Module 7B Flashcards
1
Q
the pharynx
A
a fibromuscular tube extending from the base of the skull to the upper esophageal sphincter
2
Q
fibromuscular walls of pharynx are formed by
A
3 pairs of constrictor msucles: superior, middle and inferior
3
Q
UES is fomred by
A
the lower part of the inferior consrtictor msucle of the pharynx
4
Q
what does the UES do
A
prevents reflux of food into the airway and prevents air from entering the digestive tract
5
Q
three divisions of the pharynx
A
- Nasopharynx
- Oropharynx
- Laryngopharynx
6
Q
nasopharynx communicates with nasal cavities anteriorly by the
A
choanae (posterior nasal aperatures)
7
Q
what is located on the lateral walls of the nasopharynx
A
eustachian tubes (connect nasopharynx with middle ear)
8
Q
roof of nasopharynx
A
collection of lymphatic tissue called the pharyngeal tonsil
9
Q
inferiorly, the nasopharynx communicates with the
A
oropharynx by the pharyngeal isthmus
10
Q
how can the pharyngeal isthmus be closed
A
by elevation of the soft palate during swallowing
11
Q
path of COVID 19 swab
A
enters nasal cavity via nasal vesibule, travels parallel to nasal conchae, across choana and past opening of eustacian tube, inferior to the pharyngeal tonsil
12
Q
oropharynx
A
communicates anteriorly with the oral cavity via the oropharyngeal isthmus
13
Q
each side of the oropharynx consists of
A
two folds of mucous membranes supported by underlying muscles: anterior and posterior palatoglossal arches
14
Q
what exists between the mucous membrane folds in the oropharynx
A
collection of lymphatic tissue: the palatine tonsil
15
Q
medial surface of palatine tonsil
A
projects into oropharynx
16
Q
lateral surface of the palatine tonsil
A
lies against superior constrictor muscle
17
Q
Laryngopharynx
A
extends from the oropharynx into the esophagus
18
Q
laryngeal inlet
A
opens into the anterior wall of the laryngopharynx
19
Q
cavity of the laryngopharynx entends anteriorly on each side of the laryngeal inlet, forming
A
the piriform recesses
20
Q
piriform recesses
A
form channels that direct food from the oral cavity to either side of the raised laryngeal inlet, towards the esophagus
21
Q
Choking
A
- foreign object blocking airway usually above vocal folds
-partial or full obstruction
-symptoms: irregular breathing, cough, wheezing, no breathing, lips blue, panicked
22
Q
larynx is formed by
A
cartilaginous skeleton held together by ligaments
23
Q
cartilages and ligaments of the larynx
A
- vestibular and vocal ligaments
-cricothyroid ligament
-arytenoid cartilage
24
Q
vestibular and vocal ligamnets
A
- both ar eenclosed by their respective superficial folds :
- the vestibular fold (false vocal fold) and vocal fold (tru vocal fold)
25
Cricothyroid Ligament
-originates from the upper border of the cricoid cartilage
-extends superiorly where its free upper margin forms the vocal ligament (true vocal fold)
26
Arytenoid Cartilage
-located at back of the larynx
-primry function is to close the vocal folds when swallowing
-secondary function is to change tension of the vocal cords for the production of sound
27
the intrinsic muscles of the larynx _______ the vocal folds during respiration
abduct (open)
28
the intrinsic muscles of the larynx _______ the vocal folds during eating/swallowing
adduct (close)
29
the intrinsic muscles of the larynx _______ the vocal folds during phonation
adduct and alter the tension of
30
intrinsic laryngeal muscles
- thyroarytenoid
- cricothyroid
31
function of intrinsic laryngeal msucles
control shape of the rima glottdis, and the length and tension of the vocal ligamnets during breathing, swallowing,and phonation
32
Thyroarytenoid muscle
- originates from inferoposterior aspect of the angle of thyroid cartilage
-attaches to anterolateral arytenoid cartilage
-acts to relax the vocal ligament, producing softer voice
33
motor innervation to thyroarytenoid msucle
by the recurrent laryngeal nerve, branch of vagus nerve
34
Cricothyroid muscle
-originates from the anterolateral cricoid cartilage
-attaches inferior margin of the thyroid cartilage
-stretches and tenses the vocal ligaments for the production of loud speech and different tones
35
motor innervation to the cricothyroid muscle
by the external laryngeal nerve, branch of the superior laryngeal nerve
36
Laryngospasam
- vocal folds (cords) suddenly seize due to disruption in nervous imput from laryngeal nerves
-lead to airway obstruction
-typically resolves within a few mins
-can be provoked by various triggers, liek asthma, allergies, exercise, irritants, stress or GERD (most common)
37
why would gerd trigger laryngospasams
due to malfunctioning LES, stomach acid can enter esophagus, impacting the laryngeal nerves that are in proximity to esophagus
38
symptoms of laryngospasams
high pitch noises, inability to breathe,speak, choking sensation
39
where is thyroid gland found
deep to neck muscles, siting on anterior surface of trachea, just inferior to the larynx
40
thyroid gland consists of
right and left lateral lobes, with an isthmus connecting lobes
41
arterial supply of thyroid gland
thyroid gland supplied by superior thyroid artery, a branhc of external carotid a. and the inferior thyroid artery, a branch of the thyrocervical trunk, which arises from subclavian a.
42
venous supply of the thyroid gland
-thyroid gland is drained by superior, middle and inferior thyroid veins
-these form venous plexus on anterior surface of it, and descends anterior to trachea
43
where do superior and middle thyroid veins drain
internal jugular v.
44
where does the inferior thyroid vein drian
brachiocephalic v
45
what may be a source of bleeding during tracheostomy
inferior thyroid veins
46
innervation of the thyroid gland
regulated by autonomic nervous system and recieves both sympathetic and para sympathetic innervation via vagus nerve and sympathetic trunk
47
vagus nerve innervation to thyroid
- thyroid gland innervated by parasympathetic fibres arising from superior laryngeal nerve and recurrent laryngeal nerve, both branches of vagus nerve
48
sympathetic trunk innervation of the thyroid gland
thyroid gland innervated by sympathetic nerve fibres arising from the superior, middle and inferior cervical ganglia of the sympathetic trunk
49
Goiter
- abnormal enlargement of the thyroid gland at the inferior pole
-it can compress neck structures & symptoms display which structures may be compressed
50
compressed cricothyroid in goiter
since this msucle stretches and tenses vical ligaments for forceful speech and tone, goiter would alter tone of individuals speech
51
compressed vagus nerve in goiter
since vagus nerves forms a cardiac and pulmonary and esophageal plexus, goiter may have difficulty breathing and swallowing
52
compressed trachea in goiter
since thyroid gland wraps around anterior/lateral trachea, goiter can cause tightness in throat and coughing
53
compressed phrenic nerve in goiter
since phrenic nerve innervates diaphragm, goiter can lead to difficulty breathing
54
Superficial muscles of the neck
platysma and SCM
55
Platysma
-located in subcutaneous tissue
-runs from upper 2 ribs to lower margin of the mandible
56
what happes when platysma contracts
tenses the skin of neck and is responsible for facial expression
57
SCM
-originates inferiorly on the manubrium of the sternum and medial end of clavicle
-inserts superiorly on the mastoid process
58
waht does SCM do
-works with platysma to flex the head and neck and neck
-alone it will ilt the head toward the shoulderon the same side, rotating the head to turn to face the opposite side
59
what is SCM innervated by
accessory nerve (CN XI)
60
deep muscles of the neck
scalenes and levator scapulae
61
fucntion of deep neck muslces
stabilize and facilitate movement of the head, neck and spine
& work with superficial muscles to promote good posture and stability
62
Scalenes
-3 muscles found in the deep lateral neck, spanning between transverse processes of cervical vertebrar and first 2 ribs
63
functions of scalenes
flex and laterally rotate the neck
& accessory muscles of respiration, elevating the ribs during forced inspiration
64
Levator Scapulae
-long muscle situated at posterolateral neck
-originates on transverse process of cervical vertebrae 1-4 and inserts on scapula
64
function of levator scapulae
-main function to lift scapula and support vertebral column
65
without effects of immobilising the scapula on the vertebral column, what would happen
the vertebral column would flex and rotate during rotation of the scapula
66
what initiates abduction of the arm
suprasinatus
67
what extends and medially rotates the humerus
rhomboid major
68
SCM syndrome
- knot/sensitive area in neck
-trigger points
-since SCM is largest superficial muscle of the neck, it can cause trigger points
69
causes of SCM syndrome
stress, overuse, poor posture, inactivity
70
symptoms of SCM syndrome
slight pressure causes great pain on lateral neck, jaw, posterior head, and throat, headaches, neck stiff, tingling in face
71
hyoid bone
- U shaped bone superior to larynx and attached to thyroid membrane
-does not articulate with any other bones
-suspended by neck muscles and ligaments
72
Suprahyoid muscles
4 pairs that play role in swallowing and phonation by ELEVATING hyoid bone & larynx:
digastric, stylohyoid, mylohyoid, geniohyoid
73
Digastric muscles
-posterior belly that attaches to the mastoid process and anterior belly that attaches to mandible
-intermediate tendon runs between anterior and posterior bellies held by a fascial sling
74
Stylohyoid
originates from the styloid process on temporal bone and inserts on hyoid bone
75
Mylohyoid
-paired mylohyoid muscles formfloor of oral cavity by joining together at the midline raphe
- originate on the mandible and insert on the hyoid bone
76
geniohyoid
-medial and deep to the mylohyoid
-best visualized in the superior view
-originates from mandible and inserts on hyoid
77
Posterior Belly of Digastric muscle Strain
- the digastric muscle assists with complex jaw motions such as speaking, swallowing, breathing and chewing
-the two bellies are supplied by different cranial nerves (anterior- mandibular branch of trigeminal) (posterior - facial nerve)
- strain can occur from jaw misalignment
78
symotoms of Posterior Belly of Digastric muscle Strain
pain in neck, and under chin
-pain may also be referred to the SCM
79
trigger points of posterior belly of digastric muscle
located under the angle of the mandible as it is innervated by the facial nerve
80
trigger points if anterior belly of digastric muscle
lower front teeth as it is innervated by mandibular nerve
81
general structures supplied by internal carotid arteries
brain & eyes
82
general structures supplied by the external carotid arteries
face and neck
83
left and right common carotid arteries become
each branch into internal and external carotid artery
84
subclavian arteries
paired arteries originating in the thorax
-supply blood to structures of the thorax, head, neck and upper limbs
85
on left side of the body, the subclavian artery arises directly from
the aortic arch
86
the right subclavian artery arrises from
the brachiocephalic trunk
87
what does the thyrocervical trunk branch from
the subclavian artery
88
Internal Jugular Veins
-drain blood rom the brain and superficial regions of the face and neck
-joins subclavian vein to form brachiocephalic vein at junction of neck and thorax
89
superior thyroid vein drains into the
internal jugular vein
90
subclavian veins
-originate at the outer border of the first rib as continuations of the axillary veins
-large, central and relatively superficial
-important role in lymphatic drainage of head and neck
91
what veins are often used for central venous lines
subclavian veins
92
what drains into the subclavian vein
external jugular drains into suprascapular which drains into subclavian
93
Atherosclerosis of internal carotid artery
-build up of fats, cholesterol, and other substances in artery wall
-build up in internal carotid artery may lead to narrowing and irregularity of artery lumen, preventing BF to brain
-as this wornsens, plaque can break off and obstruct smaller vessels supplying the brain
94
symptoms of Atherosclerosis of internal carotid artery
headache,dizzy, confusion, fainting, death
95
tow main groups of lymph drainage of the neck
a superficial ring of nodes at the junction of the head and neck (collar nodes) and two vertical groups of lymph nodes (superficial and deep cervical lymph nodes)
96
order of lymph drainage of the head and neck
1. Superficial nodes (collar)
2. Vertical nodes (cervical)
3. Jugular trunk
4. Thoracic and Rigth Lymphatic Trunk
97
Superficial (collar) nodes
the superficial ring of nodes includes the submandibular nodes and submental nodes inferior to the chin
98
Vertical (cervical) nodes
-the superficial cervial nodes are found on surface of SCM and associated with external jugular vein
-deep cervical nodes are found deep to SCM and closely related to internal jugular vein
99
Juglar trunk
-all lymphatic vessels of the head and neck drain into the deep cervical nodes
-deep cervical nodes drain into jugular trunks
100
Thoracic and Right Lymphatic Trunk
the jugular trunks empty into the thoracic duct on the left side and the right lymohatic duct on the right
101
Recurrent Strep Throat
-a bacterial infection in the pharynx
-lymph nodes become enlarged
-other symptoms include stiffness, difficulty swallowing, headaches, fever, sore throat, palatine tonsils
-may suggest antibiotics used to treat strep are not working or underlying immune condition
102
Infrahyoid muscles
sternohyoid, omohyoid, thyrohyoid, sternohyoid
103
function of infrahyoid muscles
depress the hyoid bone and larynx during swallowing and phonation
104
Sternohyoid
originates from the manubrium of sternum and inserts on hyoid bone
105
Omohyoid
-teo bellies
-inferior belly originates on the scapula and inserts on the the intermediate tendon (attached to the clavicle by facial sling)
- superior belly originates at the intermediate tendon and inserts on hyoid bone
106
Thyrohyoid
originates from the thyroid cartilage and inserts on the hyoid bone
107
Sternothyroid
originates from the manubrium of sternum and inserts on the thyroid cartilage
108
Omohyoid Muscle Syndrome
- omohyoid is strap muscle consisting of a superior and inferior belly united at angle by intermediate tendon
-presents as mass in the neck located superior to the clavicle only visible when swallowing
-caused by irritation or damage to the muscle from excessive vomiting or neck trauma
109
symotoms of Omohyoid Muscle Syndrome
stiff neck, tenderness
110
what cranial nerves enter the neck from the skull, initially passing deep to the posterior digastric muscle
CN IX-XII
111
Glossopharyngeal nerve (CN IX)
travels anteriorly to provide sensory innervation to the tounge, pharynx, and middle ear
112
Hypoglossal nerve (CN XII)
curved anteriorly, passing deep to posterior digastric muscle to supply muscles of tongue
113
Vagus nerve (CN X)
-located in superior and posterior mediastinum
-unique pathway on L & R sides
114
pathway of vagus nerves
each descend through the neck, passing anterior to subclavian artery to enter thorax
115
Vagus nerve plexuses
both R & L vagus nerves give rise to nerves that fomr the pharyngeal, parasympathetic cardiac, pulmonary and esophageal plexuses
**also branches to form superior laryngeal nerves
116
R recurrent laryngeal nerve
a branch of the R vagus nerve, loops around subclavian atery and ascends in the groove b/w the esophagus and trachea to travel towards larynx
117
L recurrent laryngeal nerve
a branch of the left vagus nerve, loops beneath arch of aorta around the ligamentum arterosium and ascends in the groove between the esophagus and the trachea towards the larynx
118
Unilateral Vocal Fold Paraylsis
-immobility of the vocal folds due to damage of their principle nerve
-both recurrent laryngeal nerves innervate intrinsic muscles of the larynx (except cricothyroid) and mucous membrane between folds
-occurs from dysfunction of the recurrent laryngeal or vagus nerve
-usually from blunt trauma
119
symptoms of Unilateral Vocal Fold Paraylsis
-affect structures innervated by recurrent laryngeal nerve
-swallowing difficulty
-shortness of breath
-weak cough
-hoarseness of voice
120
all 4 infrahyoid muscles are supplied by
cervical plexus
121
thyrohyoid is innervated by
C1 via hypoglossal nerve
122
cervical plexus is formed by
-the ventral rami of cervical spinal nerves 1-4
-these supply motor innervation to most of neck muscles and sensory innervation to skin of neck and back of scalp
123
major branch of cervical plexus
phrenic nerve
124
Infrahyoid muscle paralysis
- trauma to C spine can damage cervical plexus resulting in muscular weakness/paralysis from infrahyoid muscles
-difficulty swallowing, hoarse voice and tightness of throat
-
125
how would you differentiate between Unilateral Vocal Fold Paraylsis and infrahyoid muscle paralysis
innervation patterns
- if an indiviudal is experiencing a tight throat in conjection w hoarse voice, it is more liekly infrahyoid paralysis
126
Phrenic Nerves
C3, C4, C5
- major branches of cervical plexus
- provide motor and cutaneous innervation to teh diaphragm
-en route to thoracic inlet, each passes obliquely over anterior suface of scalene muscles and subclavian arteries
127
R phrenic nerve
- passes anterior to the R subclavian artery
-enters thorax through thoracic inlet
-descends anterior to right lung root
-courses along pericardium of the R atrium of the heart
-pierces diaphragm at opening of IVC
128
Left Phrenic Nerve
- passes anterior to left subclavian artery
-enters thorax through thoracic inlet
- descends anterior to the left lung root
-crosses aortic arch and left vagus nerve
-courses along the pericardium of the left ventricle
-pierces and innervates the diaphragm
129
Phrenic Nerve Damage
- manifests as hiccups
- may result from trauma to neck or cervical vertebrae
-trauma to skeleton of thoracic inlet can also lead to this
-difficulty breathing, shortness of breath, faint feeling
130
sympathetic nerve fibres
leave spinal cord to form sympathetic trunk
131
how long is sympathetic trunk
length of vertebral column, from base of skull to coccyx
132
what is the sympathetic trunk formed by
sympathetic nerve fibres and ganglia
133
three main sympathetic ganglia in the cervical neck region
superior cervical, middle cervical and inferior cervical
134
ech cervical sympathetic ganglia lies
medial to the phrenic nerve
135
superior cervical ganglion
-largest of the three
-up to 3cm
-positioned posterior to the carotid arteries and anterior to C1-2
136
Middle Cervical Ganglion
located anterior to the inferior thyroid artery and C6
**may be absent in some ppl
137
Inferior cervical ganglia
anterior to C7 and is usually fused w first thoracic ganglion
138
139
140
