Lec 10

Question 1

General use of Pharynx

Answer 1

Respiration, swallowing, phonation. Walls lined by mucous muscles. Posteriorly opposed by prevertebral fascia

Question 2

Describe the Nasopharynx

Answer 2

behind nasal cavity above soft palate (velum). Post and superior aspects of nasopharynx related to basilar occipital bone and arch of atlas, Continuous anteriorly with nasal passage

Question 3

Describe the Oropharynx

Answer 3

soft palate to epiglottis, ant border is post 1/3 tongue and continuous anterior with oral region

Question 4

Describe the laryngopharynx

Answer 4

lies post to larynx and extends from epiglottis to lower border of cricoid, opens ant into oropharynx and continues inferior with larynx and esophagus

Question 5

Buccinator and muscles of pharynx

Answer 5

3 constrictors form post limit of pharynx. Sup cons is apposed to buccinator at pteryo-mandibular raphae and therefore encloses oral region. Mid cons inserts at hyoid bone, inf cons inserts on thyroid cartilage and continuous with esophagus. Post region of constrictors is associated with thyroid gland, sym chain, sup cervical ganglion, vagus and glossopharygeal nerve

Question 6

Nasopharynx structures

Answer 6

Begins at choanae , contains pharyngotympanic tube , small aggregate of lymphoid tissue (tubal tonsils) posterior to E tube. Otitis media = infection of E tube. Hypertrophy or edema of tubal tonsils occludes E tube. Salpingopharyngeus originates at end of aud tube and inserts into pharyngeal muscle. Acts to raise pharynx and is innervated by vagus

Question 7

Adenoids

Answer 7

lymph root of nasopharynx inferior to spenoid sinus, hypertrophy results in nasal respiratory interference and infections. If enlarged = sleep apnea. Can become tumerous.

Question 8

Velum (soft palate)

Answer 8

Tensor veli palatini: aud tube to ptrygoid to velum
Levator veli palatini: lat to chonae, medial to aud tube - goes contralateral to velum
N: M (t = V)(L= ambiguous nucleus)
S - 9

Question 9

Oropharynx borders

Answer 9

Ant: faucies sup and post 1/3 tongue inf
Post: mid constrictor

Question 10

What are the Faucies

Answer 10

Bound to retropharyngeal isthmus and formed by 2 muscles
Palatoglossus M: Palate to tongue, raises palatoglossal arches ant to lateral wall of oropharynx
Palatophayngeus M: palate to pharyngeal musculature, acts as sphincter N is Vagus via pharyngeal plexus

Question 11

Palatine Tonsils

Answer 11

Between faucies, bed is danger area containing sup pharyngeal constrictor, pheryngopalatine raphae, mid ph constrictor, glossopharyngeal nerve

Question 12

Lingual tonsils

Answer 12

post 1/3 tongue if enlarged lead to gag reflec and dysphagia (diff swallowing)

Question 13

Waldeyrs ring

Answer 13

Tonsil ring as seen from mouth

Question 14

Borders of Laryngopharynx

Answer 14

Ant = larynx, post = mid and inf cons at C4-6
Sup= oroph Inf = continuous with esophagus

Question 15

What is the epiglottis

Answer 15

makes upper surface of larynx and guards air passage

Question 16

What is the glossoepiglottic fold

Answer 16

base of tongue to either side of larynx

Question 17

What is the piriform recess

Answer 17

Sharp swallow can get stuck here, tumors in recess as most hypopharyngeal cancers develop in this region, factors = 65 yrs, hist of smoking, results in hoarseness and dysphagia (squamous cell carcinoma)

Question 18

What are the pharyngeal constrictors

Answer 18

1. Sup
2. Mid
3. Inf
4. Stylopharyngeal

Question 19

Describe the superior constrictor

Answer 19

Pterygomandibular raphae to pharygeal tubercle of basil occipital bone. E tube passes through hiatus to open nasopharynx

Question 20

Describe the middle constrictor

Answer 20

Fan shaped, stylohyoid ligament and greater/lesser horns of hyoid to pharyngeal raphae. Gap = stylopharyngeal muscle, pharyngealglossus nerve, lingual N+A

Question 21

Describe the inferior constrictor

Answer 21

Oblique line of lamina of thyroid cart to ph raphae. Cricoid portion functions as sphincter at sup end of esophagus. Failure to relax during swallowing causes mucosa to herniate to form diverticulum

Question 22

Describe the stylopharyngeus

Answer 22

Stylod process to pharyngeal musculature to raise pharynx during swallowing N - 9

Question 23

Innervation of pharynx

Answer 23

1. Eff - 9 (stylopharyngeus) 10 (all others)
2. Aff: inf petrosal ganglion (pharynx velum carotid sinus special senses) to solitary nucleus (reflex action)
3. Jugular ganglion (pain and touch for ph and velum)

Question 24

Gag reflex

Answer 24

Aff 9 by touch to velum or ph, eff 10 elevating palate and gags. Refers pain to ear

Question 25

Esophageal sphincters

Answer 25

UES formed by cricopharyngeal muscle
LES at entrance of abdomen = cardiac sphincter (GERD symptoms)
Indentions - left main bronchus + arch of aorta

Question 26

Zenkers Diverticulum

Answer 26

weak spot at convergence of inf cons and cricopharyngeus muscle. Herniation through weak pt at Killian Laimen triangle results in outpouching of post ph wall above cricoph m. Most common in greater 60 years, men, dysphagia

Question 27

Innervation of esophagus

Answer 27

Vagal PSNS, SNS enteric

Question 28

Barrett’s esophagus

Answer 28

Peristent GERD changes to eso lining, men, chronic leads to dysplasia (also increases cancer risk)

Question 29

Achalasia

Answer 29

Cardiac sphincter remains closed = obstruction 2 types
primary - inflamed idiopathic - autoimmune
secondary - paralysis - chagas disease via dmg to mysenteric plexus

Question 30

What are the esophageal syndromes

Answer 30

Mallery Weiss - tear limited to mucosal lining

Boelrhaaue’s - rupture leading to air entry to peritoneal and pericardial sacs 95% fatal