Larynx and Pharynx

Question 1

The pharynx is located posterior to the nasal cavity, mouth, and larynx. It extends from the ______ ______ to the level of cervical vertebra ____

Answer 1

Pharyngeal tubercle; 6

Question 2

3 phases of deglutition (swallowing)

Answer 2

Oral
Oropharyngeal
Pharyngo-esophageal

Question 3

Oral phase of deglutition

Answer 3

Mastication

Question 4

Oropharyngeal phase of deglutition

Answer 4

Elevation of the floor of the mouth and tongue in order to push the bolus into the oropharynx

Question 5

Pharyngoesophageal phase of deglutition

Answer 5

Oropharynx elevates and constricts around the bolus, propelling it down the esophagus

Question 6

What reflex initially begins as a series of expiratory cough triggered by a noxious stimulus to the supraglottic laryngeal mucosa?

Answer 6

Airway protective cough reflex

Question 7

T/F: laryngeal displacement throughout human development corresponds to high incidence of SIDS around 2-4 months of age

Answer 7

False; there is not a significant increase in the rate of laryngeal displacement around the 2-4 month age, laryngeal descent did not coincide with the epidemiological reports of the peak age of SIDS

Studies suggested that the development of the laryngeal cough reflex and its role in neurological airway protection may be more involved

Question 8

3 divisions of the pharynx

Answer 8

Nasopharynx
Oropharynx
Laryngopharynx

Question 9

The nasopharynx communicates with the nasal cavity via the _______, the middle ear cavity via the auditory tube, and the oropharynx via the _____ _______

Answer 9

Choanae; pharyngeal isthmus

Question 10

3 primary structures located on the lateral wall of the nasopharynx

Answer 10

Torus tubarius

Pharyngeal opening of eustachian tube

Pharyngeal tonsil

Question 11

The oropharynx communicates with the nasopharynx via the pharyngeal isthmus, the oral cavity via the ____ ____, and the laryngopharynx at the level of the ____ bone

Answer 11

Faucial isthmus; hyoid

Question 12

What are the 2 primary structures on the lateral wall of the oropharynx?

Answer 12

Palatoglossal fold

Palatine tonsil

Question 13

Almost 1/3 of congenital neck masses are remnants of branchial clefts or _____ ______

Although the prevalence varies from childhood to adults, these cysts, sinuses, or fistulae are usually related to second cleft/pouch malformation and may be distributed along the anterior border of the ______ muscle

Answer 13

Pharyngeal pouches

SCM

Question 14

The laryngopharynx is located posterior to the larynx. It communicates with the oropharynx at the level of the hyoid; larynx via the laryngeal ______, and esophagus at the level of ____

Answer 14

Aditus; C6

Question 15

The _____ _____ are situated posterior and lateral to the arytenoid cartilages in the laryngopharynx. The epithelium in this area is innervated by the _____ _____ n. and supplied by the superior laryngeal artery

Answer 15

Piriform recesses; internal laryngeal n.

Question 16

Major pharyngeal mm.

Answer 16

Stylopharyngeus m.

Superior constrictor
Middle constrictor
Inferior constrictor

Question 17

The stylopharyngeus m. arises from the styloid process and inserts on the pharyngeal wall between the superior and middle constrictors. What is the action and innervation of this m.?

Answer 17

Action: elevates pharynx during deglutition

Glossopharyngeal n. (NOTE this is the ONLY muscle innervated by the glossopharyngeal n.)

Question 18

The horizontal fibers of the inferior constrictor m. of the pharynx comprise what muscle?

Answer 18

Cricopharyngeus m. — used during pharyngeal speech

Question 19

Zenker’s diverticulae are frequently located at the junction of what 2 groups of musculature?

Answer 19

Cricopharyngeus and esophageal musculature

This junction is devoid of a muscular layer

Question 20

Most esophageal diverticula result from what?

Answer 20

Abnormal luminal pressure due to a stricture, esophageal spasm, or abnormal lower esophageal sphincter functions

Question 21

_______ fascia covers the posterior surface of the buccinator m. and the pharynx; and it forms the anterior fascial wall of the ________ space. It attaches to the pharyngeal tubercle, pterygomandibular raphe, hyoid, and the thyroid and cricoid cartilages. The _______ plexus is also embedded in the portion of the fascia covering the middle constrictor

Answer 21

Buccopharyngeal; retropharyngeal; pharyngeal

Question 22

What named space is between the buccopharyngeal fascia and prevertebral fascia, continuous from the base of the skull to the mediastinum?

Answer 22

Retropharyngeal space

Question 23

What is the clinical importance of the retropharyngeal space in terms of infection and surgical fusion?

Answer 23

Infections can spread from either the skull or mediastinum via the retropharyngeal space

In surgical fusion of the cervical vertebrae, the anterior bodies of the cervical vertebrae are approached via the retropharyngeal space

Question 24

The pharynx is supplied from branches of what 2 arteries?

Answer 24

Ascending pharyngeal a.

Inferior thyroid a.

Question 25

The pharynx is innervated by the ____ ____, which is embedded in the buccopharyngeal fascia

Answer 25

Pharyngeal plexus

Question 26

The pharyngeal plexus receives sensory (GVA) info from the pharyngeal branch of the _____ n. and motor (SVE) fibers from the pharyngeal branch of the _______ n.

Answer 26

Glossopharyngeal; vagus

Question 27

The GVA fibers of the pharyngeal plexus (those from the glossopharyngeal n.) contribute the afferent info for the _____ reflex

Answer 27

Gag

Question 28

The SVE motor fibers to the pharynx and larynx originate in the _____ ______ (cranial portion of the accessory nucleus). These fibers exit the brainstem with the ____ ____ n. and at the level of the jugular foramen, join the _______ n.

Answer 28

Nucleus ambiguus; spinal accessory; vagus

Question 29

The pharyngeal branches of the vagus n. supply motor fibers to the _____ _____, which innervates all the pharyngeal muscles except the stylopharyngeus

Answer 29

Pharyngeal plexus

Question 30

Pharyngeal branches of the ______ n. convey the sensory (afferent) component of the gag reflex Pharyngeal branches of the _____ n. mediate the motor (efferent) component of the gag reflex

Answer 30

Glossopharyngeal Vagus [in by IX, out by X]

Question 31

The glossopharyngeal n. Passes through the interval formed by the ______ and the middle and superior constrictor mm., enters the base of the tongue, and supplies GVA and SVA fibers to the posterior _____ of the tongue, and sends a pharyngeal branch to the pharyngeal mucosa (GVA)

Answer 31

Styloglossus 1/3

Question 32

3 branches of CN IX

Answer 32

Pharyngeal n. to pharyngeal plexus Sensory (GVA) to mucosa of post 1/3 tongue and pharynx and sensory SVA to taste buds of post 1/3 tongue Motor (SVE) to stylopharyngeus muscle

Question 33

The _______ _____ slightly dilate if the patient says “a-a-a” in a low voice. Secretions may gather here, but they should disappear when swallowing. If they do not, the patient has “_____” sign, which suggests obstruction or paralysis of upper esophagus

Answer 33

Piriform recesses; pooling

Question 34

What cartilage forms the laryngeal prominence?

Answer 34

Thyroid cartilage

Question 35

The superior horn of the thyroid laminae (laryngeal prominence) is continuous with the _____ bone via the ______ ligament

Answer 35

Hyoid; thyrohyoid

Question 36

The inferior horn of the thyroid laminae articulates with the ____ cartilage via the ______ joint

Answer 36

Cricoid; cricothryoid

Question 37

T/F: after age 30, portions of the thyroid cartilage may show areas of ossification on Xray

Answer 37

True

Question 38

General location (vertebral level) of cricoid cartilage

Answer 38

C6

Question 39

Cricoid cartilage has “signet ring” configuration and has what 2 principle components?

Answer 39

Cricoid lamina | Cricoid arch

Question 40

The cricoid lamina is located on the posterior aspect of the larynx, and is approximately 2-3 cm long in its vertical dimension. It articulates with the _____ cartilages. The _____ arch forms the main supporting element of the laryngeal airway

Answer 40

Arytenoid; cricoid

Question 41

The 2 arytenoid cartilages are perched on the superior edge of the cricoid cartilage. The apex of the arytenoid cartilage articulates with the _____ cartilage The vocal process is attached to the vocal ligament of the vocal fold. The muscular process is attached to the posterior and lateral ________

Answer 41

Corniculate Cricoarytenoids

Question 42

The _____ cartilages form the posterior attachment of the vocal ligaments. They are highly moile in both rotational and transverse directions. During phonation, they rotate along a vertical axis to control the tension on the vocal folds. During respiration, they slide laterally to open the ____ ____. The aryepiglottic folds, vestibular folds, and the vocal folds are the sphincters of the larynx that protect the lower respiratory passages from foreign bodies, and help build intrathoracic pressure for coughing and other functions

Answer 42

Arytenoid Rima glottidis

Question 43

The _____ cartilages are small rod-shaped cartilages that articulate with the apex of the arytenoid cartilages. The ______ cartilages are long rod-shaped cartilages which are embedded in the aryepiglottic folds and quadrangular membranes. These cartilages add structural support to the membranous wall

Answer 43

Corniculate; cuneiform

Question 44

The _____ is a spoon-shaped elastic cartilage located posterior to the tongue and anterior to the laryngeal aditus. It is directly connected to the tongue via _______ folds and the hyoid bone via the _____ ligament

Answer 44

Epiglottis; glossoepiglottic; hyoepiglottic

Question 45

What ligament attaches to the apex of the epiglottis to the inner surface of the thyroid cartilage?

Answer 45

Thyroepiglottic ligament

Question 46

What ligament attaches the epiglottis to the hyoid?

Answer 46

Hyoepiglottic ligament

Question 47

During deglutition, the tongue moves backwards in the mouth and pushes the ______ posteriorly to cover the laryngeal aditus. The bolus of food/fluid cascades over the lateral edges of this structure, flowing through the _____ recess, the mucosal “gutters” adjacent to the larynx in the laryngopharynx

Answer 47

Epiglottis; piriform

Question 48

The ____ ____ are cup-shaped recesses between the tongue and epiglottis They are separated from each other by the ___ ____ ____ and bounded laterally by _____ _____ ____

Answer 48

Valleculae epiglottica Median glossoepiglottic; lateral glossoepiglottic folds

Question 49

During intubation of a patient, the blade is often placed in the ____ _____. As the end of the blade is moved forward, so is the tongue and epiglottis. This movement opens the laryngeal aditus. To examine these structures more distinctly, the examiner asks the patient to phonate

Answer 49

Valleculae epiglottica

Question 50

T/F: large veins are frequently seen in the valleculae epiglottica; these are normal

Answer 50

True

Question 51

A fracture of the laryngeal skeleton may result from blows received during boxing, karate, or compression by a shoulder strap during an automobile accident. These fractures may lead to what complications?

Answer 51

Submucosal hemorrhage Edema Respiratory obstruction Hoarseness Dysarthria

Question 52

The ______ joint is a circular hinge type that functions during increases in pitch. The _________ n. courses posterior to this joint. The _______ joint is a combination sliding and rotatory type of joint associated with the larynx

Answer 52

Cricothyroid; recurrent laryngeal n. Cricoarytenoid

Question 53

The ______ membrane extend between the thyroid cartilage and the hyoid bone. It is pierced by the _______ a. and ________ n.

Answer 53

Thyrohyoid; superior laryngeal; internal laryngeal

Question 54

The _________ and __________ extend from arytenoid to the epiglottic cartilages. The cartilages are embedded in these membranous structures. The conus elasticus (cricovocal) extends from the vocal ligament to the first tracheal ring. It forms the dome of the infraglottic region

Answer 54

Aryepiglottic fold; quadrangular membrane

Question 55

The _____ ligament extends from the vocal process of the arytenoid cartilage to the inner surface of the thyroid cartilage just above the inferior thyroid notch The _____ _____ ligament is located on the anterior side of the larynx between the cricoid and thyroid cartilages

Answer 55

Vocal ligament Median cricothyroid ligament

Question 56

What ligament is cut during an emergency cricothyrotomy

Answer 56

Median cricothyroid ligament

Question 57

The muscle serves as the ONLY abductor of the vocal cords?

Answer 57

Posterior cricoarytenoid m.

Question 58

What muscle is located at the cricoid lamina to the muscular process of the arytenoid?

Answer 58

Posterior cricoarytenoid m.

Question 59

What muscle is on the anterior exterior surfaces of the cricoid and thyroid cartilages and when it contracts it increases the tension on the vocal cords?

Answer 59

Cricothyroid m.

Question 60

What innervates the cricothyroid m

Answer 60

External laryngeal n. of the vagus

Question 61

How can the cricothyroid m. function be tested?

Answer 61

Have the patient say “e-e-e” in a high-pitched voice. Under these conditions, the examiner can palpate the decrease in width of the cricothyroid membrane

Question 62

What muscle is located from the cricoid arch to the muscular process of the arytenoid?

Answer 62

Lateral cricoarytenoid m.

Question 63

Action of lateral cricoarytenoid m.

Answer 63

Adducts the vocal cords

Question 64

What muscle is found between the arytenoid cartilages?

Answer 64

Arytenoideus

Question 65

The arytenoideus makes up the _____ sphincter

Answer 65

Laryngeal

Question 66

The _____ muscle is located lateral and parallel to the vocal ligaments

Answer 66

Thyroarytenoid

Question 67

The thyroarytenoid m. is subdivided into what 2 muscles?

Answer 67

Vocalis m. (Medial) Thyroepiglottic m.

Question 68

What muscle extends superior and anterioly from the inner surface of the thyroid cartilage to the epiglottis and quadrangular membrane, serving as an important sphincter of the laryngeal aditus?

Answer 68

Thyroepiglottic m.

Question 69

The ______ m. lies immediately adjacent and parallel to the vocal ligament. When it contracts, it decreases the tension on the vocal ligament

Answer 69

Vocalis m.

Question 70

The action of the vocalis m. is opposed by what m.?

Answer 70

Cricothyroid m.

Question 71

T/F: the cricothyroid m. increases vocal fold tension by tilting the thyroid cartilage forward

Answer 71

True

Question 72

What muscle(s) serve as abductor(s) in the larynx?

Answer 72

Posterior cricoarytenoid only

Question 73

What muscle(s) serve as adductor(s) in the larynx?

Answer 73

Lateral cricoarytenoid m. | Arytenoideus m.

Question 74

What muscles alter the tension on the vocal cords?

Answer 74

Cricothyroid - increases tension Vocalis - decreases tension

Question 75

The vagus n. exits the ______ foramen and gives of the pharyngeal branch (motor to the pharyngeal muscles except the _________), and superior laryngeal nerve. Just posterior to the _____ artery, the superior laryngeal n. bifurcates into internal and external branches

Answer 75

Jugular; stylopharyngeus; internal carotid a.

Question 76

The internal branch of what nerve pierces the thyrohyoid membrane along with the superior laryngeal a.?

Answer 76

Internal branch of superior laryngeal n. (ibSLN)

Question 77

What is the chief sensory nerve to the interior of the larynx?

Answer 77

The internal branch of the superior laryngeal n. (ibSLN) As such, it supplies GVA sensory fibers to the interior of the larynx, and it is involved in the cough reflex. It also supplies parasympathetic fibers (GVE) to the saccule glands of the larynx such as the saccule

Question 78

The laryngeal receptors and afferent fibers of the internal branch of the superior laryngeal n. represent the afferent component of what reflex?

Answer 78

Laryngeal expiratory reflex (LER) [if the ibSLN is not functional during the initiation of the protective cough reflex, the protective value of the LER is compromised, and there is an increased risk of developing aspiration pneumonia in neurologically impaired patients]

Question 79

What nerve innervates the cricothryoid m.?

Answer 79

External branch of superior laryngeal n.

Question 80

After the _____ ______ n. crosses the cricothyroid joint and enters the larynx, it is called the inferior laryngeal n. It conveys SVE fibers to the laryngeal mm., except the _______ m. These fibers originate from the nucleus ______

Answer 80

Recurrent laryngeal; cricothyroid; nucleus ambiguus

Question 81

Lesions or paralysis of recurrent laryngeal n. may lead to what effects?

Answer 81

Hoarseness Dysphagia May also be coughing or choking d/t collapse of aryepiglottic fold and subsequent drainage of fluids into larynx

Question 82

What are the 2 major vessels supplying the larynx?

Answer 82

Superior and inferior laryngeal aa.

Question 83

The superior laryngeal a. is a branch of the ______ a. The inferior laryngeal a. is a branch of the ________ a.

Answer 83

Superior thyroid Inferior thyroid

Question 84

The superior and inferior laryngeal veins drain the larynx. The superior laryngeal v. drains into the ______v. The inferior laryngeal v. drains into the _______ v.

Answer 84

Superior laryngeal Inferior laryngeal

Question 85

The _______ nerve, originating from the superior laryngeal n., is the chief sensory nerve to the interior of the larynx and piriform recess

Answer 85

Internal laryngeal n.

Question 86

The _______ a, originating from the superior thyroid a., distributes to the interior of the larynx

Answer 86

Superior laryngeal

Question 87

The ______ n., originating from the superior laryngeal n., innervates the cricothyroid m.

Answer 87

External laryngeal

Question 88

The ________ a, originating from the external carotid a., supplies the lobes of the thyroid gland

Answer 88

Superior thyroid

Question 89

The _______ a., originating from the inferior thyroid a., supplies the thyroid gland and parathyroids

Answer 89

Inferior laryngeal a.

Question 90

The larynx primarily drains into what general group of lymph nodes?

Answer 90

Deep cervical nodes

Question 91

The superior half of the larynx drains into the _______ and superior deep cervical nodes The inferior half of the larynx drains into the _____, _____, and ______ LNs

Answer 91

Infrahyoid Prelaryngeal, pretracheal, paratracheal

Question 92

The ______ LNs, located on the midline of the thyrohyoid membrane, become enlarged with thyroid carcinoma and subacute thyroiditis

Answer 92

Delphian

Question 93

The 3 regions of the interior larynx are demarcated by the vestibular and vocal folds. What are these 3 regions?

Answer 93

Vestibule Ventricle Infraglottic regions

Question 94

_______is a triangular shaped opening between the laryngopharynx and larynx. During deglutition, it collapses inward and is covered by the epiglottis

Answer 94

Laryngeal aditus

Question 95

Define the vestibule of the larynx

Answer 95

Cavity located between the laryngeal aditus (opening) and the vestibular folds — it is continuous with the laryngopharynx superiorly and the ventricle inferiorly

Question 96

The ____ ____, or false vocal cords, lie directly above and slightly lateral to the true vocal folds Although they do not normally produce sound, they can act as laryngeal sphincters. Ordinarily they appear dull pink in color and thicker than the vocal cords. _____ _____ is the elliptical shaped opening formed by the free edge of the vestibular folds

Answer 96

Vestibular folds Rima vestibularis

Question 97

During laryngoscopy, the vocal folds reflect light and therefore appear white and sharp-edged — however, their color is not white and the edges are rounded Anteriorly the cords meet at the midline where they are attached to the ____ cartilage. This area is difficult to see by indirect laryngoscopy. Posteriorly, they are attached to the vocal processes of the _______ cartilages. The anterior attachment is fixed, but the posterior attachment is mobile and allows the cords to open and close during respiration and phonation

Answer 97

Thyroid; arytenoid

Question 98

The _____ is a slit-like cavity located between the vestibular and vocal folds. It is continuous with the larynx superiorly and inferiorly, and the saccule drains into it laterally. Some of the ventricle can be seen during indirect laryngoscopy by having the patient tilt his or her head sideways

Answer 98

Ventricle

Question 99

The ______ is a mucous secreting gland located superolateral to the ventricle; it drains into the ventricle and onto the vocal cords. Dilations of the this structure (laryngocele) may occur due to prolonged periods of intralaryngeal pressure; this condition may occur in musicians (horns) and singers and is generally non-pathological

Answer 99

Saccule

Question 100

What are the superior and inferior boundaries of the infraglottic region? What forms the walls?

Answer 100

Extends from the vocal folds to the first tracheal ring Its walls are formed by the conus elasticus (cricovocal membrane)

Question 101

What happens if one of the vocal folds is paralyzed?

Answer 101

It remains fixed while the other moves in and out. In elderly patients, the vocal folds frequently do not completely adduct during phonation

Question 102

Tumors of the vocal folds result in hoarseness, or _______, which can be detecte early. Therefore, they have a more favorable dx and prognosis. Mucous on the vocal folds can be confused with tumors. However, coughing will remove the mucous

Answer 102

Dysphonia

Question 103

Describe potential effects of inhalation of sharp foreign bodies

Answer 103

Results in choking, sharp pain, and progressive obstruction to breathing d/t inflammation of the larynx and edema of the glottis Edema does not extend inferior to the vocal folds. The vocal folds are extremely sensitive and contact with a foreign body produces immediate explosive coughing Aspiration of a foreign object such as food into the larynx causes the laryngeal mm. to spasm and closes the rima glottidis. The airway is thereby completely blocked until the object is directly or indirectly removed, or bypassed by cricothyrotomy