Mouth, Tongue and Larynx Flashcards
What salivary gland is found in the floor of the mouth?
the sublingual gland
the submandibular gland has a deep portion that curls up over the posterior border of the mylohyoid muscle too
How do the ducts of the sublingual gland differ from those of the parotid and submandibular glands?
WHile the parotid and submandibular glands have one large duct, the sublingual gland is drainedby about 10-20 minor ducts emptying direclty through the mucosal membrane
Where does the submandibular duct empty into the oral cavity?
It opens at the sublingual caruncle at the vase of the frenulum of the tongue on each side
What is the relationship of the submandibular duct to the lingual nerve?
The submandibular duct crosses over the lingual nerve on its way to the sublingual caruncle
What functional components are associated with the lingual nerve after it is joined by the chorda tympani?
- carries preganglionic parasympathetic fibers to the submandivular and sublingual glands
contains taste fibers
What is the relationship of the hypoglossal nerve to the hypoglossus muscle?
The hypoglossal nerve runs lateral to the hypoglossus muscle
What type of villi are found on the tongue?
Filiform - most numerous
fungiform - scattered among the filiform, broader
Vallate (circumvallate) - arrange in a V-shaped row pointing posteriorly near back of the oral part with foramen cecum at the apex
With which villi are taste buds associated?
vallate ?
What nerv supplies the intrinsic and extrinsic muscles of the tongue?
hypoglossal (does all except the palatoglossus - innervated by the vagus)
What blood vessel supplies the tongue?
lingual artery off the external carotid.
(branches to the tongue include the dorsal lingual, sublingual, and deep lingual)
What is the significance of the lymphatic drainage from the central portion of the tongue?
It drains bilaterally!
this eans metastatic involvment from a primary tongue malignancy will go to both sides
What nerves are involved in innervation for taste and general sensation from the anterior two-thirds and the posterior one-third of the tongue?
Anterior 2/3: taste from fibers of CN7 that course int he chorda tympani to join the lingual nerve; sensory from lingual nerve of V3
Posterior 1/3: taste and sensory from the glossopharyngeal and some from the vagus
What structure is responsible for “tongue-tie” or ankyloglossia?
What important function is served by the genioglossus muscle?
It is what protrudes the tongue
if it’s paralyzed, the tongue will fall back and block the airway
(this is why airways need to be established when pt is under general anesthesia)
What nerves innervate the tongue and what would occur with loss of innervation by one or both motor nerves?
The hypoglossal nerve supplies motor innervation to all of the tongue muscles escept the palatoglossus, which is supplied by the vagus
if you lose motor innervation on one side, the muscles will be paralyzed and atropy
when the patient sticks their tongue out, it will deviate TOWARDS the affected side in this peripheral damage
Why do patients with angina pectoris place nitroglycerin pills under the tongue?
Drugs ccan be absorbed into the deep lingual veins very quickly when placed under the tongue - in under a minute
Based on the lymphatic drainage of the tongue, how do lingual tumors metastasize?
tumors from the anterior and posterior tonuge will metastasize to the submental, submandibular and superior deep cervical lymph nodes on the same side as the cancer
tumors from the central part of the tongue can metastasize to obht sides of the neck causing widspread metastatic involvement
What cartilages compose the larynx?
Thyroid cartilage
cricoid cartilage
arytenoid cartilage
corniculate and cuneiform
WHat cartilage forms the laryngeal prominence?
the thyroid cartilage
(adam’s apple)
Where is the lamina of the cricoid cartilage found?
the cricoid cartilage is shaped like a signet ring, with the lamina being the broad signet and the arch being the ring
the lamina is located posteriorly
How is the cricoid cartilage related to the thyroid cartilage?
the cricoid cartilage is located inferior to the thyroid cartilage
anteriorly, they are connected thorugh the median cricothyroid ligament
Laterally they are connected by the cricothyroid joint - a synovial joint
What are the two processes of the arytenoid cartilages? With what cartilage do the arytenoid cratilages articulate?
they are pyramidal in shape with an apex and a base
the anterior projection is a vocal process for the attachment of the vocal folds
lateral projection is the muscular process for the attachment of the muscles that move the vocal folds
With what cartilage is the epiglottis attached?
it attaches inferiorly to the inner border of the thyroid cartilage
What artery and nerve pierce the thyrohyoid membrane?
superior laryngeal artery
internal branch of the superior laryngeal nerve
What structure is formed by the free inferior border of the quadrangular membrane?
vestibular ligament (covered in mucous membrane = false focal cord)
What structure is formed by the free upper border of the cricothyroid ligament?
the vocal ligament (plus mucous membrane = focal fold = vocal cord)
What is a cricothyrotomy?
When you use a pen to bore a hole thorugh the medial circothyroid ligament to establish an emergency airway
What structures are associated with the vocal fold?
each vocal fold is formed by…
a conus elasticus (the vocal ligament, lateral cricothyroid ligament and median cricothyroid ligament)
a vocalis muscle
and mucous membrane covering
What is the rima glottidis and glottis?
the rima is hte opening between the vocal folds
the glottis is the vocal folds plus the rima
What is the relationship of the vestibular folds to the vocal cords?
they are located immediately superior to the vocal cords, but they’re not involved in sound production - “false cords”
What structures bind the inlet of the larynx?
the epiglottis and the aryepiglottic folds
What four compartments can be defined in the larynx and what are their limits?
- laryngeal vestibule (from inlet to the vestibular folds)
- Middle part of the laryngeal cavity (central airway between vestibular and true vocal folds)
- Laryngeal ventricle (lateral recesses between the vestibular nad vocal folds
- infraglottic cavity (below vocal fodls to bottom of cricoid cartilage)
What happens to the vocal folds when the cricothyroid muscle contracts?
they tighten and lengthen
What happens to the rima glottidis when the lateral cricoarytenoid contracts?
contraction pulls the muscular process forward, casing the vocal folds to adduct, closing the rima
What is the only muscle which abducts the vocal folds?
posterior cricoarytenoid
What happens to the rima glottidis when the posterior cricoarytenoid contracts?
it opens
Where is the vocalis muscle located?
It extends from the inner surface of the thyroid cartilage to the vocal process of the arytenoid carilage
(located along the vocal ligament)
What muscle is found in the aryepiglottic fold?
the aryepiglottic muscle
it’s fibers from the oblique arytenoid muscles that extend beyond the apex to reach teh epiglottis
What is the function of the arytenoid and aryepiglottic muscles?
when they contract, they act as a sphincter of the laryngeal inlet
What muscles serve as elevators and depressors of the larynx?
Basically, they’re all elevators except for the strap muscles, which are the depressors
so elvators: digastric, stylohyoid, mylohoyoid, beniohyoid, stylopharyngeus, salpingopharyngeus, palatopharyngeus
What blood vessels supply the larynx? From what vessels are they derived?
the superior and inferior largyngeal arteries
the superior laryngeal is off the superior thyroid artery (off the external carotid)
the inferior is a branch of the inferior thyroid artery (off the subclavian)
What nerve supplies the mucos of the larynx ABOVE the fold?
internal branch of the superior laryngeal nerve (off vagus)
What nerve supplies the mucosa below the vocal fold?
recurrent laryngeal nerve (vagus)
What nerve supplies the cricothyroid muscle?
motor supply from the external branch of the superior laryngeal nerve (only one of the intrinsic muscles that’s not supplied by the recurrent laryngeal)
What nerve supplies all the intrinsic muscles of the larynx other than the cricothyroid muscle?
recurrent laryngeal
What is the usual place for aspirated materials to become lodged?
the piriform fossa
What is the difference between a cricothyrotomy and a tracheotomy?
a cricothyrotomy is done through the cricothyroid membrane below the thyroid
a tracheostomy is done through the anteiror wall of the trachea- typically between the first and secod rings
so it’s done lower.
