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GP block (Y3) > Week 5: ENT 2 (anatomy of nose, mouth and throat) > Flashcards

Week 5: ENT 2 (anatomy of nose, mouth and throat) Flashcards

1
Q

function of the nose

A
  • Smell and taste
  • Breathing- route for inspired air
    • Filters inspired air trapping particle sin nasal hair and mucous
    • Moistens (humidifies) and warms
  • Resonating chamber for speech
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2
Q

anatomy of the nasal cavity

A
  • External nose (vestibule) from the external nose to the nasopharynx
  • Anterior nares= nostrils (apertures)
  • Posterior nasal apertures (choanae)
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3
Q

external nose

A
  • Made up of cartilage (near the nostrils) and bone
  • Important bone = nasal bone (paired bone)
  • Clinical correlates
    • Prominence of nasal bone makes them susceptible to fracture in facial injury
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4
Q

vestibule

A

Lined with skin containing sebaceous/sweat glands and hair filters inspired air

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5
Q

nasal cavity

A

Has bony boundaries and is divided into left and right by midline septum

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6
Q

the nose has 2 lateral walls - describe their structure

A
  • Irregular due to presence of bony projections (conchae/ turbinate’s)
    • Superior (part of ethmoid)
    • Middle (part of ethmoid)
    • Inferior (other bone
  • These creates meatuses
    • Superior
    • Middle
    • Inferior
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7
Q

opening sunder the meatuses allows for

A

drainage of the

  • Paranasal air sinus in nasal cavity
  • Nasolacrimal duct in nasal cavity
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8
Q

Why does the nose have this irregular anatomy?

A
  • slows airflow by causing turbulence of airflow
  • increases surface area over which air passes
  • doesn’t always require immediate intervention
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9
Q

bones whcih form the food of the nasal cavity

A

frontal bone

nasal bone

ethmoid bone (cribriform plate)

sphenoid

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10
Q

the nasal roof can be used to

A

access parts of the brain found ont he cranial floow

e.g. Transsphenoidal surgical approach- e.g. gaining access to the pituitary gland via the sphenoid bone

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11
Q

medial wall of the nasal cavity- the septum

A
  • Consists of a bony and cartilaginous part
    • Anterior= septal cartilage
    • Posterior= perpendicular plate of the ethmoid bone and the vomer bone
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12
Q

if you dont treat a septal heamtoma what forms and why

A

saddle nose deformity

untreated septal haematoma e.g. caused by trauma leads to avascular necrosis of cartilaginous septum

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13
Q

nerve innervation of the nasal cavity

A
  • V1- Ophthalmic
  • V2- Maxillary
    • Majority of nasal cavity (particularly lateral wall) supplies by V2
  • V3- mandibular
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14
Q

lining of the nasal vaity

A

Vestibule lined by skin

Deeper lined with mucus membrane - very vascular

  • olfactory region
  • respiratory region
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15
Q

olfactory region

A
  • Olfactory mucous membrane
    • Contains dendrites of olfactory nerves
      • Covers over roof of the nasal cavity (including superior concha/superior part of the septum)
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16
Q

Respiratory mucous membrane

A
  • Pseudostratified columnar epithelium
  • Rich in goblet cells
  • Filters (mucous and cilia)
  • Humidifies and warms(rich blood supply)
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17
Q

Rich blood supply to the nasal mucosa

A

Allows for warming and humidification of inspired air

  • Mucosa and blood vessels are easily injured
    • Nose bleed (epistaxis)
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18
Q

arterial supply of the nose includes

A

ophthalmic artery

maxillary artery

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19
Q

ophthalmic artery blood supply to the nose

A

Ethmoidal arteries (anterior and posterior)

  • feed into Little’s / kiesselbachs plexus
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20
Q

maxillary artery branches supplying the nose

A
  • Form a rich arterial anastomoses in the anterior septum (Keisselbachs plexus)
    • Most common source of bleeding in epistaxis (e.g. picking of nose)
    • Easily treatable with simple first aid measure- pinching nose
    • Usually just one sided
    • Sphenopalatine artery
      • Small proportion of nosebleeds
        • Potentially more serious and difficult to reach(harder to reach to tamponade
        • Bleeding in both nostrils
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21
Q

venous drainage of npse

A
  • Form a rich arterial anastomoses in the anterior septum (Keisselbachs plexus)
    • Most common source of bleeding in epistaxis (e.g. picking of nose)
    • Easily treatable with simple first aid measure- pinching nose
    • Usually just one sided
    • Sphenopalatine artery
      • Small proportion of nosebleeds
        • Potentially more serious and difficult to reach(harder to reach to tamponade
        • Bleeding in both nostrils
          *
22
Q

paranasal sinuses: name

A

1. Frontal air sinuses (can have 2,3 or 4)

2. Ethmoid air sinuses

3. Maxillary air sinuses- most common infection due to gravity and draining mucus

4. Sphenoidal air sinuses

23
Q

what are paranasal sinuses

A
  • Air filled spaces that are extension of the nasal cavity
  • Rudimentary or absent at birth
  • Lined with respiratory mucosa
    • Ciliated and secretes mucous
  • Named according to the bone in which they are found
  • Various functions – humidify and warm inspired air
    • Reduce weight of the skull
  • Drain into the nasal cavity via small channels (ostia in middle conchia) into a meatus
    • Most in the middle meatus
  • Infection of nasal cavity involving sinuses (sinusitis)
    • Maxillary sinus most commonly infected
24
Q

importnant anatomical relations of paranasal sinuses include

A

nasal cavity, orbit and anteriro cranial foss

  • roots of upper teeth can progest into maxiallary sinus
25
Q

sensory innervation of paranasal sinuses

A

from the trigeminal (V)

  • Va (frontal, ethmoidal and sphenoid sinus)
  • Vb (maxillary sinus)
26
Q

Nasal cavity separate to oral cavity=

A

the hard and soft palate

  • Tip of soft palate= uvula
27
Q

how many teeth

A

32

28
Q

area between lips and teeth

A

vestibule

29
Q

palatoglossal and palatopharyngeal arches

A

(Mc Donald’s signs)

  • Where tonsils sit within
30
Q

salivary glands

A

x3 paiers

  • parotid
  • submandibular
  • sublingual
31
Q

parotid glands

A
  • Lies anterior to the SCM and ear
  • Behind the masseter and zygomatic arch
  • Duct opens up in the upper region of the oral cavity- Stenson’s duct (near upper 2nd molar)
  • produces 25% of all saliva
  • serous consistency with lots of enzymes
32
Q

sublingual gland

A
  • Lie under the tongue
  • 5% of saliva
  • More mucous saliva and less enzymes than the parotid gland
33
Q

submandibular gland

A
  • Sits below the mandible and in submandibular triangle
  • Produces a mixed saliva
    • Serous
    • Mucous
    • Biggest contributor volume wise- 70% of all saliva
34
Q

production of saliva

A

Exocrine structure of the salivary gland

  • Acinus is where the saliva is produced
    • Isotonic with plasma
    • Isotonic solution passes out of the acinus due to myoacinus epithelial cells which contract the acinus to move saliva into the duct
    • Once in the ductal region , ductal cells use transporters to move Na+ and Cl- out of the solution and K+ and HCO3- into the solution
      • Producing a hypotonic solution near the end of the duct (removal of ions >secretion)
    • The amount of modification by the ductal cells depends on how quickly the saliva is moving through the ductal system
      • Basal level- most hypotonic solution
      • When eating the solution moves through much quicker, less contact with ductal cells- smallest change to the tonicity of the isotonic solution (more secretion of HCO3- when active saliva production
35
Q

tongue made up of

A

intrinsic and extrinsic muscles

36
Q

intrinsic muscles of the tongue

A
  • Intrinsic muscle (not attached to other muscles except other intrinsic muscles)
    • 4 pair muscles
      • Longitudinal
      • Transverse
      • vertical
    • Motor innervation – hypoglossal nerve
37
Q

extrinsic muscles of the tongue

A
  • arise from other structures and insert into tongue
    • Genioglossus
    • Hyoglossus
    • Styloglossus
      • Motor innervation: hypoglossal nerve
    • Palatoglossus
      • Motor innervation (vagus nerve)
38
Q

sensory supply of the tongue

A
  • Divides tongue into
    • Anterior 2/3
      • Sensation- trigeminal (V3)
      • Taste- facial
    • Posterior 1/3
      • Sensation and tase- glossopharyngeal
39
Q

throat - pharynx divided into

A
  • Nasopharynx
    • Behind nasal cavity
  • Oropharynx
    • Behind oral cavity
  • Laryngopharynx
    • Behind larynx
40
Q

the nasopharynx- upper pharynx

A
  • Pink part in the photo
  • Behind the nasal cavity
  • borders
    • Base of skull- upper border
    • C1,C2- posterior border
  • Nasal cavity- anterior border
  • Contains
    • Pharyngeal tonsil e.g. adenoids
  • glossopharangeal sensory supply
41
Q

the oropharynx- middle pharnx

A
  • Yellow part on photo
  • Starts where the nasopharynx end
  • Borders
    • Soft palate to epiglottis
    • Anterior- oral cavity
    • Posterior (C2,C3)
  • Contains
    • Palatine tonsils
  • glossopharangeal supply
42
Q

palatine tonsils

A

collection of lymphoid tissue in the oropharyngeal mucosa. They form part of Waldeyer’s ring

function: preventing infection in the respiratory and digestive tracts by producing antibodies (B and T cells) that help kill infective agents

43
Q

laryngopharynx- lower pharynx

A
  • Blue part on photos
  • Borders
    • Oropharynx to oesophagus
    • Epiglottis to cricoid cartilage
      • Anterior- larynx
      • Posterior (C4, C5, C6)
  • Contains
    • Piriform fossa
  • pharyngeal branches of the vagus nerve
44
Q

piriform fossa

A

Epiglottis (flap on right photo) acts as a director of flow of fluid and water into the piriform fossa into the oesophagus instead of the trachea

45
Q

General overview of muscle arrangements in the pharynx

A

3x longitudinal muscles

  • Stylopharyngeus
  • Palatopharyngeus
  • Salpingopharygeus

3x constrictors (circular)

46
Q

Stylopharyngeus

A
  • Originates from the styloid process and goes down to the posterior border of the thyroid cartilage
  • Innervation- glossopharyngeal nerve (CN IX)
47
Q

palatopharyngeys

A
  • Originates from the hard palate and extends down to the attach to the posterior border of the thyroid gland
  • Pharyngeal branch of vagus (CN X)
48
Q

salpingopharyngeaus

A
  • Originates from the cartilaginous part of ET- merges with the palatopharyngeus
  • Pharyngeal branch of vagus (CN X)
49
Q

Pharyngeal constrictors

A

X3 circular (more semi-circular) muscles all insert on the pharyngeal raphe)

  • Superior pharyngeal constrictor
    • Origin – pterygomandibular raphe
    • Middle pharyngeal constrictor
      • Origin- hyoid bone
    • Inferior
      • 2 parts
        • Thyropharyngeal (origin- thyroid cartilage)
        • Cricopharyngeal (origin- cricoid cartilage
  • All supplies by the vagus nerve
50
Q

aim of pharngeal constrictors

A
  • Constrict walls of pharynx when swallowing
51
Q

General overview of nerve innervation of pharynx

A
  • Pharyngeal plexus
    • Located mainly on surface of middle constrictor muscle
    • Vagus, glossopharyngeal and cervical sympathetic nerve
  • Motor
    • CNX -Vagus innervates all muscles
      • Except stylopharyngeus (glossopharyngeal nerve (CN IX))
  • Sensory
    • Nasopharynx (glossopharyngeal nerve CN IX)
    • Oropharynx ( glossopharyngeal nerve CN IX)
    • Laryngopharynx (vagus nerve CNX)
52
Q

swallowing

A

1) Oral stage

  • Voluntary
  • Tongue touching hard-palate

2) Pharyngeal phase

  • Involuntary
  • Tongue touching hard palate
  • Soft palate elevation
  • Dangerous stage- shared airway space
    • Need to protect airway
      • By shortening longitudinal muscles- elevate larynx and pharynx→ widening it
      • Closure of epiglottis (sealing the airway)

3) Oesophageal phase

  • Relaxes upper oesophageal sphincter
  • Rapid peristalsis
  • Lower oesophageal sphincter relaxes and bolus goes into stomach

GP block (Y3) (39 decks)

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