Larynx and Pharynx Flashcards
The pharynx is located posterior to the nasal cavity, mouth, and larynx. It extends from the ______ ______ to the level of cervical vertebra ____
Pharyngeal tubercle; 6
3 phases of deglutition (swallowing)
Oral
Oropharyngeal
Pharyngo-esophageal
Oral phase of deglutition
Mastication
Oropharyngeal phase of deglutition
Elevation of the floor of the mouth and tongue in order to push the bolus into the oropharynx
Pharyngoesophageal phase of deglutition
Oropharynx elevates and constricts around the bolus, propelling it down the esophagus
What reflex initially begins as a series of expiratory cough triggered by a noxious stimulus to the supraglottic laryngeal mucosa?
Airway protective cough reflex
T/F: laryngeal displacement throughout human development corresponds to high incidence of SIDS around 2-4 months of age
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
3 divisions of the pharynx
Nasopharynx
Oropharynx
Laryngopharynx
The nasopharynx communicates with the nasal cavity via the _______, the middle ear cavity via the auditory tube, and the oropharynx via the _____ _______
Choanae; pharyngeal isthmus
3 primary structures located on the lateral wall of the nasopharynx
Torus tubarius
Pharyngeal opening of eustachian tube
Pharyngeal tonsil
The oropharynx communicates with the nasopharynx via the pharyngeal isthmus, the oral cavity via the ____ ____, and the laryngopharynx at the level of the ____ bone
Faucial isthmus; hyoid
What are the 2 primary structures on the lateral wall of the oropharynx?
Palatoglossal fold
Palatine tonsil
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
Pharyngeal pouches
SCM
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 ____
Aditus; C6
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
Piriform recesses; internal laryngeal n.
Major pharyngeal mm.
Stylopharyngeus m.
Superior constrictor
Middle constrictor
Inferior constrictor
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.?
Action: elevates pharynx during deglutition
Glossopharyngeal n. (NOTE this is the ONLY muscle innervated by the glossopharyngeal n.)
The horizontal fibers of the inferior constrictor m. of the pharynx comprise what muscle?
Cricopharyngeus m. — used during pharyngeal speech
Zenker’s diverticulae are frequently located at the junction of what 2 groups of musculature?
Cricopharyngeus and esophageal musculature
This junction is devoid of a muscular layer
Most esophageal diverticula result from what?
Abnormal luminal pressure due to a stricture, esophageal spasm, or abnormal lower esophageal sphincter functions
_______ 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
Buccopharyngeal; retropharyngeal; pharyngeal
What named space is between the buccopharyngeal fascia and prevertebral fascia, continuous from the base of the skull to the mediastinum?
Retropharyngeal space
What is the clinical importance of the retropharyngeal space in terms of infection and surgical fusion?
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
The pharynx is supplied from branches of what 2 arteries?
Ascending pharyngeal a.
Inferior thyroid a.
The pharynx is innervated by the ____ ____, which is embedded in the buccopharyngeal fascia
Pharyngeal plexus
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.
Glossopharyngeal; vagus
The GVA fibers of the pharyngeal plexus (those from the glossopharyngeal n.) contribute the afferent info for the _____ reflex
Gag
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.
Nucleus ambiguus; spinal accessory; vagus
The pharyngeal branches of the vagus n. supply motor fibers to the _____ _____, which innervates all the pharyngeal muscles except the stylopharyngeus
Pharyngeal plexus
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
Glossopharyngeal
Vagus
[in by IX, out by X]
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)
Styloglossus
1/3
3 branches of CN IX
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
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
Piriform recesses; pooling
What cartilage forms the laryngeal prominence?
Thyroid cartilage
The superior horn of the thyroid laminae (laryngeal prominence) is continuous with the _____ bone via the ______ ligament
Hyoid; thyrohyoid
The inferior horn of the thyroid laminae articulates with the ____ cartilage via the ______ joint
Cricoid; cricothryoid
T/F: after age 30, portions of the thyroid cartilage may show areas of ossification on Xray
True
General location (vertebral level) of cricoid cartilage
C6
Cricoid cartilage has “signet ring” configuration and has what 2 principle components?
Cricoid lamina
Cricoid arch
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
Arytenoid; cricoid
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 ________
Corniculate
Cricoarytenoids
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
Arytenoid
Rima glottidis
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
Corniculate; cuneiform
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
Epiglottis; glossoepiglottic; hyoepiglottic
What ligament attaches to the apex of the epiglottis to the inner surface of the thyroid cartilage?
Thyroepiglottic ligament
What ligament attaches the epiglottis to the hyoid?
Hyoepiglottic ligament
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
Epiglottis; piriform
The ____ ____ are cup-shaped recesses between the tongue and epiglottis
They are separated from each other by the ___ ____ ____ and bounded laterally by _____ _____ ____
Valleculae epiglottica
Median glossoepiglottic; lateral glossoepiglottic folds
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
Valleculae epiglottica
T/F: large veins are frequently seen in the valleculae epiglottica; these are normal
True
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?
Submucosal hemorrhage
Edema
Respiratory obstruction
Hoarseness
Dysarthria
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
Cricothyroid; recurrent laryngeal n.
Cricoarytenoid
The ______ membrane extend between the thyroid cartilage and the hyoid bone. It is pierced by the _______ a. and ________ n.
Thyrohyoid; superior laryngeal; internal laryngeal
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
Aryepiglottic fold; quadrangular membrane
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
Vocal ligament
Median cricothyroid ligament
What ligament is cut during an emergency cricothyrotomy
Median cricothyroid ligament
The muscle serves as the ONLY abductor of the vocal cords?
Posterior cricoarytenoid m.
What muscle is located at the cricoid lamina to the muscular process of the arytenoid?
Posterior cricoarytenoid m.
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?
Cricothyroid m.
What innervates the cricothyroid m
External laryngeal n. of the vagus
How can the cricothyroid m. function be tested?
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
What muscle is located from the cricoid arch to the muscular process of the arytenoid?
Lateral cricoarytenoid m.
Action of lateral cricoarytenoid m.
Adducts the vocal cords
What muscle is found between the arytenoid cartilages?
Arytenoideus
The arytenoideus makes up the _____ sphincter
Laryngeal
The _____ muscle is located lateral and parallel to the vocal ligaments
Thyroarytenoid
The thyroarytenoid m. is subdivided into what 2 muscles?
Vocalis m. (Medial)
Thyroepiglottic m.
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?
Thyroepiglottic m.
The ______ m. lies immediately adjacent and parallel to the vocal ligament. When it contracts, it decreases the tension on the vocal ligament
Vocalis m.
The action of the vocalis m. is opposed by what m.?
Cricothyroid m.
T/F: the cricothyroid m. increases vocal fold tension by tilting the thyroid cartilage forward
True
What muscle(s) serve as abductor(s) in the larynx?
Posterior cricoarytenoid only
What muscle(s) serve as adductor(s) in the larynx?
Lateral cricoarytenoid m.
Arytenoideus m.
What muscles alter the tension on the vocal cords?
Cricothyroid - increases tension
Vocalis - decreases tension
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
Jugular; stylopharyngeus; internal carotid a.
The internal branch of what nerve pierces the thyrohyoid membrane along with the superior laryngeal a.?
Internal branch of superior laryngeal n. (ibSLN)
What is the chief sensory nerve to the interior of the larynx?
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
The laryngeal receptors and afferent fibers of the internal branch of the superior laryngeal n. represent the afferent component of what reflex?
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]
What nerve innervates the cricothryoid m.?
External branch of superior laryngeal n.
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 ______
Recurrent laryngeal; cricothyroid; nucleus ambiguus
Lesions or paralysis of recurrent laryngeal n. may lead to what effects?
Hoarseness
Dysphagia
May also be coughing or choking d/t collapse of aryepiglottic fold and subsequent drainage of fluids into larynx
What are the 2 major vessels supplying the larynx?
Superior and inferior laryngeal aa.
The superior laryngeal a. is a branch of the ______ a.
The inferior laryngeal a. is a branch of the ________ a.
Superior thyroid
Inferior thyroid
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.
Superior laryngeal
Inferior laryngeal
The _______ nerve, originating from the superior laryngeal n., is the chief sensory nerve to the interior of the larynx and piriform recess
Internal laryngeal n.
The _______ a, originating from the superior thyroid a., distributes to the interior of the larynx
Superior laryngeal
The ______ n., originating from the superior laryngeal n., innervates the cricothyroid m.
External laryngeal
The ________ a, originating from the external carotid a., supplies the lobes of the thyroid gland
Superior thyroid
The _______ a., originating from the inferior thyroid a., supplies the thyroid gland and parathyroids
Inferior laryngeal a.
The larynx primarily drains into what general group of lymph nodes?
Deep cervical nodes
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
Infrahyoid
Prelaryngeal, pretracheal, paratracheal
The ______ LNs, located on the midline of the thyrohyoid membrane, become enlarged with thyroid carcinoma and subacute thyroiditis
Delphian
The 3 regions of the interior larynx are demarcated by the vestibular and vocal folds. What are these 3 regions?
Vestibule
Ventricle
Infraglottic regions
_______is a triangular shaped opening between the laryngopharynx and larynx. During deglutition, it collapses inward and is covered by the epiglottis
Laryngeal aditus
Define the vestibule of the larynx
Cavity located between the laryngeal aditus (opening) and the vestibular folds — it is continuous with the laryngopharynx superiorly and the ventricle inferiorly
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
Vestibular folds
Rima vestibularis
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
Thyroid; arytenoid
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
Ventricle
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
Saccule
What are the superior and inferior boundaries of the infraglottic region? What forms the walls?
Extends from the vocal folds to the first tracheal ring
Its walls are formed by the conus elasticus (cricovocal membrane)
What happens if one of the vocal folds is paralyzed?
It remains fixed while the other moves in and out. In elderly patients, the vocal folds frequently do not completely adduct during phonation
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
Dysphonia
Describe potential effects of inhalation of sharp foreign bodies
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
