Larynx/Pharynx Flashcards
Pharynx general aspects:
- where does it extend from and how far down
- phases of swallowing/associated reflexes
pharyngeal tubercle on occipital bone
Neurological airway protection:
-what nerve?
-Internal branch of superior laryngeal nerve responsible for expiratory cough reflex if anyting gets into the vestibular region under the epiglottis, primarily middle ramus
Divisions of the pharynx and boundaries
Nasopharynx:
- how does it communicate with nasal cavity, middle ear cavity, and oropharynx?
- structures on the walls of nasopharynx
Laryngopharynx:
- communicates w/ oropharynx at what level, larynx via what structure, esophagus at what level
- signficance of piriform recesses
food and fluid split by the epiglottis
“epiglottis is bow of the boat, parts food and fluid which flows into the esophagus”
Pharyngeal muscles:
Stylopharyngeus muscle
-innervation, O/I, action
Superior constrictor
-O/I, action
Middle constrictor
-attached to
Inferior constrictor
-attaches to? what do its horizontal fibers comprise, their purpose
Zinker’s diverticula
-where do they form, due to?
Buccopharyngeal fascia:
- what does it cover
- forms anterior fascial wall of what space?
- attached to?
- what plexus is embedded in its fascia over the middle constrictor?
retropharyngeal space:
- boundaries, continuous w/ what
- clinical significance w/ infections
blood supply of pharynx
branches from ascending pharyngeal and inferior thyroid arteries
Innervation of the pharynx:
- which plexus and where is it embedded
- GVA comes from?
- SVE comes from?
- what carries afferent for gag reflex?
- SVE fibers originate where?
- where do these fibers exit
- what supplies motor fibers to pharyngeal plexus?
- what does pharyngeal plexus innervate?
Gag reflex:
- what nerves are tested by touching the back of the throat?
- what conveys sensory component?
- what conveys motor response
- CN 9 passes through interval formed by what muscles, enters the tongue, and supplies what type of fibers to posterior 1/3 tongue, and sends what type of branch to pharyngeal mucosa?
*efferent component is mediated by vagus and assisted by intercostal, phrenic, and abdominal nerves
IN by 9 OUT by 10
pooling sign in larynx
Laryngeal Cartilages:
-six types
Thyroid Cartilage
The thyroid laminae form the laryngeal prominence (“Adam’s apple”). Its
superior horn is continuous with the hyoid bone (thyrohyoid ligament), and its
inferior horn articulates with the cricoid cartilage (cricothyroid joint). After age
30, portions of the thyroid cartilage may show areas of ossification on X-rays.
Cricoid Cartilage has a “signet ring” configuration, and has two principal components. 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 arytenoid cartilages. The cricoid
arch forms the main supporting element of the laryngeal airway. It is generally
located at the level of CV6
Arytenoid Cartilages (2) are pyramidal-shaped (“twin penguins”) perched on the
superior edge of the cricoid cartilage. The apex of the arytenoid cartilage articulates with the corniculate cartilage. The base articulates with the cricoid cartilage, and has an L-shaped, turn-style configuration formed by vocal and muscular processes. The vocal process is attached to the vocal ligament of the vocal cord. The muscular process is attached to the posterior and lateral cricoarytenoids.
The arytenoid cartilages form the posterior attachment of the vocal ligaments.
They are highly mobile 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 rima glottidis. The
aryepiglottic folds, the vestibular folds, and the vocal folds are the sphincters of
the larynx that protect the lower respiratory passages from foreign bodies, and
help build up intrathoracic pressure for coughing and other functions.
Corniculate Cartilages and Cuneiform Cartilages
The corniculate cartilages are small rod-shaped cartilages that articulate with the apex of the arytenoid cartilages. The cuneiform 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.
Epiglottic Cartilage The epiglottis is a spoon-shaped elastic cartilage located posterior to the tongue and anterior to the laryngeal aditus. It is directly connected to the tongue (glossoepiglottic folds) and hyoid bone (hyoepiglottic ligament). Thyroepiglottic ligament attaches to the apex of the epiglottis to the inner surface of the thyroid cartilage. Hyoepiglottic ligament attaches to the epiglottis to the hyoid. When the tongue is moved forward during intubation or laryngoscopy, the epiglottis also moves forwards and opens the laryngeal aditus.
During deglutition, the tongue moves backwards in the mouth and pushes the epiglottis posteriorly to cover the laryngeal aditus. The bolus of food and/or fluid cascades over the lateral edges of the epiglottis, and flows through the piriform recess, (the mucosal “gutters” adjacent to the larynx) into the laryngopharynx.
Valleculae Epiglottica: what are they?
- what separates them
- bounded laterally by
- intubation significance
Laryngeal Joints, Membranes
- recurrent laryngeal passes through which joint
- types of two laryngeal joints
- thyrohyoid membrane extends from where to where, what structures pierce it? edge? wall?
Ligaments of the larynx:
Muscles of the larynx:
- which is abductor of vocal cords?
- what muscle is tested by having pt say “e-e-e” in a high pitched voice
-
-most innervated by recurrent laryngeal nerve of vagus, one isnt the cricothyroid is innervated by the external branch of the superior laryngeal N of vagus
what abducts vocal cords
what adducts
what provides tension
muscles of laryngeal aditus?
muscles of internal sphincter (coughing)
Cricothyroid muscle increases vocal fold tension by tilting the thyroid cartilage forward. It is opposed by the vocalis muscle.
Vagus Nerve:
- what does internal branch of superior laryngeal nerve do?
- what does external branch of the superior laryngeal nerve do?
what is the chief sensory nerve to larynx? what is it involved in? what does it provide to saccule glands
- what innervates the cricothyroid muscle
- when does RLN become the inferior laryngeal nerve, what does it convey
*Paralysis of the recurrent laryngeal nerve. Lesions of the recurrent laryngeal nerve result in hoarseness and dysphagia. There may also be coughing or choking due to the collapse of the aryepiglottic fold and subsequent drainage of fluids into the larynx.*
Laryngeal Expiration reflex:
- stimulus
- afferent component
- efferent component
study this
what is the laryngeal aditus?
-what region of internal larynx
part of vestibule
Vestibular folds
Rima vestibularis
- what part of larynx?
- describe them
rima vestibularis are perimeters of vocal folds
Ventricle region of larynx
- Ventricle: location, where does saccule drain
- saccule: what does it do, problems in singers
- vocal folds (cords) formed by what? from A to P what do they attach to.
- what is the rima glottidis
- unilateral cord paralyzed what happens, tumor of cords, what happens when foreign object enters larynx?
The ventricle 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.
