Pharynx and Larynx Flashcards
where is the oral vestibule located?
between the lips and the teeth
boundary between the oropharynx and laryngopharynx?
tip of epiglottis
oral cavity vs oral cavity proper?
oral cavity = everything between tongue and hard palate
oral cavity proper = distance between epiglottis and hard palate (includes tongue)
where is the hyoid?
in line with the base of the mandible
what is the frenulum?
connection between anterior surface of tongue and floor of mouth
what is the swelling in the middle of the frenulum called and what does it do?
sublingual caruncle
opening for submandibular gland
large vein on inferior/anterior surface of tongue?
deep lingual vein
what are the 2 muscles of the floor of the mouth?
geniohyoid = in midline, between hyoid and chin (on mandible) mylohyoid = lateral, underneath geniohyoid, between hyoid and mandible
what nerves innervate the muscles of the floor of the mouth?
geniohyoid = C1 via hypoglossal nerve mylohyoid = CN V3
how does submandibular gland interact with floor of mouth muscles?
wraps around the myohyoid to curve up into the floor of the mouth and towards the sublingual caruncle
what are the 3 major salivary glands?
parotid (near ear)
submandibular (under mandible)
sublingual (under tongue)
what do the minor salivary glands o
do?
1000s in oral mucosa basal secretion (background and continuous) to keep moth moist
give 2 stimuli for salivation
thought, sight, smell of food or presence of food in the mouth
painful oral conditions (teething, fractured mandible etc)
where does each major salivary gland secrete into the mouth?
parotid = crosses face and secretes into mouth by upper 2nd molar
submandibular = submandibular duct enters floor of mouth and secretes via lingual caruncle
sublingual gland = lays in floor of mouth and secretes via several ducts superiorly
how does the facial nerve supply salivary glands?
chorda tympani branch leaves middle ear and piggy backs on V3 nerve to supply parasympathetics to submandibular and sublingual glands and taste to anterior 2/3rds of tongue
what nerve supplies parasympathetics to the parotid gland?
CN IX (piggy backs on V3 via otic ganglion)
sulcus terminalis?
divides anterior and posterior tongue
what is the tongue made of?
skeletal muscle covered in mucosa
features of posterior 1/3rd of tongue?
vertical orientation
not in oral cavity
taste and sensation via CN IX
features of anterior 2/3rds?
horizontal orientation
in oral cavity
general sensation = V3
taste = CN VII
name and position of papillae?
foliate = on lateral sides of tongue at the back vallate = along the border between anterior and posterior tongue (V shaped) fungiform = around middle of tongue (contain tastebuds) filiform = near front of tongue (touch, temperature etc)
where does the thyroid develop?
originates in the pharynx around level of 3rd and 4th arches
descends through foramen caecum infront of the larynx, through thyroglossal duct
how do thyroid swellings move?
move superiorly then inferiorly on swallowing due to attachment to larynx
how is the tongue suspended in the oral cavity?
suspended by 4 pairs of skeletal muscles
what do the extrinsic muscles of the tongue do?
change the position of the tongue during mastication, swallowing and speech
what do the 4 intrinsic tongue muscles do?
modify the shape of the tongue during function
what are the 4 intrinsic tongue muscles?
palatoglossus
styloglossus
hyoglossus
genioglossus
what innervates the tongue muscles?
CN XII (hypoglossal) palatoglossus = CN X (vagus)
how does the hypoglossal nerve connect to the CNS?
via many rootlets that attach to the medulla oblongata
describe the course of the hypoglossal nerve
exits via hypoglossal canal (on anterior wall of foramen magnum)
descends in neck lateral to carotid sheath
passes anteriorly to hyoid towards the lateral aspect of tongue
supplies most tongue muscles
how can you test CN XII (hypoglossal)?
stick tongue straight out
if both CN XII are functional the tongue tip remains in the midline upon protrusion
in unilateral CN XII damage the tongue tip will point towards the side of the injured nerve
where is the main blood supply to the tongue found?
blood supply is medial to the hyoglossus (lingual artery - right and left)
where is nerve supply to the tongue found?
lateral to hyoglossus
where are the palatine tonsils found?
between arches of soft palate
where are the front 4 teeth found?
intermaxillary segment
what bones form the hard palate?
right and left palatine process of the maxilla
right and left palatine bone
lateral and medial pterygoid plates of the sphenoid bone
what is the suture between right/left bones of the hard palate?
median palatine suture
what are the 2 foramen of the palate?
greater and lesser palatine foramina
allows passage of branches of V2 and branches of maxillary artery
surface features of hard palate?
minor salivary glands in the palatal mucosa which secrete mucous
duct openings of the palatine glands
palatal ruggae
what are the 5 muscles of the soft palate?
tensor veli palatine levator veli palatine musculus uvulae palatoglossus palatopharyngeus
function and innervation of tensor veli palatine?
CN V3
tenses palatine aponeurosis (tenses palate when swallowing)
function and innervation of levator veli palatine?
CN X
lifts palatine aponeurosis
function and innervation of musculus uvulae?
CN X
shortens uvula
function and innervation of palatoglossus?
CN X
brings tongue and soft palate together
function and innervation of palatopharyngeus?
CN X
lifts pharynx and thyroid cartilage
3 functions of soft palate?
functions as a trap door
- stops food entering the nose during swallowing
- directs air into the nose or the mouth during speech, sneezing, coughing and vomiting
- helps to close off the entrance into the oropharynx during gag reflex
how can CN X be tested?
ask patient to say “aahh”
if the nerves are functioning on both sides, the uvual will lift straight up in the midline
if there is unilateral nerve pathology the uvula will not lift up on that side, so the uvual will be pulled away from the non-functioning side and will point the opposite way
describe the 3 outer circular muscles of the pharynx
constrictor muscles
skeletal
during sequential contraction, pushes food bolus inferiorly towards oesophagus
describe the 3 inner longitudinal muscles of the pharynx
3 paired vertical muscles
skeletal
during contraction, pull larynx superiorly shortening pharynx during swallowing
what is the combined action of pharynx muscles and what innervates them?
combined peristaltic action
all innervated by CN X (except stylopharyngeus)
where does the superior constrictor circular muscle attach?
pterygoid haulus
pterygomandibular raphe
mylohyoid line
where does the middle constrictor circular muscle attach?
greater horn of hyoid
where does the inferior constrictor circular muscle attach?
thyroid cartilage (oblique line) cricoid cartilage
what travels through the gap between circular muscles of the pharynx (“gateway to the mouth”)?
CN IX
lingual artery
stylopharyngeus muscle
describe the layout of the circular muscles of the pharynx
overlap each other
internal and external fascial coverings
all insert onto midline raphe
what nerve innervates the circular muscles of the pharynx?
CN X via pharyngeal plexus
what are the 3 longitudinal muscle of the pharynx?
stylopharyngeus
palatopharyngeus
salpingopharyngeus
what is the course of the stylopharyngeus?
originates on the styloid process
passes through the “gateway to the mouth” with the glossopharyngeal nerve
what nerve supplies the longitudinal muscles?
stylopharyngeus = CN IX
palatopharyngeus and salpingopharyngeus = CN X
where do the longitudinal muscles insert and what is their combined function?
posterior border of thyroid cartilage
elevate pharynx and larynx
what is the torus tubarius and where is it found?
cartilaginous covering of the opening of the eustachian tube
5 features of the nasopharynx?
choanae torus tubarius pharyngeal recess salpingopharyngeal fold opening for eustachian tube
4 features of he oropharynx?
palatine tonsil
palatoglossal arch
palatopharyngeal arch
lingual tonsil
2 features of laryngo pharynx?
laryngeal aditus (inlet) piriform fossa (recess)
what is waldeyer’s tonsillar ring?
ring of tonsils within the mucosa of the nasopharynx and oropharynx
- pharyngeal tonsils (adenoid)
- tubal tonsils
- palatine tonsils
- lingual tonsils
what lymph node drains the palatine tonsil?
jugulo-diastric node
what are the 5 regional lymph nodes of the ear, nose and throat?
submental submandibular deep cervical jugulo-digastric retropharyngeal nodes
features of infected lymph nodes?
swollen painful soft smooth not fixed to adjacent structures improves rapidly with antibiotics
features of cancerous lymph nodes?
swollen not painful hard irregular fixed do not improve
how do midline structures drain?
often drain bilaterally (across the midline)
e.g - the tip of the tongue may drain to the left or right submental lymph nodes to the examination of the lymph nodes of the head and neck must be bilateral
which bilateral regional lymph nodes must be examined?
submental
submandibular
parotid (pre-auricular)
mastoid (post auricular)
occipital
deep cervical (along internal jugular vein)
superficial cervical nodes (along external jugular vein)
