W5: Neck, floor of the mouth, pharynx and larynx

Question 1

List and describe the four fascial compartments and what they contain

Answer 1

Investing layer: deep layer, completely surrounds neck
* attaches posteriorly to spinous process of vertebrae
* splits to encole trapezius and SCM

Superficial fascia: contains platysma

Question 2

What are fascia? What are the implications clinically - specifically when infection occurs

Answer 2

Tough C.T sheaths which seperate layers of tissues and allow for spread of substances/communication between spaces, including infection - provide a conduit for spread of infection down the superior mediastinum!
Infection in Md or Mx molar spreads to buccal fat pad, submasseteric, pterygomandibular spaces and parapharyngeal and retropharyngeal spaces (spread up and down the neck) -> Occlusion of the AIRWAY

Question 3

Describe the shape, attachments, articulations and action of the hyoid bone

Answer 3

subdivides anterior triangle into a suprahyoid and infrahyoid region (for muscle classification)

Question 4

What is Ludwigs angina?

Answer 4

Question 5

Describe the 3 compartments of the investing layer (fascia)

Answer 5

Question 6

The neck is divided into anterior and posterior triangle for descriptive purposes. Define the borders of each.

Answer 6

Question 7

List the 4 subdivisions of the anterior triangle

Answer 7

Submd, Submental, Muscular, Carotid
SUSPEND THE HYOID

Question 8

List the three extrinsic muscles of the tongue and their action

Answer 8

Question 9

What muscle makes up the pillar of the fauces? What is their role

Answer 9

Muscosa overlying muscles associated with the soft palate…Palatoglossos (anterior arch), Palatopharyngeaus (posterior arch)
(in between is palatine tonsil)
= constrict the oropharyngral isthmus in swallowing

Question 10

What are the 2 ‘roles/action’ of the soft palate

Answer 10

Question 11

What defines the ‘neck’

Answer 11

Question 12

What two muscles attach to the pterygomandibular raphe

Answer 12

Superior pharyngeal constrictor and buccinator muscles

Question 13

List the origin, insertion, nerve and action of the sternocleidomastoid

Test - Actions?

Answer 13

Question 14

List the origin, insertion, nerve and action of the trapezius

Answer 14

Question 15

Describe the passage of the XI cranial nerve

Answer 15

Question 16

Why is the XI nerve likely to be damaged with a superficial injury

Answer 16

The XI nerve is quite superficial as passes through the posterior triangle, therefore damage is likely

Question 17

List and describe the action of the ANTERIOR suprahyoid muscles

Answer 17

Anterior Belly of digastric
Mylohyoid
Geniohyoid

Question 18

List and describe the action of the POSTERIOR suprahyoid muscles

Answer 18

Posterior belly of digastric
Stylohyoid
Action: elevate the hyoid and larynx when Md is stabilised

Question 19

List the nerve innervation to each of the suprahyoid muscles

Answer 19

Question 20

List the origin, insertion, nerve and action of the stylohyoid

Answer 20

Question 21

List the origin, insertion, nerve and action of the digastric

Answer 21

Question 22

List the origin, insertion, nerve and action of the mylohyoid

Answer 22

Question 23

List the origin, insertion, nerve and action of the geniohyoid

Answer 23

Question 24

List the 4 infrahyoid muscles and there associated insertions/origins as well as the innervation

Answer 24

Question 25

What is the anatomical name of the 'adams apple'

Answer 25

thyroid cartilage (laryngreal cartilage)

Question 26

Which two **endocrine glands** are positioned **anteriorly** in the **neck**. Describe there location

Answer 26

**Thyroid gland** is a large unpaired gland, located inferior and lateral to the thyroid cartilage. It consists of two lateral lobes connected by an isthmus (crossing the ant. surfaces of 2nd and 3rd Cricoid cartilage tracheal cartilages). It lies within the pretracheal fascia together with pharynx, trachea and oesophagus. Highly vascular, thyroid hormones **Parathyroid gland**

Question 27

Describe the embryolocial origin of the thyroid and parahyroid glands and the associated clinical relevance

Answer 27

*Both glands have developmental origins as **pharyngeal outgrowths**, and **migrate caudally**.* **Parathyroid glands**- Two pairs derived from **3rd (superior) or 4th (inferior) pharyngeal pouches**.

Question 28

Describe the **arterial** supply to the **thyroid and parathyroid glands**

Answer 28

Question 29

Describe the **venous** supply to the **thyroid and parathyroid glands**

Answer 29

Question 30

What **nerves** are closely associated with the **thyroid and parathyroid glands**

Answer 30

Left and right recurrent laryngeal nerves

Question 31

What is the role of the parathyroid gland

Answer 31

Secrete parathyroid hormone, control of calcium and phosphorous metabolism.

Question 32

What pocket of lymphoid tissue helps form waldeyers ring

Answer 32

Palatine tonsil

Question 33

What **bones** make up the **Hard palate**

Answer 33

Question 34

Describe the anatomy of the tongue (including important landmarks and function of posterior 1/3 vs anterior 2/3)

Answer 34

Anterior 2/3: Posterior 1/3:

Question 35

What foramen is associated with the thyroglossal duct?

Answer 35

Foramen Caecum - thyroglossal duct: developmental passage of the thyroid gland

Question 36

List the **intrinsic** muscles of the tongue, their function and associated innervation

Answer 36

Hypoglossal N (XII)

Question 37

List the **extrinsic** muscles of the tongue, their function and associated innervation

Answer 37

Question 38

How would you test the viability of the XII nerve

Answer 38

Ask patient to **poke out their tongue**

Question 39

List the origin, insertion, nerve and action of the **genioglossus**

Answer 39

Question 40

List the origin, insertion, nerve and action of the **hyoglossus**

Answer 40

Question 41

List the origin, insertion, nerve and action of the **palatoglossus** with regard to the tongue

Answer 41

Question 42

List the origin, insertion, nerve and action of the **styloglossus**

Answer 42

Question 43

Describe the innervation of the tongue

Answer 43

Question 44

What is likely to be the **presentation** if the if the **XII** is **damaged**

Answer 44

Possibly by fracture of the Md as the nerve runs just deep to the body of the Md

Question 45

Describe the passage of the **lingual artery**

Answer 45

Branch of external carotid runs posterior/medially to hyoglossus, travels superior to enter the tongue Supplies: Sublingual and submandibular gland and muscles of the tongue

Question 46

What are the three parts of the pharynx

Answer 46

Nasopharynx Oropharynx Laryngopharynx

Question 47

What 5 muscles contribute to the formation and movement of the soft palate

Answer 47

**tensor veli palatini** **levator veli palatini** **palatopharyngeus** **palatoglossus** **musculus uvulae**

Question 48

List the origin, insertion, nerve and action of **tensor veli palatini**

Answer 48

When tenses forms stable platform in which any of the muscles of the soft palate is able to pull **IMPT MUSCLE - ONLY ONE THAT CLOSES GAP - ALLOWS SWALLOWING**

Question 49

What is the palatine aponeurosis

Answer 49

Question 50

Which muscle is involved in equalisation of pressure when a change in air pressure occurs

Answer 50

**tensor veli palatini** = trying to equalise pressure in the middle ear by **straightening the pharyngotypamic tube**

Question 51

List the origin, insertion, nerve and action of **levator veli palatini**

Answer 51

Question 52

List the origin, insertion, nerve and action of **palatopharyngeus**

Answer 52

Question 53

List the origin, insertion, nerve and action of the **palatoglossus** with regard to the soft palate

Answer 53

Question 54

List the origin, insertion, nerve and action of the **musculus uvulae** with regard to the soft palate

Answer 54

Question 55

Which 2 muscles help in **narrowing the pillars of fauces** to allow swallowing

Answer 55

Question 56

Which gland curves around the mylohyoid, lying superior and inferior

Answer 56

submd gland

Question 57

Describe the **innervation** to the salivary glands

Answer 57

Question 58

What lymphoid structure provides protection (immune cells) against foreign particles entering through the two orifices

Answer 58

Waldeyer's ring

Question 59

Describe the parts of the Pharynx

Answer 59

**A musculo-fascial tube that links the ora and nasal cavities in the head to the oesophagus and larynx in the neck. **Runs from base of the skull to the oesophagus (approx C6) 3 parts: -**nasopharynx**- posterior apertures of the nasal cavities open into this -**Oropharynx** - posterior opening of the oral cavity -**Laryngopharynx** - posterior to larynx - including laryngeal inlet

Question 60

Describe the **constrictor** muscles of the **pharynx** (including the innervation and origin/insertion)

Answer 60

Unite posteriorly at the paryngeal raphe

Question 61

Describe the orientation of the fibres of the muscles of the pharynx

Answer 61

Question 62

Describe the **longitudinal** muscles of the **pharynx** (including the innervation and origin/insertion)

Answer 62

Question 63

Describe **motor innervation to the pharynx**

Answer 63

Question 64

Describe **sensory innervation to the pharynx**

Answer 64

Question 65

Describe the composition of the larynx including the structure and innervation

Answer 65

Question 66

The thyroid cartilage is the most superior and largest cartilage of the larynx. Otherwise known as the laryngeal prominence, "Adam's Apple". Which muscles attach here?

Answer 66

*Lateral oblique line- attachment of **extrinsic muscles of larynx and inferior constrictor** unpaired

Question 67

What cartilage is most inferior, completely encircling the airway?

Answer 67

Cricoid cartilage - unpaired *Broader posterior than anterior*

Question 68

What is known as the 'leaf shaped cartilage'

Answer 68

Epiglottis - unpaired

Question 69

List the three paired cartilages of the larynx

Answer 69

Arytenoid Cuneiform Corniculate

Question 70

List and describe the two functionally important intrinsic fibro-elastic membranes of the larynx

Answer 70

**Cricothyroid membrane/ ligament:** Extends between the cricoid cartilage and thyroid cartilage anteriorly. Superiorly the free border thickens to form the **vocal ligament **(**true vocal cord**) of the larynx. **Quadrangular membrane:** Extends between the epiglottis and arytenoid cartilages, and extends anteriorly to the thyroid cartilage. Thickened free border forms the **vistibular ligament (false vocal cord).**

Question 71

What allows movement of the vocal ligaments?

Answer 71

Question 72

Describe how the laryngeal functions - During **quiet respiration and forced inspiration**

Answer 72

Question 73

Describe how the laryngeal functions - During **phonation (forming sounds)**

Answer 73

Question 74

Describe how the laryngeal functions - During **effort closure**

Answer 74

Question 75

Describe how the laryngeal functions - During **swallowing**

Answer 75