SGW 10 Flashcards
which muscles help keep food within the oral cavity proper while chewing and what are they innervated by?
orbicularis oris and buccinators
facial nerve (CN VII)
(muscles of mastication innervated by CN V)
what happens during oral (preparatory and propulsive) phase of swallowing?
- chewing of food into bolus to be swallowed
- bolus pushed back to soft palate by teeth and tongue
(all voluntary)
what what happens in pharyngeal phase of swallowing>
automatic: food propel to pharynx
1. elevate soft palate (seal off nasopharynx)
2. upward and forward movement of hyoid bone + larynx (suprahyoid muscles)
3. tongue pushed back + down = push food into oropharynx
4. vocal cords close
5. epiglottis pulled posterior-inferiorly over laryngeal outlet = protect airways (trachea)
6. progressive contraction of pharyngeal constrictor muscles (superior to inferior) to move bolus down oesophagus
oesophageal phase of swallowing?
movement of bolus by peristaltic action of oesophageal muscles
how does upper oesophageal sphincter open?
contraction of thyropharyngeus and relax cricopharyngeus (inferior pharyngeal constrictor - prevent buildup of intrapharyngeal pressure)
muscles of oesophagus?
upper 1/3rd: (straited) skeletal muscle
middle 1/3rd: mixed
inferior 1/3rd: smooth muscle
role of suprahyoid muscles during swallowing?
larynx + hyoid lifted UP + FORWARD by suprahyoid muscles
prevent aspiration of food into airway (trachea)
(hyoid lifted up as attachment of suprahyoid muscles, so up when they contract)
role of infrahyoid muscles during swallowing?
stabilise the larynx by opposing the actions of suprahyoids during swallowing
how does acute tonsillitis present?
swollen, oedematous tonsils (palatine) white exudate (pus) coating tonsils and filling the crypts (if become abscess = quinsy, medical emergency, drain, can obstruct nasopharynx)
which lymph nodes are swollen during tonsillitis? location?
jugulo-digastric (deep cervical)
just below angle of mandible, form part of deep cervical chain of lymph nodes
where do jugulo-digastric lymph nodes drain into?
tonsillar + posterior pharyngeal regions
how do jugulo-digastric lymph nodes appear in tonsillitis?
enlarged + tender
what are the deep cervical lymph nodes and where are they found?
deep to SCM
closely related to IJV + carotid sheath
(will be closely related to IJV as within carotid sheath)
jugulo-digastric (superior SCM)
jugulo-omohyoid (anteiror SCM)
supraclavicular lymph nodes (within supraclavicular fossa) - L. SLN = virchow’s (GI malignancy)
contents of carotid sheath?
IJV, common carotid artery, internal CA, vagus (CNX)
bifurcation of common carotid artery?
upper border of the thyroid cartilage (C4)
what is quinsy? how does it occur?
peritonsillar abscess
rare complication of acute tonsillitis, but can occur without prior tonsillitis
how does quinsy present?
unilateral swelling, causing deviation of soft palate + uvula to opposite side
symptoms of fever + painful swallow
trismus (difficulty opening mouth) may occur
voice may be altered (hot potato voice)
why might trismus occur in quinsy?
(difficulty opening mouth)
due to muscle spasm
why may voice be altered in quinsy?
by pharyngeal oedema + muscles spasm
how do you treat quinsy?
refere to ENT:
IV antibiotics + aspiration of abscess (drain)
what is glue ear and how does it appear?
otitis media with effusion
ear drum appears:
yellow, retracted (sucked in), with air bubble visible
how does glue ear normally present?
history of recurrent ear infections
hearing is poor
complains of pain in ear, but otherwise well
what causes glue ear?
eustachian (pharygotympanic) tube dysfunction
middle ear cannot equalise with atmosphere because the tube doesn’t open properly
mucous membrane continuously absorbs air in middle ear and the tube causing a negative pressure within
(absorb air but can’t leave = negative pressure)
what can happen with glue ear?
fluid accumulates within the middle ear, may be thick + stick OR thin + watery
exudate = ideal growth medium for pathogens
what does eustachian tube malfunction occur with?
adenoids hypertrophy
URTI
nasal allergy
tumours of nasopharynx
what is the difference between glue ear and otitis media?
glue ear = doesn’t necessary have to be an infection
otitis media: CAUSED by an infection
would glue ear hearing loss be conductive or sensorineural? why?
conductive hearing loss (middle ear)
accumulation of fluid within middle ear, prevents vibration of tympanic membrane + ossicles
what does sensorineural hearing loss occur with?
pathology affecting inner ear structures / CN VII (vestibulocochlear nerve)
how to treat glue ear?
surgical grommet insertion (lasts about 9 months)
what is the function of a grommet?
helps drain away fluid in the middle ear and maintain air pressure
