Pharynx, Larynx and Pre-Vertebral Region Flashcards
what are the three divisions of the pharynx?
nasopharynx, orophraynx and laryngopharynx
what lines the pharynx?
mucous membrane
epithelium varying from ciliated (superiorly) to stratified squamous (inferiorly)
fibrous layer underneath connecting it to the base of the skull and into the submucous coat of oesophagus
muscular layer underneath fibrous has almost circular constrictor muscles and longitudinal muscles
where is the nasopharynx and what are it’s boundaries?
behind nasal cavity above soft palate
roof: sphenoid, occipital and pharyngeal tonsil
floor: soft palate (the pharyngeal isthmus)
anterior: nasal passages
posterior: roof and C1
lateral: auditory/eustacian tube, salpingophrayngeal fold
where is the oropharynx and what are it’s boundaries?
soft palate –> upper border of epiglottis
roof: soft palate
floor: posterior 1/3rd tongue, lingual tonsil, glossoepiglottic folds
anterior: mouth
posterior: C2/3
lateral: palatoglossal and palatopharyngeal golds with the palatine tonsil
where is the laryngopharynx and what are its boundaries?
behind larynx and laryngeal opening
anterior: larynx
posterior: C3-6
lateral: supported by the thyroid cartilage, aryepiglottic fold adn thyrohyoid membrane
what are the muscles of the pharynx?
superior, middle and inferior constrictors
stylopharyngeus
salpingopharyngeus
palatopharyngeus
where is the superior constrictor?
medial pterygoid plate and its hamulus, pterygomandibular raphe, alveolar process of mandible and side of tongue –> pharyngeal tubercle of occipital; blends with middle constrictor
what is the function of the superior constrictor?
pull posterior pharyngeal wall anteriorly to close off the nasopharynx and propel food to middle constrictor
what innervates the superior constrictor?
CN X
where is the middle constrictor?
stylohyoid ligament + greater and lesser cornua of hyoid -> pharyngeal raphe; blends with superior and inferior constrictor
what is the function of the middle constrictor?
propel food towards the inferior constrictor
what innervates the middle constrictor?
pharyngeal plexus (CN X)
where is the inferior constrictor?
lamina of thyroid cartilage (thyropharyngeus part) and cricoid cartilage (cricopharyngeus part) –> pharyngeal raphe; blend with middle constrictor and oesophagus
what is the function of the inferior constrictor?
propel food to the oesophagus
sphincter effect prevening entry of air between acts of swallowing (cricopharyngeus)
what innervates the inferior constrictor?
pharyngeal plexus (CN X) cricopharyngeus by external laryngeal nerve
what are the two parts of the inferior constrictor called?
thyropharyngeus and cricopharyngeus
what are the longitudinal muscles of the pharynx?
stylopharyngeus, salpingopharyngeus and palatopharyngeus
constrictor muscles are not longitudinal!
where is stylopharyngeus?
base of styloid process of temporal bone –> posterior border of thyroid cartilage
passes across ICA between superior and middle constrictors
what is the function of stylopharyngeus?
elevates larynx and pharynx during swallowing
what innervates stylopharyngeus?
CN IX
where is salpingopharyngeus?
cartilage of auditory tube –> blends with palatopharyngeus
what is the function of salpingopharyngeus?
elevate pharynx
what innervates salpingopharyngeus?
pharyngeal plexus (CN X)
where is palatopharyngeus?
hard palate and palatine aponeurosis –> lamina of thyroid cartilage (posterior)
what is the function of palatopharyngeus?
elevate pharynx
what innervates palatopharyngeus?
pharyngeal plexus (CN X)
what gives sensory innervation to the divisions of the pharynx?
nasopharynx: CN V2
oropharynx: CN IX
laryngopharynx: CN X
what is the name give to the ring of lymphoid tissue in the pharynx and what is it formed of?
Waldeyer’s Ring
contains: 1x pharyngeal, 2x tubal, 2x palatine and 1x lingual tonsils
what nerves supply the pharyngeal plexus, where is it and what does it supply?
supply from: CN IX and X and sympathetic fibres
location: surface of middle constrictor
supplies sensory to oropharynx and laryngopharynx and supplies all pharyngeal muscles (except stylopharyngeus)
what arteries supply the pharynx?
pharyngeal branches from the maxillary artery
branches of the ascending pharyngeal artery (from medial surface of ECA)
what gives venous drainage of pharynx?
pharyngeal plexus –> IJV
what provides lymphatic drainage of the pharynx?
deep cervical
what are the pre-vertebral muscles?
longus capitis, longus coli, rectus capitis anterior and lateralis
where is longus capitis?
transverse process of cervical vertebrae –> anterior tubercles C3-6 to base of occipital
what is the function of longus capitis?
flexion of head
what innervates longus capitis?
ventral rami C1-3
where is longus colli?
and it’s three parts
Atlas –> T3
inferior oblique: T2/3 –> anterior tubercle of transverse processes C5+6
superior oblique: anterior tubercle C3-5 –> atlantal anterior tubercle
vertical: anterior aspect of T1-3 –> C3-6
what is the function of longus colli?
flexion of neck
rotation to opposite side via inferior oblique part
what innervates longus colli?
ventral rami C2-6
where is rectus capitis anterior?
anterior surfaces and root of transverse process of atlas –> occipital bone (anterior to occipital condyle)
what is the function of rectus capitis anterior?
flex atlanto-occipital joint
what innervates rectus capitis anteiror and lateralis?
ventral rami C1-2 loop
where is rectus capitis lateralis?
transverse process of atlas –> occipital bone (inferior surface of jugular process
crossed by IJV
what is the function of rectus capitis lateralis?
lateral flexion of head
what is the route of the cervical sympathetic ganglia?
base of skull to joint thoracic
behind ICA and CCA
medial to CN X
embedded in deep fascia between the carotid sheath and fascia over surface of longus capitis and colli
what are the three divisions of the cervical sympathetic ganglia?
superior, middle and inferior
where is the superior cervical ganglia found?
immediately below the skull
large
what does the superior cervical ganglia form plexuses?
internal carotid plexus (with postganglionic internal carotid nerve)
branches to form plexus of common and external carotid arteries
cardiac plexus
what does the superior cervical ganglia give?
grey rami communicates to C1-4 ventral rami
superior cardiac branch to cardiac plexus
what supplies the superior cervical ganglia?
CN IX, X, XII
pharyngeal branches join CN IX and X in pharyngeal plexus
where is the middle cervical ganglion and what is it related to?
at level of cricoid cartilage
small
related to loop of inferior thyroid artery
what does the middle cervical ganglia give?
grey rami communicantes to C5+6 ventral rami
thyroid branches along artery to thyroid gland
middle cardiac branch to cardiac plexus
what connects the middle and inferior cervical ganglia?
ansa subclavia
anterior bundle passes anterior to 1st part of subclavian artery and then behind it
where is the inferior sympathetic ganglion?
usually fused with 1st thoracic ganglion to form the stellate ganglion
lies behind vertebral artery between transverse process of C7 and head of rib 1
what does the inferior sympathetic ganglion give?
grey rami communicantes to ventral rami C7+8
arterial branches to subclavian and vertebral arteries
inferior cardiac branch to cardiac plexus
what type of cartilage is found in the larynx?
hyaline
with small plane synovial joints
what is the function of the larynx?
voice production
what are the names of the cartilages found in the larynx?
thyroid cricoid arytenoid corniculate cuneiform epiglottis
what does the oblique line of the thyroid cartilage allow attachment of?
sternothyroid
thyrohyoid
inferior constrictor
what does cricoid cartilage contain facets for?
arytenoid cartilage
inferior horn of thyroid
what do the vocal processes of arytenoid cartilages give attachment for?
vocal folds
what does the muscular process of the arytenoid cartilages give attachment to?
posterior and lateral cricoarytenoid muscles
where are the cuneiform cartilages and what is their role?
within the aryepiglottic folds
support these folds
what is the role of the corniculate cartilage of the larynx?
attach aryepiglottic fold
what type of cartilage is the epiglottis?
elastic cartilage
what are the anterior and lateral connections of the epiglottis?
anterior: to body of hyoid bone and posterior surface of the thyroid cartilage
lateral: to arytenoid cartilages via aryepiglottic folds
what covers the epiglottis, what does it reflect onto and what folds does it form?
mucous membrane
reflect onto posterior surface of tongue
forms median glossoepiglottic fold and lateral pharyngoepiglottic folds
what does the quadrangular ligament attach and what is the name given to it’s free edge?
attaches arytenoid cartilages to epiglottis
free edge = vestibular ligament (false vocal cord)
what does the cricothyroid membrane attach and what does it’s free upper border form?
attaches cricoid, thyroid and arytenoid cartilages
free upper border = vocal ligament
what forms the vocal folds?
infoldings of mucous membranes stretched horizontally anteriorly to posteriorly across the larynx
what innervates the vocal folds?
CN X
what do changes in air flow through the larynx cause?
phonation, individual words/sounds created by movement of lips, cheeks and tongue
what muscles cause elevation of the larynx?
digastric, stylohyoid, mylohyoid and geniohyoid (stylo-, salping- and palatopharyngeus)
what muscles cause depression of the larynx?
sternothyroid, sternohyoid and omohyoid (elastic recoil of trachea)
what effect do the extrinsic muscles have on the larynx?
move the entire larynx, such is in swallowing
usually by supra and infrahyoid muscles which attach to the hyoid bone or thyroid cartilage to move the larynx!
what effect do the intrinsic muscles have on the larynx?
move the cartilages or vocal folds
they pass between elements of teh larynx
where is the cricothyroid muscle?
intrisic muscle
cricoid cartilage –> lamina and inferior cornu of thyroid cartilage
what is the function of the cricothyroid muscle?
tense and elongate vocal ligaments
inc. distance between thyroid cartilage and vocal processes of arytenoid
what innervates the cricothyroid muscle?
external laryngeal branch of CN X
where is the thyroarytenoid muscle?
intrisic muscle
inner surface of angle og thyroid cartilage –> anterolateral surface of arytenoid cartilages
upper fibres run alongside the vocal ligament (vocalis muscles)
what is the function of the thyroarytenoid muscle?
relax and shorten the vocal ligaments
pull arytenoids forward towards the thyroid cartilage
what innervates the thyroarytenoid muscle?
recurrent laryngeal (CN X)
where is the posterior cricoarytenoid muscle?
posterior of lamina of cricoid cartilage –> muscular process of arytenoid cartilage
what is the function of the posterior cricoarytenoid muscle?
abduction of vocal folds
pulls muscular process of arytenoid backwards, rotating vocal process laterally
what innervates the posterior cricoarytenoid muscle?
recurrent laryngeal (CN X)
where is the lateral cricoarytenoid muscle?
upper edge of arch of cricoid cartilage –> muscular processes of arytenoid cartilages
what is the function of the lateral cricoarytenoid muscle?
adduction of vocal fold
pulls the muscular process forwards, rotate vocal processes medially
what innervates lateral cricoarytenoid?
recurrent laryngeal (CN X)
where is the oblique arytenoid muscle?
muscular processes of arytenoid cartilage –> apex of opposite arytenoid cartilage
some fibres from the aryepiglottic muscles in aryepiglottic fold
what is the function of the oblique arytneoid muscle?
sphincter of laryngeal inlet
what innervates oblique arytenoid muscle?
recurrent laryngeal (CN X)
where is the transverse arytenoid muscle?
posterior and medial surfaces of arytenoid carilages –> opposite arytenoid cartilage
what is the function of the transverse arytenoid muscle?
closes posterior part of rima glottis
which of the intrisic muscles of the larynx is the only one that is not innervated by the recurrent laryngeal branch of CN X?
cricothyroid, external laryngeal
what arteries supply the larynx and thyroid and where do they arise from?
inferior thyroid: from thyrocervical trunk from subclavian
inferior laryngeal: from inferior thyroid
superior thyroid: from ECA
superior laryngeal: from superior thyroid
what gives venous drainage of the larynx and thyroid?
superior laryngeal
superior thyroid
inferior laryngeal
inferior thyroid
where does lymph from thyroid and larynx drain to?
superior deep cervical lymph nodes
inferior deep cervical nodes
pretracheal nodes
paratracheal nodes
