Prevertebral Region and Pharynx Flashcards
Where are the anterior vertebral muscles and what are their names?
. Directly posterior to the retropharyngeal space . Longus colli . Longus capitis . Rectus capitis anterior . Anterior scalene
Where are the prevertebral muscles located? What are the two groups of prevertebral muscles?
. Posterior to the cervical viscera and anterolateral to the vertebral column
. Anterior and lateral groups
Where are the lateral vertebral muscles located and what are their names?
. Posterior to the cervical and brachial plexuses and subclavian artery . Rectus capitis lateralis . Splenius capitis . Levator Scapulae . Middle Scalene . Posterior Scalene
What is the root of the neck?
Junction between the thorax and neck
What are the boundaries of the root of the neck?
. Inferior boundary: formed laterally by the first pair of ribs and their costal cartilages
. Anterior boundary: manubrium
. Posterior boundary: body of T1 vertebrae
What is the largest branch off of the aorta and what are its 2 immediate branches?
. Brachiocephalic trunk
. R common carotid and R subclavian
(the L subclavian is a direct branch off of the aorta)
What are the three divisions of the subclavian artery, and what muscle divides it?
. The anterior scalene divides it (runs over the 2nd part)
. 1st part = gives off vertebral, internal thoracic, and thyrocervical trunk
. 2nd part = costocervical artery
. 3rd part = no branches, unless dorsal scapular comes off it, which happens 25% of the time
What are the 4 parts of the vertebral artery? Where do they pass through?
. Cervical: arises from the first part of the subclavian and ascends in the pyramidal space (between scalene and longus colli muscles)
. Vertebral: transverse foramina of C1-C6
. Suboccipital: courses in a groove on the posterior aspect of the atlas before it enters the foramen magnum
. Cranial: merge to form the basilar artery
What are the two large veins that terminate in the root of the neck and what do they drain?
. EJV and Anterior JV
. EJV drians the face and scalp
. AJV drains the superficial aspects of the submental and muscular triangles
What veins form the jugular venous arch and where is it?
. Anterior jugular veins
. Above the manubrium
The brachiocephalic vein is formed by which two veins? What is another name for it and what happens here?
. IJV and subclavian
. Venous angle
. Drainage site of R lymphatic and thoracic ducts
What are relevant branches of the vagus nerve in this region?
. Recurrent laryngeal nerves
. Cardiac branches
Where do the L and R recurrent laryngeal nerves wrap around? What is the name of the groove they course through?
. L wraps around the arch of the aorta
. R wraps around the R subclavian
. Both course through the the tracheoesophageal groove
Where do the carotid branches originate from and what are their functional components?
. Branches from the neck as well as the thorax
. Para/pre and VA fibers to the cardiac plexus
Phrenic nerve: roots, innervation, course
. ventral rami of C3-C5
. diaphragm
. anterior surface of anterior scalenes
The cervical portion of the sympathetic trunks lie _________ to the vertebral column and extend to _________
. Anterolateral
. C1 vertebrae
After __________ fibers synapse at one of the 3 cervical ganglia, ________ fibers can travel to what 3 types of nerves/plexuses?
. Sym/pre
. Sym/post
1. Cervical spinal nerves (via gray rami communicantes)
2. Sup/Mid/Inf Cardiopulmonary Splanchnics (to thoracic viscera)
3. Sympathetic periarterial plexuses
What are the names of the 3 cervical sympathetic ganglia and where are they found?
. Superior: C1-C2
. Middle: C6
. Inferior: C7
*referring to vertebral levels
What are the 3 branches off the superior cervical sympathetic ganglion?
. Form internal/external carotid sympathetic plexuses
. Sends sym/post fibers to ventral rami of C1-C4
. Gives off the superior cardiopulmonary splanchnic
What are the 2 branches off of the middle cervical sympathetic ganglion
. Sym/post fibers to the ventral rami of C5-C6
. Middle cardiopulmonary splanchnic
What is special about the inferior cervical sympathetic ganglion? What are its 2 branches?
. It fuses with the first thoracic ganglion = stellate ganglion
. Sym/post fibers to ventral rami of C7-C8
. Inferior cardiopulmonary splachnic
How long is the pharynx and where does it extend to/from?
. 12-15cm
. Base of skull to C6 vertebrae (where the trachea begins)
What does the pharynx do?
. Directs air to the larynx
. Directs food to the esophagus (via the pharyngeal constrictor muscles)
What are the two fascial layers associated with the pharynx and which is thicker?
. Pharyngobasilar (thicker)
. Buccopharyngeal
Name the pharyngeal wall layers and spaces.
. (Lumen) . Submucosa . Mucosa . Pharyngobasilar fascia . Pharyngeal muscles . Buccopharyngeal fascia . Retropharyngeal spae . Alar fascia . Prevertebral space (danger zone) . Prevertebral fascia
Where is the retropharyngeal space and where does it lead?
. Between the buccopharyngeal and alar fascias
. Superior mediastinum
Where is the prevertebral space and where does it lead?
. Between the alar and prevertebral fascias
. Posterior mediastinum
Where are the 3 divisions of the pharynx?
. Nasopharynx - choanae to pharyngeal isthmus
. Oropharynx - pharyngeal isthmus to epiglottis
. Laryngopharynx - epiglottis to esophagus
What are the internal structures of the nasopharynx?
. Pharyngeal tonsil (adenoids if inflamed… can lead to otitis media)
. Torus tubarius (tubal tonsils here) (upper ridge of auditory tube)
. Salpingopharyngeal fold (extends from auditory tube)
. Pharyngeal recess
What are the internal structures of the oropharynx?
. Lingual tonsil
. Palatine tonsil (in the tonsillar bed)
. Palatoglossal arch (made up by the palatoglossal muscle)
. Palatopharyngeal arch (made up by the palatopharyngeal muscle)
What are the folds called that are between the tongue and the epiglottis? What are the depressions between the folds?
. Median glossoepiglottic fold
. Lateral glossoepiglottic folds
. Valleculae
What are the functional components of the internal laryngeal nerve?
. VE-para/pre
. VA
. SS-taste (from anterior epiglottis)
Where is the laryngopharynx located and what are its specific boundaries?
. Lies posterior to the larynx
. From epiglottis to cricoid cartilage
How does the laryngopharynx communicate with the larynx?
Laryngeal inlet
What is the piriform recess and which two nerves lie below its mucosa?
. Its the two impressions where food travels on the way to the esophagus
. Internal laryngeal nerve
. Recurrent laryngeal nerve
What do the longitudinal muscles of the pharynx do and what stage of deglutition do they assist with?
. Raise larynx and elevate pharynx (by shortening it)
. 2nd stage of deglutition (swallowing)
What are the principle muscles of the pharynx? What do they do? What stage of deglutition are they involved in?
. Constrictor muscles
. Propel the food bolus into the esophagus by involuntary contraction
. 3rd stage of deglutition (swallowing)
Where are the 4 pharyngeal wall gaps?
#1 - above the superior pharyngeal constrictor #2 - in between superior/middle pharyngeal constrictors #3 - in between middle/inferior pharyngeal constrictors #4 - under the inferior pharyngeal constrictor
What passes through the first pharyngeal wall gap?
1 - nada (covered with pharyngobasilar fascia)
What passes through the second pharyngeal wall gap?
2 - stylopharyngeus muscle, CN IX, stylohyoid ligament
What passes through the third pharyngeal wall gap?
3 - internal laryngeal nerve and superior laryngeal artery/vein
What passes through the fourth pharyngeal wall gap?
4 - recurrent laryngeal nerve, inferior laryngeal artery/vein
What are the 2 sources of innervation for the pharynx?
. PPG (pterygopalatine ganglion)
. Pharyngeal plexus
What does the pharyngeal nerve off the PPG supply? What are the functional components of the 3 types of fibers?
. Superior nasopharynx
. Sym/post to blood vessels
. Para/post to mucosal glands
. SA (somatosensory) to mucosa
What are the functional components of the PPG branches?
. Sym/post
. Para/post
. SA
. (VA)
What nerve fibers form the pharyngeal plexus?
. CN IX fibers
. CN X fibers
. Sympathetic fibers
Pharyngeal plexus:
What type of fibers are sent to blood vessels?
Sym/post
Pharyngeal plexus?
What type of fibers are sent to the mucosal glands, and by what nerve?
CN X sends para/pre fibers to mucosal glands
Pharyngeal plexus:
What types of fibers are sent to the inferior portion of nasopharynx and the oropharynx, by which nerve?
CN IX sends SA fibers
Pharyngeal plexus:
The laryngopharynx receives what type of fibers, from what nerve?
VA fibers via CN X (viscerosensory)
Pharyngeal plexus:
Pharyngeal muscles receive what fibers from what nerve?
BM from CN X
*the BM fibers from CN IX to the stylopharyngeus muscle are not part of the pharyngeal plexus
Are there cell bodies in the pharyngeal plexus?
Nope
What nerve provides sensory innervation to the superior portion of the nasopharynx? What are the functional components?
. CN V2 (maxillary)
. SA
What provides sensory innervation to the inferior portion of the nasopharynx and the oropharynx? What functional components?
. CN IX
. SA
What provides sensory innervation to the laryngopharynx? Functional components?
. CN X
. VA
What provides motor innervation to the superior portion of the nasopharynx? Functional Components?
. CN VII via PPG and the pharyngeal branch
. VE-para/post
What provides motor innervation to the inferior portion of the nasopharynx and oropharynx? Functional components?
. CN X
. VE-para/post
What provides motor innervation to the laryngopharynx? Functional components?
. CN X
. VE-para/post
What branches off of the external carotid artery supply the pharynx?
. Ascending pharyngeal
. Facial
. Lingual
What branch off the inferior thyroid artery supplies the pharynx?
. Pharyngeal artery branches
Anterior scalene innervation and function
. ventral rami of C4-C6
. laterally flexes neck and raises first rib during forced inspiration
Middle scalene innervation and function
. ventral rami of C3-C8
. laterally flexes neck and elevates first rib during forced inspiration
Posterior scalene innervation and function
. ventral rami of C7-C8
. laterally flexes neck and elevates second rib during forced inspiration
Innervation and function of longus colli
. ventral rami of C2-C6
. flexes neck and anteriorly/laterally bends cervical vertebrae C2-C7
Innervation and function of longus capitis
. ventral rami of C1-C3
. flexes neck and anteriorly/laterally bends head relative to the vertebral column at the atlanto-occipital joints
Rectus capitis lateralis innervation and function
. ventral rami of C1-C2
. flexes head and stabilizes it
Rectus capitis anterior innervation and function
. ventral rami of C1-C2
. flexes neck and anteriorly/laterally bends neck relative to the vertebral column at the atlanto-occipital joints
What is otitis media?
An infection that spreads from the nasopharynx to the middle ear which may result in temporary or permanent hearing loss
What is Waldeyer’s ring?
Pharyngeal tonsillar ring around the superior part of the pharynx composed of: Palatine tonsils Lingual tonsils Pharyngeal tonsils Tubal tonsils
Salpingopharyngeus muscle innervation and function
. CN X
. Elevates pharynx and larynx during swallowing and speaking
Palatopharyngeus innervation and function
. CN X
. elevation of pharynx and larynx during speaking and swallowing
Stylopharyngeus muscle innervation and function
. CN IX
. elevation of larynx and pharynx during swallowing and speaking
Innervation and function of the superior/middle/inferior pharyngeal constrictor muscles
. CN X
. constrict wall of pharynx while swallowing
The three stages of deglutition, involuntary or voluntary?
1 voluntary
2 involuntary
3 involuntary
Muscles involved in the three stages of deglutition?
1 tongue muscles
2 suprahyoid and longitudinal pharyngeal muscles
3 constrictor muscles
Stellate ganglion block
May relieve vascular spasms involving the brain and upper limb
Surgical resection of the ganglion may be beneficial if there is excess vasoconstriction of the upper ipsilateral arm
Horner’s syndrome
Caused by lesion to the sympathetic trunk in the neck
Causes pupillary constriction (dilator pupillae), ptosis (drooping of upper eyelid because superior tarsal muscle), enopthalomos (sinking of eyeball), vasodilation and anhydrosis (absence of sweating on the face because of lack of nerve supply to vessels and sweat glands)
