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Anatomy Exam 3 > Posterior pharynx and larynx > Flashcards

Posterior pharynx and larynx Flashcards

1
Q

The pharynx is a ________ tube that extends from the _______ to the ________ at the level of the ______ vertebrae. Name the 3 parts it consists of.

A
  • fibromuscular tube
  • nasal cavity to cricoid cartilage at level of 6th cervical vertebrae
  • nasopharynx, oropharynx, and laryngopharynx
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2
Q

What 4 things are found on the lateral wall of the nasopharynx?

A
  1. opening of auditory tube
  2. levator veli palatini
  3. tensor veli palatini
  4. salpingopharyngeus
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3
Q

What innervates the mucosa of the nasopharynx?

A
  • pharyngeal nerve, a branch of the maxillary division of V2
  • also by branches of glossopharyngeal nerve in the pharyngeal plexus
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4
Q

Describe the position of the nasopharynx

A

-superior to soft palate and posterior to nasal cavity

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5
Q

Describe the location of the oropharynx

A

-between the soft palate and tip of epiglottis, posterior to oral cavity

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6
Q

Name 3 things found on the lateral wall of the oropharynx

A
  • palatoglossal arch and palatoglossal muscle
  • palatopharyngeal arch and palatopharyngeus muscles
  • tonsilar fossa (separates above arches) that contains the palatine tonsil
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7
Q

What crosses the tonsillar fossa?

A

-lingual branch of the glossopharyngeal nerve (CN IX)

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8
Q

What does the floor of the oropharynx contain and what innervates this structure?

A
  • posterior 1/3 of tongue
  • both taste and general sensations from posterior 1/3 of tongue are carried by lingual branches of the glossopharyngeal nerve (CN IX)
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9
Q

Where does the laryngopharynx extend from and to? What does it become continuous with at its ending?

A
  • from epiglottis behind the larynx to the level of the cricoid cartilage
  • inferior to cricoid cartilage, the LP is continuous with the esophagus
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10
Q

What does the lateral wall of the laryngopharynx contain? What courses in the walls of this space?

A
  • piriform recess

- internal branch of superior laryngeal nerve of the vagus and superior laryngeal artery

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11
Q

What innervates the mucosa of the laryngopharynx?

A

-internal branch of the superior laryngeal nerve of the vagus

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12
Q

The pharynx consists of skeletal muscles that form an ________ layer and an _________ layer.

A
  • outer circular layer

- inner longitudinal layer

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13
Q

What muscles make up the outer circular layer of the pharynx? Where do they overlap? What do they do? What innervates these muscles?

A
  • superior, middle, and inferior constrictor muscles
  • overlap and interdigitate in the posterior midline at the pharyngeal raphe
  • constriction of the 3 constrictor muscles propels a bulus through the oropharynx and laryngopharynx during swallowing
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14
Q

What does the inferior constrictor muscle of the pharynx become continuous with and where?

A

-esophagus at cricoid cartilage

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15
Q

Name the 3 muscles that form the inner longitudinal layer of muscles of the pharynx and their actions

A
  • salpingopharyngeus
  • palatopharyngeus
  • stylopharyngeus
  • they act to elevate (shorten) pharynx during swallowing
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16
Q

All of the muscles of the pharynx are innervated by branches of the _____________ through the __________ except for which muscle? What is the innervation of this muscle?

A
  • vagus nerve
  • pharyngeal plexus
  • stylopharyngeus which is innervated by glossopharyngeal nerve (CN IX)
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17
Q

Describe the passage of the stylopharyngeus muscle and glossopharyngeus nerve and the passage of the stylohyoid muscle.

A
  • Stylopharyngeus: pass from medial side of the styloid process anteromedially through the interval between the superior and middle constrictor muscles
  • stylohyoidL passes from lateral side of styloid process and splits on its way to the hyoid bone to accomodate passage of the tendon of the digastric
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18
Q

What makes up the pharyngeal plexus and what does this plexus give rise to?

A
  • pharyngeal branches of CN IX and CN X form the plexus

- CN IX supplies sensory component while CN X supplies motor innervation to pharynx

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19
Q

At what vertebral level does the esophagus begin?

A

-C6

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20
Q

Name the structures that enter the esophagus between the skull and superior constrictors, superior and middle constrictors, middle and inferior constrictors, and inferior constrictors and esophagus.

A
  • skull/superior: auditory tube, levator veli palatini muscle, ascending palatine artery
  • superior/middle: stylopharyngeus, stylohyoid ligament, glossopharyngeal n (CN IX)
  • middle/inferior: internal branch of superior laryngeal nerve of vagus (CN X) and superior laryngeal artery and vein
  • inferior/esophagus: inferior laryngeal nerve (recurrent) of CN X and inferior laryngeal artery
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21
Q

What types of fibers does the glossopharyngeal nerve (CN IX) contain?

A
  • skeletal motor axons
  • preganglionic parasympathetic axons
  • taste fibers
  • general sensory fibers
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22
Q

How does the glossopharyngeal nerve leave the skull? what does it innervate?

A
  • traverses jugular foramen and its skeletal motor axons innervate a single muscle: stylopharyngeus
  • preganglionic parasympathetic axons in CN IX innervate parotid gland
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23
Q

What is the only muscle CN IX innervates?

A

-stylopharyngeus

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24
Q

Describe the course taken by the parasympathetic fibers of CN IX

A
  • these preganglionic axons course in the tympanic nerve and in the lesser petrosal nerve
  • lesser petrosal n passes through foramen ovale and synapses in the otic gangliion, located in infratemporal fossa just below foramen ovale
  • postganglionic parasympathetic axons from otic ganglion join auriculotemporal nerve (V3 branch) to reach parotid gland
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25
Q

Describe the sensory branches of the Glossopharyngeal nerve: where they arise from and what they innervate.

A
  • innervates mucous membranes on posterior wall of oropharynx and nasopharynx inferior to entrance of auditory tube via pharyngeal plexus (pharyngeal branch)
  • lingual branch conveys general sensation and taste from posterior 1/3 of tongue
  • tonsillar branch supplies mucosa of palatoglossal and palatopharyngeal arches and intervening tonsillar fossa
  • carotid sinus branch innervates carotid body and carotid sinus
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26
Q

What fibers make up the gag reflex and what occurs during this reflex?

A
  • sensory fibers from glossopharyngeal nerve (IX) in oropharyngeal mucosa and motor fibers in vagus nerve
  • stimulation of CN IX results in bilateral contraction of pharyngeal musculature and elevation of soft palate
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27
Q

May be pharyngeal tonsillitis lead to otitis media?

A

-infection can spread along auditory tube into middle ear

28
Q

If you position yourself at the base of the pharynx, what is posterior and anterior to you?

A
  • anterior: inferior border of cricoid cartilage

- posterior: C6 vertebrae

29
Q

The nasopharynx has a _______ function. The nose opens into it via 2 large posterior apertures called _____________. The roof and posterior wall of nasopharynx form a continuous surface that lies inferior to 4 things?

A
  • respiratory
  • choanae or internal nares
  • body of sphenoid bone, basilar part of occipital bone, anterior arch of atlas, body of axis
30
Q

What is found in the mucous membrane of the roof and posterior wall of the nasopharynx? What is this and what is it called when enlarged?

A

-pharyngeal tonsil: a collection of lymphoid tissue which is called adenoids when enlarged

31
Q

The nasopharynx communicates laterally with the tympanic cavity via the __________ (3 names). What is found on the pharyngeal opening to this? What forms this projection?

A
  • auditory tube
  • eustachian tube
  • pharyngotympanic tube
  • hook-like tubal elevation called the torus of the auditory tube; formed by base of the cartilaginous part of the auditory tube
32
Q

The lymphoid tissue at the opening of the auditory tube is designated as the ___________.

A

-tubal tonsil

33
Q

Describe the folds surrounding the torus of the eustachian tube. What is found posterior to fold off of posterior eustachian tube?

A
  • salpingo-pharyngeal fold: vertical fold of mucous membrane that descends from posterior limb of torus to lose itself in pharyngeal wall; it covers the salpingopharyngeus muscle
  • laterally directed slit-like recess called pharyngeal recess of fossa of Rosenmuller
  • salpingo-palatine fold: small fold descending from anterior margin of torus to soft palate
34
Q

What is another name for the pharyngeal recess?

A

-fossa of Rosenmuller

35
Q

What does the salpingopharyngeus muscle do?

A

-opens auditory tube during swallowing

36
Q

Adenoid facies is associated with what? What else can this cause?

A
  • hypertrophy or enlargement of pharyngeal tonsils
  • this obstructs passage of air from nasal cavities thru choanae into nasopharynx which makes mouth breathing necessary and in chronic cases, patient developed adenoid facies
  • impairment in hearing if nasal obstruction and blockage of pharyngeal orifice of auditory tubes
  • infection may spread to tubal tonsils causing swelling and closure of auditory tubes and further to otitis media
37
Q

5 layers of pharyngeal wall from internal to external

A
  • mucous membrane lining pharynx and is continuous with cambers with which it communicates
  • submucosa
  • fibrous layer forming pharyngobasilar fascia which is attached to skull
  • muscular layer composed of inner longitudinal and outer circular parts
  • loose connective tissue layer forming buccopharyngeal fascia
38
Q

What is the buccopharyngeal fascia continuous with and what does it contain and allow movements of?

A
  • epimysium covering buccinator and pharyngeal muscles
  • permits movements of pharynx
  • contains pharyngeal plexus of nerves and veins
39
Q

What are the palatine tonsils? Where are they located?

A
  • 2 masses of lymphoid tissue in lateral walls of oropharynx
  • each located in triangular cleft called tonsillar sinus between the diverging palatoglossal and palatopharyngeal folds or arches
40
Q

What covers the medial surface of palatine tonsils? Where does it extend inferiorly, anteriorly, and superiorly? What covers its deep surface?

A
  • mucous membrane with 10-20 crypts that extend deeply into tonsillar structure
  • inferiorly invades dorsum of tongue and superiorly the soft palate
  • anteriorly extends for some distance under palatoglossal arch
  • deep surface is covered by a capsule
41
Q

Usually the tonsil and its capsule are separated easily from pharyngeal bed except for when __________ Why?

A
  • after chronic tonsillitis, when there is fibrous adhesion between capsule and deep tonsillar bed
  • resection of capsule in these cases is likely to cause much bleeding because many blood vessels run into posterior tonsillar capsule
42
Q

Each palatine tonsil is separated from the palatine and tonsillar branches of the facial artery by the _________. Describe the internal carotid artery’s position relative to the tonsil.

A
  • superior constrictor muscle

- internal carotid artery lies posterolatral to tonsil

43
Q

If going from palatine tonsil to internal carotid artery, what structures would you cross?

A
  • middle constrictor and palatopharyngeal muscles

- facial artery and its tonsillar branch, ascending pharyngeal artery, glossopharyngeal nerve

44
Q

Blood supply and venous drainage of palatine tonsils

A
  • receives blood from facial artery through its ascending and tonsilar branches, the ascending pharyngeal artery of external carotid, and descending palatine branch of maxillary artery
  • one or more veins leaves inferior part of tonsil and open into pharyngeal plexus or facial vein
45
Q

What vessel courses close to lateral surface of palatine tonsil?

A
  • large external palatine vein aka paratonsillar vein
  • descends from palate and passes close to lateral surface of palatine tonsil before joining the pharyngeal plexus of veins
46
Q

Describe where innervation of palatine tonsils comes from and why this can explain why tonsillitis may refer pain to ear?

A

-nerves to palatine tonsil are from the pterygopalatine ganglion through lesser palatine nerve and from the glossopharyneal nerve, which by its tympanic branch, also supplies mucosa of tympanic cavity; hence by tonsillitis can refer pain to ear

47
Q

Describe lymphatic drainage of palatine tonsils and why nicknames have arisen

A
  • to LN near angle of mandible and to jugulodigastric node

- due to frequent enlargement of jugulodigastric node in tonsillitis, often called tonsillar node

48
Q

Where and when may a peritonsillar abscess develop? Why can this be troublesome?

A
  • external to tonsillar capsule
  • usually following bought of acute suppurative tonsillitis
  • abscess may penetrate wall of pharynx and break through into retropharyngeal space and lead to spread of infection to mediastinum
49
Q

What is the lymphatic ring of the throat and what is another name for it? What are its components?

A
  • Waldeyer’s ring
  • protective annulus of lymphoid tissue located in naso- and oro-pharynx
  • lingual tonsil anteriorly and inferiorly, palatine and tubal tonsils laterally and pharyngeal tonsil superoposteriorly
50
Q

Name the 4 arteries of the pharynx

A
  • ascending pharyngeal
  • ascending palatine branch of facial artery
  • descending palatine and pharyngeal branches of maxillary artery
51
Q

Where do the veins of the pharynx drain and communicate with?

A
  • drain into pharyngeal plexus of veins and thence into internal jugular vein
  • pharyngeal plexus communicates with pterygoid venous plexus
52
Q

Give parasympathetic, sensory, and motor nerve innervation of nasopharynx

A
  • sensory supply of mucous membrane is mainly from pharyngeal branch of maxillary nerve V2
  • motor nerve supply to muscles of palate is from pharyngeal plexus, except for tensor veli palatini which is innervated by CN V3
  • parasympathetic secretomotor innervation to the mucous glands is derived from pterygopalatine ganglion
53
Q

Where is the pharyngeal plexus of nerves found and what 3 components feed into it?

A
  • on middle constrictor muscle
  • formed by brances of vagus and glossopharyngeus nerves and sympathetic branches from superior cervical sympathetic ganglion
54
Q

2 muscles not supplied by vagus n

A
  • tensor veli palatini (CN V3)

- stylopharyngeus (CN IX)

55
Q

Sensory fibers in the pharyngeal plexus are derived mainly from glossopharyngeal nerve and innervate most of the mucosa of the pharynx except for the nasopharynx which is innervated mainly by _______.

A

-pharyngeal branch of CN V2

56
Q

4 types of fibers found in vagus nerve

A

-skeletal motor axons, preganglionic parasympathetic axons, taste fibers, and general sensory fibers

57
Q

The vagus nerve traverse the _________ and innervates all of the muscles of the palate except for _________, all of the pharynx except for ________ and all of the muscles of the _______.

A
  • jugular foramen
  • tensor veli palatini
  • stylopharyngeus
  • larynx
58
Q

The vagus nerve innervates mucosa where? What visceral sensations does it carry? And where does it convey preganglionic parasympathetic axons?

A
  • root of tongue and in laryngopharynx and larynx
  • visceral sensation other than pain from thoracic and abdominal viscera
  • preganglionic parasympathetic axons to terminal ganglia in thoracic and abdominal viscera
59
Q

Complete lesions of vagus nerve commonly result in a weakness of __________, _________, and _________ muscles.

A
  • palate
  • pharyngeal
  • laryngeal
60
Q

Weakness of levator veli palatini due to vagus lesion may result in what?

A
  • drooping of palate on side of injured nerve
  • deviation of uvula to side of uninjured nerve
  • patients may have nasal speech and nasal regurgitation of liquids during swallowing
61
Q

Weakness of pharyngeal constrictors due to vagus lesion may result in…

A

-dysphagia or difficulty swallowing

62
Q

Lesions of vagus that include laryngeal nerves may result in a weakness of all laryngeal muscles on the affected side. What position will vocal cord be in and what does this result in?

A

-vocal cord will assume a fixed position midway between abduction and adduction, resulting in weak, hoarse speech

63
Q

What reflex-ually happens if pharyngeal branches and laryngeal nerves are lesioned (of vagus)?

A

-loss of motor limb of gag reflex and cough reflex, respectively

64
Q

Name the adductors, abductors, tensors, and relaxers of the vocal cords

A
  • adductors: arytenoid muscles and lateral cricoarytenoid muscles
  • abductors: posterior cricoarytenoid muscles
  • tensors: cricothyroid muscles
  • relaxer: thyroarytenoid muscles
65
Q

The recurrent laryngeal nerve innervates all the intrinsic muscles of the larynx except for which one and what is it innervated by?

A

-cricothyroid: external branch of superior laryngeal nerve

66
Q

What innervates mucosa of larynx above and below the vocal folds?

A

-recurrent laryngeal below and internal branch of superior laryngeal nerve above folds

Anatomy Exam 3 (9 decks)

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