hns 3 Flashcards
what nerve is tested when examing the oral cavity
cn 10- vagus
what is the soft tissue thats dangling down
uvula
how should the uvula hang
directly down midline
cranial nerve 10- working properly
if it deviates to one side
problem with one of the vagus nerve
which way will it deviate based on the lesion
opposite side
what is the back of the mouth behind teh uvula
posterior wall of the oropharynx
what are the folds called
Palatoglossal
fold
what is the fold behind (cant see if tonsil are enlarged)
Palatopharangeal
fold
what is teh structure behind the tongue that stops food from entering your airway/laryngeal inlet
Epiglottis
3 sections of the pharynx
Nasopharynx
Oropharynx
Laryngopharynx
which sections opens up into the oesophagus
Laryngopharynx
what is a delicate (strong sensory inervation) area in which food can get stuck
Piriform fossa
how many muscles does the pharynx have
3
what are they
Superior, middle and inferior constrictors
what cranial nerves form the pharyngeal plexus
9 10
sensory innervation
which cranial nerve carry the movement of the constrictors
10 and some contrubution by 11
what do the Superior, middle and inferior constrictors
allow
swallowing
how mnany pairs of salivary gland
3
parotid gland- cn9
submandibular- cn7
sublingual- cn 7
how does the saliva get from parotid gland to the mouth
parotid duct,
upper part of mouth
molar
What innervates the parotid gland
9 - glossopharyngeal
what sort of saliva is made by the parotid and teh submandibular
mainly serous
and sublingual
mainly mucous
what innervates teh muscles of teh tongue
hypoglossal 12
extrinisc mucles of the tongue
Styloglossus
Palatoglossus
Genioglossus
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
