of _____________
The C3/4 vertebral level contains:
i) upper margin of thyroid cartilage
ii) bifurcation of common carotid artery
The C6 vertebral level contains:
i) arch of _____________
ii) superior end of ____________
iii) superior end of ___________
The C6 vertebral level contains:
i) arch of cricoid cartilage
ii) superior end of esophagus
iii) superior end of trachea
What is the clinical name of the “Adam’s apple”?
Thyroid cartilage
What are the 3 superficial anterior structures of the neck (from superior to inferior)?
1) Hyoid bone
2) Thyroid cartilage
3) Cricoid cartilage
What are the bounds of the anterior triangle of the neck?
Base/superior: inferior margin of mandible
Lateral: Sternocleidomastoid
Medial: Midline of neck
Which structure divides the anterior and posterior triangles of the neck?
Sternocleidomastoid muscle
What are the bounds of the posterior triangle of the neck?
Base/inferior: Clavicle
Medial: posterior margin of sternocleidomastoid
Lateral: anterior margin of trapezius
How do the structures coursing through the anterior and posterior triangles of the neck differ?
Anterior: btwn head and thorax
Posterior: btwn thorax/neck and upper limb
Which structure separates the internal and external jugular vein?
Sternocleidomastoid
Which muscle can be found within the superficial fascia of the neck?
Platysma
Which muscles form the “wall” of the neck?
Anterior: SCM
Posteior: Trapezoids
Which group of muscles are found directly inferior to the hyoid bone?
Infrahydoid (Strap) muscles
What is the arrangement of the structures of the neurovascular bundle of the neck (lateral to medial)?
1) Internal jugular vein
2) Vagus nerve (CNX)
3) Carotid artery
Which muscles sandwich the brachial plexus at the neck?
Scalenus anterior and medius
Where is the phrenic nerve located with reference to the pre-vertebral muscles of the neck?
Anterior to scalenus anterior
What are the 3 groups of deep fascia in the neck/deep cervical fascia ?
1) Investing layer
2) Pre-vertebral fascia
3) Pre-tracheal layer
What is formed by the union/contribution of the 3 deep cervical fascia?
Carotid sheath
What are the muscles of the anterior triangle of the neck that attach to the hyoid bone?
1) Digastric (anterior and posterior) (suprahyoid)
2) Omohyoid (1/4 infrahyoid muscles)
What are the strap/infrahyoid muscles of the neck?
1) Omohyoid
2) Sternohyoid
3) Sternothyroid
4) Thyrohyoid
True or false: In the neck the vertebral vein and artery run together.
True
True or false: The arterial branches that supply the neck arise from both the internal and external carotid artery.
False.
Internal carotid no branches in neck.
All branches from external carotid.
Where does the vertebral artery arise from?
Subclavian artery
Describe the path of the vertebral artery.
Subclavian → vertebral artery
→ pass through foramen transversarium
→ enter cranial cavity with internal carotid
What are the branches of the external carotid artery?
Some – Superior thyroid
Anatomists – Ascending pharyngeal
Like – Lingual
Freaking – Facial
Out – Occipital
Poor – Posterior auricular
Medical – Maxillary
Students – Superficial temporal
Describe the innervation of the strap muscles of the neck?
By branches of the ansa cervicalis (branch of cervical plexus)
What structure connects the anatomical lobes of the thyroid gland?
Isthmus
Which structure at the 2nd-4th tracheal ring level of the neck maybe injured during a tracheostomy?
Isthmus of thyroid gland
What is the muscle between the thyroid and cricoid cartilage?
Cricothyroid muscle
Describe the collateral circulation supplying the thyroid gland.
1) Superior thyroid (from external carotid)
2) Inferior thyroid (from subclavian)
Describe the venous drainage of the thyroid gland.
1) Superior thyroid vein → internal jugular vein
2) Inferior thyroid vein → subclavian or brachiocephalic vein
Which nerve supplies the cricothyroid muscle?
External laryngeal nerve (branch of vagus nerve)
Which nerve is closely associated to the superior thyroid artery?
External laryngeal nerve
Which nerve is closely associated to the inferior thyroid artery?
Recurrent laryngeal nerve
What are the cervical lymph nodes?
1) Submental
2) Submandibular
3) Auricular
4) Mastoid
5) Parotid
6) Occipital
→ Drain to nodes surrounding internal jugular vein
7) Deep cervical nodes
→ thoracic duct (L) / R lymphatic trunk
What are the 2 structures located superior to the nasal ridge?
Depression: Nasion
Elevation: Glabella
The zygomatic arch is ___________ to the maxilla.
Lateral
Where is the pterion?
1 finger length lateral from lateral border of orbit and above zygomatic arch
What is the clinical significance of the pterion?
1) Thinnest part of skull
2) Middle meningeal artery and vein run directly deep
What are the layers of the scalp?
S - Skin
C - Connective tissue
A - Aponeurosis (Epicranial)
L - Loose areolar tissue
P - Pericranium
What bony landmark is located bilaterally on the anterior surface of the mandible?
Mental foramina
What bony landmark of the maxillary bone is located bilaterally below the orbits?
Infraorbital foramina
What bony landmark of the frontal bone is located bilaterally above the orbits?
Supraorbital ridge/foramina
What type of joint is formed between the bones of the skull?
Fibrous
What is the pterion formed by?
Junction of:
1) Frontal
2) Parietal
3) Temporal
4) Sphenoid bones
What is the biggest opening in the skull?
Foramen magnum
Which bones form the hard palate?
1) Maxilla
2) Palatine
What are the bounds of the scalp?
From supraorbital margin
to external occipital protuberance and superior nuchal line
What are the communications between the scalp and the cranial cavity?
Venous
- emissary vein (valveless)
(route of infection)
What are the 2 muscles that attach to the aponeurosis of the scalp?
1) Frontalis
2) Occipitalis
Why are longitudinal lacerations of the scalp more favorable than lateral?
Lateral → scalp will be pried open by action of occipitalis and frontalis muscles
What type of muscles close the eye and the mouth orifices?
Sphincteric
What are the sphincteric muscles of the eye?
Orbicularis oculi
What are the sphincteric muscles of the mouth?
Orbicularis oris
What type of muscles open the eye and mouth?
Levator
What are the levator muscles of the eye?
Levator palpebro superioris
What are the levator muscles of the mouth?
1) Levator labi superioris
2) Depressor labi inferioris
What muscle rests on the nasion of the face?
Procerus
What muscle is found deep to the frontalis?
Corrugator supercili
What are the muscles lateral to the mouth/nasal cavity?
Lateral to medial:
1) Risorius
2) Zygomaticus major
3) Zygomaticus minor
4) Levator labi superioris
5) Levator angularis oris
What are 3 facial muscles inferior to the mouth?
1) Depressor angularis oris
2) Depressor labii inferioris
3) Platysma
4) Mentalis
Which 2 muscles are the parotid duct related to?
Courses superficial to masseter before piercing the buccinator
What are 3 muscles that move the ear?
Auricular
- superior
- anterior
- posterior
How would a botox injection of the corrugator supercilli and procerus cause a droopy eyelid?
Injection may spread to underlying levator palpebra superioris
What is the embryological origin of the muscles of facial expression?
2nd pharyngeal arch
What is the nerve that supplies the muscles of facial expression?
CNVII: Facial nerve
What is the nerve that is closely related to the parotid gland?
CNVII: Facial nerve
What are the terminal branches of the facial nerve?
Superior to inferior:
1) Temporal
2) Zygomatic
3) Buccal
4) Mandibular
5) Cervical
Describe the innervation of the muscles of the face.
Mainly by CNVII: facial nerve (LMN)
- receives bilateral UMN influence motor cortex
- EXCEPT lower part of face → only contralateral
What are the muscles of mastication supplied by?
Trigeminal
- all from 1st pharyngeal arch
Describe the sensory innervation of the head.
Front: CNV1-3 (ophthalmic, maxillary, mandibular)
Back: Cervical plexuses
- ventral rami (supply lateral behind ear to neck)
- dorsal rami (posterior skull)
Describe the arterial supply of the face?
1) Internal carotid → cranial cavity → orbit (opthalmic artery)
2) External carotid →
i) Facial
ii) Superficial temporal
iii) Maxillary → infraorbital
iv) Occipital
v) Posterior auricular
How does the facial nerve exit the skull before entering the parotid gland?
Stylomastoid foramen
Which muscles are (i) superficial (ii) deep to the rami of the mandible?
i) Masseter
ii) Medial pterygoid
What are the anterior relations of the parotid gland (3)?
Medial to lateral:
1) Medial pterygoid
2) Rami of mandible
3) Masseter
What are the posterior relations of the parotid gland?
Medial to lateral:
1) Sternocleidomastoid
2) Mastoid process
3) Digastric muscles
4) Styloid process
5) Styloid process muscles (styloglossus, stylohyoid, and stylopharyngeus)
What are the vessels that are within the parotid gland?
Deep to superficial:
1) External carotid artery
2) External carotid vein
3) Facial nerve
Describe the innervation of the parotid gland.
CNIX: Glossopharyngeal
What are the 2 sets of lymph nodes of the head and neck
1) Submandibular
2) Submental
3) Parotid
4) Mastoid
5) Occipital
All drain to:
6) Deep cervical lymph nodes (along internal jugular vein)
- R → right lymphatic trunk
- L → thoracic duct
What forms the boundaries of the cranial fossae?
Anterior and middle → lesser wing of sphenoid bone
Middle and posterior → Petrous part of Temporal bone
Which bone forms the boundary of the posterior aperture of the nasal cavity?
Sphenoid
Which bones of the skull are air sinuses found?
1) Ethmoid
2) Sphenoid
3) Frontal
4) Maxillary
Which part of the sphenoid bone forms part of the pterygoid?
Greater wing
What are the sutures of the cranial cavity?
1) Coronal
2) Sagittal
3) Lambdoid
What are the holes located along the superior sagittal sinus of the skull?
Granular foveolae
(for arachnoid granulations)
Which cranial fossa is the cerebellum located in?
Posterior
Which part of the cranial cavity are the inner and middle ear located?
Petrous part of temporal bone
Where is the olfactory nerve in relation to the cranial cavity?
Cribriform plate of the anterior fossa
Where is the oculomotor nerve in relation to the cranial cavity?
Superior orbital fissure of middle fossa
Where is the adducens nerve in relation to the cranial cavity?
Superior orbital fissure of the middle fossa
Where is the trochlear nerve in relation to the cranial cavity?
Superior orbital fissure of middle fossa
Where is the ophthalmic vein in relation to the cranial cavity?
Superior orbital fissure of middle fossa
What are the contents of the optic canal?
1) Optic nerve
2) Ophthalmic artery
What are the contents of the superior orbital fissure?
1) Oculomotor nerve
2) V1: Ophthalmic branch of trigeminal nerve
3) Abducens nerve
4) Trochlear nerve
5) Ophthalmic vein
What are the contents of the foramen rotundum of the cranial cavity?
V2: Maxillary nerve
What are the contents of the foramen ovale of the brain?
V3: Mandibular nerve
What are the contents of the foramen spinosum of the brain?
Middle meningeal artery
Describe the venous communication between the extra and intracranial cavities.
Emissary veins pass through cartilage of foramen lacerum
Where is the pituitary gland in relation to the cranial cavity?
Hypophyseal fossa (formed by body of sphenoid bone)
What are the contents of the hypoglossal canal?
CNXII: Hypoglossal nerve
What are the contents of the jugular foramen?
1) Internal jugular vein
2) CNIX: Glossopharyngeal nerve
3) CNX: Vagus nerve
4) CNXI: Accessory nerve
What are the contents of the internal acoustic meatus?
1) CNVII: Facial nerve
2) CNVIII: Vestibulocochlear nerve
3) Labyrinthine artery
Which nerve is located within the pterygopalatine fossa?
V2: Maxillary nerve
What are the structures located within the pterygopalatine fossa?
1) Maxillary nerve
2) Maxillary artery
3) Pterygopalatine ganglion
How does the internal carotid artery enter the cranial cavity?
1) Carotid canal
2) Foramen lacerum
3) Intracranial cavity
What are the folds of the dura and what do they separate?
1) Falx cerebri
- lateral hemispheres of cerebrum
2) Tentorium cerebelli
- occipital lobe from cerebellum
3) Falx cerebelli
- lateral hemispheres of cerebellum
What are the 2 venous sinuses found on the falx cerebri?
1) Superior sagittal sinus
2) Inferior sagittal sinus
How do infections of the face and orbit spread into the cranial cavity?
Via ophthalmic vein
Describe the deep venous sinus drainage of the cranial cavity.
1) Superior + Inferior Sagittal Sinus
→ Straight Sinus
→ Confluence of Sinuses
→ Transverse Sinus
→ Sigmoid Sinus
→ Internal Jugular vein
2) Ophthalmic vein
→ Cavernous Sinus
→ Superior + Inferior Petrosal Sinus
Which cranial nerves/lobes would be affected in a cavernous sinusitis?
1) Temporal lobe
2) Internal carotid artery
3) CNIII: Oculomotor
4) CNIV: Trochlear
5) CNV1: Ophthalmic
6) CNV2: Maxillary
7) CNVI: Abducens
What are the 3 sets of veins in the brain?
1) Superficial
2) Dural venous sinuses
3) Deep
True or false:
The dural venous sinuses contain valves to prevent the backflow of blood from the deep to the superficial cranial veins.
False.
Dural venous sinuses no valves
- low resistance blood drainage
Where is CSF produced?
Choroid plexus
- modified capillaries along wall of ventricles
How does CSF travel from the ventricles to the subarachnoid space?
Via 3 openings of 4th ventricles
How does CSF get reabsorbed into venous circulation?
Openings in 4th ventricles
→ subarachnoid space
→ arachnoid granulations along superior end of skull
→ superior sagittal sinuses
Epidural and subdural haemorrhages are differentiated on imaging as they present as _________shape due to being confined by ___________ respectively.
Epidural: Middle meningeal artery
- confined by cranial sutures → biconcave lens
Subdural: Bridging veins
- confined by dural reflections → crescent
What are the arteries that supply the spinal cord?
2 from vertebral arteries:
1) Anterior spinal artery
2) Posterior spinal artery
1 from aorta/branches of aorta:
3) Segmental (radicular) arteries
Which spinal tracts would be affected in a posterior spinal artery lesion?
Dorsal column (DCML)
- conscious proprioception, fine touch, vibration
The ciliary body is an extension of which layer of the eye?
Choroid
Which cranial cavity does the orbit project into?
Middle cranial fossa
The roof of the orbit forms the floor of the _________________________.
Anterior cranial fossa
The medial wall of the orbit is related to the ______________.
Nasal cavity + Ethmoid sinuses
The lateral wall of the orbit is related to the _________ fossa.
Temporal
The floor of the orbit is related to the ________ and its sinus.
Maxilla (Maxillary sinus)
What are the bones that form the walls of the orbit?
Roof: Frontal
Lateral: Sphenoid + Zygomatic
Floor: Maxilla
Medial: Ethmoid + Lacrimal + Maxilla
What are the openings of the orbit and their contents?
1) Optic canal
- optic nerve
- ophthalmic artery
2) Superior orbital fissure
- CN3, 4, V1, 6
- ophthalmic vein
3) Inferior orbital fissure
4) Infraorbital foramen
5) Lacrimal fossa + Nasolacrimal duct
Which extraocular muscle that is supplied by CNIII: Oculomotor nerve but does not control the eyeball?
Levator Palpebrae Superioris (lifts eyelid)
Where do the extraocular muscles originate from and attach to?
Origin: Common tendinous ring over optic canal and superior orbital fissure
Attachment: Sclera
Which muscle runs parallel to the axis of the orbit?
Superior Rectus
What nerve provides somatic sensory innervation to the orbit?
V1: Ophthalmic nerve
What are the components of the lacrimal apparatus and their functions?
1) Lacrimal gland
- secrete tears
2) Excretory ducts
- convey tears to surface (via conjunctival fornix)
3) Lacrimal canaliculi
- empty tears into lacrimal sac
4) Lacrimal sac
5) Nasolacrimal duct
- convey tears into nasal cavity
What is the function of the lacrimal apparatus?
Tear production and drainage
What are the parts of the conjunctiva and where do tears accumulate before flowing laterally?
1) Palpebral (inner side of eyelid)
2) Bulbar (on sclera)
3) Conjunctival fornix
- where tears accumulate
What are the Meibomian (tarsal) glands and where are they located?
Modified sebaceous glands → produce meibum to prevent evaporation of eye’s tear film
Along rims of eyelid
What is the superior tarsal (Muller’s) muscle is its function?
Smooth muscle component of levator palpebrae superioris muscles
- helps raise upper eyelid
What is the pathophysiology of partial ptosis in a superior cervical ganglion lesion?
Disrupted autonomic innervation to the Muller’s muscle (smooth muscle component of the levator palpebrae superioris muscle)
What structure separates the left and right nasal cavities?
Nasal septum
What are the names of the nostril and the opening into the nasopharynx?
Anterior and posterior nasal aperture respectively
What are the structures lining the lateral walls of the nasal cavities?
Concha (count from bottom up)
1) Inferior
2) Middle
3) Superior
What is the name of the space between the conchi?
Meatus
What are 2 important relations of the superior posterior aspect of the nasal cavity?
1) Sphenoidal sinus
2) Pituitary gland and fossa
Where do the nasolacrimal ducts open into?
Inferior meatus
What is the space above the superior meatus?
Spheno-ethmoidal recess
- where 1 of the paranasal sinuses open into
What are the structures found in the middle meatus?
1) Ethmoidal bulla → ethmoidal sinus
2) Semilunar groove → frontal sinus + maxillary sinus
Which sinus opens into the superior meatus?
Ethmoidal sinus
The majority of the nasal cavity is lined by _______________ epithelium, with the exception of ___________________.
Respiratory (ciliated pseudostratified columnar epithelium)
- except:
1) nasal vestibule → keratinized stratified squamous with hair
2) Roof of nasal cavity → olfactory epithelium/mucosa
Describe the innervation of the nasal cavity.
Somatosensory:
1) V2/Maxillary nerve
2) CNI: Olfactory nerve
(Ophthalmic nerve a bit to external nose via anterior ethmoidal nerve)
Which artery supplies the nasal cavity?
Maxillary artery (branch of external carotid artery)
(a bit from anterior ethmoidal artery from ophthalmic artery)
Which branch of the maxillary nerve and artery also supply the palate, other than the nasal cavity?
Artery: Sphenopalatine branch
Nerve: Nasopalatine branch
How do the sphenopalatine branch of the maxillary artery and the nasopalatine branch of the maxillary nerve enter the oral cavity?
Via the incisive canal
Which area of the nose is most prone to nose bleeds and why?
Nasal septum
- rich blood supply/anastomoses by lateral branches of maxillary artery on both sides
What are 2 veins that drain the nasal cavity?
1) Maxillary
2) Ophthalmic
Which of the paranasal sinuses are most prone to infection?
Maxillary
- very big but hole into inferior meatus is not on floor of sinus → difficult to drain
- closely related to upper teeth → infection can spread
True or false:
The paranasal sinuses are fixed at birth and thus do not stay proportionate to facial size.
False.
Grow with age
How does the pterygo-palatine fossa communicate with the nasal cavity?
Sphenopalatine foramen
How does the pterygo-palatine fossa communicate with the cranial cavity?
1) Foramen rotundum
2) Pterygoid canal
(both into middle cranial fossa)
How does the pterygo-palatine fossa communicate with the infratemporal fossa and their contents?
Pterygomaxillary fissure
- infraorbital nerve and artery
How does the pterygo-palatine fossa communicate with the palate?
Palatine canal
Where is the oral vestibule?
Between cheeks/lips and teeth
Where are the frenulum of the upper and lower lip?
Midline of oral cavity within vestibule
What structure separates the oral cavity and oropharynx?
Oropharyngeal isthmus
- superiorly: palate
- lateral: palatoglossal fold
- anterior: posterior 1/3 of tongue
Which fold is located posterior to the palatoglossal fold?
Palatopharyngeal fold
Which muscle run deep to the oropharyngeal isthmus within the oropharynx?
1) Palatoglossus
2) Palatopharyngeus
What structure is found between the palatopharyngeal and palatoglossal folds?
Palatine tonsils
What structure is found between the lingual tonsils and epiglottis?
Valeculla
Where is the foramen caecum and what is its embryological significance?
Between terminal sulci of tongue
- where thyroid gland orginated before descending
What structure of the tongue has a very high density of taste buds?
Circumvallate papilla
What are the muscles of the tongue?
Extrinsic (move tongue):
1) Palatoglossus → elevate
2) Styloglossus → retract
3) Hyoglossus → depress
4) Genioglossus → protrude
Intrinsic (change shape of tongue):
5) Superior longitudinal
6) Vertical
7) Transverse
8) Inferior longitudinal
Describe the innervation of the tongue.
Motor:
All by CNXII: Hypoglossal
- except Palatoglossus by CNX: Vagus
Sensory:
Anterior 2/3
General → Lingual nerve (branch of CNV3: Mandibular)
Taste →Chorda tympani (branch of CNVII: Facial) (except circumvallate papilla → follow posterior)
Posterior 1/3
General + taste → CNIX: Glossopharyngeal
Which artery supplies the tongue
Lingual artery (branch of external carotid)
What is the term for the ridges found posterior to the incisors on the roof of the mouth?
Palatine rugae
Describe the innervation and blood supply of the hard palate.
Innervation:
1) Nasopalatine nerve (anterior part)
2) Greater palatine nerve (from greater palatine foramen → posterior)
Blood supply:
1) Sphenopalatine artery (anterior part)
2) Greater palatine artery (from greater palatine foramen → posterior)
What are the muscles of the soft palate?
1) Tensor veli palatini → tense + elevate
2) Levator veli palatini → elevate
3) Palatoglossus → depress
4) Palatopharyngeus → depress
5) Musculus uvulae
Describe the innervation of the muscles of the soft palate.
All by CNX: Vagus
- except tensor villi palatine (by CNV: trigeminal)
What are the 2 branches of the mandibular nerve?
1) Lingual
- supply tongue
2) Inferior alveolar nerve
- supply teeth and gingiva
What are 3 glands of the oral cavity?
1) Parotid
2) Submandibular
3) Sublingual
What nerve branches from the inferior alveolar nerve before it enters the mandibular foramen and what does it supply?
Nerve to mylohyoid
- mylohyoid + anterior belly of digastric
What does the lingual nerve curve around before supplying the tongue?
Submandibular duct
The chorda tympani is a branch of the _________ nerve and synapses at the _______ before supplying the _____________.
Branch of CNVII: Facial
Synapse at submandibular ganglion
Supply submandibular and sublingual glands
The hypoglossal nerves crosses the ______ before supplying the muscles of the tongue.
Internal and external carotid arteries
How do the the histology of the salivary glands differ?
Parotid:
- totally serous, very basophilic
Sublingual:
- very mucous, lighter
Submandibular:
- mixed
What are the ligaments of the TMJ?
1) Lateral ligament
2) Stylomandibular ligament
3) Sphenomandibular
4) Capsule
What are the bony components of the TMJ?
Condyle of mandibular and mandibular groove temporal bone + articular tubercle
What kind of cartilage lines the TMJ?
Fibrocartilage
What makes the TMJ a modified hinge joint?
2 cavities separated by articular disc (fibrocartilage):
i) Superior → plane joint
ii) Inferior → hinge joint
What are the movements of the TMJ?
1/2: Elevation/depression
3/4: Protrusion/retraction
5: Lateral
What are the muscles of mastication?
1) Masseter
- elevate
2) Temporalis
- anterior: elevate
- posterior: retract
3) Medial pterygoid
- elevation
4) Lateral pterygoid
- protrusion
True or false:
The medial pterygoid attaches to the medial plate of the pterygoid process while the lateral pterygoid attaches to the lateral plate of the pterygoid process.
False.
Both attach to lateral plate
i) Medial → medial surface
ii) Lateral → lateral surface
Which artery and nerve supplies the TMJ?
Maxillary artery
Mandibular nerve
What are the 3 parts of the pharynx?
1) Nasopharynx
2) Oropharynx
3) Laryngopharynx
What are the components of Waldeyer’s ring?
1) nasopharyngeal tonsils
2) palatine tonsils
3) lingual tonsils
Where does the eustachian tube open into?
Nasopharynx (pharyngeal orifice)
What are 2 muscles that are related to the tubal elevation/pharyngeal orifice of the eustachian tube?
1) Salpingopharyngeal → (fold)
2) Levator vili palatini
The nasopharynx extends from the ______________ to the ________________.
Choana/posterior nasal aperture → epiglottis
What are 2 locations in the upper GIT that fish bones commonly get stuck?
1) Vallecula (oropharynx)
2) Piriform recess (laryngopharynx)
What are the muscles of the pharynx?
Longitudinal:
1) Stylopharyngeus
2) Salpingopharyngeus
3) Palatopharyngeus
Circular(sphincteric):
4) Superior constrictor
5) Middle constrictor
6) Inferior constrictor
How does the lining epithelium of the pharynx change as it descends?
Nasopharynx: respiratory
Oro/laryngopharynx: stratified squamous
Describe the nerve and blood supply of the pharynx.
Blood supply:
Pharyngeal branches of external carotid
Nerve supply:
Pharyngeal plexus
- all by CNX (+XI) except stylopharyngeus (CNIX)
What are the cartilages of the larynx?
1) Thyroid
2) Cricoid
3) Epiglottis
Paired
4) Arytenoid
5) Corniculate
6) Cuneiform
What are 2 features of the lateral fold of the larynx?
1) Vestibular fold (superior)
2) Vocal fold (inferior, whiter)
What are the rima vestibule and glottidis?
The space between the vestibular and vocal folds respectively
What is the lining epithelium of the larynx?
Respiratory epithelium
- except vocal fold (stratified squamous)
The larynx extended from the __________ to the __________.
Epiglottis to cricoid cartilage
The vocal folds are attached to the _________.
Arytenoid cartilage
What are the muscles of the cartilage?
1) Cricothyroid
2) Thyroepiglottis
3) Thyroarytenoid
4) Vocal
5) Cricoarytenoid (lateral and posterior)
6) Aryepiglottic muscles
7) Inter/transverse arytenoid
8) Oblique arytenoid
Which muscles control the laryngeal inlet?
1) Aryepiglottic muscles
2) Lateral cricoarytenoids
3) transverse (inter) arytenoids)
4) oblique arytenoids,
What are the movements of the vocal folds?
1/2) Ab/adduct
Which muscle abduct the vocal folds?
Posterior cricoarytenoid
Which muscle raises the pitch of our voice?
Cricothyroid (tenses vocal folds)
What forms the laryngeal inlet?
Superior: epiglottis
Lateral: periepiglottic folds
Inferior: interarytenoid folds
What are the branches of the superior laryngeal nerve (from CNX)?
1) Internal laryngeal nerve: sensory to area superior to vocal folds
2) External laryngeal nerve: motor to cricothyroid
Where does the superior thyroid artery arise from and what does it supply?
External carotid
- supply (i) thyroid (ii) larynx (iii) pharynx
In the supply of the larynx, both the ____________ and _____________ are closely opposed to each other.
Superior supply:
- superior thyroid artery and external laryngeal nerve
Inferior supply:
- inferior thyroid artery and recurrent laryngeal nerve
What nerve supplies the larynx?
Vagus
i) Superior laryngeal nerve → external/internal laryngeal nerve
ii) Recurrent laryngeal nerve
What type of cartilage forms the skeleton of the larynx?
All hyaline except epiglottis (elastic)
The left recurrent laryngeal nerve loops around the _____________ while the right recurrent laryngeal nerve loops around the _________________.
Left → Arch of aorta
Right → Subclavian artery
During phonation, the vocal folds are ______ while the vestibule is ________.
Vocal folds adducted
Vestibule open
During forced inspiration, the vocal folds are ______ while the vestibule is ________.
Vocal folds abducted (rima glottis open)
Vestibule open
During effort closure, the vocal folds are ______ while the vestibule is ________.
Vocal folds adducted
Vestibule closed
What does the pharyngotympanic tube connect?
Nasopharynx and middle ear
What are the ossicles (from lateral/closest to tympanic membrane to medial)?
1) Malleus
2) Incus
3) Stapes
What are the muscles of the middle ear, innervations, and their function?
1) Tensor tympani (malleus)
- CNV
2) Stapedius (stapes)
- CNVII
Both: pull ossicles away to disrupt transmission during loud noise
What is the nervous supply to the middle ear?
Tympanic branch of CNIX: glossopharyngeal nerve
What are the relations of the middle ear?
Superior:
i) temporal lobe
Medial:
i) Inner ear
ii) Stapes
iii) Promontory
iv) Tympanic nerve
v) Round window
vi) Oval window
Anterior:
i) Eustachian tube
ii) Internal carotid + sympathetic plexus
Inferior:
i) Internal jugular vein
Posterior:
i) Facial nerve
ii) Mastoid antrum (to mastoid sinus)
What is the blood supply of the inner ear?
Labyrinthine arteries (branch of basilar artery)
What are 5 sources of referred pain of the ear?
1) C2/3
2) CNIX (posterior 1/3 of tongue + oropharynx)
CNX:
3) Oesophagus
4) Larynx + hypopharynx
CNV:
5) Teeth
6) Parotid
7) TMJ
8) Nose + Sinuses
Which 2 structures are at most risk of being damaged during a thyroidectomy?
1) Recurrent laryngeal nerve
2) Parathyroid glands
