Lecture 10 - Pharynx and larynx

Question 1

Why is this important

Answer 1

• oropharyngeal cancer
• laryngitis
• tracheostomy (blocked airway)
• Cricothyroidotomy (getting into airways)

Question 2

Where does the larynx attach?

Answer 2

Upper part of pharynx attaches to medial pterygoid plate, then comes to scaphoid fossa, then runs over cartilagenous position of pharyngotympanic tube, also runs over peterous part of temporal bone and goes to pharangeal tuburcle of occipital bone
-anteriorly - has no attatchment as open

-comes down over the medial pterygoid plate and runs over raphe (pterygomadibular raphe) - comes from terygoid hamulus

middle attachment - ligament between hyoid bone and styloid process
-and goes to lesser horn and higher horn of hyoid bone

oblique line - on cartilage - attatches along here, goes along cricoid plate

Question 3

Pharynx - no bony structure, just muscles

• COnstrictor
• learn - he went over this twie

Answer 3

Constrictor muscles (C shapped muscles)
-anterior - attaches to base of skull, and to ligament connecting styloid process to mandible -has a free edge a structure can run underneath
- attatches to roof - base of skull
Middle - attaches to stylohyoid ligament and lesser and greater horn of hyoid bone
Inferior constrictor - lower part attaches to oblique line and cricoid

-right and left halves join to midline at pharyngeal rafee

Question 4

Longitudinal muscles - these stablise the constrictor muscles

Answer 4

Salpingopharyngeus - from pharyngotympanic tube

Palatopharynges - originate from palate - coming to pharynx

Stylopharangeus

Question 5

Fascia

Answer 5

-above C6 - the buccopharayngeal fascia replaces the pretracheal fascia only on posterior aspect (retropharangeal space behind here- lymphatics of cacner drain here from pharynx)

Pharyngobasilar fascia -helps stabalise pharynx - from basilar part of skull runs down into pharynx
-lies between mucosa and muscle (on anterior surface of constrictor muscles)

Question 6

Oropharangeal triangel

Answer 6

-Made form posterior edge of mylohyoid, upper border of medial constrictor, and free lower margin of superior constrictor

• stylopharangeus runs here
• cranial nerve 9, 12, lingual artery, vien all go into this cavity

Question 7

Gap between lower part of medial constrictor and upper part of inferior constrictor

Answer 7

-internal laryngeal nerve and vessels run here

Question 8

free margin of inferior constrictor

-what does recurrent laryngeal artery come off

Answer 8

• this comes off arch of aorta on left side, on right side - from right subclavian artery
• recurrent laryngeal nerve and vessels run up here
• then runs up groove of eosophagus and trachea
• runs deep to inferior constrictor and reaches final destination which is larynx

Question 9

Diagram of what you can see when examining the patient

Answer 9

• pharyngotympanic tube (regulates pressure between middle ear and pharynx)
• babies get more infections as this tube has not fully developed

Pharangeal tonsil at roof - babies may be enlarged - difficulty with breathing as it blocks the nasopharynx

Palatine tonsil - lies between 2 arches, palatoglossal and paltopharangeal

lingual tonsil - lies at most posterior part of tongue (in oropharynx)

Question 10

Blood supply

-venous drainage

Answer 10

all branches of external carotid

veins - covered with many viens - pterygoid plexus drains from pharynx (in contact with intracranial cavity) - if infection can get it back to crainum

Question 11

Muscle innovation to pharynx

Answer 11

All innovated by vagus, apar from stylopharangeal - this is innovated by no. 9.

Sensory - important -

Nasopharynx - V2

Oropharnx - IX

Laryngopharynx - X

Question 12

Layrnx - need to know the cartilages

Answer 12

Formed by cartilages
-epiglotus, thyroid cartilage, cricoid cartilage (anterior narrower than posterior) , deep to this the trachea starts

Thyroid caritilage - articualres with layrnx (has facets)
-has superior and inferior thyrodi notch

Arterylenoid cartialge - sits on top of cricoid

• corniculate cartilage on top of this
• also have cunifomr cartilages

Question 13

ligaments

Answer 13

Extrnisic -runing between hyoid bone and thyrodi cartialge - called thryohyoid membrane

Intrisic ligaments - cricothyroid ligament - runs between thyroid cartialge and cricoid cartialge , upper boreder is thicker and forms vocal ligament

have quadrangular membrane - attatches to corniculate cartialge and thyroid cartilage and inferior margin of this ligament is thicker - vestipubalr ligament (false vocal cord)

-can see vestibular and vocal ligament hwen look down on it

Question 14

Cavity of larynx

Answer 14

can see vocal folds and vestibular folds
-vestibule is above middle part ofcavity
and infraglottic space is below

Question 15

LOOK AT IMAGE ON SLIDE - vocal cord

Answer 15

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Question 16

Muscles

Answer 16

cricothyroid muscle - innovated by internal laryngeal nerve

Need to remember - posterior cricoarytenoid muscle - can breathe with this muscel - if damage this or paralysie - cannot breathe , vocal cords shut, coarseness of voice if lose one side

-rest of muscles (including cricoarterynoid) - are innovated by recurrent laryngeal nerve

Question 17

Blood supply

Answer 17

• from inferior and superior thyroid artery - gives of suepriro larangeal artery and inferior larangeal artery
• these suplly the larynx

Veins - superior and inferior larangeal drains back to thyroid glands

lymphatics runs with arteries - can see that above vocal cords - ..??

Question 18

Innervation

Answer 18

all muscles- recurrent larangelal excpet for cricothyroid *which is by internal larangeal

Important to know - most important muscle is supplied by laryngeal