Pharynx and Larynx Flashcards
the three phases of swallowing are
the oral phase
the oropharyngeal phase
the pharyngo-esophageal phase
The opening to the larynx is called
laryngeal aditus
oral phase is synonymous with
mastication
oropharyngeal phase
involves elevation of the floor of the mouth and tongue i norder to push the bolus into the oropharynx
tongue acts as a piston
the pharyngo-esophageal phase
oropharynx elevates and constricts around the bolus and propels it down the esophagus
define the airway protective cough reflex
a series of expiratory cough triggered by a noxious stimulus to the supraglottic layngeal mucosa
why is the cough reflex a vital function in humans
uniqueness of the position of the human larynx, which makes it vulnerale to aspiration during swallowing or inhaliation
every particle of food and drink has to pass over the orifice of the trachea
2 evolutionarily important developments in humans
- displacement of the larynx from the back of the neck to the throat (happens in the first year of life, has to do with vocal function and speech development.)
- descent of the bladder from abdomen to pelvis as we become bipedal (bladder is in abdomen of children)
Is the epiglottis in the same place for children and adults?
no. in children, the epiglottis overlaps the soft palate
Vocal sounds in infants vs adults
Infants - nasalized vocal sounds, not peak frequencies that humans can pick up
adults - movement of the larynx to the throat allows for peak frequenceies - huge for development of language
Protection of the airway in children vs. adults
human infants have functional separation of the airway and swallowing function. the epiglottis articulates with the soft palate
human adults require neurological airway protection and RARs in the larynx
Why do we have spincters that close in places in the body
to protect the airway, urinary bladder, rectum
Respiratory afferents drive ______ abdominal pressure event (_____)
up
anticipation
stress urinary incontinence = increased abdominal pressure–>leak
Pharynx is divided into 3 regions
nasopharynx
oropharynx
laryngopharynx
Nasopharynx location
posterior to the nasal cavity
Nasopharynx communicates with the ________ via _____ (x3)
nasal cavity via the chonae
middle ear vie the auditory tube
oropharynx via the pharyngeal isthmus
anterior opening of the pharynx to the nasal cavity
chonae
inferior opening of the nasopharynx
closed over by
pharyngeal isthmus
soft palate - dont’ want food up in your nasopharnx
Oropharynx is related to which major landmark of head and neck
hyoid bone
laryngopharynx is located
posterior to the larynx
laryngopharynx becomes continuous with the _____ at the important head and neck landmark____
esophagus
CV6
laryngopharyx communicates with the oropharynx at the level of what head and neck landmark
hyoid bone
Piriform recess
part of the laryngopharynx
posterior and lateral to the arytenoid cartilages
food flows down this gutter into the esophagus
piriform recess
the epithelium in this area is innervated by____ and its arterial supply is _____
internal laryngeal nerve
superior laryngeal artery
pooling sign suggest obstuction or paralysis of upper esophagus
Inner elevators of the pharynx
stylopharyngeus muscle
salpingopharyngeus muscle
palatopharyngeus muscle
vagal function in the pharynx
elevation (except styolopharyngeus muscle)
Stylophayngeus muscle
between superior and middle constrictors
innervated by SVE fibers of IX
ONLY ONE INN BY IX
Salpingophayngeus muscle and palatopharyngeus muscle
innervated by vagus n
Pharyngeal constictor muscles
superior constrictor (at pterygoid process and mandible) middle constrictor (at hyoid) inferior constrictor (at oblique line of thyroid cartilage and cricoid cartilage)
attach posteriorly to the midline pharyngeal raphe
Inferior constrictor
cricopharyngeus muscle is used during phayngeal speach. is the larges constrictor group. also transition level of orientation of horizontal fibers from pharynx, to vertical fibers of esophagus
Kilian’s triangle
weak spot of transition at cricopharyngeus/ inferior constrictor level from oblique fibers to vertical fibers of the esophagus
Zenker’s diverticulum
located just above cricopharyngeus mucslce (above the upper sphincter of the esophagus) it is a false diverticulum (not involving al layers of esophagus wall)
Buccopharyngeal fascia
covers outer surface of buccinator muscle and the pharynx
pharyngeal plexus
embedded in the portion of the buccopharyngeal fascia covering the middle constrictor
Retropharyngeal space
between buccophayngeal fascia and prevertebral fascia - it is continuous from the base of the skull to the mediastinum
infections can spread from either region via this space
in srugical fusion of cervical vertebrae, the anterior bodies of the vervical vertebrae are approaced via the retropharyngeal space
Gag reflex
remember not everyone has a gag relflex
afferent IX, efferent X
Blood supply to pharynx
ascending pharyngeal and inferior thyroid arteries
Innervation of the Pharynx \_\_\_\_\_\_\_\_plexus embeded in \_\_\_\_\_\_\_\_ receives sensory (GVA) from \_\_\_\_\_\_\_\_\_\_\_ receives motor (SVE) from \_\_\_\_\_\_\_\_\_ afferent information for the \_\_\_\_\_ reflex
pharyngeal plexus embedded in buccopharyngeal fascia
GVA from pharyngeal branch of glossopharyngeal nerve
SVE from the pharyngeal branch of vagus nerve
gag
Branches of IX (3)
- pharyngeal nerve to pharyngeal plexus
- sensory (GVA) to mucosa of post 1/3 tongue and pharynx
sensory (SVA) to taste buds of post 1/3 tongue - motor (SVE) to stylopharyngeus muscle
why do we need neurological airway protection of the larynx
because of its displacement from the back of the eck to the torat in the first year of life
movement of the laryx has to do with
vocal function and speech development
The _____ acts as a teeter totter between _____ and _____
hyoid
tongue and larynx
Thyroid cartilage
thyroid laminae form the laryngeal prominence
superior horn continuous with hyoid bone
inferior horn articulates with cricoid cartilage (cricothyroid joint)
may show ossifications on X-rays after age 30
Cricoid cartilage
most of this cartilage is posterior
cricoid lamina located on posterior aspect of larynx, articulates with the arytenoid cartilages
cricoid arch
formas main supporting element of laryngeal airway
arytenoid cartilages
turnstyle configuration
vocal process attached to vocal ligament of vocal cord
muscular process attached to posterior and lateral cricoarytenoids
posterior attachement of vocal ligaments
arytenoid cartilages
during phonation arytenoid cartilages
rotate along a vertical axis to control tension on the vocal folds
during respiration arytenoid cartilages
slide laterally to poen the rima glottidis
vocal cords apart for breathing
Why dont you want to direct your cut upwards during a cricothyrotomy
you will hit the vocal cords
What happens when you swallow (with the epiglottis)
tongue pushes back over the larynx and pushes epiglottis over the larynx
vocal folds close also
Only abductor of vocal cords
posterior cricoarytenoid muscle (cricoid lamina to the muscular process of the arytenoid)
GERD
acid is damaging to larynx (digestion of lining of upper airway)
will complain of cough
MOST important nerve in the body. will keep you alive
internal branch of superior laryngeal nerve
ibSLN
ibSLN course
pierces thyrohyoid membrane along with superior laryngeal artery
ibSLN function
CHIEF SENSORY NERVE TO THE INTERIOR OF THE LARYNX
supplies GVA fibers to interior of larynx and it is involved in the cough reflex
also supplies GVE to the saccule glands of the larynx
afferent component of the laryngeal cough reflex (LCR)
laryngeal receptors and afferent fibers of the ibSLN
If ibSLN not functional during initiation of protective cough reflex,
protective value of LCR is compromised, and there is an increased risk of developing aspiration pneumonia in neurologically impaired patients
External branch of superior laryngeal nerve
innervates cricothyroid muscle
recurrent laryngeal nerve course
crosses cricothyroid joint and enters larynx, is then called inferiror laryngeal nerve
inferior laryngeal nerve function
conveys SVE fibers to the laryngeal muscles except CRICOTHYROID
these fibers originate from the nucleus ambiguus
paralysis of recurrent laryngeal nerve
result in hoarseness and dysphagia.
there may also be coughing or choking due to the collapse of the aryepiglottic fold and subsequent drainage of fluids into the larynx.
