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OCB > Pharynx and Larynx > Flashcards

Pharynx and Larynx Flashcards

1
Q

What is the pharynx?

A

Muscular tube lined with mucosa that communicates with nasal, oral and laryngeal cavities.

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2
Q

Where does the pharynx extend from?

A

From cranial base to lower border of cricoid cartilage and becomes continues with oesophagus.

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3
Q

What is the cricoid cartilage?

A

Cartilage that surrounds the trachea near the middle of the neck (below the thyroid cartilage).

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4
Q

Describe the borders of the nasopharynx

A

Floor formed by soft palate.
Posterior wall - superior constrictor muscle.
Lateral wall - contains opening of Eustachian tube / auditory tube. Lymphoid tissue is behind this.
Roof contains pharyngeal tonsils (lymphoid tissue).

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5
Q

Describe the borders of the oropharynx

A

Lies beneath soft palate. Can be separated from nasopharynx by raising soft palate (swallowing).
Anteriorly - palatoglossus and palatopharyngeal arches with palatine tonsils between.
Contains the superior constrictor muscle.

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6
Q

What is the blood supply for the palatine tonsils?

A

Ascending pharyngeal, lingual and lesser palatine arteries

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7
Q

Why is there a risk of haemorrhage during tonsillectomy?

A

The ascending pharyngeal, lingual and lesser palatine arteries anastomose in the tonsil.

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8
Q

Describe the laryngopharynx

A

Between superior border of epiglottis and ends at inferior border of cricoid cartilage at C6 by joining into oesophagus.
Contains middle and inferior constrictor muscles.

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9
Q

What are the 4 layers of the pharynx?

A
  • Mucosal coat
  • Submucosa
  • Muscular coat
  • Areolar coat
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10
Q

What does the submucosa contain and why?

A

Fibrous coat that anchors the pharynx to the cranial base.

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11
Q

What does the areolar coat contain and why?

A

Buccopharyngeal fascia which covered the exterior of the pharynx.

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12
Q

How do the 3 constrictor muscles work?

A

They contract sequentially from superior to inferior to constrict the lumen to produce peristaltic waves to move bolus down oesophagus.

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13
Q

What are the 2 longitudinal muscles?

A

Palatopharyngeus and Stylopharyngeus.

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14
Q

What is the origin and insertion of the Palatopharyngeus?

A

Arises from palatal aponeurosis and Eustachian tube.

Inserts into posterior part of pharynx, hyoid bone and thyroid cartilage.

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15
Q

What is the origin and insertion of the Stylopharyngeus?

A

Arises from styloid process.
Descends through gap between middle and inferior constrictor muscles.
Enters pharynx where its fibres mingle with Palatopharyngeus muscle and inserts similarly.

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16
Q

What is the origin of the constrictor muscles?

A
  • Superior = pterygomandibular ligament, alveolar process of mandible and medial pterygoid plate and pterygoid hamulus of the sphenoid bone.
  • Middle = stylohyoid ligament and the greater/lesser horns of the hyoid bone.
  • Inferior = superior part arises from thyroid cartilage and inferior component arises from cricoid cartilage
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17
Q

Where do the constrictor muscles insert?

A

They meet at the pharyngeal raphe which attaches to the pharyngeal tubercle on the cranial base (on occipital bone).

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18
Q

What motor nerve innervates the constrictor muscles?

A

Vagus (X) - pharyngeal branch.

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19
Q

What motor nerve innervates the longitudinal muscles?

A

Vagus (X) - pharyngeal branch, for all except stylopharyngess which is inverted by Glossopharyngeal (IX).

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20
Q

What are the sensory innervations for the Pharynx?

A

Main sensory = Glossopharyngeal (IX).
Maxillary branch of Trigeminal (CN V2) - soft palate and roof of pharynx (superior and anterior aspect of nasopharynx).
Inferior laryngopharynx - Vagus (X) - internal branch.

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21
Q

Describe the arterial blood supply of the pharynx.

A

Via branches of external carotid artery:

  • Ascending pharyngeal artery
  • Superior & Inferior thyroid artery (pharyngeal branch).
  • Facial artery.
  • Maxillary artery.
  • Lingual artery.
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22
Q

Describe the venous drainage of the pharynx.

A

Pharyngeal venous plexus, which drains into the internal jugular vein.
Communicates with pterygoid plexus.

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23
Q

Describe the lymphatic drainage of the pharynx.

A

Most lymph vessels enter the deep cervical lymph nodes.

Some posterior lymph vessels enter the retropharyngeal nodes (lie between the prevertebral and buccopharyngeal fascia).

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24
Q

What bone does the Eustachian tube attach to?

A

Temporal

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25
Q

Where does the pharyngeal tonsil sit?

A

Roof and posterior wall of nasopharynx.

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26
Q

What conditions can cause food to travel into the Eustachian tube?

A
  • Vomiting

- Cleft palate

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27
Q

What is the blood supply to the palatine tonsil?

A

Tonsilar branch of facial artery.

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28
Q

What forms the superior border of the laryngeal inlet?

A

Epiglottis and laterally by aryepiglottic fold

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29
Q

What is the piriform recess?

A

Gutter that separates the aryepiglottic fold from the thyroid cartilage and thyrohyoid membrane.

Foreign bodies can lodge in it and removal can damage the internal laryngeal nerve.

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30
Q

Where does the larynx sit?

A

Anterior to larygopharynx.
Extends from base of tongue to trachea (C3-C6).
Inlet lies behind posterior 1/3 of tongue.

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31
Q

What is the function of the larynx?

A
  • Passageway for air - linking pharynx with trachea.
  • Sphincter, preventing food entering trachea.
  • Organ of phonation.
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32
Q

What are the 3 unpaired cartilages of the larynx?

A
  • Thyroid
  • Cricoid
  • Epiglottis
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33
Q

What are the 3 paired cartilages of the larynx?

A
  • Arytenoid
  • Cuneiform
  • Corniculate
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34
Q

Describe the thyroid cartilage

A
  • Largest.
  • 2 quadrilateral plates of hyaline cartilage fused in the midline.
  • Posterior parts extend superiorly and inferiorly to form superior / inferior horns. Inferior horns articulate with cricoid cartilage.
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35
Q

Why is the Adam’s apple more prominent in men?

A

Union between the thyroid cartilage produces a more acute angle in males. This is less prominent in females.

36
Q

Describe the cricoid cartilage

A
  • Signet-ring shaped.
  • Only cartilage to completely encircle the larynx.
  • Immediately below thyroid cartilage at level of C6.
  • Thin band of quadrilateral plate facing posteriorly.
37
Q

Describe the epiglottis

A
  • Fibroelastic.
  • Leaf-like shape.
  • Orientated upwards and backwards lying behind hyoid bone, reaching posterior part of tongue.
38
Q

Describe the arytenoid cartilage

A
  • 2 pyramid shaped cartilages on posterior lamina of cricoid cartilage.
  • Provides attachment for vocal process and has laryngeal muscle insertions.
39
Q

What type of joint articulates the arytenoid cartilage with the cricoid cartilage?

A

Synovial joint.

40
Q

How do the arytenoid cartilages allow phonation?

A

Laryngeal muscles move the arytenoid cartilages to change length, tension and position of vocal ligaments and folds.

41
Q

Where are the cuneiform cartilage found?

A

Aryepiglottic folds (lateral walls of pharynx).

42
Q

Describe the corniculate cartilage

A

Tiny elastic cartilages found at apices of arytenoid cartilages

43
Q

Where are the vestibular folds and vocal folds located?

A

Vestibular folds = inferior to epiglottis.

Vocal folds = inferior to vestibular folds. Attaches between thyroid and arytenoid cartilages.

44
Q

What is the space between the vestibular folds and vocal folds called?

A

Laryngeal ventricle

45
Q

What are the purpose of the glands in the laryngeal ventricle?

A

Keep it lubricated to allow speech and resonance.

46
Q

What is the rima glottidis?

A

Opening (horizontal fissure) between the true vocal cords and arytenoid cartilage.

47
Q

What are the ligaments of the larynx?

A
  • Thyrohyoid membrane
  • Vocal ligaments
  • Ventricular ligaments
  • Aryepiglottic ligaments
  • Quadrangular membrane
  • Cricothyroid membrane
48
Q

Describe the Thyrohyoid membrane

A

Fibroelastic sheet joining the inferior surface of the hyoid bone to superior aspect of thyroid cartilage.

49
Q

Describe the Vocal ligaments

A

Thick fibroelastic bands that attach between the thyroid and arytenoid cartilages.
Covered by mucous membrane (true vocal folds).

50
Q

Describe the Ventricular ligaments

A

2 fibrous bands that run from arytenoid cartilages to internal lamina of thyroid cartilage.
Covered by mucous membrane (false vocal folds = ventricular folds).
These are above the vocal ligaments.

51
Q

Describe the Aryepiglottic ligaments

A

Pass upwards from apices of arytenoid cartilage to lateral border of epiglottis.

52
Q

Describe the Quadrangular membrane

A

Thin fibroelastic sheet between aryepiglottic ligament and ventricular ligament.

53
Q

Describe the Cricothyroid membrane

A

Fibroelastic sheet between vocal folds and cricoid cartilage (conus elasticus).

54
Q

What are the extrinsic muscles of the larynx?

A

Supra and infra hyoid muscles.

55
Q

What are the purpose of the extrinsic larynx muscles?

A

Move larynx up and down.

56
Q

What are the intrinsic larynx muscles?

A
  • Posterior cricoarytenoid
  • Lateral cricoarytenoid
  • Transverse cricoarytenoid
  • Vocalis
  • Cricothyroid
57
Q

What are the functions of the intrinsic larynx muscles?

A
  • Open rima to allow air in and out.
  • Close rima glottidis and vestibule during swallowing to prevent aspiration of food.
  • Control tension in vocal folds for phonation.
58
Q

What is the function of the vocalis?

A

Changes tone.

59
Q

What is the function of the cricoarytenoid?

A

Stretches vocal folds.

60
Q

Where do the extrinsic larynx muscles insert into?

A

Larynx / hyoid bone.

61
Q

Where do the intrinsic larynx muscles originate from and insert into?

A

Laryngeal cartilages

62
Q

What is the function of the Posterior cricoarytenoid?

A

Open the vocal folds.

63
Q

What is the function of the Lateral cricoarytenoid?

A

Close rima glottidis.

Adduct (close) the vocal folds

64
Q

What is the function of the Transverse cricoarytenoid?

A

Adduct (close) the vocal folds

65
Q

What type of joint unites the cricoid and arytenoid cartilages? What movements are possible here?

A

Synovial joint.
Allows arytenoids to glide on cricoid so they can move closer/further apart.
Arytenoid can also rotate around their vertical axis.

66
Q

What cartilages form the boundaries of the vestibule?

A

Anteriorly - epiglottis.

Posteriorly - arytenoid cartilages.

67
Q

Where is the vestibule located?

A

Above the vestibular folds.

68
Q

What does each vocal fold consist of?

A

Conus elasticus, vocal ligament + muscle fibres which are covered by mucous membrane.

69
Q

What does the shape of the rima glottidis depend on?

A

Shape varies according to the movements of the arytenoid cartilages on the cricoid cartilage and the movements between the cricoid and thyroid cartilage.

70
Q

Which muscle raises the pitch of the voice? How is this achieved?

A

Cricothyroid.

Elongating and tightening the vocal folds. The lamina of the cartilage is tilted backwards to achieve this.

71
Q

How dos the internal laryngeal nerve enter the larynx?

A

Pierces the thyrohyoid membrane.

72
Q

What is the course of the recurrent laryngeal nerve on the left side? How does it differ to the right?

A

Left:

  • Recurs around arch of aorta and travels between the oesophagus and trachea to reach the larynx.
  • Enters the larynx by passing deep to the inferior constrictor muscle.

Right:
- Recurs around the right subclavian artery.

73
Q

What is the motor innervation to the intrinsic larynx muscles?

A

Branches of the vagus nerve (CN X).

All muscles supplied by recurrent laryngeal nerve (inferior branch) branch EXCEPT for cricothyroid.

Cricothyroid supplies by superior laryngeal nerve (external branch).

74
Q

What is the sensory innervation to the intrinsic larynx muscles?

A

Branches of the vagus nerve (CN X).

Superior laryngeal nerve (internal branch) = mucous membrane ABOVE vocal folds.

Recurrent laryngeal nerve = mucous membrane BELOW vocal folds.

75
Q

What is the blood supply to the larynx?

A

Superior thyroid artery - gives off internal laryngeal branch.

Inferior thyroid artery - gives off inferior laryngeal branch.
(accompanies the recurrent laryngeal nerve into larynx).

Laryngeal veins - drains into superior and inferior thyroid veins.

76
Q

Describe the lymphatic drainage of the larynx.

A

Above vocal folds: - pierces thyrohyoid membrane to drain into upper deep cervical lymph nodes.

Below vocal folds: - drains into lower deep cervical lymph nodes.

77
Q

When does phonation normally take place?

A

During expiration.

78
Q

What is the average breathing rate?

A

15 breaths per minute.

79
Q

How is breathing rate altered when speaking?

A

Inspiration quicker and expiration slower.

80
Q

What is the frequency of the flow of air during phonation?

What determines the frequency?

A

16-20,000 Hz

Frequency determined by sub-glottal pressure and mass/tension on vocal ligaments.

81
Q

How does phonation occur?

A
  1. Vocal cords closed (adducted).
  2. Air flow obstructed.
  3. Pressure builds up until it forces folds apart.
  4. Air escapes.
  5. Cycle is repeated and converts air into a series of puffs.
82
Q

What determines the pitch (intonation) and expression?

A

Frequency of the air.

83
Q

How are vowels formed?

A

Via continuous flow of air through the oral cavity.

Shape is modified by tongue and lips.

84
Q

How are consonants formed?

A

Via contraction of the vocal tract.

Labial - contact between lips (B, M, P).

Labiodentals - contact between lower lips and incisors (F, V).

Lingopalatal:

  • Tip of tongue and anterior part of hard palate (D, T, R).
  • Dorsum of tongue and posterior part of hard palate (J, L).
  • Dorsum of tongue and soft palate (K).
85
Q

How are sibilants formed?

A

Air passes through narrow space between tip of tongue and hard palate (S, SH, Z).

Air expelled through nose (M, N).

86
Q

What dental problems/issues affect speech?

A
  • Loss of teeth.
  • Dentures
    (most people adapt).
  • Cleft palate
  • Short lingual frenulum
    (these can make speech impossible to understand)

OCB (8 decks)

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