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Block 2 > The Pharynx > Flashcards

The Pharynx Flashcards

1
Q

What is the pharynx?

A

Muscular tube that enables multiple areas to interconnect

Tube is not rigid, it is highly mobile + distensible + can undergo peristalsis

Hangs from base of skull to where oesophagus begins connecting nasal + oral cavities with larynx + oesophagus

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2
Q

What are the 3 regions of the pharynx? What is their sensory innervation?

A

Nasopharynx (Cn Vb + IX)
Oropharynx (CN IX)
Laryngopharynx (CN IX + X)

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3
Q

What travels through our pharynx? What route do they take?

A

Air: goes down larynx/tracheobronchial tree route

Food/fluid: oesophagus (fluid can come out too e.g. in vomiting)

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4
Q

What major structures drain into the nasal cavity?

A 
Frontal sinus
Sphenoid sinus
Maxillary sinus 
Ethmoidal sinus
Nasolacrimal duct
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5
Q

What structure stops food going up our nose when we swallow?

A

Soft palate as it seperates nasopharynx + oropharynx -> moves posterior-inferiorly when you swallow to block off nasopharynx

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6
Q

What 2 muscles control the soft palate and auditory tube? What do they do?

A

Tensor veli palatini: tenses palate laterally

Levetor veli palatini: elevates palate superiorly

Also open auditory tube when contracted as its normally closed

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7
Q

What is the structure posterior to the nasal cavity called?

A

Choanae = body of C1 + lower border of soft palate

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8
Q

What are the borders of the 3 sub-structures of the pharynx?

A

Nasopharynx: choanae + lower border of soft palate

Oropharynx: upper border of soft palate, palatal arches (muscles covered in mucosa that sit either side of tonsils)+ lower border of epiglottis

Laryngopharynx: base of tongue/upper epiglottis + cricopharyngeus muscle

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9
Q

What is the epiglottis?

A

Cartilage of larynx

Covers laryngeal inlet during swallowing

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10
Q

As you move down the pharynx, the regions get larger. What epithelium transition occurs?

A

Pseudostratified ciliated columnar epithelium(respiratory mucosa) -> stratified squamous epithelium (stops abrasions when you eat)

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11
Q

What is the cricopharyngeus muscle?

A

Circular strong muscle considered true oesophageal sphincter -> not a true anatomical sphincter but a physiological one as it has to relax to allow food to pass down

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12
Q

What cranial nerve carries sensory information from all portions of the pharynx, middle ear, auditory tube and inner side of tympanic membrane? Why is this relevant?

A

Glossopharyngeal nerve (CN IX)

Pain can refer from and to all of these structures

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13
Q

What are the 3 muscles of the pharynx? What do they do?

A
  1. Superior constrictor
  2. Middle constrictor
  3. Inferior constrictor
  • Lined by continuous internal fascia + mucosa - End at cricopharyngeus
  • > supplied by vagus nerve (CN X) to contract = reduce diameter of pharynx squeezing food down (peristalsis)
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14
Q

What 2 nerves control the gag reflex?

A

Vagus (CN X) - motor

Glossopharyngeal (CN IX) - sensory

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15
Q

If there is a vagus nerve (CN X) lesion and the pharyngeal muscles are paralysed, what symptoms might this lead to?

A

Dysphagia (uncoordinated/difficult swallowing)
Gag reflex compromised
Increased risk of aspiration

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16
Q

Describe the bony and ligamentous attachments to the pharyngeal muscles.

A

Styloid process -> attached to stylohyoid ligament -> stabilises hyoid bone + muscles

Also, pterygomandibular raphe, thyroid cartilage + cricoid cartilage

17
Q

What is eagle syndrome? How would patients present?

A

Styloid processes grow exceptionally long so they poke into soft tissue of pharynx

Leads to:
Dysphagia
Feeling of something stuck in throat 
Facial pain on head rotation
Carotid artery compression
18
Q

Why does the pharynx have a weak spot?

A

Pharyngeal constrictors overlap each other forming a functional unit + attaching posteriorly along a midline raphe (long tendon) which extends from base of skull to ‘weak spot’

Weak spot between inferior constrictor + cricopharyngeus as direction of muscle fibres change -> herniation can occur here posteriorly

19
Q

What 3 processes have to occur for normal swallowing to happen?

A
  1. Coordinated peristalsis of all pharyngeal constrictor muscles
  2. Relaxation of cricopharyngeus muscle
  3. Drop in intrapharyngeal pressure to allow food to progress downwards
20
Q

What is a Zenker (pharyngeal) diverticulum? What can this cause?

A

Posteriorly herniated pharyngeal lining at ‘weak spot’ forming a pouch

-> food/liquid will collect in pouch as oesophagus in front of it = halitosis+ coughing up of old food

21
Q

What is the piriform fossae? What is their function?

A

Mucosal lined pouch with walls formed by laryngeal structures i.e. recess between central larynx + lateral thyroid cartilage (CN IX)

Permits passage of food/liquids during swallowing in a directive route alongside larynx (foreign bodies e.g. bones can get stuck here -> pain referral to ear)

22
Q

What is the vallecula of the piriform fossa useful for?

A

Blade of laryngoscope can be placed in vallecula to pull tongue forward, opening up beginning of larynx if trying to intubate the trachea

23
Q

What motor nerve innervates all pharyngeal muscles? What are the 2 exceptions?

A

Vagus (CN X)

EXCEPT

Stylopharyngeus (CN IX) + tensor veli palatini (Cn Vc)

24
Q

What are longitudinal internal muscles called that elevate, shorten + widen the pharynx?

A

Stylopharyngeus
Salpingopharyngeus
Palatopharyngeus

All attach to soft palate + go down

25
Q

What is the salpingopharyngeus muscle? What does it do?

A

Longitudinal, internal muscle that arises from auditory tube to pharynx

It helps open tube on swallowing + equalizes pressure

Aids in elevating, shortening + widening pharynx in swallowing

26
Q

What are the palatoglossus and palatopharyngeus muscles? What do they do?

A

Both hang down from soft palate joining tongue + pharynx at entrance of oropharynx (surround palatine tonsils) - called ‘arches’ when covered with mucosa

When contracted, elevate the pharynx helping to cover food bolus

27
Q

What will happen if there is damage to CN X or Vc?

A

Ipsilateral soft palate paralysis - if this is on the right, soft palate will contract towards left (uvula will point to working side) -> issues aspirating food/liquid + also food/liquid will go into nasopharynx

28
Q

Gag reflex often diminished in the ___.

A

Elderly

29
Q

How do you text the gag reflex?

A
  1. Inspect soft palate + oropharynx for asymmetry
  2. Ask patient to phonate; if there is a weak side, palate + uvula will pull away from weak side
  3. Touch pharynx to elicit reflex:
    - Motor loss - sensation but unilateral/no contraction = CN X lesion
    - Sensory loss - no gag reflex when touching side with sensory loss but full gag when touching other side = CN IX lesion
  4. Assess swallowing + character of voice (if appropriate)
30
Q

What 4 bits of lymphoid tissue make up the Waldeyer Ring in the nasopharynx + oropharynx? Why do we need these?

A
  1. Pharyngeal (adenoid)
  2. Tubal
  3. Palatine
  4. Lingual

Need these here as there are lots of thins going in/out of this region

31
Q

What happens if any of the Waldeyer Ring lymphoid tissues increase in size?

A

Enlarged adenoids/tonsils
Tonsilitis

Adenoids can get so big breathing problems can ensue, auditory tube gets blocked so more prone to inner ear infections or tonsillitis repeatedly

Impedes swallowing, coordination + changes voice (can happen if tonsils taken out too)

Block 2 (45 decks)

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