hns 3 Flashcards by J A

what nerve is tested when examing the oral cavity

cn 10- vagus

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what is the soft tissue thats dangling down

uvula

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how should the uvula hang

directly down midline

cranial nerve 10- working properly

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if it deviates to one side

problem with one of the vagus nerve

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which way will it deviate based on the lesion

opposite side

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what is the back of the mouth behind teh uvula

posterior wall of the oropharynx

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what are the folds called

Palatoglossal

fold

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what is the fold behind (cant see if tonsil are enlarged)

Palatopharangeal

fold

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what is teh structure behind the tongue that stops food from entering your airway/laryngeal inlet

Epiglottis

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3 sections of the pharynx

Nasopharynx
Oropharynx
Laryngopharynx

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which sections opens up into the oesophagus

Laryngopharynx

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what is a delicate (strong sensory inervation) area in which food can get stuck

Piriform fossa

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how many muscles does the pharynx have

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what are they

Superior, middle and inferior constrictors

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what cranial nerves form the pharyngeal plexus

9 10

sensory innervation

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which cranial nerve carry the movement of the constrictors

10 and some contrubution by 11

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what do the Superior, middle and inferior constrictors

allow

swallowing

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how mnany pairs of salivary gland

3
parotid gland- cn9
submandibular- cn7
sublingual- cn 7

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how does the saliva get from parotid gland to the mouth

parotid duct,
upper part of mouth
molar

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What innervates the parotid gland

9 - glossopharyngeal

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what sort of saliva is made by the parotid and teh submandibular

mainly serous

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and sublingual

mainly mucous

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what innervates teh muscles of teh tongue

hypoglossal 12

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extrinisc mucles of the tongue

Styloglossus
Palatoglossus
Genioglossus

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where does the Palatoglossus run from

palate to tongue

Styloglossus

styloid process to the tongue

Genioglossus

mandible to tongue

test function of cn 12

ask them to stick tongue out | if it deviates away from the centre then there is a lesion

what is the relationship between teh lesion and the and teh deviation of teh tongue

towards the lesion

what cn supplies the fron 2/3 of your tongue for sensory touch

trigeminal

posterior 2/3 of the tongue | sensory touch and taste

glossopharyngeal

and anterior 2/3 for taste

facial nerve

first phase of swallowing

Oral preparatory phase

what happens to the food

Food / liquid chewed & formed into a bolus | Bolus held on centre of tongue

what structures are required

Lip, jaw, tongue & palate sensory & motor function needed [& dentition]

which cranial nerves

V, VII, IX, X, XII

is it voluntary or involuntray

V, VII, IX, X, XII

what is phase 2

Oral transit phase

what happens

Bolus propelled to back of mouth | Palate seals entrance to nasal cavity

what structures

Lip, jaw, tongue & palate sensory & motor function needed

which cranial nerves

V, VII, IX, X, XII

vol or invol

Voluntary control

are the airways closed

NB: AIRWAY OPEN

next ohase is called

Pharyngeal phase I

what happens

triggered when bolus reaches faucial arch Palate stays elevated Tongue retracts, to push bolus to pharynx

what structures

Tongue, palate & laryngeal sensory & motor function needed

invol or vol

Reflex control

which cranial nerves

IX, X, XII

and airway

AIRWAY CLOSED

what happens next

Pharyngeal phase II

what happens

Bolus propelled through pharynx

which structures

Tongue, palate & laryngeal sensory & motor function needed

vol or invol

Reflex control

which cranial nerves

IX, X, XII

airways

AIRWAY CLOSED by epiglottis, vocal cords & arytenoid action

what problem is common with Cerebellar haematoma

Uncoordinated tongue retraction to propel food

problem

Delayed airway closure  food enters airway

why didnt solution work -problem

Delayed & ineffective cough to clear airway  food aspirated to lungs

solution

Flexed neck during swallow prevents aspiration

what happens in a Lower motor neurone lesion/Excised Acoustic Neuroma

Ipsilateral paresis of pharynx, larynx, tongue

causes

Weak bolus propulsion  pharyngeal & oral residue

why solution wont work- problem

Failed airway closure  aspiration

solution

head rotation to direct bolus down strong side of pharynx & airway closure

Parkinsons Disease causes

Difficulty initiating swallow

symptoms

Typical repetitive tongue movements | Linked with muscle rigidity, unable to lower the back of the tongue

resalution

Active range of motion exercises of lips and tongue

what is The larynx made up

``` Hollow structure Composed of: Cartilages Membrane Muscles ```

function

Acts as a: Valve Sound producer

what bone is above the larynx | and structure below

hyoid bone | trachea

where us the Cricoid | cartliage found

top of the trachea | ring at front and plate at the back

what is the function of Cricoarytenoid

important in movements of the vocal folds

what is the biggest cartilage in the larynx

thyroid/adams aple

what are the folds in the l

vocal folds just above vestibule fold

what is the structue below this

infraglottic space

what is the opening known as

the glottis

what muscles move the voxal cords

arytenoid muscles

where does the posterior crico aryteniod muscle start and end

from crico cartliage and arytenoid cartilage

what will contraction cause

open or abduct of vocal fold

what closes vocal folds

lateral crico arytenoid

how

contraction/abduct

which muscle tenses the vocal cords/change pitch

crico thyroid muscle

which cn causes gagging reflex

9 glossopharyngeal

describe the divisionsof the vagus nerve

superior laryngeal nerve to internal and external laryngeal nerve and recurrent larngeal nerve

if there is a lesion before the branches arise

complete paralysis of the layrnx

if lesion is to the internal LN

loss of sensation above vocal fold

if external LN

paralysis of cricothyroid

if to recurrent LN

paralysis of all muscles of larynx except cricothyroid and loss of sensation below vocal folds

is there a sepearation between thyroid and thyroid cartilage

yep

what vein in on the sternocleidomastoid muscle

external jugular vein

where do the opthalmic nerves drain

to cavernous sinus | potential route of entry of infection to cranial cavity

can you insert a central venous line via the subclavian vien

yes

where is the most common place to put a central line

internal jugular vein