Trans 24: basic sciences ent part 2 Flashcards
functions of the mucociliary system
• Function:
o Humidification
o Cleaning of inspired air
o Eliminating debris and excess secretion from paranasal sinus and nasal airway
trace the flow of the mucociliary system
• Mucociliary flow: mass motion of mucous layer at 1 cm/min (migration in the maxillary sinus begins at the floor of maxillary sinus → natural ostium → nasal cavity → nasopharynx
Components of mucociliary system? (3)
o Ciliated, pseudostratified columnar epithelium
o Double layered mucous blanket
o Mucous producing glands
: Deep, less viscous, serous fluid Inner part
Sol phase
Superficial, more viscous, mucous fluid At the top Acts like a conveyer belt where bacteria and foreign particles get trapped because it is viscous and with the action of the cilia the particles will be moved.
gel phase
roof of nasal cavity and adjacent area of superior turbinate and upper part of septum
olfactory mucosa
- diminished sense of smell o Causative factors ▪ Old age (presbyosmia) ▪ Hypogonadal women, menopause ▪ Tobacco smoker ▪ Radiation therapy of nose ▪ Surgical removal of the mucosa
hyposmia
It is a qualitative change - There occurs an unpleasant change in sense of smell o It may occur in the following conditions: ▪ Skull fractures ▪ Injury to uncus of the temporal lobe ▪ May follow administration of streptomycin
Parosmia
- Loss of the sense of smell o Its causes are the following: ▪ Obstructive lesions in the nose and nasopharynx ▪ Lesions of mucosa ▪ Trauma ▪ Neuritis ▪ Central lesions in the brain In our time today, the most common cause of anosmia would be COVID – 19 infection
Anosmia
The anterior and posterior ethmoidal air cells are separated from the orbital contents by the
lamina papyracea
represents a region through which the paranasal sinuses drain • Obstruction may lead to acute or chronic sinusitis
osteomeatal complex
Significance of the osteomeatal complex?
The importance of the osteomeatal surface is because it’s near the middle turbinate and middle meatus. This is the area where the maxillary sinus, frontal sinus, and anterior ethmoid drain. If there is a mass or polyp, it can block this drainage. That is the importance of the osteomeatal complex.
Vocal cord nodule aka
teacher’s nodule or singer’s nodule because they are commonly found in people with vocal abuse.
why is the nodule commonly found at the junction?
Because in the area where the nodules are found this is where the vocal cord is most mobile and has a stronger vibration. Therefore, trauma frequently occurs here especially in vocal abuse.
If the patient has vocal cord paralysis, what should we see?
The vocal cord is immobile
is the cavity at the back of the nose, mouth and larynx. • Fibromuscular tube that extends from the base of the skull to the inferior border of the cricoid cartilage • It opens into the esophagus at its inferior end
Pharynx/ larynx
part of the pharynx that lies at the back of the nose, above the level of the palate
nasopharynx
– part of the pharynx beyond the mouth
oropharynx
below the oropharynx Below the epiglottis
Hypopharynx
lining of nasopharynx vs lining of the oropharynx?
• The pharynx is lined with a mucus membrane that is respiratory (pseudostratified columnar) in the nasopharynx, but changes to non-keratinising stratified squamous epithelium in the parts that are exposed to food
what are the OUTER CIRCULAR PHARYNGEAL CONSTRICTOR MUSCLE LAYER
There are three constrictor muscles named simply the superior, middle and inferior constrictors
There are three constrictor muscles named simply the superior, middle and inferior constrictors and their main function is to
propel the food bolus downwards
INNER LONGITUDINAL MUSCLE LAYER
Three longitudinal paired muscles
salpingopharyngeus, stylopharyngeus and palatopharyngeus
fxn of inner lonigtudinal muscle layer?
Most of these muscles elevate the pharynx during swallowing
protective mechanisms that happen during
swallowing
• Protect the nasal airway from food through the action of the soft palate The soft palate goes up so that the food doesn’t enter the nose • Protect the lower airway via laryngeal mechanisms that include contraction of the laryngeal inlet and elevation of the larynx so bringing the epiglottis to lie like a lid over the inlet Elevation of the larynx pushes the epiglottis upwards • Relax the upper esophageal sphincter to allow the food to proceed into the digestive tract proper
Blood supply of the pharynx
• Ascending pharyngeal artery • Facial artery via ascending palatine and tonsillar arteries • Maxillary artery via greater palatine and pterygoid arteries • Lingual artery
nerve supply of the stylophrayngeus?
CN 9while all other pharyngeal muscle is supplied by CN 10
Sensory supply of nasopharynx?
maxillary nerve CN V2 and CN 9
sensory supply of oropharynx>
CN 9
Sensory supply of laryngopharynx
internal laryngeal nerve (CN 10)
is the organ of phonation Where sound is produced
larynx
How does the larynx produce sound?
Through the vibration of the vocal cords when air enters the larynx coming from the lungs during exhalation.
For the vocal cords to vibrate, they have to meet at the midline and close the laryngeal inlet. When the pressure increases due to the air coming from the lungs while the laryngeal inlet is closed, this pressure will overcome the tension of the closed vocal cords, causing them to open. Once opened, the pressure will be released and the vocal cords will close again. This cycle repeats and happens quickly.
most prominent structure or landmark in the anterior neck especially in males Above it is the hyoid bone and below is the cricoid cartilage
Thyroid cartilage
is an important landmark for emergency cricothyroidotomy to gain airway access in upper airway obstruction
Median cricothyroid ligament or membrane
Another important landmark is the median cricothyroid ligament. What is the importance of this? In emergency airway obstruction, if there is no equipment available, palpate this structure because it is easy to locate and is somewhat superficial. There are no other structures overlying the median cricothyroid ligament. You can puncture this o establish airway without causing too much bleeding.
The movement of the _________ causes the opening and the closing of the vocal cords.
arytenoids
the region above the vocal folds
Supraglottis
the level of the vocal folds
Glottis
the region below the vocal folds
subglottis
The level of the vocal folds that includes the vocal processes of the arytenoid cartilages and the space between the vocal folds (narrowed on phonation) is called the:
glottis
trachea starts at what landmark?
lower border of cricoid
Difference of intrinsic and extrinsic muscles?
When we say intrinsic muscles, the insertion and origin of these muscles are located at the laryngeal cartilages while extrinsic muscles contain attachments that are not laryngeal cartilages. • Extrinsic laryngeal muscles either originate or are inserted onto structures besides the laryngeal cartilages.
in general, what is the function of the extrinsic laryngeal muscles?
The extrinsic laryngeal muscles elevate or depress the larynx
what are the extrinsic depressors?
sternohyoid, sternothyroid, thyrohyoid, and omohyoid muscles
what are the extrinsic elevators?
geniohyoid, digastric, mylohyoid, stylohyoid muscles
in general what are the action of intrinsic muscles?
move the vocal chords
only vocal fold abductor?
posterior cricoarytenoid
nerve of post cricoarytenoid?
Recurrent laryngeal nerce
only intrinsic muscle supplied by external branch of superior laryngeal nerve?
Cricothyroid
(chief pitch-changing muscle)
Cricothyroid
The higher the tension, what happens to the pitch?
higher
only unpaired intrinsic muscle?
Interarytenoid
After thyroidectomy some patients experience changes in their voice, for example the patient is a singer and cannot reach high notes when singing or the pitch of the voice became lower, it could be that the _________ is damaged
external branch of SLN
Our vocal cords are composed of the (3)
e thyroarytenoid muscles, the vocal ligaments, and the mucosa. They are attached to the vocal process of the arytenoid and to the thyroid cartilage anteriorly.
Posterior cricoarytenoid muscles – attached to the
muscular process of the arytenoid cartilage
When the posterior cricoarytenoid contracts, the vocal process of the arytenoid will pivot, causing the vocal cords to
Abduct
When the cricothyroid contracts, it tilts the thyroid cartilage forward and this
this stretches and lengthens the vocal cords.
- All of the intrinsic laryngeal muscles Adduct the vocal cords, except:
The posterior cricoarytenoid muscle, which is an Abductor
. All of the intrinsic laryngeal muscles are innervated by the recurrent laryngeal nerve, except:
The cricothyroid muscle, that is innervated by the external laryngeal nerve (a branch of the superior laryngeal nerve)
– elderly olfaction or old age olfaction; is the gradual loss of olfactory abilities that occurs in most people as they grow older
presbyosmia
– A harsh vibrating sound heard during respiration in cases of obstruction of the air passages
Stridor
