Throat Anatomy Flashcards
what is the posterior boundary of the oral cavity
oropharynx
what is the superior border of the oral cavity
hard palate and soft palate
what is the anterior border of the oral cavity
upper and lower teeth
what is the inferior border of the oral cavity
floor of mouth/tongue
what muscles are the muscles of the floor of the mouth
mylohyoid, geniohyoid, anterior belly of digastric
what is the anterior surface of the tongue
ventral surface; when lifting tongue up
what surface anatomy can be seen on the floor of the mouth
sublingual papillae, lingual vein, L/R sublingual folds, frenulum
what are the sublingual papillae
opening of submandibular salivary glands ducts
what causes a tongue tie
frenulum too short; binds tongue to gingivae of lower incisors
name the major salivary gland pairs
parotid, submandibular, sublingual
what type of salivary glands are responsible for basal secretions
minor salivary glands
where are the minor salivary glands
oral mucosa of lips, cheeks, palate
where is the parotid gland
anterior/inferior to ear
is the parotid gland normally palpable
no
where is the submandibular gland
inferior to mandible
is the submandibular gland normally palpable
yes
where is the sublingual gland
under floor of mouth
is the sublingual gland normally palpable
no
what is the supply to the parotid gland
parasympathetic secretomotor CNIX
what is the supply to the submandibular gland
chorda tympani parasympathetic secretomotor supply
what is the supply to the sublingual gland
chorda tympani CNVII supply
where is the duct of the parotid gland
crosses masseter, pierces buccinator to open on parotid papillae of buccal mucosa
where is the duct of the submandibular gland
opens on sublingual papillae
where is the duct of the sublingual gland
opens on sublingual fold
what type of muscle is the tongue made of
skeletal
what is the sensory supply to the anterior 2/3 of the tongue
sensory CNV3, special sensory CNVII chorda tympani
what is the sensory supply to the posterior tongue
CNIX
what parts of the tongue are located within the oral cavity
only anterior 2/3
where is the foramen ceacum
midline depression at apex of terminal groove of tongue
what is the embryological significance of the foramen caecum
origin of thyroid gland
what type of mucosa are on the tongue
lingual mucosa
what is the function of the vallate papillae
taste buds
name the papillae of the tongue
vallate, foliate, fungiform, filiform
what are the possible embryological abnormalities of the thyroid gland
thyroglossal duct cysts or ectopic location
where are thyroglossal duct cysts
anywhere on path of descent from foramen caecum to thyroid
how can you tell if a lump in the neck is part of the thyroid
thyroid lumps move with the larynx on swallowing
whats the difference between extrinsic and intrinsic tongue muscles
intrinsic are within the tongue
what is the function of the extrinsic tongue muscles
change tongue position
name the extrinsic tongue muscles and where they originate
palatoglossus (palate), styloglossus (styloid process), hyoglossus (hyoid), genioglossus (mandible)
what is the function of the intrinsic tongue muscles
change tongue shape
where does CNXII attach to the CNS
rootlets at medulla oblongata
what is the intracranial path of CNXII
anteriorly towards hypoglossal canal
which bone is the hypoglossal canal a part of
occipital bone
what is the extracranial path of CNXII
descends lateral to carotid sheath, at hyoid level passed anteriorly to lateral tongue
what is the arterial supply to the tounge
lingual artery from external carotid
where is CNXII in relation to the loop of the lingual artery
lateral
how to clinically test CNXII
ask patient to stick tongue straight out
what will unilateral CNXII damage cause when testing CNXII
tip points toward damaged side
where is the palatine tonsil
in tonsillar fossa (space between arches of soft palate)
what are the arches of the soft palate formed of
skeletal muscle covered in mucosa
what structure is the uvula a part of
soft palate
what is the management of an injury to the vermillion border
refer to plastic surgeon
what bones form the hard palate
maxillae, palatine and sphenoid
what structure runs in the midline of the hard palate
median palatine suture
what parts of the sphenoid contribute to the hard palte
lateral & medial pterygoid plates
what foraminae are seen on the hard palate
palatine foraminae and incisive foramen
what runs though the palatine foraminae
CNV2 branches & vessels
what is seen on surface anatomy of the hard palate
palatal rugae and duct openings of the palatine glands
what bone is the pterygoid hamulus a part of
sphenoid
what are the 5 muscle pairs of the soft palate
levator veli palatine, tensor veli palatini, palatoglottus, palatopharyngeus, musculus uvulae
what is the function of tensor veli palatini
tenses soft palate
what is the function of levator veli palatini
lifts soft palate towards base of skull
what is the innervation of the soft palate skeletal muscles
all CNX except tensor veli palatini (CNV3)
3 functions of the soft palate
stops food going in nose when swallowing, directs air in nose, closes orophaynx entrance in gag reflex
how to test the motor function of soft palate
ask patient to say ‘ahhh’
what is an normal result when testing the motor function of the soft palate
uvula should lift straight up in midline
what is an abnormal result when testing the motor function of the soft palate
in unilateral nerve damage uvula pulled away from non-functioning side
describe the external layer of the pharynx
circular constrictor voluntary muscles overlapping each other
what is the innervation of the external constrictor muscles of the pharynx
CVX pharyngeal plexus
what are the names of the external constrictor muscles of the pharynx
superior, middle and inferior constrictor muscles of the pharynx
where do the constrictor muscles of the pharynx insert
onto the midline raphe
and onto pharyngeal tubercle of occipital bone
what is cricopharyngeus
upper oesophageal sphincter
what vertebral level is circopharyngeus
C6
name the longitudinal muscles of the pharynx and where do they originate
stylopharyngeus (styloid process), palatopharyngeus (palate), salpinogopharyngeus (pharyngotympanic tube cartilage)
where do the longitudinal muscles of the pharynx insert
thyroid cartilage posterior border
what is the innervation of the longitudinal muscles of the pharynx
all CNX except stylopharyngeus (CNIX)
what is the function of the longitudinal muscles of the pharynx
elevate pharynx & larynx
what is a tonsil
mucosal site of lymphoid tissue
name the tonsil of the nasopharynx and oropharynx
palatine tonsil, pharyngeal tonsil, tubal tonsils, lingual tonsil,
(also palate associated lymphoid tissue)
where are the tubal tonsils
in mucosa of eustachian tube opening
where is the pharyngeal tonsil
in mucosa of roof of nasopharynx
where is the lingual tonsil
in mucosa on posterior 1/3 of tongue
what is Waldeyer’s ring
defensive ring of lymphoid tissue in pharynx
define regional node
group of LN that 1st receive lymph drained from a given structure
where are the retropharyngeal nodes
in the retropharyngeal space
where are the submental nodes
posterior to the mental process of the mandible
where are the submandibular nodes
superficial to the submandibular gland
where are the deep cervical nodes
in the carotid sheath
what node drains the palatine tonsil
jugulo-digastric node
what are the region of nodes for the tip of the tongue
submental nodes
where do all nodes of the head/neck eventually drain to
deep cervical LN
what is the clinical difference between a lymph node in infection and a lymph node in cancer
infection: pain, soft, smooth, not fixed
cancer: no pain, hard, irregular, fixed
what is the function of the larynx
regulates airflow & protects against aspiration
where is the larynx located
between pharynx & trachea in the visceral layer of the pretracheal fascia in the neck
name the fascia compartments of the neck
retropharyngel space, pretrcheal fascia, carotid sheath, investing fascia, prevertebral fascia
what are the content of the pretracheal fascia
strap muscles, thyroid, trachea, larynx, oesophagus, pharynx, recurrent laryngeal nerves
what are the strap muscles
infrahyoid muscles (could go into more detail here?)
what is the function of the strap muscles
accessory muscles of breathing
where is the pretrachial fascia in relation to the investing fascia
deep
what type of fascia are the fascia compartments of the neck
deep fascia
where is the larynx in relation to the laryngopharynx
anterior
what is the laryngopharynx
region of pharynx from epiglottis to oesophagus
what vertebral level is the larynx
between C4-C6
what vertebral level is the hyoid bone
C3
what vertebral level are the tracheal cartilages
C2-4
what are the carotid sheath contents
internal jugular vein, common carotid artery, vagus nerve, deep cervical lymph nodes
is the spinous process of T1 normally palpable
yes
is the spinous process of C7 normally palpable
yes
is the spinous process of C6 normally palpable
no
are the transverse processes of cervical vertebrae normally palpable
yes
what parts of the mandible are palpable
angle of the mandible, lower border of the mandible, mental process of the mandible
is the hyoid bone normally palpable
yes
what is the laryngeal inlet
opening into airway from mouth
what direction does the epiglottis move to reduce the risk of aspiration when the laryngeal inlet closes
posteriorly
where is the thyrohyoid membrane
vertical fibres between hyoid bone and superior border of thyroid cartilage
what is the adam’s apple
Laryngeal prominence of the thyroid cartilage
what shape is the 1st tracheal ring
C shaped
what is the cricothyroid joint
joint between cricoid cartilage and inferior horn of the thyroid cartilage
what is the epiglottis made of
elastic cartilage
name the processes of the arytenoid cartilages
vocal process and muscular process
where and how do the arytenoid cartilages attach
to the cricoid cartilage via the cricoarytenoid joint
what are the cartilages that make up the laryngeal cartilages
thyroid cartilage, cricoid cartilage, arytenoid cartilages
what is compressed in cricoid pressure
pressing on lamina of cricoid cartilage compresses the oesophagus against the C6 body
what is the benefit of cricoid pressure
oesophagus closed but airway open to allow ventilation but prevent prevent aspiration
what is the other name for the laryngeal inlet
aditus
where is the false vocal cord in relation to the true vocal fold
superior
what structure separates the true and false vocal fold
laryngeal ventricle
what part of the larynx is inferior to the true vocal cord
infra-glottic cavity
what part of the larynx is superior to the false vocal cord
laryngeal vestibule
what is the difference between a vocal cord and a vocal fold
become cords when covered in connective tissue
where do the false vocal cords attach
arytenoid cartilage to epiglottis
where do the true vocal cords attach
arytenoid cartilage to thyroid cartilage
what is the difference in the function of the true and false vocal cords
only the movement of the true vocal cords impacts sound
where is the quadrangular membrane
between vestibular ligament and epiglottis
where is the conus elasticus
between cricoid and vocal ligament
where is the vestibular ligament
free lower border of quadrangular membrane
where is the vocal ligament
free upper border of conus elasticus
where is a laryngoscope placed
vallecula
where is the vallecula
space between epiglottis and tongue
what is the rima glottidis
space between the true vocal cords
what is the aryepiglottic fold
superior border of quadrangular membrane
what type of muscles are the intrinsic muscles of the larynx
skeletal muscle
what is the function of the intrinsic muscles of the larynx
movement of the vocal cords
how will tension of the vocal cords affect voice
increase pitch
how will relaxation of the vocal cords affect voice
decrease pitch
how will adduction of the vocal cords affect voice
quieter
how will abduction of the vocal cords affect voice
louder
what is the innervation to the intrinsic muscles of the larynx
all CNX
what intrinsic muscle of the larynx tenses the vocal cords
cricothyroid muscles
what ixtrinsic muscle of the larynx relaxes the vocal ligament
thyroarytenoid muscles
what are the attachments of the cricothyroid muscles
anterolateral cricoid cartilage to inferior horn of thyroid cartilage
action of the cricothyroid muscles
‘nod’ thyroid cartilage
what are the attachments of the thyroarytenoid muscles
posterior thyroid to anterior arytenoid cartilage
what intrinsic muscles of the larynx adducts the vocal ligaments
lateral crico-arytenoid muscles and arytenoid muscles
what intrinsic muscle of the larynx abducts the vocal ligaments
posterior crico-arytenoid muscles
what are the attachments of the lateral crico-arytenoid muscles
muscular process of the arytenoid to anterior cricoid cartilage
what are the attachments of the arytenoid muscles
1 arytenoid cartilage to another cricoid cartilage
what are the components of the arytenoid muscles
oblique band and transverse band
what is the action of the arytenoid muscles
close rima glottidis
what are the attachments of the posterior crico-arytenoid muscles
posterior cricoid cartilage to muscular process of arytenoid cartilage
what is the action of the posterior crico-arytenoid muscles
open rima glottidis
what happens to the intrinsic muscles of the larynx when whispering
Lateral crico-arytenoids
contract
what happens to the intrinsic muscles of the larynx in phonation
Arytenoids contract and lateral crico-arytenoids assist
what happens to the intrinsic muscles of the larynx in forced respiration
Posterior crico-arytenoids contract
what happens to the intrinsic muscles of the larynx at rest
Laryngeal muscles relaxed
which LN do supra-glottic tumours spread to
deep cervical nodes
where do glottic tumours spread do
95% stay on the cords
which LN to sub-glottic tumours spread do
paratracheal nodes
what is subglottal pressure
pressure in respiratory tree inferior to larynx
what happens in the larynx during phonation
when subglottal pressure threshold is reached then air crosses vocal cords causing vibration
role of the pharynx, oral &nasal cavities in phonation
amplify laryngeal buzz
nasal sounds
“m”, “n” or “ing”
what is tracheo-oesophageal puncture
Air flow directed through oesophagus below cricopharyngeus muscle
innervation of intrinsic muscles of the pharynx
all inferior laryngeal nerve apart from cricothyroid (external laryngeal)
innervation of mucosa above the folds
internal laryngeal nerve
innervation of mucosa below the folds
inferior laryngeal nerve
where does left recurrent laryngeal become inferior laryngeal nerve
at the level of cricothyroid joint
what are the ENT relevant branches of the vagus nerve
left recurrent laryngeal and superior laryngeal nerve
what does the superior laryngeal nerve branch into
internal laryngeal nerve and external laryngeal nerve
what is galen’s anastomosis
anastomosis between internal laryngeal nerve & inferior laryngeal nerve
where does the recurrent laryngeal nerve branch off CNX
in mediastinum (left under arch of aorta)
how to clinically test the CNX supply of the pharynx
get patient to swallow small sip of water and watch the larynx move
how to clinically test the CNX supply of the larynx
listen for voice hoarseness and listen/watch the power of their cough
