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DCL 304 > Pharynx and Larynx > Flashcards

Pharynx and Larynx Flashcards

1
Q

Describe the anatomical relationships: Anterior to the pharynx

A
  • Opening into nasal cavity
  • Soft palate
  • Opening into oral cavity & posterior surface of tongue
  • Opening into larynx
  • Posterior surface of larynx
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2
Q

Describe the anatomical relationships: Posterior to the pharynx

A
  • Buccopharyngeal part of visceral layer of deep cervical fascia
  • Retropharyngeal space
  • Prevertebral fascia
  • C1-C6 vertebrae: anterior arch of atlas, vertebral bodies C2-C6
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3
Q

Describe the anatomical relationships: Postero-lateral to the pharynx

A
  • Internal jugular vein, internal carotid artery

* Sympathetic trunk, CN IX, X, XI, XII

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4
Q

Name the pharyngeal constrictor muscles and where they originate/attach

A

• Superior pharyngeal constrictor
o Main origin: pterygomandibular raphe & adjacent bone on the mandible & pterygoid hamulus

• Middle pharyngeal constrictor
o Main origin: Upper margin of greater horn of the hyoid bone

• Inferior pharyngeal constrictor
o Main origin: Cricoid cartilage, tendinous arch etc
o The inferior pharyngeal constrictor muscle includes the cricopharyngeus forms → upper oesophageal sphincter

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5
Q

Name the elevators of the pharynx, and their INNERVATION

A

Palatopharyngeus = CNX
Stylopharyngeus == CNIX
Salpingopharyngeus = CNX

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6
Q

What is in the Nasopharynx?

What makes the roof of the nasopharynx

A
  • Roof: Occipital & sphenoid bones
  • Tonsil on roof = pharyngeal tonsil (adenoids when enlarged)

• Opening of the eustachian tube (pharyngotympanic tube, auditory tube)
o Other end of tube: middle ear (tympanic cavity)
o Allows equalization of pressure across the tympanic membrane
o Note: potential spread of infection from the nasal cavity to the middle ear → otitis media

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7
Q

What is in the oropharynx?

A

• Palatoglossal & palatopharyngeal arches & muscles
o Palatine tonsil lies between these two arches
• The posterior 1/3 of tongue is in the oropharynx
o Contains lingual tonsils
• Superior & middle constrictors, with stylopharyngeus & CN IX between them

CN IX: somatosensation & taste on posterior 1/3 tongue

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8
Q

What does CNIX run between and what is its function?

A

• Superior & middle constrictors, with stylopharyngeus & CN IX between them

CN IX: somatosensation & taste on posterior 1/3 tongue

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9
Q

What is in the laryngopharynx?

What holes may food lodge in?

A

• Inferior pharyngeal constrictor

• Small swallowed objects (food) may lodge in…
o Valleculae – between epiglottis & tongue
o Piriform recess – posteriorly between cricoid & thyroid cartilages
• In the flood of the recess, under the mucous membrane = internal laryngeal nerve → potential damage if something sharp lodges in the piriform recess

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10
Q

What is the lymphatics in the pharynx?

A
  • Tonsils: lymphoid aggregations in mucosa of pharynx → lingual, palatine, pharyngeal
  • Lymphatic drainage → retropharyngeal nodes → deep cervical nodes along IJV (within carotid sheath – collect most lymph from the head & neck)
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11
Q

What is the blood supply of the pharynx?

A

o From inferior thyroid artery - from thyrocervical trunk

o From superior thyroid, ascending pharyngeal, lingual, facial, maxillary arteries –> all from external carotid artery

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12
Q

Describe the innervation of muscles of the pharynx

Where are the LMN’s located

A

• All are supplied by the vagus (CN X), except stylopharyngeus by glossopharyngeal (CN IX)

  • All LMNs of IX & X are in the nucleus ambiguus (rostral medulla, posterior to the inferior olivary nucleus)
  • CN IX, X exit brainstem at the posterior olivary sulcus
  • Exit the skull via the jugular foramen
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13
Q

Describe what would happen if there was a LMN lesion to CNX

A

ipsilateral paralysis - ie. dysphagia- difficulty swallowing

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14
Q

If there is an UMN lesion

A

There would be no problems due to the nature of the CBT

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15
Q

What is the SENSORY innervation of the pharynx

A

• CNV2 (maxillary), IX, X → primary neurons in the trigeminal, petrosal & nodose ganglion
• Conscious sensory processing
o Same as for sensation from face – 2nd order neurons in main & descending nuclei of V
o → TTT → VPM → primary SSC

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16
Q

Describe the gag reflex

A

Afferent mainly CNIX, also X, V -> descending nucleus of V, nucleus ambiguus -> CNX and IX

17
Q

Describe the glossopharyngeal nerve-
where does it run?
What are its functions?

A

• Close to stylopharyngeus (supplies it), between external & internal carotid arteries

o Sensory (general & taste) to posterior 1/3 of tongue
o Sensory to much of pharynx
o Sensory – carotid sinus & body (baro & chemoreceptors)

o Parasympathetic to parotid (different pathway)
• Inferior salivatory nucleus, come out of CN IX- > inferior petrosal nerve -> synapse in Otic ganglion & travel with V3 branches to the parotid gland

18
Q

What nerves are used in the action of SWALLOWING?

A

CNX, Facial and V3

19
Q

Tongue moves food bolus posteriorly

A

CNVII

20
Q

Soft palate elevated to close off nasopharynx

A

CNX - palatoglossus, palatopharyngeus, levator tensor palitini
CNV3- tensor veli palatine

21
Q

Larynx elevated & moved anteriorly by suprahyoids & thyrohyoid, which opens laryngopharynx

A

CNV3: Suprahyoid: mylohyoid, anterior belly of digastric
CNVII: Stylohyoid,
C1 (travels with CNXII) geniohyoid

22
Q

Wave of relaxation & contraction of pharyngeal constrictors from above downwards

A

CNX

23
Q

Laryngeal inlet narrowed, epiglottis pulled posteriorly

A

CNX

24
Q

Upper oesophageal sphincter relaxes to allow food into oesophagus, then relaxes

A

CNX

25
Q

What is the larynx part of?

A 
Conducting zone (not respiratory as this means gas exchange)
Lower respiratory tract
26
Q

Functions of the larynx

A
  • Conduit for air from the URT to LRT
  • Prevents food & liquid from entering the LRT when swallowing
  • Voice production (phonation)
27
Q

Anatomical relationships

A
  • Hyoid bone – superior
  • Infrahyoid muscles – anterolateral
  • Thyroid gland – inferior, lateral
  • Trachea – inferior
  • Laryngopharynx, buccopharyngeal fascia, retropharyngeal space, vertebral bodies C3/4 – C6 – Posterior
28
Q

What are the unpaired cartilages of the larynx?

A

Thyroid cricoid epiglottic

29
Q

What are the paired cartilages of the larynx

A

Arytenoid, corniculate, cuneiform

30
Q

What is the innervation of the muscles of the larynx?

A

All by vagus nerve (CNX)

  • Most via the recurrent laryngeal nerve
  • exception: Cricothyroid - superior laryngeal nerve
31
Q

Where are the LMNs and UMNs located for the innervation of muscleso f the larynx

A

LMNs in nucleus ambiguus in rostral medulla

UMNs in corticobulbar tract in precentral gyrus

32
Q

What is the sensory innervation of the laryngeal mucosa (hint- split into above vocal fold and below)

A

CNX

  • above vocal fold: internal branch of laryngeal nerve
  • below vocal fold: recurrent laryngeal nerve
33
Q

Describe the cough reflex

A

Afferent CNX -> main and descending nucleus of t trigeminal nerve -> brainstem cough pattern generator-> controlling laryngeal muscles -> diaphragm and abdominal pain etc.

Efferent: CNX and various spinal nerves

34
Q

Damage to the laryngeal nerves- what would you see?

A

Superior laryngeal nerve damage: Cricothyroid paralysed -> cant lengthen vocal cord, voice is hoarse and easily tires
Lung tumours can compress the recurrent laryngeal nerve

• Recurrent laryngeal nerve damage →
o All muscles on same side except cricothyroid are paralysed
o Ipsilateral vocal cord cant be abducted/adducted
o Initially vocal cord bowed laterally, later adducted (voice poor → okay)
o If recurrent laryngeal nerve is damaged bilaterally, later adduction may interfere with breathing

35
Q

What is dysarthria

A

• Dysarthria → disturbance of articulation of speech

o	Could be brainstem or cranial nerve problem, cerebellum, or other causes
•	Larynx – CN X
•	Tongue – CN XII
•	Palate – CN X
•	Facial muscles – CN VII
36
Q

What is aphasia

A

• Aphasia → problems with production or comprehension of speech & writing
o higher cognitive dysfunction – cerebral cortex problem, usually left side

37
Q

What is the lymphatic drainage of the larynx

A

to deep cervical nodes aloong internal jugular vein

38
Q

What is the blood supply of the larynx?

A

ECA -> superior thyroid artery -> superior laryngeal artery

Subclavian artery -> thyrocervical trunk -> inferior thyroid artery -> inferior laryngeal artery

DCL 304 (4 decks)

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