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SHB > Pharynx and larynx > Flashcards

Pharynx and larynx Flashcards

1
Q

What protects the pharynx?

A

epiglottis

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2
Q

What is pharynx posterior to?

A

nasal and oral cavity, larynx

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3
Q

What are the layers of the pharynx from inside out?

A

mucus membrane
submucosa
pharyngo-basilar facia (fills gaps in walls of pharynx and is attached to base of skull)

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4
Q

Where is the buccopharyngeal fascia?

A

layer behind muscles of the pharynx infront of retropharyngeal space and prevertebral facia

meets buccinator muscle

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5
Q

What happens if the retropharyngeal space is puctured?

A

can go to heart

continous with thorax

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6
Q

What are the constrictors?

A

superior
middle
inferior (insert on thyroid cartiledge)

3 styrofoam cups overlapping

squeeze bolus towards esophagus

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7
Q

What happens when swallowing>

A

elevators lift pharynx to receive bolus

simultneous laryngeal elevation for closure and airway protection during swallowing

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8
Q

What nerve innervates most muscles of pharynx?

A

X

except for stylopharyngeous (IX) and oropharynx- tensor veli palatini = V

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9
Q

what is the most important blood supply to pharynx?

A

ascending pharyngeal from external cartoid A

ascending palatine and tonsilar of facial, pharyngeal branches and descending palatine of maxillary

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10
Q

What happens if the soft palate collapses?

A

sleep apnea

falls down, cant breathe when horizontal

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11
Q

Constrictors

A

Origin: Cricopharyngeus: lateral aspect of arch of cricoid cartilage. Thyropharyngeus: oblique line of laminar of thyroid cartilage and fibrous cricothyroid arch

Insertion: Cricopharyngeus: continuous with muscle of opposite side, behind pharynx. Thyropharyngeus : lower pharyngeal raphe

Action: Aids swallowing . Cricopharyngeus acts as upper esophageal sphincter

Nerve: Pharyngeal plexus (IX, X and sympathetic) via pharyngeal branch of X with its motor fibers from cranial accessory (XI)

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12
Q

stylopharyngeous

A

origin: medial aspect of styloid process

Insertion: posterolateral border of thyroid cartilage

action: elevates larynx and pharynx. aids swallowing

Nerve: muscular branch of glossopharyngeal nerve IX

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13
Q

levator veli palatini

A

origin: Apex of inferior surface of petrous temporal bone and medial rim of auditory tube
insertion: palatine aponeurosis

Action: elevates, retracts and lateral deviates soft palate. May open auditory tube on swallowing.

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14
Q

tensor veli palatini

A

origin: scaphoid fossa and medial aspect of spine of sphenoid bone
insertion: palatine aponeurosis (via pully of pterygoid hamulus)
action: tenses soft palate prior to elevation
nerve: nerve to medial pterygoid (main trunk of mandibular nerve) (V)

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15
Q

buccinator

A

origin: External alveolar margins of maxilla and mandible by molar teeth, to maxillary tubercle and pterygoid hamulus and posterior mylohyoid line respectively, then via pterygomandibular raphe between bones
insertion: Decussates at modiolus of mouth and interdigitates with opposite side
action: Aids mastication, tenses cheeks in blowing and whistling, aids closure of mouth
nerve: Buccal branch of facial nerve (VII)

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16
Q

mylohyoid

A

origin: Mylohyoid line on internal aspect of mandible
insertion: Anterior three quarters : midline raphe. posterior quarter: superior border of body of hyoid bone
action: Elevates hyoid bone, supports and raises floor of mouth. Aids in mastication and swallowing
nerve: Mylohyoid nerve (V)

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17
Q

hyoglossus

A

no sensory

origin: Superior border of greater cornu of hyoid bone
insertion: Lateral sides of tongue
action: Depresses tongue
nerve: Hypoglossal nerve (XII)

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18
Q

cricothyroid

A

Action: lengthens and tenses vocal cords by tilting thyroid cartilage forwards

Nerve: external branch of supieriorlaryngeal branch of vagus nerve X

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19
Q

What is the prefered location for trach?

A

cricothyroid b/c less blood

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20
Q

What is the only complete ring in trachea?

A

cricoid

all others are horseshoe C shaped

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21
Q

What nerve is the stripe on the barber pole and what muscle does it sit on top of?

A

IX

stylopharyngeus-> stylohyoid and styloglossus

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22
Q

What happens if sympathetic chain is cut?

A

Horner’s

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23
Q

What is the superior laryngeal nerve a branch of?

A

Vagus X

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24
Q

What does internal laryngeal nerve pierec?

A

thyrohyoid- sensation to vocal cord

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25
Q

What artery is the baroreceptor?

A

common carotid artery

9

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26
Q

What happens if the hyoid is fractured?

A

strangulation

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27
Q

What happens with a bilateral cut to recurrent laryngeal?

A

posterior carocoidaretynoid paralyzed

can’t open vocal cords because only abductor

die

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28
Q

Where hyoglossus located?

A

Between CN 12 and lingual artery

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29
Q

What is between the jugular and common carotid?

A

vagus X

30
Q

What innervates cricothyroid?

A

external laryngeal

31
Q

What 2 nerves branch off the vagus?

A

superior larygneal and recurrent laryngeal

32
Q

what does the supieror laryngeal split to>

A

internal and external laryngeal

33
Q

What does the internal laryngeal innervate?

A

sensory above the cords

34
Q

What does the exertnal laryngeal innervate?

A

cricothyroid

35
Q

What does the recurrent laryngeal innervate?

A

sensory below the cords and all other muscles (posterior cricothyroid, lateral cricoarytenoid, transverse and oblique arytenoids, vocalis, thyroarytenoid)

36
Q

What is the only abductor of the cords?

A

Cricoarytenoid

37
Q

What is the blood supply for the larynx?

A

via superior laryngeal of superior thyroid and inferior laryneal of inferior thyroid

same as thyroid!

38
Q

What is the laryngeal skeleton?

A

3 single
thyroid cartilage, cricoid catilae, epiglottis

+ 3 paired (6)
corniculate, cuneiform, arytenoid cartilage

+ 2 joints synovial
cricothyroid cicoarytenoid

39
Q

Over what vertebrae does the larynx extend?

A

C3-C6

40
Q

When does the pharynx become the esophogus?

A

C6 lower border

41
Q

What is the body guard of the body?

A

larynx- guard air way especially during swallowing

42
Q

What is the larynx continous with?

A

laryngopharynx superior

trachea below C6

43
Q

Where does food get stuck when you clear throat?

A

valleculae

44
Q

Is the angle of the thyroid cartilage the same in men and women?

A

no! 90-120 degrees

Angle different for males and females- ladies voice different from male voice

men = adams apple

45
Q

What is the onky complete ring in the respiratory system?

A

cricoid cartilage

rest are C shaped closed by trachealis

46
Q

What is the joint that connects the cricoid and the thyroid?

A

cricothyroid joint

47
Q

What does the epiglottis attach to?

A

back of hyoid bone by hyo-epiglottis ligament

anterior surface has taste buds

48
Q

What pierces the thyrohyoid membrane?

A

pierced by the internal laryngeal nerve & superior laryngeal vessels

nerve and blood for upper larynx

49
Q

Where do the arytenoid cartilages sit?

A

2 pyramids on top of cricoid cartilage

cricoarytenoid joint

2 processes- muscular and vocal

apex articulates with corniculate cartilage

50
Q

Where are the conriculate and cuneiform cartilages (nodules?)

A

embedded in aryepiglottic fold

51
Q

What are the two extrinsic membrane/ligaments?

A

thryohyoid membrane

circotracheal ligament

52
Q

What are the two intrinsic membrane/ligaments?

A

1) quadrangular membrane (2)
stretched between epiglottis and arytenoids
-upper = aryepiglottic fold
-lower= vestublar ligament (FALSE vocal cord)

2) crico-thyroid ligament (1)
- upper = vocal ligament (true vocal cord) from angle of thyroid cartilage to vocal process of arytenoid

53
Q

What is the false vocal fold?

A

vestibular ligament

lower quadrangular membrane

54
Q

What is the true vocal fold?

A

vocal ligament off upper free border of cricothyroid ligament

55
Q

What is the rima glottis?

A

space between vocal folds

If adducted, closed rima glottidis
If abducted, open rima glottidis

56
Q

When should a cricothyrotomy be done?

A

After failure of valsalva maneuver when foreign body inhaled

last result to access airway- pierce between cricoid and thyroid- if you move cricoid or thyroid you stretch vocal cord

57
Q

where is the most likely place for foreign body to be?

A

Piriform fossa (yellow)

remove of item may damage superior part of larynx- sensory- the branches of internal laryngeal nerve which lead to loss of sensation of the upper ½ of Larynx.

found in laryngeal inlet (either side of aryepiglottic fold)

58
Q

Cricothyroid

A

ONLY TENSOR/stretcher of vocal ligament

external laryngeal nerve from CN X (exception)

59
Q

Posterior cricoarytenoid

A

ONLY ABductor of vocal cords

ONLY opener of rima glottis

recurrent laryngeal from X

60
Q

Lateral cricoarytenoid

A

ADDuctor of vocal folds

recurrent laryngeal from X

61
Q

Transverse and oblique arytenoid

A

adductor of arytenoid cartilage
adduct intercarilaginous portion of vocal cords, close posterior rima glottidis)

recurrent laryngeal from X

62
Q

What muscle is the exception that all laryngeal muscles are innervated by reccurrent laryngeal from X?

A

Cricothyroid = external laryngeal from X

develops from 4th arch (not 6th)

63
Q

Thryo-arytenoid and vocalis

A

Relaxes vocal ligament

recurrent laryngeal

64
Q

What muscle whispers?

A

vocalis

65
Q

What divides the larynx into upper and lower parts?

A

vocal cords = watershed

66
Q

What is the blood supply and sensory nerve to upper larynx?

A

superior laryngeal artery of superior thyroid artery

internal laryngeal nerve of superior laryngeal Vagus X

both PENETRATE thyrohyoid membrane
superior thyroid = first branch of external carotid

67
Q

What is the blood supply and sensory nerve to lower larynx?

A

inferior laryngeal artery of inferior thyroid artery

recurrent laryngeal nerve of vagus X

68
Q

What are the 3 pairs of laryngeal structures?

A

internal laryngeal n + superior laryngeal A

External laryngeal n + superior thyroid A

recurrent laryngeal n + inferior laryngeal A

69
Q

Why should surgeon be careful during thyroidectomy?

A

blood supply of thyroid gland is close related to nerve supply of larynx so be careful of nerves

70
Q

Where do the two recurrent nerves turn?

A

(goes to heart but turns around)

Right recurrent turns at right subclavian
Left recurrent turns at arch of aorta

SHB (22 decks)

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