Swallowing Flashcards
1
Q
What are the two major functions of the pharynx?
A
breathing and swallowing (has both respiratory and digestive functions)
2
Q
Where does the pharyngeal wall (musculofascial half-cylinder) meet with the esophagus?
A
at the level of the 6th cervical vertebra
3
Q
The pharynx has openings into what 3 cavities?
A
1) nasal2) oral3) laryngeal
4
Q
What are the 3 named divisions of the pharynx?
A
1) nasopharynx2) oropharynx3) laryngopharynx
5
Q
What are the first two skeletal connections of the anterior line of the attachment of the lateral pharyngeal wall?
A
on each side, the posterior edge of the medial pterygoid plate of the sphneoid bone then onto the pterygoid hamulus
6
Q
What is a linear cord-like connective tissue ligament that spans the distance between the tip of the pterygoid hamulus and a triangular roughening immediately posterior to the third molar of the mandible?
A
pterygomandibular raphne
7
Q
What does the pterygomandibular raphne join?
A
superior constrictor (muscle of lateral pharyngeal wall) to buccinator (muscle of lateral wall of oral cavity)
8
Q
What ligament connects the tip of the styloid process of the temporal bone to the lesser horn of the hyoid bone?
A
stylohyoid ligament
9
Q
Where does the anterior line of the attachment of the lateral pharyngeal wall extend after passing the lesser horn of the hyoid bone?
A
along the entire upper surface of the greater horn of the hyoid
10
Q
From the greater horn of the hyoid bone, where does the anterior line of attachment of the lateral pharyngeal wall extend?
A
descends along the oblique line of thyroid cartilage to the inferior tubercle of the thyroid cartilage
11
Q
From the inferior tubercle of thyroid cartilage, where does the anterior line of attachment of the lateral pharyngeal wall extend?
A
over the cricothyroid muscle via the tendinous arch (between the lower aspect of the oblique line of thyroid cartilage and the cricoid cartilage)
12
Q
Where does the anterior line of attachment of the lateral pharyngeal wall terminate?
A
the cricoid cartilage
13
Q
What are the 2 groups of pharyngeal muscles?
A
1) constrictor muscles2) longitudinal muscles
14
Q
What is the thick submucosal fascia called that supports the epithelial lining of the pharyngeal wall?
A
pharyngobasilar fascia
15
Q
How many constrictor muscles are there? Name them.
A
1) superior constrictor muscle2) middle constrictor muscle3) inferior constrictor muscle
16
Q
How many longitudinal muscles are there? Name them.
A
1) Stylopharyngeus2) Salpingopharyngeus3) Palatopharyngeus
17
Q
What are 5 of the 6 pharyngeal muscles innervated by?
A
CN X (pharyngeal branches)
18
Q
Which pharyngeal muscle is NOT innervated by CN X? What is it innervated by?
A
stylopharyngeus is innervated by CN IX (pharyngeal branches)
19
Q
What is the layer of pharyngeal fascia located EXTERNAL to the pharyngeal muscles called?
A
buccopharyngeal fascia
20
Q
What space is located between the buccopharyngeal fascia and the prevertebral fascia?
A
retropharyngeal space
21
Q
What is the deepest constrictor muscle?
A
superior constrictor is “deeper” if looking from a posterior view
22
Q
Does the pharynx have an anterior wall?
A
not really, it opens into many cavities anteriorly so the walls are mostly lateral and posterior
23
Q
What nerves contribute to the pharyngeal plexus?
A
CN IX (GSA)CN X (GVE parasympathetic)superior cervical sympathetic ganglia (GVE sympathetic)
24
Q
Name the 4 layers of the pharyngeal wall from the inside out?
A
1) mucous membrane2) pharyngobasilar fascia (submucosa)3) muscular layer (with constrictors and longitudinal muscles)4) buccopharyngeal fascia
25
Generally, which is deeper? Constrictors or longitudinal muscles of the pharynx. What is the exception?
Longitudinal muscles form mainly an inner layer but the exception is the superior portion of the stylopharyngeus being external
26
What makes up the uppermost aspect of the pharyngeal wall?
only the pharyngobasilar (continuous with periosteum at base of skull) and buccopharyngeal fascia *NO MUSCLE
27
What allows for the spread of infection from the skull into the mediastinum?
loose areolar tissue of the retropharyngeal space can fill with pus and cause swallowing and breathing problems
28
What muscular band helps to close off the nasopharynx during swallowing?
palatopharyngeal sphincter
29
What is the cricopharyngeus portion of the inferior constrictor called?
upper esophageal sphincter
30
What is the role of the upper esophageal sphincter?
helps to keep corrosive stomach contents from regurgitating back into the pharynx or laryngeal inlet
31
What can occur if the upper esophageal sphincter does not relax properly and chronic pressure builds up in the pharynx?
diverticulum
32
What is responsible for eructation? What is another name for eructation?
the upper esophageal sphincter makes the sound of eructation (belching)
33
What creates the first gap of the pharyngeal wall?
the gap between the superior constrictor and the base of the skull
34
What fills in the first gap of the pharyngeal wall?
pharyngobasilar fascia
35
What structures pass through the first gap of the pharyngeal wall?
1) cartilaginous portion of the auditory tube2) levator veli palatini3) ascending palatine branch of the facial artery4) palatine branch of the ascending pharyngeal artery
36
What creates the 2nd gap of the pharyngeal wall?
the gap between the middle and superior constrictor
37
What fills in the 2nd gap of the pharyngeal wall?
pharyngobasilar fascia
38
What passes through the second gap of the pharyngeal wall?
1) stylopharyngeus muscle (to get to thyroid cartilage)2) grossopharyngeal nerve3) lingual artery
39
At what point does the pharyngobasilar fascia begin to "thin out"?
below the hyoid bone
40
What forms the third gap of the pharyngeal wall?
the gap between the middle and inferior constrictors
41
What fills in the third gap of the pharyngeal wall?
thyrohyoid membrane
42
What passes though the third gap of the pharyngeal wall?
1) internal branch of the superior laryngeal nerve2) superior laryngeal artery
43
What forms the 4th and "last" gap of the pharyngeal wall?
the gap between the inferior constrictor and the esophagus
44
What passes though the 4th and final gap of the pharyngeal wall?
1) recurrent laryngeal nerve (which then is called the inferior laryngeal nerve)2) laryngeal branch of the inferior thyroid artery
45
What are the superior and inferior insertions of the pharyngeal raphe?
superior: pharyngeal tubercle of occipital boneinferior: continuous with the esophagus
46
What branches from the posterior surface of the external carotid artery and ascends on the pharynx?
ascending pharyngeal artery
47
What nerve passes laterally to the internal jugular vein to penetrate the sternocleidomastoid muscle?
accessory nerve
48
What structure originates from the vagus nerve at the base of the skull (just below the jugular foramen)?
superior laryngeal nerve
49
Where does the superior laryngeal nerve divide? What does it divide into?
the superior laryngeal nerve enters the carotid triangle and divides into the internal and external laryngeal nerves
50
What exits the hypoglossal canal posterior to the jugular foramen?
hypoglossal nerve
51
Lateral to the pharynx at the level of the atlas, the hypoglossal nerve receives fibers from which cervical ventral rami?
first and second
52
What is the fate of the C1 fibers that travel with the hypoglossal nerve?
1) some leave in the carotid triangle to form the superior root of the ansa cervicalis2) some continue with the hypoglossal nerve to innervate the thyrohyoid and geniohyoid muscles
53
What is found lying on the posterior surface of the stylopharyngeus muscle?
glossopharyngeal nerve
54
Is the internal carotid artery anterior or posterior to the stylopharyngeus muscle?
anterior
55
Where is the pharyngeal plexus located?
on the middle pharyngeal constrictor, near the greater horn of the hyoid bone
56
Where is the nasopharynx located?
between the base of the skull and the soft palate
57
Where is the oropharynx located?
between the soft palate and the base of the tongue/hyoid bone
58
Where is the laryngopharynx located?
between the hyoid bone and the level of the cricoid cartilage
59
What does the laryngeal inlet connect?
posterior pharyngeal wall and vestibule of the larynx
60
What two structures border the laryngeal inlet?
1) epiglottis2) aryepiglottic folds
61
What is located lateral to each aryepiglottic fold (on each side of the cricoid cartilage)?
piriform recesses
62
What provides sensory innervation to the mucosa of the piriform recess and laryngeal inlet (cough reflex)?
internal laryngeal nerve
63
What connects the base of the tongue to the epiglottis?
median and lateral glossoepiglottic folds
64
What are the pockets in the glossoepiglottic folds called?
valleculae epiglottica
65
Name the 4 phases of swallowing.
1) oral phase2) oral propulsive phase3) pharyngeal phase4) esophageal phase
66
What two parts of the oral phase are necessary for forming a bolus?
1) moistening (parasympathetic)- from saliva2) mastication (muscles controlled by CN V3)
67
What two nerves contribute to the release of saliva during the oral phase of swallowing? What salivary glands do they stimulate?
1) CN VII chorda tympani- submandibular and sublingual glands2) CN IX lesser petrosal- parotid gland
68
What nerve determines if the bolus is too dry to swallow?
lingual nerve (V3)
69
What are the two parts of the oral propulsive phase?
1) trough formation2) movement of the bolus posteriorly
70
What muscles allow the elevation of the tongue against the hard palate during trough formation? What nerves innervate these?
1) mylohyoid (CN V3)2) genioglossus (CN XII)3) styloglossus (CN XII)4) hyoglossus (CN XII)
71
What occurs when the bolus reaches the palatoglossal arch?
the involuntary pharyngeal reflex
72
What receptors initiate the involuntary pharyngeal reflex?
afferent limb of reflex (CN IX)efferent limb of reflex (pharyngeal plexus CN IX and X)
73
What must occur during the pharyngeal phase?
potential outlets from the pharynx other than the esophagus (nasopharynx and larynx) must be closed
74
What is inhibited during the pharyngeal phase?
chewing, breathing, coughing, and vomiting
75
During the closure of the nasopharynx, what tenses and elevates the soft palate?
tense- tensor veli palatini (CN V3)elevate- levator veli palatini (CN X)
76
During the closure of the nasopharynx, what is responsible for the contraction of the walls of the pharynx to meet the posterior free border of the soft palate?
1) palatopharyngeus 2) upper part of superior constrictor (pharyngeal plexus- CN X)
77
What pulls the pharynx upwards and forwards to receive the bolus?
1) suprahyoid2) stylopharyngeus (CN IX)3) salpingopharyngeus (CN X)4) palatopharyngeus (CN X)
78
What brings the palatopharyngeal folds on each side of the pharynx together so that only a small bolus can pass?
superior constrictor muscles
79
What is responsible for the closure of the oropharynx in the pharyngeal phase?
1) palatoglossus (X)2) intrinsic muscles of the tongue (XII)3) styloglossus (XII)
80
What is the primary mechanism to prevent aspiration during swallowing? What performs this action?
closure of the vocal folds (larynx) by lateral cricoarytenoids (inferior laryngeal nerve CN X)
81
What action directs the food bolus laterally towards the piriform fossa?
the retroversion of the epiglottis
82
What muscles work to pull the larynx up under the tongue during swallowing?
1) stylopharyngeus (CN IX)2) salpingopharyngeus (CN X)3) palatopharyngeus (CN X)4) Inferior constrictor (CN X)
83
What cranial nerves are involved in the reflex that inhibits respiratory center of the brain during swallowing?
Cranial Nerves V, X, XI, and XII
84
What works to elevate the hyoid during swallowing? What does this do?
1) Digastric (CN V and VII) 2) Stylohyoid muscle (CN VII)it elevates the pharynx and larynx up even farther
85
What moves the bolus through the pharynx and toward the esophagus? What controls this?
the pharyngeal constrictor muscles perform peristalsis (controlled by pharyngeal plexus: sensory- IX, motor- X)
86
Does gravity play a large role in swallowing of food?
NO
87
Where does the bolus move faster, the esophagus or the pharynx?
the pharynx!
88
What controls the esophageal phase of swallowing?
involuntary neuromuscular control (striated muscle- recurrent laryngeal (CN X) then smooth muscle (CN X))
89
What occurs due to elastic recoil after suprahyoid muscle contraction ends?
relaxation phase where larynx and pharynx move down from the hyoid
90
Why does speech therapy have a beneficial effect on some swallowing problems?
speech process uses the same neuromuscular structures as swallowing
91
What leads to the death rattle?
failure of the swallow reflex leading to build-up of mucus and saliva in the throat and airways
92
What is achalasia?
failure of the lower esophageal sphincter to respond properly to swallowing
93
What is found in the mucosa lying along the basilar part of the occipital bone (roof of the nasopharynx)?
pharyngeal tonsil (adenoids)
94
What is the entrance of the nasal cavities into the pharynx?
choanae (2 oval openings to either side of the nasal septum).
95
What is the elevated mucosa covering of the cartilaginous portion of the auditory tube called as it penetrates through the pharyngobasilar fascia?
torus tubarius
96
What is the vertical fold of mucosa called that extends inferiorly from the posterior border of the torus tubarius?
salpingopharyngeal fold (overlying salpingopharyngeus muscle)
97
What is the deep space at the superior end of the nasopharynx, just posterior to the torus and extending behind the upper part of the salpingopharyngeal fold?
pharyngeal recess
98
In what part of the pharynx does the digestive and respiratory systems cross?
oropharynx
99
What marks the end of the oral cavity and the anterior extent of the oropharynx?
tonsillar pillars (more specifically, the palatoglossal fold)
100
What are the tonsillar pillars?
mucosal folds overlying palatoglossus muscle anterior to the tonsil and the palatopharyngeus muscle posterior to the tonsil
101
What lies between the tonsillar pillars?
palatine tonsil
102
Where are the pharyngoepiglottic folds?
spanning between the palatopharyngeal fold and the epiglottis
103
What attaches to the superior border of the thyroid cartilage just deep to the pharyngoepiglottic folds?
stylopharyngeus muscle
104
What is the clinical significance of the piriform recesses?
they are common places for swallowed materials to lodge (superior laryngeal nerve crosses here!)
105
Where do CN 9, 10, and 11 exit the skull?
jugular foramen
106
Which cranial nerves coming from the jugular foramen have superior and inferior ganglia?
CN 9 and CN 10
107
Where are the superior and inferior ganglions of CN 9 and 10 located?
intracranially (superior) and outside the skull (the larger inferior ganglions)
108
What muscle is innervated by CN IX? What type of fibers perform this innervation?
stylopharyngeus, branchiometric (BE) motor innervation
109
What do the tonsillar and lingual branches of CN IX do?
1) sensory (GSA) information from posterior 1/3 of tongue and area around pharyngeal tonsil2) Taste (SA) from posterior 1/3 of tongue
110
What provides GSA sensory innervation from the nasopharynx and oropharynx?
pharyngeal branches (from CN IX)
111
What provides sensory nerve supply to the laryngopharynx?
pharyngeal branches of the vagus nerve (CN X)
112
What carries sensory innervation from the carotid body and sinus?
BODY: reflex loop from CN IX and CN XSINUS: reflex loop from CN IX
113
What is the function of the carotid body?
chemoreceptors for oxygen, CO2, pH and temperature
114
What is the function of the carotid sinus?
contains baroreceptors that sense pressure
115
What potential space extends from the base of the skull to the sheath of the submandibular gland?
lateral pharyngeal space
116
What does the lateral pharyngeal space communicate with? Why is this significant?
the retropharyngeal space (allows infections to spread from base of skull into mediastinum)
117
What could occur if something impaled the posterior pharyngeal wall?
the internal carotid artery or internal jugular vein could be penetrated or a wound could cause deep infection in lateral pharyngeal space
118
Where does the auditory tube extend?
from the pharynx to the middle ear
119
Does the nasopharyngeal wall move?
Not much, there is little muscle in the wall of the superior pharynx
120
What is the "entryway" between the oral cavity and pharynx
fauces (or oropharyngeal isthmus)
121
Name the arteries of the pharynx.
1) ascending pharyngeal (from external carotid)2) ascending palatine and tonsillar branches (of facial artery)3) descending palatine and pharyngeal branches (of maxillary artery)4) unnamed branches of lingual artery5) branches of inferior thyroid artery
122
Where does the pharyngeal plexus of veins drain?
1) pterygoid plexus2) internal jugular veins (via facial/thyroid veins)
123
Where are the retropharyngeal lymph nodes located?
between the pharynx and vertebral column
124
Where do the retropharyngeal lymph nodes drain?
deep cervical nodes
125
What is the primary lymph drainage from the nasopharynx?
jugulodigastric node
