Unit 10:swallowing Flashcards
What are the three different regions of the pharnyx?
The nasopharnyx
The oropharnx
The larynopharnyx
What are the different categories of muscles found in the pharynx?
The constrictor muscles
The longitudinal muscles
What are the three constrictor muscles found in the pharynx?
The superior constrictor
The middle constrictor
The inferior constrictor
What are the common posterior attachments for all the constrictor muscles in the pharynx?
The pharyngeal raphe
What is the innervation of constrictor muscles of the pharnyx?
The vagus nerve (CNX)
What is the common functionn of the constrictor muscles of the pharynx?
Constrict the pharynx - help proper bolus towards the oesophagus through peristaltic movement
Aided by circular fiber direction
What are the three different langitudinal muscles of the pharynx?
Stylopharyngeus
Salpingopharyngeus
Palatopharyngeus
What is the common insertion of the longitudinal muscles of the pharynx?
The pharangeal wall
What is the innervation of the stylopharyngeus muscle?
The glassopharyngeal nerve (CN9)
What is the innervation of the salpingopharyngeus muscle?
The vagus nerve (CNX)
What is the innervation of the palatopharnygeus muscle?
The vagus nerve (CNX)
What is the common function of the longitudinal pharnygeal muscles?
Elevate the larynx
Widen and shorten the pharynx
Aid swallowing
Due to vertical fibre direction
What is the additional function of the palatopharngeus muscle?
Closure of the oropharnygeal isthmus
Brings the pharynx anteriorlyy towards the soft palate
What is the main sensory innervation to the pharnyx?
The glassopharnygeal nerve
What are the additional contributes to the pharnyx sensory innervation?
Superior and anterior Nasopharnyx may have contribution from the CNV2
Inferior laryngopharynx may have contribution from the vagus nerve
What is the function of the gag reflex?
In real life - help prevent choking
In medical school - helps test the functioning of CN9 (glassopharnygeal - detects sensation) and CN10 (vagus nerve - activates the reflex)
How can the inferior constrictor be seperated into different parts?
The thyropharyngeal - oblique fibres to thyroid cartilage
The cricophrayngeus - horizontal fibres to the cricoid cartilage
What is Killian’s Dehiscence?
Point of weakness in the inferior constrictor of the pharynx
No muscle fibres in this area.
What is pharnygeal diverticulum?
Also called zenkers diverticulum
Originates from area of weakness in the killian dehiscence
Budling of pharnyx through the space, where food may accumulate during swallowing
Occurs when the thyropharngeus contraction and cricopharangeus relaxation does not occur in sync during swallowing.
What are some symptoms of pharyngeal diverticulum?
Regurgitation
Cough
Infection
bad breath - hallotis
Dysphagia
What three structures does the pharynx open into?
The larynx
The nasal cavity
The oral cavity
What are the boundaries of the nasopharynx?
base of the skull to the soft palate
What are the boundaries of the oropharnynx?
The uvula/ soft palate to tip of the epiglottis C3
What are the boundaries of the laryngopharynx?
The epiglottis C3 to inferior edge of cricoid cartilage
What are the five muscles of the soft palate?
The tensor veli palatini
The levator veli palatini
The musculus Uvulae
Palatopharnygeus
Palatoglossus
What strucutre seperates the buccinator muscle and the superior constrictor pharnygeal muscle?
pterygoidmandibular raphe
What is the function of the tensor veli palatini?
Forms an aponeurosis for attachement of other soft palate muscles
Tenses the palate which must be done in order for the palate to move anteriorly
Opens auditory tube
What is the function of levaotr veli palatini?
Elevates and retracts the soft palate
What is the function of the musculus uvulae?
Elevates and retracts the ulvula
What is the common area of attachement for the soft palate muscles?
Palatine aponeurosis
What is the function of the palatopharyngeus?
Elevate the pharnyx
May also pull in an anterior and medial direction
What is the function of the platoglossus muscle?
Elevate and retract the tongue - bring palatoglossus arches together
Why are the palatoglossus and the palatapharngeal muscle important clinically?
Mucosa surrounds these muscles
Creates a palatoglossus arch anteriorly and a platopharnygeal arch posteriorly
Between these two arches the palatine tonsil can be identified in the oral cavity
What structure can be seen in the throat posterior to the palatopharngeal arch?
The oropharnyx
Draw a diagram to show the location of the uvula, palatin tonsils, oropharynx, palatopharngyeal arch and the palatoglossal arch in the oral cavity.
What is shown in the image?
How can you tell?
Tonsilitis
Enlarged
White present - indicates pus associated with a bacteria infection
Results in red and enlarged tonsils, sore thorat
What is waladeyers ring of lymphoid tissue?
The ring of tonsils (all lymphoid tissue)
Includes the adenoids (pharangeal tonsils) at the back of the nasal cavity
The palatine tonsils in the oral cavity
The lingual tonsil in the root of the tongue
How does uvular deviation relate to anatomy?
Indicates one of the musculus uvulae is not working
Uvula will deviate towards the functional side that is able to contract (r)
Other side of mouth is the muscle that is not functioning (L)
The contralteral side of the brain will be damaged (R)
Indicates a problem with the vagus nerve
What are the different wats to test the vagus nerve function?
Gag reflex
Speech (larynx)
Uvula deviation
As provides motor innervation to the soft palate, pharynx and larynx
What nerves are responsible for the gag reflex?
Sensory - glossopharyngeal to oropharynx
Motor efferent of the vagus to pharyngeal and laryngeal muscles
What are the four suprahyoid muscles?
Stylohyoid
Geniohyoid
Mylohyoid
Digastric
What is the origin and insertion of the stylohyoid muscle?
Originates at the syloid process and inserts at the hyoid bone
What is the origin and insertion of the geniohyoid bone?
Originates at the genoid mass (inferior mental spine )and inserts at the hyoid.
What is the origin and insertion of the mylohyoid bone?
Originates at the myloid line of the mandible, inserts onto the myloid raphe and the hyoid bone
What is the origin and insertion of the digastric muscle?
Consists of two bellys
Posterior bellys spans between the mastoid process and the hyoid bone
Anterior belly spans between the hyoid bone and the digastric fossa on the mandible
What is the innervation of the stylohyoid muscle?
Facial nerve
What is the innervation of the mylohyoid muscle?
Trigeminal nerve
What is the innervation of the geniohyoid muscle?
C1 via hypoglossal
What is the innervation of the digastric muscle?
Anterior belly -trigeminal nerve V3
Posterior belly - facial nerve
What is the action of the stylohyoid muscle?
Elevate and retract the hyoid bone
What is the function of the mylohyoid muscle?
Protract and elevate the hyoid
What is the function of the digastric muscle?
Posterior belly - elevate and retract the hyoid
Anterior belly - elevate and protract the hyoid
When the hyoid is fixed the anterior belly may help to depress the mandible
Identify the epiglottis
What is its function?
9
Flatten when swallowing to prevent food passing down into the trachea
Identify the hard palate
13
Identify the hyoid bone
14
Identify the inlet of the larynx
15
Identify the mandible
20
Identify the nasal septum?
25
Cartilageenous and bony structure found in the idline of the nose that separates the left and right nostril
Identify the nasopharnyx
26
Indentify the opening of the auditory tube
27
What is structure 29?
Oropharnyx
What is strucutre 30?
Pharangeal tonsils (adenoids)
What is structure 34?
Soft palate
What is structure 42?
Vallecula
Depression at the base of the tongue, can trap saliva nad substances to inhibit the swallowing reflex
What close anatomical relationships are useful to remember when imaging the oesophagus?
Anterior - trachea
Posterior - vertebrae
What structure differentiates the oesophagus from the pharynx?
Circipharyngeus
What are the different sections of the oesophagus?
Cricopharyngesu to sternal notch - cervical
Sternal notch to diaphragmatic hiatus T10 - thoracic
Below the diaphragm till gastroesophageal junction at T11 - abdominal
What is the joureny of the oesophagus in the thorax?
Posterior and slightly to the left of the trachea
Posterior to the heart
Slight deviation to the left at dome of diaphragm where passes through the hiatus at T10
What is the main imaging method used for the oesophagus?
Barium meal on x-ray (contrast shows oesopagus, when asked to swallow food or water mixed with barium)
What features can be identified on this x-ray of the oesophagus?
-Orange - Valecculae - depression at base of tongue before the epiglottis
Blue - Piriform sinuses - depression aid speech production in the larynopharnyx
Green - cricoid
What is the narrowed structure at the bottom of the oesophagus?
Gastrooesophageal junction
What are the features of BArrets Oesophagus on a barium meal?
Faint white lines are reticular mucosal changes
Narrowing of the OJ
What is shown in the below image on the left ?
Barrets Oesophagus - narrowed oesophagus
What is shown on the image below on the right?
Oesophageal carcinoma
Are these normal or pathological images of the Lower oesophageal junction?
Normal
A - closed
B - open with some movement of liquid
What are the features of the Oesophagus on the image?
Red angry mucosa
Barrets Oesophagus
What are the features of the oesophagus on this image?
Oesophageal cancer
What are the stages of swallowing?
Oral
Oropharangngeal
Oesophageal
What is the medical term for swallowing?
Deglutition
What is part of the oral phase of swallowing?
Is under voluntary control - cortical areas such as motor control centre
Food is chewed mixed with saliva
Tongue pushes food up to the hard palate and backwards towards the pharynx
The hyoid bone is elevated and moves anteriorly to make room for the passage of bolus.
What is part of the pharyngeal phase of swallowing?
Tactile receptors in the oral pharynx are stimulated by bolus
The swallow reflex is initiated under involuntary neurmuscular control.
TOngue blocks oral cavity
Elevated Soft palate blocks the nasopharynx
Vocal folds and epiglottis closes and larynx is pulled superior to block passage to the trachea
UES opens to allow passage into the oesophagus
What are the stages of the oesophageal swallowing?
Food bolus is moved down the oesophagus by peristalsis
Larynx moves to inferiroly back to the original position
What are the clinically important features of the nasopharynx?
Conchae - turbulent air flow, helps humidfyt and eliminate large particles
Adenoids (pharyngeal tonsils) - immune response
Pharyngeal opening of the auditory tube - help stabilise pressure between the middle ear and ambient atmosphere
What is ottitis media?
Inflammation of the middle ear that has spread from the nasal cavity by the pharnygeal opening of the auditory tube
More common in children as tube is horter and more horizontal
Results in fever and ear pain
What is the clinical importance of the adenoids?
Epsteem bar virus, streptoccus
Leads to acute adenoiditis
Causing fever, nasal airway obstruction and rhinorrhae
What is pharyngitis?
Most common in children - inflammation of the pharyngeal mucosa
Sore throat and redness of pharyngeal walls
Fever and cough are less common
Streptoccal pharyngitis can be caused by Group A strep (risk of kidney and heart disease), causes puss on the tonsils
What is the laryngeal inlet?
Communcation between larynx and larynopharynx
What is epiglottitis?
Inflammation of epiglottis
Commonly caused by Haemophiluus influenza type 8
Causes obstruction of the airway
Commonly affects children
Fever, drooling, difficulty swallowing, stridor, cyanosis
May require intubation
What is the clinical importance of the piriform fossa?
Depressions just above the larynx
Small bones can become lodged
Causes pain, chocking or gagging.
What provides sensory innervation to the pharynx?
Naso: CNV2
Oro: CN9
Laryn :CN10
What provides innervation to the larynx?
Vagus nerve provides sensory and motor innervation.
What provides motor innervation the pharynx?
Vagus nerve (all expcet the stylopharnygeus which is innervated by the glassopharnygeal nerve)
How large is the pharynx?
From the base of the skull to C6
What are the five muscles of the soft palate shown in the image?
Tensor veli palatinit
Levator veli palatini
Musculus uvulae
Palatopharyngesus
Palatoglossues
What muscle groups contribute to the movement of the hyoid bone?
The suprahyoid - elevate
The infrahyoid - depress
What are the different sections of the hyoid bone?
Body of the hyoid
Lesser horn
Greater horn
What level is the hyoid bone found?
C3
Describe how the movement of the hyoid and the larynx are related?
Hyoid and the thyroid cartilage and epiglottis
Connected by membranes
What structures is the hyoid bone attached to?
Tongue
Mandible
Thyroid cartilage
Epiglottis
Describe how the airways are closed during swallowing?
Epiglottis moves down over laryngeal inlet
Larynx moves upwards and forwards
Cricopharnygeal sphincter relxes and oesophagus opens temporarily
Vocal cord close halting breathing
Identify the muscle
Músculos uvulae
Identify the muscle
Palatopharnygeus
Identify the muscle
Palatoglossus
Identify the muscle
Levator veli palatini
Identify the muscle shown
Tensor veli palatini
Identify the muscle shown
Posterior belly of digastric muscle
What are the different features of the hyoid bone
Blue body
Green lesser horn
Pink greater horn
Identify the muscle shown
Anterior belly of digastric
Identify the muscle shown
Stylohyoid muscle
Identify the muscle shown
Mylohyoid muscle
Identify the muscle shown
Geniohyoid muscle
Identify the muscle shown
Inferior pharyngeal constrictor
Identify the muscle shown
Middle pharyngeal constrictor
Identify the muscle shown
Superior pharyngeal constrictor
Identify the muscle shown
Stylopharnageus
Identify the muscle shown
Salpingopharngeus muscle
