pharynx and swallowing Flashcards
the pharynx
1) fibromuscular tube
2) open anteriorly
3) extent
- base of skull
- cricoid cartilage (C6)
4) continuous with the esophagus
pharynx relation to skull base
1) attachment to the pharyngobasilar fascia to skull base
2) jugular foramen (CN 9-12) internal carotid artery, sympathetic trunk
fascial spaces in the neck
1) pharynx / esophagus
2) retropharyngeal space:
- between buccopharyngeal anteriorly (part of pretracheal fascia) and prevertebral fascia posteriorly
3) three constrictors is superficial
4) pharyngobasilar membrane
regions
1) nasopharynx
- via choanae
2) oropharynx
3) laryngopharynx (hypopharynx)
systems:
-respiratory
- digestive
nasopharynx
1) from skull base to soft palate
oropharynx
1) soft palate to epiglottis
2) constrictor muscles posteriorly
3) oral cavity anteriorly
laryngopharynx
1) epiglottis to cricoid cartilage
2) epiglottis superiorly
3) cricoid inferiorly
relationships
1) lateral
- carotid sheath and contents
2) CN IX, XI, XII
- CN IX innervates stylopharyngeus *will be on exam
3) sympathetic trunk
- superior cervical ganglion
layers of the wall
1) mucosa
2) submucosa
3) muscularis
- outer circular
- inner longitudinal
4) adventitia
- buccopharyngeal fascia
5) pterygomandibular raphe
6) prevertebral fascia and space??
constrictor muscles
1) superior, middle, inferior
2) insertion is pharyngeal raphe
3) action
- constrict sequentially during swallowing
superior constrictor
1) hamulus of pterygoid bone
2) pteryogomandibular raphae
middle cosntrictor
1) hyoid bone
2) stylohyoid ligament
inferior constrictor
1) thyroid and cricoid cartilages
2) cricopharyngeus (upoer esophageal sphincter)
stylopharyngeus
1) styloid process
2) merges to palatopharyngeus
palatopharyngeus
1) hard palate
2) thyroid cartilage
salpingopharyngeus
1) pharyngotympanic tube
longitudinal muscles
1) elevate the pharynx during swalling
gap 1
1) above superior constrictor
2) auditory (eustachian, pharyngotympanic tube)
3) levator palatini passes over top of
gap 2
2) stylopharyngeus
3) CNIX
gap 3
1) between middle and inferior constrictors (thyrohyoid membrane)
2) internal laryngeal nerve
3) superior laryngeal artery and vein
gap 4
1) below inferior constrictor
2) recurrent laryngeal nerve
3) inferior laryngeal artery
internal pharynx
1) nasopharynx
2) oropharynx
3) laryngopharynx
nasopharynx features
1) pharyngeal tonsils (adenoids)
2) opening of eustachian tube
- below torus tubarius
3) sapingopharyngeus- has a fold of mucosa above it
4) posterior choanae
pharyngotympanic tube
1) salpingopharyngeus is stretched by yawning and swallowing
2) the eustachian tube opens and passes into the middle ear
1st pharyngeal pouch
1) middle ear and auditory tube
2) trigeminal nerve innervates
studyd the arches
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oropharynx contents
1) soft palate (velum)
2) posterior tongue (lingual tonsil)
2) fauces (oropharyngeal isthmus)
- palatine tonsil
- palatoglossal arch
- palatopharyngeal arch
4) tonsillar ring (of waldeyer)
oral view of fauces
1) palatoglossal arch
2) palatopharyngeal arch
3) bed of tonsils between
laryngopharynx/hypophaynx
1) epiglottis
2) laryngeal inlet
2) cricoid cartilage
4) piriform recess / fossa
- things can be lodged here
oropharynx is the point of airway and foodway
1) two valves to protect airway
- soft palate
- epiglottis
pathologies of oropharynx
1) mouth breathers
- long face syndrome
- obstruction from pharyngeal tonsil
2) insufficiency of two valves
- aspiration may lead to pneumonia
3) hypotonia of tongue and pharyngeal musculature
- apneic episodes
- can be due to swollen adenoids
inhaled aerosols
1) inhaled drugs will go to target in lungs, but only 10%
2) the rest is in digestive system
- systemic issues
piriform recess
1) the vallecula lie on the sides of frenulum (from tongue to epiglottis)
2) piriform recess
innervation
1) pharyngeal plexus (GSA)
- CN IX
- CN X
- sympathetic
2) motor (GSE)
- CN IX to stylopharyngeus (exception)
- CN X to all other pharyngeal muscles (CNXI via X)
superior and recurrent laryngeal nerve
1) to innervate larynx
2) motor and sensory
GSA
1) CN V1 and V2
- nasal cavity
2) CN IX
- oropharynx
3) CN X
-laryngopharynx
-
gag reflex
bloos supply is regional
1) branches of facial artery
- ascending palatine a.
- tonsillar a.
2) branches of ext. carotid
- ascending pharyngeal a.
- superior thyroid a.
3) inferior thyroid a. from thyrocervical trunk
4) venous drainage to internal jugular v
swallowing(deglutition)
1) coordinated set of muscle contractions
2) can be initiated voluntarily but mostly automatic (up to 1000 swallows per day)
3) 20 muscles and 5 cranial nerves (V, VII, IX, X, XII) involved
4) central pattern generator (swallowing center) is in the medulla
oral phase
1) stage 1 (voluntary) - jaws closed, lips, cheeks compressed, tongue raised (pushes bolus into oropharynx)
2) CN XII
pharyngeal phase (2 and 3)
1) soft palate elevates to seal off nasopharynx
2) the pharynx/larynx (stylopharyngeus, palatoglossus, suprahyoid muscle) raises to close the lower airway
3) larynx closed by epiglottis, constrictors contract sequentially (superior, middle, inferior)
*involuntary
esophageal phase
1) cricopharyngeal relaxes
2) bolus enters esophagus
3) peristalsis propels it on, airway reopens
Dysphagia
1) difficulty swallowing
2) 6.2 million americans over 60
3) possible causes
- dysfunction of neural pathways
- muscle damage
- structural (tumors, gastroesophageal junction tumor)
4) adverse consequences
- malnutrition
- aspiration pneumonia
