Head & Neck / Larynx & Pharynx Anatomy Flashcards
Name the foramen through which the structure passes:
- Meningeal branch of V3
- Terminal branch of V2
- V3 and accessory meningeal artery
- Sphenopalatine artery
- III, IV, VI, Vl
- V2
- Meningeal branch of V3: Foramen spinosum
- Terminal branch of V2: Infraorbital foramen
- V3 and accessory meningeal artery: Foramen ovale
- Sphenopalatine artery: Sphenopalatine foramen
- III, IV, VI, Vl: Superior orbital fissure
- V2: Foramen rotundum.
Where does Stenson’s duct arise from in relation to the zygoma
1.5 em inferior to the zygoma.
What % of the population has a thyroidea ima artery
10%.
What is the normal resting pressure of the lower esophageal sphincter (LES)
10-40 mm Hg.
What is the distance from the incisor teeth to the cricopharyngeus in adults
16 em.
What are the nine cartilages of the larynx
3 unpaired: thyroid, cricoid, epiglottis; 3 paired: arytenoids, comiculates, cuneiforms.
What are the treatment options for Frey’s syndrome
3% scopolamine cream, section Jacobson’s nerve, sternocleidomastoid muscle flap, interpose fascia lata between skin and gland.
What is the distance from the incisor teeth to the cardia of the stomach in adults
40 em.
How much saliva is produced per day
500 - 1500 cc.
Where is the facial nerve trunk located in relation to the tympanomastoid suture line
6 - 8 mm anteroinferior (between the suture line and the styloid process).
How much of the blood supply to the brain is normally provided by the internal carotid arteries
80°/o.
What is the angle of the thyroid cartilage at the anterior commissure in men and women
90 degrees in men; 120 degrees in women.
What nerve parallels the superficial temporal vessels
A uric ulotempora l nerve.
How do the vocal folds move during quiet respiration
Adduct during expiration and abduct during inspiration.
What is the threshold for the laryngeal adductor reflex response in normal patients
Air pulse stimulus less than 4 mm Hg.
What structures form the common facial vein
Anterior retromandibular and facial veins.
Where does the stylomastoid foramen lie in relation to the origin of the posterior belly of the digastric muscle
Anterior.
How far is the pes anserinus from the stylomastoid foramen
Approximately 1.3 em.
Where is Auerbach’s plexus in the esophagus
Between the longitudinal and circular muscle fibers.
Where do pharyngoesophageai/Zenker’s diverticula occur
Between the oblique and transverse fibers of the inferior constrictor (Killian’s dehiscence), most commonly on the left, and between the cricopharyngeus and the esophagus (Killian-Jamieson area).
What is the plane of dissection for raising flaps during parotidectomy and how can one identify this more easily
Between the SMAS and the superficial layer of the deep fascia… identify the platysma first and work superiorly.
What is a stye
Blockage of the sebaceous or sweat glands surrounding the eyelashes.
What vessels are in direct contact with the anterior trachea
Brachiocephalic artery and the left brachiocephalic vein.
What is the only sensory nerve arising from the anterior division of V3
Buccal nerve.
What branch of the facial nerve travels with Stenson’s duct
Buccal.
What muscle does Stenson’s duct pierce
Buccinator.
What is the vertebral level of the hyoid in adults
C3.
What is the vertebral level of the cricoid in adults
C6.
What problem results from blockage of the Meibomian glands
Chalazion.
What is the only complete cartilage ring of the respiratory tract
Cricoid.
What finding on barium swallow is classic for cricopharyngeal dysfunction
Cricopharyngeal bar.
What does the external branch innervate
Cricothyroid muscle.
What is the membrane between the cricoid cartilage and the first tracheal ring
Cricotracheal membrane.
What is shimmer
Cycle-to-cycle variation in the amplitude of the glottal pulse.
What is jitter
Cycle-to-cycle variation in the frequency of the glottal pulse.
What is the origin of the superior tarsal muscle (of Muller)
Deep side of the levator palpebrae superioris.
What defines the anterior-posterior glottic diameter
Distance from the anterior commissure to the posterior border of the cricoid cartilage.
What is damping
Elevation of pitch by narrowing the glottic aperture.
What test is used to diagnose a Mallory-Weiss tear
Endoscopy (contrast studies are not beneficial as the tear is only mucosal).
Which layers of the vocal cord are primarily responsible for TVC vibration
Epithelium and superficial layer of the lamina propria.
What is another term for “inion?’’
External occipital protuberance.
T/F: Enlargement of the preauricular lymph nodes is indicative of parotid pathology
False… these nodes enlarge from inflammation or metastasizing tumors from the scalp.
What muscle descends to insert upon the hyoid
Geniohyoid.
What type of joint is the TMJ
Ginglymoarthrodial (hinge/sliding) joint.
What is Frey’s syndrome
Gustatory sweating, secondary to cross-reinnervation of the divided auriculotemporal nerve with cutaneous nerves, after parotidectomy.
What is the normal resting pressure of the upper esophageal sphincter (UES)
I 00 mm Hg in the anteroposterior orientation;
What are 6 ways to identify the facial nerve trunk during parotidectomy
Identification of the tympanomastoid suture line, tragal pointer, posterior belly of the digastric, or styloid process; tracing a distal branch retrograde or tracing the proximal portion forward by drilling out the mastoid segment.
From which branchial arch does the stylohyoid muscle arise
II.
What structures pass through the superior orbital fissure
III, IV, VI, VI, superior ophthalmic vein.
Which branchial arches is the larynx derived from
III, IV, VI.
Where does the retromandibular vein lie in relation to the facial nerve
In most people, it courses deep to both trunks of the facial nerve. In up to I O% of people, the vein crosses either trunk laterally.
What is the effect of beta-adrenergic blockers on LES
Increase LES pressure.
What structures pass through the mandibular foramen
Inferior alveolar artery and nerve.
What part of the thyroid cartilage articulates with the cricoid cartilage
Inferior cornu.
Which skeletal muscles are innervated by the inferior division of III
Inferior oblique, inferior rectus, medial rectus muscles.
What is the blood supply to the esophagus
Inferior thyroid artery (branch of the thyrocervical trunk), 2 - 3 branches directly from the thoracic aorta, and the esophageal branch of the left gastric artery.
What is the venous drainage of the esophagus
Inferior thyroid vein, azygous and hemiazygous veins (into the IVC ), and esophageal veins (into the coronary vein and eventually the portal vein).
Where does the superior laryngeal artery lie in relation to the superior laryngeal nerve
Inferior.
What is the terminal branch of V2
Infraorbital nerve.
What are the 2 branches of the superior laryngeal nerve
Internal and external.
Which of these supplies sensation to the larynx above the glottis
Internal branch.
What structures are found in the poststyloid compartment of the parapharyngeal space
Internal jugular vein, internal carotid artery, IX, X, XI, XII.
What nerve provides sensory innervation to the pyriform recess of the larynx
Internal laryngeal branch of the superior laryngeal nerve.
Where does Stenson’s duct open intraorally
Just opposite the 2”d upper molar.
What is the name of the fleshy, pink mound of tissue in the medial canthus
Lacrimal caruncle.
Which muscles does the anterior branch of the recurrent laryngeal nerve innervate
Lateral cricoarytenoid, thyroarytenoid, vocalis muscles.
What muscle protracts the mandible
Lateral pterygoid muscle.
What factors determine pitch
Length, tension, and cross-sectional mass of vocal folds; frequency of vibration.
Where is the tear most commonly located
Lower esophagus or cardia of the stomach.
What structures define the thoracic inlet
Manubrium, I st ribs, and the body of C I.
What separates the two valleculae associated with the tongue and the epiglottis
Median glosso-epiglottic fold.
What is the common insertion of the three pharyngeal constrictors
Median pharyngeal raphe.
What nerve and vessel pass through the foramen spinosum
Middle meningeal artery and meningeal branch of V3.
What are the anatomic correlations to hoarseness and breathiness
Mucosal irregularity causes hoarseness; incomplete glottic closure causes breathiness.
What is dysphonia plicae ventricularis
Muffled hoarseness secondary to approximation of false vocal folds during phonation.
What structures are found in the prestyloid compartment of the parapharyngeal space
Muscles (stylopharyngeus, styloglossus, and stylohyoid), fat.
What are the 3 layers of the esophageal mucosa
Muscularis mucosa, lamina propria, epithelium.
From what nerve do the anterior and posterior ethmoidal nerves arise
Nasociliary nerve.
What nerve usually passes from lateral to medial over the optic nerve
Nasociliary.
What three motor branches does the facial nerve give off just after exiting the stylomastoid foramen
Nerve to posterior belly of the digastric, nerve to the stylohyoid, nerve to the postauricular muscle.
Which lymph nodes drain tumors from the parotid gland
Nodes just inferior to the gland adjacent to the sternocleidomastoid muscle and the external jugular vein.
Which muscles anchor and elevate the larynx
Omohyoid, sternohyoid, sternothyroid muscles.
Periosteum and periorbita meet at the orbital margin and continue into the eyelids as what
Orbital septum.
What is the name of the point at which the facial nerve divides into the upper and lower divisions
Pes anserinus.
What is the only abductor of the vocal cords
Posterior cricoarytenoid muscle.
What is the major venous drainage of the parotid gland
Posterior facial vein.
What structures form the external jugular vein
Posterior retromandibular and posterior auricular veins.
What is the blood supply to the upper molars
Posterior superior alveolar artery.
Describe the pathway of parasympathetic innervation to the parotid gland
Preganglionic parasympathetic fibers leave the inferior salivatory nucleus via the glossopharyngeal nerve, pass through the jugular foramen, travel through the middle ear (as Jacobson’s nerve), then travel along the floor of the middle cranial fossa (as the lesser petrosal nerve) to the otic ganglion; postganglionic parasympathetic fibers leave the otic ganglion via the auriculotemporal branch of V3 and travel to the parotid gland.
What are the 2 types of squamous epithelium lining the TVCs
Pseudostratified columnar (superiorly and inferiorly) and stratified nonkeratinizing squamous (at the contact points of the TVCs).
What is the name of the opening through which the maxillary artery passes after giving rise to infraorbital and posterior superior alveolar branches
Pterygomaxillary fissure.
What are the 3 phases of speech
Pulmonary, laryngeal, oral.
What are the 2 types of diverticula
Pulsion and traction.
Which of these is associated with high intraluminal pressure
Pulsion.
Which of these is Zenker’s diverticulum
Pulsion.
What are the three primary parameters of voice
Quality, loudness, pitch.
What is the efficacy of ranitidine 150 mg BID compared to proton pump inhibitors in the healing of esophagitis
Ranitidine: 35 - 65% efficacy. Proton pump inhibitors: 95% efficacy.
What nerve provides sensory innervation to the infraglottic space
Recurrent laryngeal nerve.
What is the function of the auriculotemporal nerve
Sensation of the scalp, auricle and carries postganglionic parasympathetic nerves from the otic ganglion to the parotid gland to stimulate secretions.
What are the layers of the eyelid from superficial to deep
Skin, subcutaneous tissue, voluntary muscle, orbital septum, tarsal plate, smooth muscle, and conjunctiva.
The pterygoid plates are part of which bone
Sphenoid.
What is the name of the maxillary artery after it passes through the pterygomaxillary fissure
Sphenopalatine artery.
What are the layers of the vocal fold from superior to deep
Squamous epithelium, Reinke’s space (superior layer of lamina propria), intermediate and deep layers of the lamina propria (comprising the vocal ligament), thyroarytenoid muscle.
What membrane separates the parotid gland from the submandibular gland
Stylomandibular membrane.
What 2 structures pass between the superior and middle pharyngeal constrictors
Stylopharyngeus muscle and IX.
What factors determine voice loudness
Subglottic air pressure, glottal resistance, rate of airflow, amplitude of vibration.
Where is Meissner’s plexus in the esophagus
Submucosa.
Which layer of lymph nodes has the most nodes (superficial or deep)
Superficial.
What blood vessel travels with the internal branch
Superior laryngeal artery.
What muscle inserts on the disk of the TMJ
Superior part of the lateral pterygoid muscle.
Which muscles are innervated by the superior division of III
Superior rectus and levator palpebrae superioris muscles.
Where are the cell bodies of the motor fibers of the chorda tympani nerve
Superior salivatory nucleus.
