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ENT Advanced > The Pharynx > Flashcards

The Pharynx Flashcards

1
Q

What is the pharynx?

A

A muscular tube

Connects the larynx and oesophagus to the nasal cavities

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2
Q

What can pass down the pharynx?

A

Air and food

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3
Q

Where, precisely, does the pharynx begin and end?

A

Begins at the base of the skull

Ends inferior to the cricoid cartilage (C6)

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4
Q

Name the three parts of the pharynx

A

Nasopharynx

Oropharynx

Laryngopharynx

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5
Q

What are the muscles of the pharynx innervated by?

A

The vagus nerve (CN X)

Except for the stylopharyngeus, innervated by the glossopharyngeal nerve (CN IX)

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6
Q

What is the function of the circular muscles of the pharynx?

A

Contract sequentially from superior to inferior to constrict the lumen and propel bolus of food inferiorly into the oesophagus.

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7
Q

Structure of the circular muscles of the pharynx?

A

Stacked like glasses

Form an incomplete muscular circle

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8
Q

Name the circular muscles of the pharynx and the parts in which they are found.

A

Superior pharyngeal constrictor - oropharynx

Middle pharyngeal constrictor - laryngopharynx

Inferior pharyngeal constrictor - laryngopharynx

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9
Q

What are the two components of the inferior pharyngeal constrictor

A

Superior (thyropharyngeus) - has oblique fibres that attach to the thyroid cartilage

Inferior (cricopharyngeus) - horizontal fibres attaching to the cricoid cartilage

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10
Q

Generally, what is the structure of the wall of the pharynx?

A

Pharyngeal mucosa

Incomplete ring of lymphoid tissue

Longitudinal muscular layer

Circular muscular layer

Buccopharyngeal fascia

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11
Q

Function of the longitudinal muscles of the pharynx?

A

Shorten and widen the pharynx

Elevate it during swallowing

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12
Q

Attachements of the longitudinal muscles of the pharynx?

A

Stylopharyngeus - styloid process of temporal bone to the pharynx

Palatopharyngeus - hard palate of oral cavity to the pharynx

Salpingopharyngeus - Eustachian tube to pharynx

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13
Q

What extra function does the salpingopharyngeus perform?

A

Opens the Eustachian tube to equalise pressure in the middle ear with the atmosphere.

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14
Q

Sensory innervation of the pharynx?

A

Nasopharynx - maxillary

Oropharynx - glossopharyngeal

Laryngopharynx - vagus

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15
Q

Sympathetic innervation to the pharynx?

A

From the superior cervical ganglion

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16
Q

Arterial supply to the pharynx?

A

Branches of the external carotid

  • ascending pharyngeal
  • lingual
  • facial
  • maxillary
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17
Q

Venous drainage of the pharynx?

A

Pharyngeal venous plexus, drains into the internal jugular

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18
Q

Where does the nasopharynx run between?

A

Base of the skull to the soft palate

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19
Q

Function of the nasopharynx?

A

Extension of the nasal cavity

Conditions inspired air and propogates it into the larynx

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20
Q

Epithelium of the nasopharynx?

A

Ciliated pseudostratified columnar with goblet cells

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21
Q

Where are the adenoid tonsils found?

A

In the posterio-supeior nasppharynx

22
Q

What can cause enlargement of the adenoid tonsils?

A

Viral infections of the upper respiratory tract

23
Q

What can happen if the adenoids keep becoming infected and enlarged?

A

Obstruct the opening of the Eustachian tube

Prevents equalising of pressure in the middle ear and normal drainage of fluids for excretion

Glue ear

24
Q

Where does the oropharynx run from and to?

A

Soft palate and supeior border of the epiglottis

25
Q

What does the oropharynx contain?

A

Posterior third of the tongue

Lingual tonsils

Palatine tonsils

Superior constrictor muscle

26
Q

What is the function of the oropharynx?

A

Voluntary and involuntary phases of swallowing

27
Q

Where are the palatine tonsils found?

A

In the tonsilar fossa between the palatoglossal and palatopharyngeal arches of the oral cavity

28
Q

Where are the lingual tonsils found?

A

Inferiorly to the tongue

29
Q

What is inflammation of the palatine tonsils (tonsilitis) accompanied by?

A

Enlarged jugulo-digastric lymph nodes

30
Q

What can bleed during a tonsillectomy?

A

External palatine vein

Tonsilar branch of the facial artery

31
Q

What can be damaged during a tonsillectomy?

A

Glossopharyngeal nerve

Internal carotid artery

32
Q

If an infection spreads from the palatine tonsils to the peritonsilar tissue, what is this known as and what happens?

Why is it an emergency?

A

Cause an abscess

Can get deviation of the uvula (quinsy)

Potential obstruction to the pharynx

33
Q

How is quinsy treated?

A

Drain the abscess

Antibiotics

34
Q

Where does the laryngopharynx run between?

A

Superior border of the epiglottis

Inferior border of the cricroid cartilage (C6)

Becomes continuous with the oesophagus

35
Q

Where is the laryngopharynx found in relation to the larynx?

A

Posterior to the larynx

36
Q

What does the laryngopharynx contain?

A

Middle and inferior pharyngeal constrictors

37
Q

Where can foreign objects become lodged in the pharynx?

A

Valleculae in the nasopharynx

Piriform fossae in the laryngopharynx

38
Q

How are objects in the piriform fossae visualised and removed?

A

With a pharyngoscope

39
Q

What can be affected when something is lodged in the piriform fossa?

A

Can compress the internal laryngeal nerve and the recurrent laryngeal nerve

40
Q

What happens during swallowing normally with the inferior pharyngeal constrictor?

A

The superior part - thyropharyngeus - contracts

The cricopharyngeus relaxes

This allows the bolus to be propelled into the oesophagus and prevent intrapharyngeal pressure from rising

41
Q

What can happen if there is not the relaxation of the cricopharyngeus during swallowing?

A

Intrapharyngeal pressure rises

Pharyngeal mucosa forms a midline diverticulum between the thyropharyngeus and cricopharyngeus

Food can accumulate here, leading to dysphagia

42
Q

Where are the widest and narrowest parts of the pharynx?

A

Widest (5cm) opposite the hyoid

Narrowest (1.5cm) at the inferior end

43
Q

What is between the muscle layer and the mucosa of the pharynx?

A

The pharyngobasilar fascia

44
Q

What are the phases of swallowing?

A

Voluntary phase

Pharyngeal phase

Oesophageal phase

45
Q

What happens in the voluntary phase of swallowing?

A

Tongue moves bolus to the back of the pharynx

46
Q

What happens in the pharyngeal phase of swallowing?

A

Afferent info from pressure receptors in the palate and anterior pharynx reaches the swallowing centre in the brain stem

Triggers movements:

  • Inhibition of breathing
  • Raising of larynx
  • Closure of the glottis
  • Opening of the upper oesophageal sphincter
47
Q

What happens in the oesophaeal phase of swallowing?

A
  • Wave of peristalsis sweeps down the oesophagus, propelling the bolus into the stomach in about 9 seconds
  • Coordinated by extrinsic nerves from the swallowing centre of the brain
  • Lower oesophageal sphincter opens
48
Q

What triggers the gag reflex and what is the pathway?

A

Touching the back of the oropharynx

Afferent pathway - glossopharyngeal

Efferent pathway - vagus nerve

49
Q

Clinical features of enlarged adenoids?

A
  • Nasal obstruction
  • Mouth breathing and nasal speech
  • Feeding difficulty especially in infants
  • Snoring/obstructive sleep apnoea
  • Block opening of Eustachian tube
50
Q
A

ENT Advanced (24 decks)

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