Oral cavity, pharynx, larynx Flashcards
Anatomic subdivision of the pharynx from top to bottom
- Nasopharynx (skull base to soft palate)
- Oropharynx (soft palate to pharyngoepiglotic fold)
- Hypopharynx (cricopharyngeus m)
Which layer DCF covers the nasopharynx?
ML-of DCF posteriorly but anteriorly it is free (laterally the SL-DCF of the masticator space)
Which are the paired lateral spaces close to the nasopharynx/pharyngeal mucosal space?
Masticator Parapharyngeal Carotid space Parotid spase all covered by SL-DCF Behind is RPS/DS
Describe the mucosa of the nasopharynx
Anterior to Eustachian tube like nasal cavity
Posterior like oropharynx
What are the contents of the nasopharynx?
Mucosa Minor salivary glands Lymphatic tissue, pharyngeal tonsil + lateral recess of Rosenmuller Torius tubarius/eustachian tube Superior constrictor muscle Hiatus Morgagni
What is the pharyngobasilar fascia?
Very thick upper aponeurosis between superior constrictor muscle and basi-occiput
What is the Fossa of Rosenmuller?
What is the Hiatus/sinus of Morgagni
Herniation of pharyngeal mucosa through sinus of Morgagni.
Gap in the upper/lateral wall of the pharyngobasilar fascia
Pass through: Eustachian tube, levator veli palatini m. and ascending palatine artery.
Structures lateral and posterolateral walls nasopharynx?
Lateral Wall:
Tensor veli palatini m.
Eustachian tube
Levator veli palatini m.
Posterolateral Wall:
Lateral recess of Rosenmuller
Retropharyngeal LN (Rouvier)
Muscle longus colli medial, longus capitis lateral
Roof of nasopharynx?
Foramen Lacerum
Foramen Ovale
Internal carotid artery
Which foramen is in continuity with Rossenmuller fossa?
Foramen lacerum and foramen ovale with masticator space
Embryology, importance of the squamus epithelium of the oropharynx? Contents?
Endoderm, poorly differentiated cancers
Post 1/3 tongue (circumvallate papilla), lingual tonsils, vallecula, soft palate, palatine tonsils, post.pharyngeal wall
Oropharynx carcinoma subsites location incidence
PALATINE TONSIL 50%
Base of tongue 20%
Soft palate 10%
Posterior Praryngeal wall 5-10%
Embryology and Subsites of the Oral cavity
Ectoderm, more differentiated cancers.
Mucosal lips Ant 2/3 tongue Buccal mucosa Gingiva Hard palate Retromolar trigone Floor of mouth
What is the incidence of oral cavity to oropharynx neoplasms ratio?
2:1 but oropharyngeal cancers tend to increase
Sublingual and Submandibular spaces; Which one is fascia lined?
SLS - Not fascia lined
Submandibular - Fascia lined
Name the extrinsic muscles of the floor of the oral cavity
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
Which structures medially of hyoglossus muscle?
Hypoglossal n IX
Lingual artery
Palatoglossus muscle forms
Where is Styloglossus muscle located?
Palatoglossal arch
Side of Tongue (styloid think laterally)
What has changed in floor of oral cavity cancer staging?
Previous staging extrinsic muscle infiltration
Now is it the depth of infiltration that matters
T1 <5mm , T3>10mm
Sublingual space posterior extension?
Extends posteriorly along mylohyoid m. to parapharyngeal space and deep lobe of submandibulal gland. The deep lobe of submandibular gland is in the SLS!
Orifice of parotid duct?
2nd molar upper jaw
An abscess from the sublingual space can extend to:
Submandibular and parapharyngeal spaces and medially in the other sublingual space
What is the most common location for oral cavity carcinomas?
Other common locations?
The lip mucosa 30-40%
Floor of mouth 20%
Oral tongue 15%
Buccal mucosa 10%
Which is the border of the laryngeal vestibule and the piriform sinus? Possible question
AryEpiglotic fold = dividing line
What is the border of the hypopharynx and esophageal junction?
Anatomic subdivisions of hypopharynx
Inferior cricoid lamina
Piriform sinus, Post-cricoid, Posterior wall
Anatomic structures hypopharynx
Pharyngo-Epiglotic fold - superiorly
Ary-Epiglotic fold - anteromedially
Para-glottic space - anteriorly
Thyroid membrane superolaterally
Thyroid cartilage inferolaterally
Lower apex at level of cricoid
Cricoid lamina anteriorly
Posterior wall
Piriform sinus tumour postero-lateral infiltration sites
Thyroid lamina, carotid space, posterior wall
Piriform sinus tumour anterior infiltration sites?
Paraglottic space, cricoid lamina
Piriform sinus tumour extension
Medial - anterior wall: Supra- paraglottic extension
Lateral wall: Carotid-posterior cervical space, thyroid cartilage, extensive vertical extension to oropharynx
Hypopharyngeal Post-cricoid tumour extension
Below the inter-arytenoid sulcus -> cricoid cartilage, cervical esophagus
Post hypoparynx wall tumour extension
Prevertebral DL-DCF, extensive vertical extension, oropharynx, esophagus
Incidence of hypopharyngeal ca sites
PIRIFORM SINUS 60%
Posterior wall 25%
Post-cricoid 15%
Anatomic divisions of larynx
Supraglottis (epiglottis +aryepiglottic fold, false vocal cord) to floor of laryngeal ventricule
Glottis (true vocal cords & commissures) +5mm
Subglottis begins 5mm below true cord to inferior limit of cricoid
What should be the anatomic coverage on imaging of the recurrent laryngeal n. palsy?
From orbital roof (neck skull base)to below aortic arch
What is the lymphatic drainage of the supraglottic area?Question possible
Ipsi- and contra- lateral levels II-IV
Most common site of laryngeal cancer ?
GLOTTIC (65%)
Supraglottic (30%)
Subglottic (2-5%)
What is the lower border of the Retropharyngeal space?
T3
Which fascia covers the visceral space?
Middle layer deep cervical fascia
