Thursday, 3-24-Pharynx and Larynx (Stephens)

Question 1

List the 3 phases of deglutition

Answer 1

1) Oral phase-synonymous with mastication
2) oropharyngeal phase-elevation of floor of mouth and tongue in order to push the bolus into the oropharynx
3) pharyngo-esophageal phase-oropharynx elevates and constricts around the bolus, and propels it down the esophagus

Question 2

___ muscle is the key muscle in the cough reflex. It pushes the viscera inside the abdominal cavity up against the diaphragm to elevate up to the mid-sternal level

Answer 2

External abdominal oblique m.

Question 3

The pharynx is located posterior to the nasal cavity, mouth, and larynx. It extends from the pharyngeal tubercle to the level of ___ vertebra

Answer 3

C6

Question 4

List the boundaries of the pharynx:

Answer 4

• Choanae: nasal cavity and nasopharynx
• Pharyngeal isthmus: nasopharynx and oropharynx
• Facial isthmus: oral cavity and oropharynx

Question 5

The nasopharynx is located posterior to the nasal cavity. It communicates with the nasal cavity via the ___ and communicates with the oropharynx via the ___

Answer 5

chonae

Pharyngeal isthmus

Question 6

This nerve pierces the thyrohyoid membrane along with the superior laryngeal a. This is the CHIEF SENSORY NERVE TO THE INTERIOR OF THE LARYNX and is involved in the COUGH REFLEX

Answer 6

Internal branch of superior laryngeal n.

Question 7

The laryngeal receptors and afferent fibers of the internal branch of the superior laryngeal nerve represent the afferent component of the ___ reflex

Answer 7

laryngeal cough–> If ibSLN is not functional during the initiation of the protective cough reflex, the protective value of the laryngeal cough refle is compromised, and there is an increased risk of developing aspiration pneumonia in neurologically impaired pts.

Question 8

The ___ are situated posterior and lateral to the arytenoid cartilages in the laryngopharynx. It will slightly dilate if the pt says “a-a-a” in a low voice. Secretions may gather here, but they should disappear on swallowing. If they do no, the pt has a “pooling” sign, which suggests obstruction of paralysis of the upper esophagus

Answer 8

piriform recess

Question 9

The stylopharyngeus muscle is innervated by SVE fibers of the ___ n.

Answer 9

IX

Question 10

What is regarded as the most important inner elevator of the pharynx?

Answer 10

Stylopharyngeus m.

Question 11

List the pharyngeal constrictor muscles

Answer 11

• superior constrictor
• middle constrictor
• inferior constrictor

Question 12

Pts who have had a total laryngectomy may learn to use esophageal speech, which is the vibration of the ___ muscle by regurgitation of swallowed air

Answer 12

cricopharyngeus m.

Question 13

___ is a subdivision of pre tracheal fascia and covers the outer surface of the buccinator muscle and the pharynx. It attaches to the pharyngeal tubercle, pterygomandibular raphe, hyoid, and the thyroid and cricoid cartilages

Answer 13

buccopharyngeal fascia

Question 14

___ is between the buccopharyngeal fascia and pre vertebral fascia. It is important clinically because infections can spread from either region via this space. In surgical fusion of the cervical vertebra, the anterior bodies of the cervical vertebrae are approached via this space

Answer 14

Retropharyngeal space

Question 15

The pharynx is innervated by the __ plexus, which is embedded in the buccopharyngeal fascia

Answer 15

pharyngeal

Question 16

The pharyngeal plexus receives sensory (GVA) from the pharyngeal branch of the ___ n.

Answer 16

Glossopharyngeal (IX)

Question 17

The pharyngeal plexus receives motor (SVE) fibers from the pharyngeal branch of the ___ n.

Answer 17

vagus (X)

Question 18

The sensory fibers of the gag reflex are conveyed by the __ n. while the efferent component is mediated by the __ n.

Answer 18

IX

X

In by 9, out by 10

Question 19

The epithelium in the laryngopharynx region is innervated by the ___

Answer 19

internal branch of superior laryngeal n.

Question 20

The superior horn of the thyroid cartilage is continuous with the __ and its inferior horn articulates with the ___

Answer 20

hyoid bone

cricoid cartilage (cricothyroid joint)

Question 21

The cricoid arch forms the main supporting element of the laryngeal airway. It is generally located at the level of ___

Answer 21

CV6

Question 22

What does the base of the arytenoid cartilage articulate with? The apex?

Answer 22

Base articulates with the cricoid cartilage–> has a L-shaped, turn-style configuration formed by vocal ligament of vocal cord

Apex articulates with the corniculate cartilage

Question 23

The ___ cartilages form the posterior attachment of the vocal ligaments

Answer 23

arytenoid

Question 24

The ___ are cup-shaped recesses between the tongue and epiglottis. During intubation, the blade is often placed in this.

Answer 24

Valleculae epiglottica

Question 25

How is the laryngeal aditus opened during intubation?

Answer 25

The end of the blade moves the tongue and epiglottis forward

Question 26

The ___ is pierced by the ibSLN and SLA

Answer 26

thyrohyoid membrane

Question 27

Where is a cricothyrotomy performed?

Answer 27

cricoid cartilage

Question 28

Where does the recurrent laryngeal n. pass relative to the cricothyroid joint?

Answer 28

Posterior to the joint

Question 29

___ is located superior to the cricopharyngeus m. and inferior to the inferior constrictor muscles. The result is an out pouching of the posterior pharyngeal wall just above the esophagus

Answer 29

Killians triangle

Question 30

___ is located just above the cricopharyngeus m. It is a false diverticulum

Answer 30

Zenker’s diverticulum

Question 31

What is the main blood supply to the pharynx?

Answer 31

Ascending pharyngeal a.

Question 32

During an emergency cricothyrotomy, the __ ligament is cut

Answer 32

Median cricothyroid l. –> located on the anterior side of the larynx between cricoid and thyroid cartilages

Question 33

___ is the only abductor of the vocal cords

Answer 33

Posterior cricoarytenoid

Question 34

When this muscle contract, it decreases the tension on the vocal ligament

Answer 34

vocalis m.

Question 35

When this muscle contracts, it increases tension on the vocal cords. This muscle opposes the action of the vocals m.

Answer 35

circothyroid m.

Question 36

What is the innervation of the cricothyroid m.?

Answer 36

external branch of the superior laryngeal n. (of vagus)

Question 37

These laryngeal muscles are involved in adduction

Answer 37

Lateral cricoarytenoid

Arytenoideus

Question 38

After the recurrent laryngeal n. crosses the cricthyroid joint and enters the larynx, it is now called the ___ n.

Answer 38

inferior laryngeal

Question 39

Lesions of the __ n. result in hoarseness and dysphagia. There may also be coughing or choing d/t collapse of the aryepiglottic fold and subsequent drainage of fluids into the larynx

Answer 39

recurrent laryngeal

Question 40

Anteriorly, the vocal cords meet at the midline, where they are attached to the __ cartilage. Posteriorly, the vocal cords are attached to the vocal processes of the __ cartilage

Answer 40

Thyroid

arytenoid

Question 41

Which attachment of the vocal folds is mobile and allows the cords to open and close during respiration and phonation?

Answer 41

Posterior attachment –> anterior attachment is fixed

Question 42

The lobes of the thyroid gland are ___ to the trachea and the isthmus is anterior to tracheal rings ___. The carotid sheath is ___ to the trachea, the esophagus is ___ to the trachea, and the recurrent laryngeal nerve is __ to the trachea

Answer 42

lateral

2-4

lateral

posterior

posterolateral in the longitudinal groove between trachea and esophagus

Question 43

What is the afferent component of the laryngeal expiration reflex? What is the efferent component of the laryngeal expiration reflex?

Answer 43

afferent=ibSLN innervates these receptors. Afferents enter the medulla with the vagus n. and terminate in the vicinity of the NTS

efferent=recurrent laryngeal, intercostal, and abdominal nerves control laryngeal, intercostal, and abdominal muscles, respectively

Question 44

What are the 3 regions of the interior larynx?

Answer 44

Vestibule of the larynx
Vestibular folds
Ventricle of the larynx

Question 45

__ is part of the vestibule of the larynx. It is a triangular-shaped opening between the laryngo-pharynx and the larynx. During deglutition, it collapses inward and is covered by the epiglottis

Answer 45

laryngeal aditus

Question 46

The ___ (or false vocal cords) lie directly above and slightly lateral to the true vocal folds. They can act as laryngeal sphincters but do not produce sound.

Answer 46

vestibular folds

Question 47

___ is the elliptical-shaped opening formed by the free edge of the vestibular folds

Answer 47

rima vestibularis

Question 48

The __ is a slit-like cavity located between the vestibular and vocal folds

Answer 48

ventricle

Question 49

Dilations of the __ may occur due to prolonged periods of intra-laryngeal pressure; this condition may occur in musicians (horns) and singers and is generally non-pathological

Answer 49

Saccule–> laryngocele

Question 50

___ is the opening formed by the free margin of the vocal folds; it varies in shape from respiration (diamond-shaped) to vocalization (slit-shaped)

Answer 50

rima glottidis