Pharynx

Question 1

Where does the pharynx begin and end?

Answer 1

Base of skull

Proximal oesophagus

Question 2

What forms the anterior, posterior and lower borders of the nasopharynx?

Answer 2

Anterior: choanae
Posterior: Body of C1 vertebra (and superior part of C2)
Lower: Soft palate

Question 3

When is the nasopharynx closed off from the rest of the pharynx?
What controls this movement?

Answer 3

During swallowing when the soft palate contracts to close the gap.
Controlled by:
-Tensor veli palatini (Stretches soft palate)
-Levator veli palatini (elevates soft palate)

Question 4

Where does the oropharynx begin and end?

Answer 4

Palatal arches to lower border of epiglottis

Question 5

What does the pharynx connect?

Answer 5

Nasal and oral cavities with larynx and oesophagus

Question 6

What muscle stretches the soft palate and elevates the pharynx?

Answer 6

Tensor veli palatini

Question 7

What muscle elevates the soft palate and elevates the larynx?

Answer 7

Levator veli palatini

Question 8

What do the tensor and levator veli palatini muscles do to the auditory tube? What is the purpose of this?

Answer 8

Assists with drainage from the middle ear

Equalises pressure between the middle ear and nasopharynx

Question 9

What is the sensory innervation of the pharynx?

Answer 9

Nasopharynx: CNVb and IX
Oropharynx: CNIX
Laryngopharynx: CNIX and X

(CNIX supplies respiratory mucosa)

Question 10

What is the epiglottis?

What is its role?

Answer 10

Cartilage of the larynx

Covers laryngeal inlet during swallowing to prevent aspiration

Question 11

Where does the laryngopharynx begin and end?

Answer 11

Base of tongue/upper epiglottis to cricopharyngeus muscle

Question 12

Which muscle has to relax in order to allow a food bolus to pass through the laryngopharynx into the oesophagus?

Answer 12

Cricopharyngeus

Question 13

What epithelium lines the nasopharynx?

Answer 13

Respiratory epithelium: pseudostratified, ciliated, columnar

Question 14

What epithelium lines the oropharynx and laryngopharynx?

Answer 14

Stratified squamous epithelium

Resists abrasion

Question 15

What are the 3 pharyngeal constrictor muscles?

Answer 15

Superior constrictor
Middle constrictor
Inferior constrictor

Question 16

What is considered the true upper oesophageal constrictor?

Answer 16

Cricopharyngeus muscle

Question 17

What fills gaps between the pharyngeal constrictor muscles on the lateral and anterior portions?

Answer 17

Continuous internal fascia and mucosa lines all 3 pharyngeal constrictor muscles

Question 18

What is the action of the pharyngeal constrictor muscles?

Answer 18

Reduce the diameter of the pharynx

Peristalsis to propel bolus into the oesophagus

Question 19

What is the motor supply to the pharyngeal muscles?

Answer 19

All CNX except:

• Stylohyoid: CNIX
• Tensor veli palatini: CNVc

Question 20

What could paralysis of CNX lead to in the pharynx?

Answer 20

Uncoordinated swallowing

Lack of gag reflex

Question 21

The hyoid bone is an insertion point for which pharyngeal constrictor muscles?

Answer 21

Middle constrictor

Question 22

Which structure extends between the styloid process and the hyoid bone?
What is its function?

Answer 22

Stylohyoid ligament

Question 23

What is the anterior attachment point for the superior constrictor muscle?

Answer 23

Pterygomandibular raphe

Question 24

What does the middle constrictor muscle insert into anteriorly?

Answer 24

Hyoid bone

Stylohyoid ligament

Question 25

What are the complications of overgrown styloid processes?

Answer 25

Dysphasia Facial pain on head rotation Feeling of 'something in throat' Carotid artery compression

Question 26

How do the pharyngeal constrictor muscles attach to eachother?

Answer 26

Attach posteriorly at the midline raphe

Question 27

Where does the midline raphe extend from and to?

Answer 27

Base of skull to the 'weak spot' at the inferior aspect of the inferior pharyngeal constrictor muscle

Question 28

What can form through the weak spot in the pharynx? | What might be the symptoms of this?

Answer 28

``` Pharyngeal (Zenker's) diverticulum: Herniation of the pharyngeal mucosa through the weak spot -Halitosis -Infection -Feeling of fullness in throat -Regurgitation of food on coughing ```

Question 29

Coordinated peristalsis of constrictors and relaxation of cricopharyngeus causes what?

Answer 29

Drop in intrapharyngeal pressure to allow food bolus to progress downwards into oesophagus

Question 30

What is the piriform fossa? | What is its function?

Answer 30

Gutter-like recess between central larynx and lateral thyroid cartilage Helps to direct food and fluid to either side of the larynx to pass down laryngopharynx into the oesophagus without having to pass over the top of the epiglottis covering the airway.

Question 31

Where may food become stuck on swallowing in the pharynx?

Answer 31

Vallecula | Piriform fossa

Question 32

Which muscles shorten and elevate the pharynx on swallowing? | What is the effect of this?

Answer 32

``` Stylopharyngeus Palatopharyngeus Salpingopharyngeus Causes widening of the pharynx Allows intrapharyngeal pressure to drop helping swallowing of food ```

Question 33

Where does the stylopharyngeus muscle originate from and attach to? What is its motor innervation?

Answer 33

Styloid process to pharyngeal constrictor muscles | Motor supply from CNIX (only pharyngeal muscle with CNIX motor supply)

Question 34

What does the salpingopharyngeus muscle extend from and to?

Answer 34

Auditory tube to pharyngeal muscles

Question 35

What is the motor supply to the tensor veli palatini?

Answer 35

CNVc

Question 36

What muscles make up the pharyngeal arches? | Where do they connect to?

Answer 36

Palatoglossus Palatopharyngeus Connect to underside of the soft palate

Question 37

Where are the palatine tonsils located?

Answer 37

Between the palatoglossus and palatopharyngeus muscles

Question 38

What can damage to CNX or CNVc cause in the soft palate?

Answer 38

Ipsilateral soft palate motor paralysis

Question 39

How do the tensor veli palatini muscles stretch the soft palate?

Answer 39

By looping around bones behind the nasal choanae forming a right angle shaped muscle. This pulls the soft palate tight rather than upwards

Question 40

Which way will the soft palate and uvula deviate in CNVc or CNX damage?

Answer 40

Soft palate will deviate towards unaffected side, uvula will point to unaffected side

Question 41

What does a CNIX or CNX lesion do to the gag reflex?

Answer 41

CNIX: Sensory loss: No gag reflex on affected side, full gag reflex on unaffected side CNX: Motor loss: sensation but unilateral or no contraction

Question 42

What is Waldeyer's ring?

Answer 42

``` Ring of lymphoid tissue in naso and oropharynx Consists of: -Palatine tonsils -Lingual -Tubal -Adenoids ```

Question 43

What can enlargement of adenoids cause?

Answer 43

Middle ear infections (reduced drainage of middle ear due to occlusion of auditory tube entrance) Snoring: partial occlusion of airway Swallowing problems Food entering nasopharynx during swallowing Altered voice