Pharynx & Larynx Flashcards
The pharyx is a ?
Fibromuscular tube; semicircular in cross section. Collapsable tube
Where is the pharyx located anteriory-postiriorly
Anterior to the vertebral collum, posterior to the nasal & oral cavitys, and trachean
Where does the pharynx run?
From the base of the skull to the lower boarder of the cricoid cartilage
C6
Compare pharynx of a male vs female.
pharyx is variable in nature
* Male= Longer
* Female= shorter
How many muscles are responsibe for action of pharynx and how are they layered? Aid in what?
6 muscles; aid in act of swallowing
* 3 circularly layered on top of one another
* 3 Vertically oriented
How long is the pharynx and what are the 3 segments?
5 inches long
1. Nasopharynx (breath)
2. Oropharynx (swallow)
3. Laryngopharynx (hypo, voice)
What does the pharynx move?
- Food to esophagus
- Air to lungs
swallowing, breathing, voice
Pharynx in infants?
Much higher and easily viewed when they have their mouth open
extension of the Nasal Airway Important route of respiration
Nasopharynx
continuation of nasopharynx and now also involves swallowing – major area of concern associated with the tongue and airway collapse
Oropharynx
What is a major area of concern with tongue and airway collapse?
The oropharynx
continuation of the oropharynx – leads to esophagus and trachea, give rise ot airway
where esophagus & trachea divide
Laryngopharynx
What is located in the nasopharynx?
- Adenoids
- Opening of eustacian tubes
What form when the nasopharynx is infected?
Nasal Polyps
Clinical relevance of the nasal airway?
Supply air to body leads into the Nasopharynx
What 4 things are involved in the oropharynx?
- Soft palate
- Uvula
- Tonsils
- Base of tongue
Clinical relevance of the oropharynx?
- Swallowing
- 1st line of defence against infection (tonsils)
- Collapse of oropharynx is assc. withe sleep apnea
Clinical relevance of the laryngopharynx?
- Transition into esophagus & trachea
- Continue with swallowing & breathing
- Collapse is also factor in apnea
How many layers are in the wall of the pharynx?
5 Layers
Innermost:
1. Mucous membrane
2. Submucosa
3. Pharyngobasilar fasia
4. Muscular
5. Buccopharyngeal fasia
Wall of pharynx
Innermost layer of wall
Mucous Membrane
Wall of pharynx
Layer on top of mucros memebrane
Submucosa
Wall of pharynx
Explain the Pharyngobasilar fascia
- 3 layer out
- anchors the pharynx to the skull * a fibrous layer
Wall of pharynx
Explain muscular layer
- Superior consrictor is innermost
- Inferior constrictor outermost
Wall of pharynx
Explain buccopharyngeal fascia?
- loose layer of connective tissue; outermost
- continuous with fascia over Buccinator muscle and pharyngeal muscles
What is the superior skeletal attachment of the pharynx?
Posterior edge of the medial pterygoid plate, inferior ot the pharyngotympanic tube (eustachian tube)
What is th inferior attachment of the pharynx?
From the pteygoid hamulus, The pterygomandibular raphe, joining with the buccinator
U shaped fasica that attaches to the upper part of the pharyx and other soft tissue?
Pharyngobasilar fascia
How does the pharynx relate to the hyoid bone?
Relates to the hyoid bone at the lower aspect of the stylohyoid ligamaent.
Continues along lesser horn to greater horn
Where does the most inferior part of the pharynx attach?
Most inferior part attaches at the superior tubercle of thyroid cartilage to inferior tubercle continues to cricoid cartilage where it ends
What is the innermost layer of the wall of the pharynx?
Mucous membrane, continuous with the lining of mouth and trachea
What is the 2nd layer outer to the mucousa of the wall of the pharynx?
Submucousa, between the mucosa and muscles; thicker in basilar portion of the occipital area, thinner as it descends.
Where does the buccinator muscles connect?
Superior constrictor at the ptergomandibular raphe
What is the key structure for where the needle is going to pass to anesthetize the Inferior alveolar nerve?
pterygomandibular raphe
What are the 4 categories of things the pharynx is composed of?
- 3 constrictor muscles
- 3 longitudinal muscles
- Soft palate
- Cartilaginous part of the pharyngotympanic tube (Eustachian tube)
What is the pharyngeal Fasica>
Connects the pharyx to the skull
The 3 constrictor muscles begin to intergrate in what area?
Around Larynx
What provies the main sensory and motor innervation of the pharynx?
Pharyngeal Plexus
What 3 branches make up the pharyngeal plexus?
- Pharyngeal branch of glossopharyngeal (CN9)
- Pharyngeal Branch of Vagus (CN10)
- Cranial portion of spinal acessory (CN 11)
What are the 4 muscles of the superior pharyngeal constrictor?
- Pterygopharyngeal
- Buccopharyngeal
- Mylopharyngeal
- Glossopharyngeal
What are the 2 muscles of the Middle pharyngeal constrictor?
1.Chondropharyngeal
2.Ceratopharyngeal
What are the 2 muscles of the Inferior pharyngeal constrictor?
- Thyropharyngeal
- Cricopharyngeal
What occurs nea the inferior constrictor muscles?
WHere esophagus and trachea seperate
What is the action of the superior & middle constrictor muscles?
constricts upper and middle portion of the pharynx
What is the nerve supply of the Superior and middle constrictor muscles?
pharyngeal plexus
What is the 2 motor innervations of the superior and middile constrictor muscles?
- Pharyngeal branch of Vagus CN10
- Cranial part of accesory CN11
What are the 2 sensory innevration of the Superior & middle constrictor?
- Vagus CN10
- Hypoglossal CN12
What are the 3 longitudinal muscules of the pharynx?
- Stylo-pharyngeus
- Salp-pingo-pharyngeus
- Palato-pharyngeays
The palatopharyngeus does what?
- Elevates the pharynx
- Closes the oropharyngeal isthmus (soft pallete)
The:
* Stylo-pharyngeus
* Salp-pingo-pharyngeus
do what?
Elevate the pharynx
What are other 2 muscle of interest?
- Tensor Veli paletini (spread out)
- Levator veli paletinin (elavte soft pallete)
Swallowing
What occurs if the the tensor and levator veli paletine muscles are affected during oral surgery?
They lost function in those muscles and have trouble swallowing.
area where anatomical structures enter and exit the pharynx how many? holes in primarly constrictor m.
4 Aperatures of the pharynx.
Allows for blood vessles and nerves to enter/exit
What are the 4 aperatures?
- Bwtn Base of skull & sup. constrictor
- Btwn sup. constrictor
- Btwn middle and inferior contsrictor
- In inferior constrictor
Aperature
What 4 things goes through the Bwtn Base of skull & sup. constrictor aperature?
- Auditory ube
- Levator palatini m.
- Ascending pharyngeal a.
- Ascending paletin a.
Aperature
What 4 things goes through the Btwn superior and middle constrictor m aperature?
- Stylopharyngeus muscle
- Glossopharyngeal nerve (innervate tongue)
- Tonsillar branch of the ascending palatine a.
- Stylohyoid ligament (restrict mandibular opening)
Aperature
What 2 things goes through the Btwn middle and inferior constrictor m aperature?
- Internal laryngeal n
- Superior laryngeal artery & vein
Aperature
Where can throat pain stem from?
Calcifcation of the stylohyoid ligament
Constriction of the aperatues can result in what?
Constirction of the sensory nerves in the area.
What 2 things goes through the aperature below the inferior constrictor?
- Reccurent Largyngeal N (CN10)
- Inferior Laryngeal A & V
What are the tonsils of the pharynx?
First line of defense bodies defense
* 4 Sets
* Walderys ring
What are the 4 sets of tonsils?
- Pharygeal tonsils (adenoids)
- Palatine tonsils (tonsils)
- Lingual tonsils(post 3rd of tongue)
- Other **smaller lymphoid tisues **near eustasian tube in nasopharynx on upper surfae of soft palate
What is the clinical significance of waldeyers ring?
Can create upper air way obstructions if they are infected or inflamed.
WHen are tonsil structures more visible?
Age 0-4
Past that time they shrink cause bodies immune defense is more matrue.
Explain the buccinator muscle
- Modilus= Soft tissues attached to the orbicularis oris
- Posteriorly minmal attachment to the superior constrictor at the pterygomandibular raphe
What are the 5 blood supplie of the pharynx?
- Ascending pharyngeal (ECA)
- Ascending Palatine (branch off facial from ECA)
- Tonsilary a (branch off facial from ECA)
- Maxillary (ECA)
- Lingual a (ECA)
Artery that comes off external carotid artery, posteriorly at same spot as superior thyroid artery and then goes to supply the pharynx (tiny artery)
Ascending pharyngeal artery
Artery that comes off external carotid artery anteriorly, moving forward into the **geoglossal muscles and supply the floor of the oral cavity **
Lingual Artery
Artery that comes off external carotid artery across deep in the face. Terminal branch.
Maxillary Artery
Artery that comes off facial artery from ECA goes superior and supplies the superior constrictor of the pharyx & palete
Ascending Paletine artery
Artery that comes off the facial artery from ECA, goes superior to suply the angle of the mandbile and tonsils
Tosillary Artery
What are the 5 nerves of the pharynx?
top to bottom
1. Vagus CN10
2. Pharygeal plexus
3. Glossopharyngeal CN9
4. Hypoglosal CN12
5. External larygneal
6. Reccurent Laryngeal (CN10)
What occurs as the bolus of food moves back into the oropharynx by action of the tongue?
Soft Pallate elevates
Superior assit
Ridge running along hard pallete and alows soft pallet to elevate.
Passavants Ridge
2 muscles that assit in closing off the nasopharynx
Elevate expand soft pallete
Tensor & levator Veli palatine
As bolus moves towardsesophagus larynx elevates which does what?
Epiglottis closes trachea off
Explain larynx
Hollow multiligamentous structure
Framwork is mostly ligamentous; small
Location of larynx and continuity? Contains?
- Start posterior to tongue, anterior to pharynx & esophagus, suspened by hyoid.
- C3-C6
- Leads to trachea, cap to repiratory tract
- Voice box
What does the larynx prevent?
Prevents foreing bodies from entering air way, because it elevates when swalloing and makes epiglottis (supraglottis is soft tissue) seal off the trachea
The larynx is formed by what?
9 Cartilages
* 3 paired
* 3 unpaied
More prominant in males
How does the larynx act as voice box?
It is a valve to close airway and produce sound
What is the lower part and muscular control of the epiglottis?
Subglottis
WHat do you conduct at the cricoid lignament?
Tracheotomy
What large muscles runs lateral to the trachea?
Sternocleidomastoids
What is the largest and unpaired cartilage of the larynx? Located? Connects where?
Thryoid cartilage
* bwteen C4 & C6
* connect to hyoid
What is the complte ring /unpaired cartilage of the larynx? Located? Connects where?
Cricoid cartilage
* Located at C6
What paired cartilage of the larynx forms the framwork for the vocal cords?
Arytenoid Cartilge x2
**Unpaired cartilage **of the larynx that closes off the airway?
Epiglottis
2 minor cartilage that lie in the aryepiglottic folds of the larynx. Tiny ligaments, make up vocal cords
- Corniculate (minor)
- Cuneiform (minor)
What does the intrinsic muscles of the larynx do?
make up voice box, contribute for vibration of sound
Intrinsic muscle of larynx
Explain the cricthyroid m.
- Only muscles outside larynx
- Forward downward mvmt of thryroud cartilage
Intrinsic muscle of larynx
Explain the posterior cricotenoid m?
Abduction (opening) and external rotation of arytenoid cartilage
Intrinsic muscle of larynx
Lateral Cricoartenoid
Sound
internal rotation of arytenoid cartilage
Intrinsic muscle of larynx
Explain the transvers arytenoid m.
Sound
adduction of arytenoid cartilage (narrowing)
Intrinsic muscle of larynx
Oblique arytenoid
Sound
sphincter of laryngeal inlet (close)
Intrinsic muscle of larynx
Thyro-arytenoid
Sound
sphincter of vestibule and of laryngeal inlet
Intrinsic muscle of larynx
Vocalis
adjusts tension on the vocal folds
Look
Look
What is the 2 arterial supply of the larynx?
- Superior laryngeal – from external carotid
- Inferior laryngeal – from Inferior thyroid artery
What is the 2 venous drainage of the larynx?
- Superior laryngeal – drains into the the IJV via superior thyroid vein
- Inferior laryngeal drains into the brachiocephalic vein via the inferior thyroid
Where do the motor and sensory innervation to the larynx come from?
Vagus CN10
Nerve Supply of Larynx
What are the 3 nerves branches that innervate the Larynx
- Internal laryngeal; sensory from sup laryngeal (CN10 branch)
- External Laryngeal; motor from sup laryngeal (CN 10 Branch)
- Reccurent Laryngeal; sensory & motor branch from vagus
Nerves of larynx; from Vagus CN10
explain the internal laryngeal nerve
Sensory
* Branch off superior laryngeal from vagus CN10
* peirces
Nerves of larynx; from Vagus CN10
Explain the external laryngeal nerve
motor
* Branch off superior laryngeal from vagus CN10
* Stays outside
Nerves of larynx; from Vagus CN10
Explain the reccurent laryngeal
sensory & motor
* Branch from Vagus CN10 that goes down and comes up
* Sensory to laryngeal cavity
* Motor to intrinsic muscle of the larynx expcept cricothyroid
Where does the sensory of the reccurent laryngeal nerve go?
Sensory to laryngeal cavity
Where does the motor of the reccurent laryngeal nerve go?
Motor goes to all intrinsic muscle of the tongue except cricothyroid
