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LR ENT > Speech & Swallowing Anatomy > Flashcards

Speech & Swallowing Anatomy Flashcards

1
Q

Name the muscle of mastication which opens the jaw

A

Lateral pterygoid

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2
Q

Name the 3 muscles of mastication that close the jaw

A

Temporalis
Medial pterygoid
Masseter

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3
Q

Which muscle of the face aligns the food bolus between the teeth?

A

Buccinator

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4
Q

What 2 structures form the temporomandibular joint?

A

The
-Mandibular condyle of the mandible
slots between the
-Glenoid fossa and articular tubercle of the zygomatic arch of the temporal bone

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5
Q

What is the function of the…
-Intrinsic
-Extrinsic
… groups of skeletal muscles in the tongue?

A

Intrinsic: changes the shape of the tongue
Extrinsic: moves the tongue around the oral cavity

These both facilitate swallowing and speech production

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6
Q

Name the 4 extrinsic muscles of the tongue

their names help in remembering their origins

A

Palatoglossus (hard palate to tongue)
Styloglossus (styloid process to tongue)
Hyoglossus (hyoid bone to tongue)
Genioglossus (chin to tongue)

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7
Q 
State the innervation to the extrinsic muscles of the tongue (one is different)
Palatoglossus 
Styloglossus 
Hyoglossus 
Genioglossus
A

Palatoglossus: vagus nerve CN X

Styloglossus, hyoglossus, genioglossus: hypoglossal nerve CN XII

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8
Q

Where are the intrinsic skeletal muscles of the tongue located?

A

Dorsally and posteriorly in the inner tongue

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9
Q

What are the 4 fibre directions associated with the intrinsic tongue muscles?

A

Superior longitudinal
Inferior longitudinal
Horizontal
Vertical

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10
Q

What is the function of the muscles of the soft palate?

A

To elevate and tense the fibrous palatine aponeurosis during swallowing to prevent passage of food into the nasal cavity

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11
Q

The soft palate makes up the posterior 2/3rds of the palate. T/F?

A

False

The soft palate makes up the posterior 1/3rd of the palate

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12
Q

Name the 5 skeletal muscles of the soft palate

A 
Tensor veli palatini
Levator veli palatini
Palatoglossus
Musculus uvulae
Palatopharyngeus
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13
Q

All of the skeletal muscles of the soft palate are supplied by CN ? except ?

A

All of the skeletal muscles of the soft palate are supplied by CN X - the vagus nerve

Except tensor veli palatini

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14
Q

Which nerve innervates tensor veli palatini?

A

CN V3 - mandibular division of trigeminal

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15
Q 
State the function of the skeletal muscles of the soft palate:
Tensor veli palatini
Levator veli palatini
Palatoglossus
Musculus uvulae
Palatopharyngeus
A

Tensor veli palatini: tenses the palatine aponeurosis

Levator veli palatini: lifts the palatine aponeurosis

Palatoglossus: depresses soft palate towards tongue

Musculus uvulae: shortens the uvula

Palatopharyngeus: elevates the pharynx and depresses the soft palate

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16
Q

What are tonsils?

What is their function?

A

Clusters of lymphatic nodules containing a high concentration of lymphocytes

The provide immunological protection of the shared entry to the respiratory and GI tracts

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17
Q

Name the 4 tonsils involved in Waldeyer’s tonsillar ring, starting at the roof of the mouth and working around the mouth to the tongue

A

Pharyngeal tonsil
Tubal tonsil
Palatine tonsil (‘the tonsils’)
Lingual tonsil

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18
Q

Saliva is produced by major and minor seromucous glands. What are the 3 major salivary glands?

A

Parotid gland
Submandibular gland
Sublingual gland

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19
Q

State the drainage sites of the major salivary glands into the oral cavity
Parotid gland
Submandibular gland
Sublingual gland

A

Parotid gland: next to upper 2nd molar

Submandibular gland: the lingual caruncle in the floor of the mouth

Sublingual gland: via several superior ducts in the floor of the mouth

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20
Q

The salivary glands are mainly controlled by the sympathetic/parasympathetic autonomic nervous system

A

Parasympathetic

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21
Q

Which nerve senses unwanted materials in the gag reflex?

A

CN IX - the glossopharyngeal nerve

supplies the offended posterior 1/3rd of tongue, palatine tonsils and wall of oropharynx

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22
Q

Which 3 cranial nerves are involved in the motor aspect of the gag reflex i.e., closing off the oropharynx by muscular contraction?

A

CN IX - the glossopharyngeal nerve (pharynx)

CN X - the vagus nerve (pharynx + soft palate)

CN XII - the hypoglossal nerve (tongue)

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23
Q

Name the 3 muscles involved in the outer circular muscle layer of the pharynx

A

Superior pharyngeal constrictor
Middle pharyngeal constrictor
Inferior pharyngeal constrictor

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24
Q

What is the function of the 3 muscles involved in the outer circular muscle layer of the pharynx?

A

Sequential contraction from superior to inferior forces the food bolus inferiorly

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25
Q

Each of the bilateral pairs of constrictor muscles inserts on its contralateral counterpart to form…

A

A midline raphe

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26
Q

Name the 3 muscles involved in the inner longitudinal (vertical) muscle layer of the pharynx

A

Stylopharyngeus
Salpingopharyngeus
Palatopharyngeus

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27
Q

What is the function of the 3 muscles involved in the inner longitudinal (vertical) muscle layer of the pharynx?

A

They elevate the larynx and shorten the pharynx

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28
Q

All of the ipsilateral longitudinal blend together and insert onto…

A

The posterior border of the thyroid cartilage

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29
Q

All of the skeletal muscles of the pharynx are supplied by CN ? except ?

A

All of the skeletal muscles of the pharynx are supplied by CN X - the vagus nerve

Except stylopharyngeus

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30
Q

Which nerve innervates stylopharyngeus?

A

CN IX - the glossopharyngeal nerve

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31
Q

What are the 3 phases of deglutition (swallowing)?

Which are voluntary and involuntary?

A
  1. Oral phase (voluntary)
  2. Pharyngeal phase (involuntary)
  3. Oesophageal phase (involuntary)
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32
Q

How can the pharyngeal and oesophageal phases be involuntary when they are controlled by skeletal muscle?

A

Due to pattern recognition in the medulla

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33
Q

Name the 4 nerves involved in the oral phase of deglutition

A

CN V3 - the mandibular division of trigeminal
CN VII - the facial nerve
CN X - the vagus nerve
CN XII - the hypoglossal nerve

34
Q

What do each of the nerves in the oral phase of deglutition do?
CN V3 - the mandibular division of trigeminal
CN VII - the facial nerve
CN X - the vagus nerve
CN XII - the hypoglossal nerve

A

CN V3 - supplies the muscles of mastication

CN VII - supplies muscles of the face that close the lips (orbicularis oris) and push the food between the teeth (buccinator)

CN X - depresses the soft palate to close of the nasopharynx and causes the tongue to push the bolus posteriorly

CN XII - supplies intrinsic and extrinsic tongue muscles to manipulate and align the bolus

35
Q 
Which nerves provide secretomotor and general sensation to the...
-Hard palate
-Soft palate
?
These are all branches of...?
A

Hard palate: Incisive branch of nasopalatine nerve, greater palatine nerve

Soft palate: Lesser palatine nerve

These are all branches of the pterygopalatine ganglion

36
Q

The hypoglossal nerve (CN XII) gives somatic motor innervation to all of the extrinsic and intrinsic muscles of the tongue except ? which is innervated by CN ? instead

A

Except palatoglossus which is innervated by CN X (the vagus nerve) instead

37
Q

Describe the route of the hypoglossal nerve from the medulla to the floor of the mouth

A
  • Medulla
  • Passes through hypoglossal canal (near styloid foramen)
  • Descends close to carotid sheath
  • Courses lateral to hyoglossus into the floor of the mouth
38
Q

How long does the pharyngeal phase of deglutition last?

A

< 1 second

39
Q

Which two factors lead to the epiglottis being forced to cover and protect the laryngeal aditus during swallowing?

A
  • Hyoid bone is dragged superiorly and anteriorly (by suprahyoid and longitudinal pharyngeal muscles)
  • Posterior tongue pressure (from stylohyoid and hyoglossus)
40
Q

Movement of food through the oesophagus is aided by cricopharyngeus muscle relaxation/contraction?

A

Relaxation

The cricopharyngeus is the upper oesophageal sphincter (UOS) and so relaxes when food is swallowed. It is contracted in the resting state.

41
Q

The oesophageal phase of deglutition lasts ~X seconds?

A

8-20 seconds

42
Q

What is the parapharyngeal space?

A

A column of tissue allowing communication between the base of the skull and the lower neck, containing a large number of different structures (e.g., cranial nerves, blood vessels) within it

43
Q

What is the retropharyngeal space?

A

A space posterior to the pharynx and anterior to the vertebral column that forms a connection between the base of the skull and the mediastinum and can lead to spread of infection there

44
Q

Which 2 nerves form the pharyngeal plexus?

A

CN IX - glossopharyngeal

CN X - vagus

45
Q

What is the ‘gateway to the mouth’?

A

A gap between the superior and middle pharyngeal constrictor muscles that allows the glossopharyngeal nerve (CN IX) to pass through

46
Q

Why is the ‘gateway to the mouth’ of clinical importance?

A

The tonsils lie close to the gateway of the mouth so be careful not to damage the glossopharyngeal nerve during tonsillectomy

47
Q

What are the functions of the muscles of the larynx? (3)

A

They control the true vocal cords which facilitates…

  • Passage of air for respiration
  • Protection against aspiration
  • Generation of voice
48
Q

Which nerve supplies all of the intrinsic muscles of the larynx?

A

CN X - the vagus nerve

49
Q

Name the 5 intrinsic muscles of the larynx

A 
Cricothyroid muscle
Thyroarytenoid muscle
Lateral cricoarytenoid muscle
Arytenoid muscle
Posterior cricoarytenoid muscle
50
Q

During normal resting respiration, the laryngeal muscles are relaxed. T/F?

A

True

51
Q

Contraction of which laryngeal muscle abducts the vocal cords to widen the rima glottidis during forced respiration e.g., during running?

A

Posterior cricoarytenoid muscle

52
Q

Contraction of which 2 laryngeal muscles adducts the true vocal cords to firmly close the rima glottidis during swallowing?

A

Arytenoid muscle

Lateral cricoarytenoid muscle

53
Q

How does the laryngeal musculature form speech?

A
  • Air is forced through the closed rima glottidis
  • This vibrates the true vocal cords, forming sound
  • The upper respiratory tract modifies the sound to form speech
54
Q

Contraction of which 2 laryngeal muscles adducts the vocal cords to close the rima glottidis to allow air to be pushed through for speech?

A

Arytenoid muscle

Lateral cricoarytenoid muscle

55
Q

Is contraction of both the arytenoids and lateral cricoarytenoids required to facilitate a whisper?

A

No

Contraction of the lateral cricoarytenoids alone leaves a small posterior opening between the arytenoid cartilages

This opening allows air to pass through without ausciltating the vocal cords

This disrupts the flow of sound

56
Q

Contraction of which laryngeal muscle decreases the pitch of the voice? How?

A

The thyroarytenoid muscle

Contraction relaxes the true vocal cords

57
Q

Contraction of which laryngeal muscle increases the pitch of the voice? How?

A

The cricothyroid muscle

Contraction tenses the vocal cords

58
Q

Which nerve supplies the mucosa of the larynx above the vocal folds?

A

The internal laryngeal nerve (a branch of the superior laryngeal nerve of the vagus nerve)

59
Q

Which nerve supplies the mucosa of the larynx below the vocal folds, and all of the intrinsic muscles of the larynx (except one)?

A

The inferior laryngeal nerve (a branch of the recurrent laryngeal nerve of the vagus nerve)

60
Q

Which intrinsic laryngeal muscle is not supplied by the inferior laryngeal nerve?
What nerve is it supplied by?

A

The cricothyroid

It is supplied by the external laryngeal nerve (a branch of the superior laryngeal branch of the vagus nerve)

61
Q

What is Galen’s anastomosis?

A

The point where the internal and inferior laryngeal nerves meet
(just above the thyroid cartilage)

62
Q

Which nerve detects sensory stimuli in the cough reflex?

A

The internal laryngeal nerve (a branch of the superior laryngeal nerve of the vagus nerve)

(supplies the mucosa of the supraglottis i.e., the laryngeal vestibule and ventricle)

63
Q

Which nerve causes glottic closure in the cough reflex?

Which muscles is it acting on?

A

The recurrent laryngeal nerve

The arytenoid and lateral cricoarytenoid muscles

64
Q

In the cough reflex, what must occur once the rima glottidis has closed?

A

The diaphragm and/or intercostal muscles must contract to increase body cavity pressure

65
Q

In the cough reflex, when is the ‘cough’ noise generated?

A

Once subglottal pressure threshold is reached, a high pressure air jet is released from the glottis

66
Q

The majority of glottic tumours do not spread from the vocal cords. T/F?

A

True

95% stay on the cords

67
Q

What are the 4 functions of the hyoid bone?

A
  • Allows attachment for the supra- and infra-hyoid muscles
  • Maintains the patency of the airway
  • Facilitates swallowing
  • Facilitates speech
68
Q

Name the 4 infrahyoid muscles

their names help remember their attachments

A

Sternohyoid (sternum to hyoid)
Omohyoid anterior and posterior bellies (shoulder to hyoid)
Thyrohyoid (thyroid to hyoid)
Sternothyroid (sternum to thyroid)

69
Q

Name the 4 suprahyoid muscles

their names help remember their attachments

A

Stylohyoid (styloid process to hyoid bone)
Mylohyoid (mandible near the molars to hyoid bone)
Geniohyoid (chin to hyoid bone)
Digastric anterior and posterior bellies

70
Q

The vagus nerve supplies sensation to…?

A

The inferior portion of the external acoustic meatus and some of the external surface of the tympanic membrane

71
Q

The vagus nerve supplies motor innervation to…?

A

The soft palate, pharynx (except styloparyngeus) and larynx

72
Q

The vagus nerve supplies the special sensation of taste to…?

A

The epiglottis

73
Q

Which foramen does the vagus nerve exit through?

A

The jugular foramen

74
Q

Name 3 other structures that travel through the jugular foramen with the vagus nerve

A

CN IX - glossopharyngeal nerve
CN XI - spinal accessory nerve
Internal jugular vein

75
Q

Describe the route of the glossopharyngeal nerve (CN IX)

A
  • Leaves the CNS at the upper medulla oblongata
  • Passes through the jugular foramen
  • Enters the parapharyngeal space and lies on the stylopharyngeus muscle
76
Q

What is the only muscle receiving motor supply from the CN IX?

A

Stylopharyngeus (longitudinal pharyngeal muscle)

77
Q

The glossopharyngeal nerve gives parasympathetic secretoromotor innervation to…

A

The parotid gland

78
Q

How does the glossopharyngeal nerve reach the parotid gland?

A
  • Its tympanic branch passes through the middle ear
  • Becomes the lesser petrosal nerve and exits the cranial cavity via the foramen ovale
  • Synapses in the otic ganglion
  • Joins the auriculotemporal nerve (of CN V3) which travels to the carotid gland
79
Q

What sort of innervation does the glossopharyngeal nerve (CN IX) give to the tongue?

A

Taste and general sensation to the posterior 1/3rd of the tongue

80
Q

How does the glossopharyngeal get into the oral cavity to supply the posterior tongue?

A

It passes through the ‘gateway of the mouth’ between the superior and middle pharyngeal constrictors

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