Pharynx And Larynx

Question 1

The ____ and ____ physically close the aditus. The _____ reflex neurological protects the upper airway from significant aspiration of food of fluid. This reflex is triggered by aspiration of food of fluid into the ____.

Answer 1

Epiglottis and laryngeal sphincters

Laryngeal cough reflex (no reflex can cause aspiration based pneumonia)

Larynx

Question 2

What are the three phases of swallowing and describes what happens in each stage?

What is unique to newborns vs an adult?

Answer 2

Oral: mastication

Oropharyngeal: elevation of floor of mouth and tongue to push bolus into oropharynx

Pharyngo-esophageal: oropharynx elevates and constricts around bolus and propels it down the esophagus

Larynx is more anterior/superior in the infant than adult. Harder for infant to aspirate. Can breath through nasal airway while suckling at the same time; adult larynx drops more inferior (needs more protection through epiglottis and neurological protection through cough reflex)

Question 3

The internal branch of the _____ nerve is the central nerve for the interior (central region) of larynx and innervates the epiglottis.

Anything that moves into the vestibule is a threat to the airway and triggers an _____ by this nerve.

_____ and ____ go through the thyrohyoid membrane.

Answer 3

Superior laryngeal N

Expiratory reflex

Superior laryngeal A; internal branch of the superior laryngeal N

Question 4

Inhalation of air passes through the what three cavities/pharynx?

Answer 4

Nasal cavity -> nasopharynx

Oral cavity -> oropharynx

Larynx

Question 5

What are the three boundaries of the pharynx?

Answer 5

Choanae: opening between the nasal cavity into the nasopharynx

Pharyngeal isthmus: opening between the nasopharynx and oropharynx

Faucial isthmus: opening between the oral cavity and oropharynx (formed by palpoglossal folds)

Question 6

The nasopharynx communicates with the nasal cavity via the _____; middle ear cavity via the ____; and oropharynx via the _____.

Cartilaginous portion of the auditory tube is ___.

Answer 6

Choanae

Auditory tube

Pharyngeal isthmus

Torus tubarius

Question 7

The oropharynx communicates with the nasopharynx via the _____; oral cavity via the _____; and laryngopharynx at the level of the _____.

_____ nerve is found in the palatine fossa.

____ separates the anterior 2/3 of tongue from the posterior 1/3.

Answer 7

Pharyngeal isthmus

Faucial isthmus

Hyoid

Glossopharyngeal N

Palatoglossal fold

Question 8

The laryngopharynx communicates with the oropharynx at the level of the _____; larynx via the ____; and esophagus at the level of _____.

____ are on either side of the esophagus catch food and fluid.

Answer 8

Hyoid

Laryngeal aditus

C6

Piriform recess

Question 9

What are the three inner elevators of the pharynx?

What are three pharyngeal constrictor muscles? What do they attach to?

Where is the cricopharyngeus muscle?

Answer 9

Stylopharyngeus, salpingopharyngeus, palatopharyngeus

Superior: attached laterally to the pterygomandibular raphe and posteriorly to the pharyngeal raphe

Middle: attached laterally to the hyoid bone and posteriorly to pharyngeal raphe

Inferior: attached laterally to thyroid and cricoid cartilage and posteriorly to pharyngeal raphe; its horizontal fibers comprise the cricopharyngeus muscle used during pharyngeal speech

Question 10

The _____ covers the outer surface of the buccinator muscle and the pharynx.

The ____ is embedded in the portion of the buccopharyngeal fascia covering the middle constrictor muscle.

The space between the buccopharyngeal fascia and the prevertebral fascia is the ____.

Answer 10

Buccopharyngeal fascia

Pharyngeal plexus: sensory from glossopharyngeal and motor from vagus N

Retropharyngeal space

Question 11

Stylopharyngeus muscle arises from the ____ and inserts on the ____ between the superior and middle constrictors. It’s innervated by SVE fibers of the ____ nerve.

Fx?

Answer 11

Styloid process

Pharyngeal wall

CN IX

Pharyngeal elevator

Question 12

Salpingopharyngeus muscle extends from the posterior edge of the ____ to the ____. It forms a mucosal ridge called the _____. Fx?

Answer 12

Torus tubarius

Pharyngeal wall

Salpingopharyngeal fold

Pharyngeal elevator

Question 13

Where is Killian’s triangle? And what does it cause?

Answer 13

Superior to the cricopharyngeus muscle and inferior to the inferior constrictor muscle -> causes outpouching of the posterior pharyngeal wall just above the esophagus

Question 14

Where is Zenker’s diverticulum located?

Does it involve the layers of the esophageal wall?

Answer 14

Just above the cricopharyngeal muscle (above UES)

No

Question 15

What is the second branch off the external carotid A that gives blood supply to the pharynx?

Answer 15

Ascending pharyngeal A

Question 16

The pharynx is innervated by the ____ which is embedded in the ____ fascia.

This plexus receives sensory (GVA) from the pharyngeal branch of the ____ nerve. These GVA fibers in the plexus covey afferent info for the ___ reflex.

This plexus receives motor (SVE) fibers from the pharyngeal branch of the ____ nerve.

Answer 16

Pharyngeal plexus; buccopharyngeal

Glossopharyngeal N; gag reflex

Vagus N (innervates all pharynx muscles except stylopharyngeus m)

Question 17

What does the CN IX innervate?

Answer 17

Pharyngeal N to pharyngeal plexus

Sensory (GVA) to mucosa of posterior 1/3 of tongue and pharynx; sensory (SVA) to taste buts of posterior 1/3 tongue

Motor to stylopharyngeus muscle

Question 18

The sensory afferent fibers of the gag reflex are conveyed by the ____ nerve. The efferent component is mediated by the ____ nerve assisted by intercostal, phrenic, and abdominal nerves.

Answer 18

Glossopharyngeal CN IX

Vagus CN X

Question 19

During deglutition, the tongue moves backwards in the mouth and pushes the ____ posteriorly to cover the laryngeal aditus. The bolus of food cascades over the lateral edges of the epiglottis and flows through the ____ adjacent to the larynx in the laryngopharynx.

____ is where the blade is inserted during intubation to bring the tongue forward.

Answer 19

Epiglottis

Piriform recess

Valleculae epiglottica

Question 20

What are the three laryngeal membranes?

Cartilage?

Joint? What is the relationship of this joint and the vocal cords? What nerve does it have a relationship with?

____ has a turn style affect that brings the vocal cords apart for respiration and brings them together for vocalization. ____ sits on top of this cartilage.

Answer 20

Thyrohyoid membrane 
Quadrangular membrane (structural reinforcement for laryngeal wall)
Cricothyroid membrane (cricothyrotomy)

Cricoid cartilage

Cricothyroid joint; thyroid cartilage slides forward on cricoid cartilage, stretching vocal cords and increasing pitch caused by cricothryoid m; recurrent laryngeal N

Posterior cricoarytenoid m attaching from cricoid cartilage to the arytenoid cartilage; corniculate cartilage

Question 21

What are three muscles of the larynx?

What are their innervations?

Answer 21

Posterior cricoarytenoid m, vocalis m, thyroepiglottic m

Vagus N

Superior laryngeal n
External branch of superior laryngeal N: cricothryoid m; causes thyroid cartilage to slide forward on cricoid cartilage, stretching vocal cords and increasing pitch

Recurrent laryngeal n

Question 22

____ muscle increase vocal fold tension by tilting the thyroid cartilage forward, stretching the vocal cords. What’s its innervation?

It is opposed by the ____ muscle.

Answer 22

Cricothyroid muscle

External branch of the superior laryngeal N

Vocalis muscle

Question 23

Branches off the Vagus N:

The internal branch of the ____ nerve is the chief sensory nerve to the interior of the larynx and supplies GVA sensory fibers to the interior of the larynx. It’s involved in the ___ reflex. Also supplies parasympathetic fibers (GVE) to the ____.

____ innervates the intrinsic muscles of the larynx.

____ innervates the cricothyroid m.

Answer 23

Superior laryngeal N

Cough

Saccule glands

Recurrent laryngeal N

External branch of the superior laryngeal N

Question 24

After the recurrent laryngeal N crosses the cricothyroid joint and enters the larynx, it becomes the ____ and coveys fibers to all the laryngeal muscles, except the cricothyroid muscle. These fibers originate in the _____.

Answer 24

Inferior laryngeal N

Nucleus ambiguus

Question 25

____ is stimulated when there is aspiration of material into the laryngeal vestibule, stimulating receptors in the mucosa.

These afferent receptors are innervated by the ____. Afferent fibers enter the medulla with the vagus N and terminate in the _____.

The efferent component is through the ____ that controls the laryngeal, intercostal, and abdominal muscles, carrying out the reflex.

Answer 25

Laryngeal expiration reflex (cough reflex)

Internal branch of the superior laryngeal N; nucleus tractus solitarius

Recurrent laryngeal, intercostal, abdominal nerves

Question 26

The interior larynx contains what three parts?

Answer 26

Vestibule: laryngeal aditus, vestibular folds, rima vestibularis (perimeter of vestibular folds)

Ventricle: saccule, glottis, vocal cords, rima glottidis (perimeter of formed by the vocal folds)

Infraglottic region