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.
What are the 3 areas of esophageal narrowing
Superiorly, from the cricopharyngeus; inferiorly, where the esophagus enters the cardia; and in the middle, where the left mainstem bronchus and the aorta cross anteriorly.
In what directions are the muscle fibers of the inferior constrictor oriented
Superiorly, in an oblique fashion; inferiorly, in a transverse fashion.
What are the boundaries of the parotid compartment
Superiorly, the zygoma; posteriorly, the external auditory canal; anteriorly, the masseter muscle; inferiorly, the styloid process, carotid artery, jugular vessels, styloid muscles.
What is the most common cause of esophageal perforation
Surgical instrumentation.
What determines voice quality
Symmetry of vocal fold vibration.
What is the vertebral level of the carina in adults
T4 - T5.
What glands are contained within the tarsal plates
Tarsal glands (Meibomian).
Where are the left and right vagus nerves in relation to the esophagus
The left is anterior and the right is posterior.
What is unique about the lymphatic drainage of the parotid gland
The lymph nodes are contained within the gland, and it is the only salivary gland with two layers of lymph nodes.
How does the saliva produced from the parotid gland differ from that of the sublingual gland
The saliva from the parotid is serous, high in enzymes and low in mucin; that from the sublingual gland is primarily composed of mucin.
Which muscle comprises part of the vocal fold
Thyroarytenoid muscle.
What membrane must the internal branch penetrate
Thyrohyoid.
What is the function of the cricothyroid muscle
To lengthen the vocal fold and increase pitch.
What artery provides most of the blood supply to the palatine tonsil
Tonsillar branch of the facial artery.
What is the only unpaired muscle of the larynx
Transverse arytenoid muscle.
What is the blood supply to the parotid gland
Transverse facial artery, a branch of the superficial temporal artery.
T/F: The esophagus does not have a serosa
True.
T/F: The incidence of foreign body aspiration is equal between the right and left bronchus in children
True; the left bronchus is not as obliquely angled as in the adult.
What is the most consistent landmark for identification of the facial nerve trunk
Tympanomastoid suture line.
How does the musculature of the upper 1/3 esophagus differ from the lower 2/3
Upper 1/3 is striated; lower 2/3 is smooth.
What passes through the foramen rotundum
V2.
What is the name of the lower free margin of the quadrangular membrane
Vestibular fold.
What is the name of the space between the cheeks and the teeth
Vestibule.
What is the name of the upper free margin of the conus elasticus
Vocal ligament.
What is “donkey breathing?”
Vocalization during inspiration.
What test is used to diagnose Boerhaave syndrome
Water-soluble contrast esophagram (tear is transmural).
With one exception, all the muscles of the pharynx are innervated by what nerve
X.
T /F: Saliva promotes the calcification of teeth
TRUE
What is the average fundamental frequency for a child? Adult female? Adult male?
250 Hz; 200 Hz; 120 Hz.
What is the average maximum phonation time for an adult male? Adult female?
17-35 seconds; 12-26 seconds.
What is the average tracheal wall mucosal capillary pressure?
20-30 mm Hg.
What percent of neonates less than 5 days old have a functioning cough reflex?
25%.
What percent of the population has a thyroidea ima artery?
3-10%.
What is the maximum range of fundamental frequency for the human voice?
36-1760 Hz.
What is the average decibel level of the human voice?
65-75 dB.
What is the angle of the thyroid cartilage at the anterior commissure in men and women?
80 degrees in men; 120 degrees in women.
What is the Bernoulli principle?
A column of air flowing through a conduit produces a partial vacuum or negative pressure at the margins of the column that increases as the rate of flow increases.
How do the vocal folds move during quiet respiration?
Adduct during expiration and abduct during inspiration.
What prevents air from escaping through the glottis during the cough reflex?
Adduction and turning down of the false vocal cords (FVC).
Which portion of the larynx has sparse lymphatic drainage?
Anterior glottis (epithelium of the ‘IVC).
What vessels are in direct contact with the anterior trachea?
Brachiocephalic artery and the left brachiocephalic vein.
What is the vertebral level of the hyoid in adults?
C3.
What is the vertebral level of the cricoid in adults?
C6.
What is the sequence of events during the glottic closure reflex?
Closure of the true vocal cords (TVC), followed by closure of the FVC, followed by adduction of the aryepiglottic folds.
What anatomic structures inhibit malignant invasion by laryngeal cancers?
Conus elasticus, quadrangular membrane, thyrohyoid membrane, cricothyroid membrane, and internal perichondrium of the thyroid lamina.
What is the only complete cartilage ring of the respiratory tract?
Cricoid.
What does the external branch innervate?
Cricothyroid muscle.
Which laryngeal muscle is primarly responsible for pitch elevation?
Cricothyroid.
What is the membrane between the cricoid cartilage and the first tracheal ring?
Cricotracheal membrane.
What are the boundaries of the preepiglottic space?
Epiglottic cartilage posteriorly, thyrohyoid membrane and hyoid bone anteriorly, and hyoepiglottic ligament superiorly.
What structures are considered part of the supraglottis?
Epiglottis, false vocal cords, aryepiglottic folds, and arytenoids.
Which layers of the vocal cord are primarily responsible for TVC vibration?
Epithelium and superficial layer of the lamina propria.
What anatomic feature of the epiglottis facilitates extension of carcinoma into the preepiglottic space?
Fenestrations/ dehiscences.
What muscle descends to insert upon the hyoid?
Geniohyoid.
From which branchial arch does the stylohyoid muscle arise?
II.
Which branchial arches is the larynx derived from?
III, IV, and VI.
How does the position of the larynx differ between neonates and adults?
In the neonate, the larynx is positioned more anterosuperiorly, lying at the level of C2-C3, with the cricoid lying at C3-C4. In the adult, the larynx lies at the level of Cs and the cricoid at C7.
What part of the thyroid cartilage articulates with the cricoid cartilage?
Inferior cornu.
Where does the superior laryngeal artery lie in relation to the superior laryngeal nerve?
Inferior.
What are the two branches of the superior laryngeal nerve?
Internal and external.
Which of these supplies sensation to the larynx above the glottis?
Internal branch.
What nerve provides sensory innervation to the pyriform recess of the larynx?
Internal laryngeal branch of the superior laryngeal nerve.
What is the significance of a thyroidea ima artery to a head and neck surgeon?
It can cause excess bleeding while performing a tracheostomy.
Which muscles does the anterior branch of the recurrent laryngeal nerve innervate?
Lateral cricoarytenoid, thyroarytenoid, and vocalis muscles.
What is laryngospasm?
Maladaptive and exaggerated glottic closure reflex.
What separates the two valleculae associated with the tongue and the epiglottis?
Median glossa-epiglottic fold.
What are the anatomic correlations to hoarseness and breathiness?
Mucosal irregularity causes hoarseness; incomplete glottic closure causes breathiness.
Which muscles anchor and elevate the larynx?
Omohyoid, sternohyoid, and sternothyroid muscles.
What is the only abductor of the vocal cords?
Posterior cricoarytenoid muscle.
What are the two types of squamous epithelium lining the true vocal cords?
Pseudostratified columnar (superiorly and inferiorly) and stratified nonkeratinizing squamous (at the contact points of the TVCs).
What are the three phases of speech?
Pulmonary, laryngeal, and oral.
What nerve provides sensory innervation to the infraglottic space?
Recurrent laryngeal nerve.
What is the significance of Broyle’s tendon?
Serves as a pathway for tumor extension into the thyroid cartilage.
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), and thyroarytenoid muscle.
What blood vessel travels with the internal branch?
Superior laryngeal artery.
Unlike the glottic closure reflex, laryngospasm is mediated solely by stimulation of what nerve?
Superior laryngeal nerve.
What is the vertebral level of the carina in adults?
T4-T5.
What is the Venturi effect?
The acceleration of flow as a current of air or liquid enters a narrowed passage.
What are the nine cartilages of the larynx?
Three unpaired: thyroid, cricoid, and epiglottis.Three paired: arytenoids, corniculates, and cuneiforms.
What muscle adducts the false vocal cords and aryepiglottic folds?
Thyroarytenoid muscle.
What membrane must the internal branch penetrate?
Thyrohyoid.
What is the function of the cricothyroid muscle?
To lengthen the vocal fold and increase pitch.
What is the only unpaired muscle of the larynx?
Transverse arytenoid muscle.
True/False: Embryologically, the supraglottis and glottis are separate entities
True.
True/False: Compared to the gag reflex, the cough reflex correlates better with a newborn’s ability to eat safely.
True.
What is the name of the lower free margin of the quadrangular membrane?
Vestibular fold.
What is the name of the upper free margin of the conus elasticus?
Vocal ligament.
What is Broyles’ tendon?
Vocalis muscle tendon that inserts into the thyroid cartilage.
At what age gestation can an infant suckle feed?
34 weeks.
At what age should children be able to respond to their name and understand simple words?
6-10 months.
All the muscles participating in the oral phase of swallowing are striated Muscles using _______ for neurotransmission via _____receptors.
Acetylcholine; nicotinic.
How many words should a child aged 24-36 months be able to say?
Fifty.
What nerve mediates taste sensation from the circumvallate papillae?
IX.
What is the common insertion of the three pharyngeal constrictors?
Median pharyngeal raphe.
A patient complains of not being able to taste. Upon further questioning, he admits to being able to taste salt crystals, sugar crystals, lemon juice and coffee but nothing else.What is the primary problem?
Olfactory loss.
What is the plica triangularis?
Point at which the palatine and lingual tonsils meet.
Taste sensation is relayed by___ fibers from the anterior 2/3 of the tongue via the____ nerve, from the posterior 1/3 of the tongue via the_____ nerve, and from the epiglottis via the____ nerve, with these fibers terminating in the________.
Special visceral afferent; chorda tympani; lingual; vagus; nucleus tractus solitarius
How does infant swallowing differ from adult swallowing?
The pharyngeal phase of swallowing in infants is faster and more frequent.
What is the sequence of events during a normal swallow?
- Oral phase: Food is chewed and mixed with saliva.
- Oropharyngeal phase: The food bolus is propelled posteriorly.
3•Pharyngeal phase: The soft palate elevates, glottis closes, pharyngeal constrictors contract, and the cricopharyngeus relaxes.
4•Esophageal phase: The bolus is propelled into the stomach by peristaltic waves.
In what percent of the population does the carotid artery lie deep to the floor of the tonsillar fossa?
1%.
How long do taste sensory cells live?
200-300 hours.
At what age should children be able to say multiword sentences?
36 months.
When does the primary palate develop?
4-5 weeks gestation.
When does the secondary palate develop?
8-9 weeks gestation.
What is the normal thickness of the soft palate in adults?
About 12 mm; gets thinner laterally.
What immunoglobulin is produced by the tonsils?
Antigen-specific secretory IgA.
How does the secondary palate develop?
As a medial ingrowth of the lateral maxillae with fusion in the midline.
How does the primary palate develop?
As a mesodermal and ectodermal proliferation of the frontonasal and maxillary processes.
At which points is the normal vermillion the widest?
At the peaks of Cupid’s bow.
True/False: A cleft lip is always associated with a cleft alveolus.
False; a cleft alveolus is always associated with a cleft lip.
Which group of papillae on the tongue lacks taste buds?
Filiform.
What structure marks the boundary between the anterior 2/3 of the tongue and its posterior 1/3?
Foramen cecum.
What are the four extrinsic muscles of the tongue?
Genioglossus, hyoglossus, styloglossus, and palatoglossus.
What divides the palate into the primary and secondary palates?
Incisive foramen.
Why is the tongue a muscular hydrostat?
It is a structure with incompressible muscles and no skeletal support that is capable of movement. Changes in the shape of the muscle do not change its volume.
During embryologic development, what causes a cleft lip?
Lack of mesodermal proliferation results in an incomplete epithelial bridge.
What artery runs through the incisive foramen?
Lesser palatine artery.
What is Gerlach’s tonsil?
Lymphoid tissue arising from the fossa of Rosenmiiller that extends into the eustachian tube.
What structures form the hard palate?
Maxilla, horizontal process of the palatine bone, and the pterygoid plates.
Which muscles form the anterior and posterior tonsillar pillars?
Palatoglossus and palatopharyngeus, respectively.
What muscles form the soft palate?
palatopharyngeus, salpingopharyngeus, levator and tensor veli palatini, muscular uvula, palatoglossus, and superior constrictor muscles.
What muscle functionally divides the oral cavity from the oropharynx?
Palatopharyngeus.
What are the embryologic origins of the anterior 2/3 and posterior t/3 of the tongue?
The anterior 2/3 of the tongue develops from the 1st branchial arch and the posterior 1/3 of the tongue develops from the 3rd and 4th branchial arches.
What artery provides most of the blood supply to the palatine tonsil?
Tonsillar branch of the facial artery.
True/False: At no time in the development of the normal primary palate is there a separation.
True.
True/False: The four taste qualities can be perceived by all the taste buds.
True.
True/False: Boluses placed on the posterior tongue trigger swallowing at a lower volume than the anterior tongue.
True.
What are the three groups of intrinsic muscles of the tongue?
Vertical, transverse, and longitudinal.
What is the name of the space between the cheeks and the teeth?
Vestibule.
How is the quality of taste determined?
Via the central nervous system from the discharge pattern across all the sensory nerve fibers sensitive to the substance.
How is the intensity of taste determined?
Via the central nervous system from the frequency of discharge across all the sensory nerve fibers sensitive to the substance.
Which three cranial nerves mediate taste?
VII, IX, and X.
It is derived from the 4th branchial arch and its innervation comes from the nucleus ambiguous.
Don’t know
What are the boundaries of the parapharyngeal space?
Inferior - Hyoid bone. Superior - Petrous bone. Medial - Soft palate, tonsils, and superior pharyngeal constrictor. Lateral - Medial pterygoid muscle, ramus of the mandible, and posterior belly of the digastric.Dorsal- Vertebral column and paravertebral muscles. Ventral - Pterygomandibular raphe.
Which structures separate the hypopharynx from the larynx?
Aryepiglottic folds.
Where is the fossa of Rosenmuller?
Just posterior-superior to the torus tubarius of the eustachian tube orifice.
What structure in the hypopharynx marks the location of the cricoarytenoid joint?
Piriform apex.
What are the three subsites of the hypopharynx?
Pyriform sinus, postcricoid area, and posterior pharyngeal wall.
What space does the parapharyngeal space communicate with dorsally?
Retropharyngeal space.
What are the boundaries of the pyriform fossa?
Superiorly, the inferior margin of the hyoid; anteriorly, the junction of the anterior and posterior halves of the thyroid cartilage; posteriorly, the posterior edge of the thyroid cartilage; apex, the cricoarytenoid joint.
What is the average resting pressure of the remainder of the esophagus?
-5 mm Hg for the body of the esophagus and 10-40 mm Hg for the lower esophageal sphincter.
By what age is the adenoid pad mostly atrophied?
Age 7 or 8.
What kind of epithelium lines the nasopharynx?
At birth, pseudostratified columnar epithelium; by age 10, the majority is replaced by stratified squamous epithelium. The lateral portion does not change, and the area where these two types meet is lined by transitional epithelium.
Where is Auerbach’s plexus in the esophagus?
Between the longitudinal and circular muscle fibers.
What structures are found in the pos1styloid compartment of the parapharyngealspace?
Carotid sheath, IX, X, XII, and cervical sympathetic chain.
What are the boundaries of the cervical esophagus?
Cricopharyngeus muscle to sternal notch.
True/False: Oral and pharyngeal transit times of the bolus are not affected by bolus volume or bolus viscosity.
False; as volume and viscosity of the bolus increase, transit time increases.
True/False: At rest, the cricopharyngeus muscle is relaxed.
False; the cricopharyngeus muscle has a resting pressure of 100 mm Hg in the anteriorposterior direction and so mm Hg in the right and left lateral direction.
Which foramina of the skull lie in close proximity to the nasopharynx?
Foramen lacerum, carotid canal, foramen spinosum, foramen ovale, foramen rotundum, hypoglossal canal, and jugular foramen.
What is the venous drainage of the cervical esophagus?
Inferior thyroid vein.
What is the relationship of the fossa of Rosenmiiller to the parapharyngealspace?
It lies at the convergence of the fascial planes that separate the parapharyngeal space into its three compartments (prestyloid, retrostyloid, and retropharyngeal).
What effect does chin tucking have on swallowing?
It pushes the base of tongue and epiglottis anteriorly, causes the airway to narrow.
What are the six valves of the upper digestive tract that function during swallowing?
Lips, tongue, velum to back of tongue (glossopalatal valve), velopharynx, larynx, and upper esophageal sphincter.
What effect does smoking have on lower esophageal sphincter pressure?
Lowers it.
What structures are found in the prestyloid compartment of the parapharyngeal space?
Medial pterygoid muscle, fat, lymphatics, minor nerves, and vessels.
What are the layers of the posterior pharyngeal wall, from superficial to deep?
Mucosa, constrictor muscles, longus colli, retropharyngeal space, prevertebral fascia.
What are the three layers of the esophageal mucosa?
Muscularis mucosa, lamina propria, and epithelium.
Retained secretions in the hypopharynx that fail to clear with swallowing indicate a ______disorder when thickened and mucoid and a. ______ when frothy or foamy.
Neurological; structural.disorder
What effect do beta-adrenergic blockers have on lower esophageal sphincter pressure?
Raise it.
What two structures pass between the superior and middle pharyngeal constrictors?
Stylopharyngeus muscle and IX.
Where is Meissner’s plexus in the esophagus?
Submucosa.
What are the three areas of esophageal narrowing?
Superiorly, from the cricopharyngeus; inferiorly, where the esophagus enters the cardia; and in the middle, where the left mainstem bronchus and the aorta cross anteriorly.
In what directions are the muscle fibers of the inferior constrictor oriented?
Superiorly, in an oblique fashion; inferiorly, in a transverse fashion.
Where are the left and right vagus nerves in relation to the esophagus?
The left is anterior and the right is posterior.
What is the arterial supply to the cervical esophagus?
Thyroid branch of the thyrocervical trunk.
True/False: Unlike the rest of the gastrointestinal tract, the esophagus does not have a serosa.
True.
True/False: Regardless of bolus volume, airway closure and cricopharyngeal opening always occur within 0.03 seconds of each other.
True.
How does the musculature of the upper 1/3 esophagus differ from the lower 2/3?
Upper 1/3 is striated; lower 2/3 is smooth.
What effect does bolus volume have on the temporal relationship of the oral and pharyngeal stages of swallowing?
With small volumes, the oral phase preceeds the pharyngeal stage, but with larger volumes (1o cc or more), the stages occur simultaneously.
