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Semester 4 > Head And Neck Session 10 > Flashcards

Head And Neck Session 10 Flashcards

1
Q

What does the pituitary gland sit within?

A

Sells turcica

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2
Q

Why is an alternate name for the pituitary gland hypophysis Cerebri?

A

It is an extension of the cerebrum

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3
Q

What type of embryonic tissue forms the posterior pituitary gland?

A

Neuroectoderm

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4
Q

What type of embryonic tissue forms the anterior pituitary gland?

A

Ectoderm

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5
Q

What is Rathke’s pouch?

A

Outpouching of stomatodeum

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6
Q

Describe the development of Rathke’s pouch.

A

Grows dorsally, losing connection with oral cavity by the end of the 2nd month

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7
Q

What happens to the anterior wall cells of Rathke’s pouch?

A

They proliferate rapidly to form the anterior pituitary lobe and pars tuberalis

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8
Q

Describe the growth of pars tuberalis.

A

From anterior wall cells of Rathke’s pouch growing along stalk of infundibulum to surround it

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9
Q

What happens to the posterior wall cells of Rathke’s pouch?

A

Form pars intermedia

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10
Q

Does pars intermedia have significance in humans?

A

No

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11
Q

What is the infundibulum in pituitary gland development?

A

Downward extension of the diencephalon

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12
Q

In which direction does the infundibulum grow in pituitary gland development?

A

Down towards the roof of the pharynx

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13
Q

What does the infundibulum form in pituitary gland development?

A

Posterior lobe and stalk

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14
Q

What are the posterior lobe and stalk of the pituitary made up of?

A

Neurological cells and nerve fibres from the hypothalamic area

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15
Q

When does the primordia of the pituitary gland arise?

A

Third week

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16
Q

When does the primordia of the tongue arise?

A

4th week (at the same time as the palate)

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17
Q

Do all of the pharyngeal arches contribute to the development of the tongue?

A

Yes

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18
Q

What are the contributions from PA1 to the tongue?

A

2 lateral swellings and 1 median swelling (tuberculin impar)

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19
Q

Describe the development of the PA1 contributions to tongue development.

A

2 lateral swellings overgrow tuberculum impar and merge together to form the body of the tongue

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20
Q

What is the cupola in tongue development?

A

Mesenchyme proliferation from PA2, 3 &4

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21
Q

Describe the development of cupola.

A

Tissue from PA3 overgrows that of PA2 to form the root of the tongue

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22
Q

What is the contribution of PA4 to the development of the tongue?

A

Forms epiglottal swelling to create the epiglottis and extreme posterior portion of the tongue

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23
Q

What provides general sensory innervation to the body of the tongue?

A

CNV3 and glossopharyngeal

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24
Q

What explains the general sensory innervation of the body of the tongue?

A

The majority of its mucosa comes from PA1&3 therefore cranial nerves associated with these dominate

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25
Q

What gives general sensory innervation to the root of the tongue?

A

Glossopharyngeal and vagus

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26
Q

What gives general sensory innervation to the epiglottis and extremes posterior part of the tongue?

A

Superior laryngeal nerve

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27
Q

Why does chorda tympani give special sensory innervation to the body of the tongue despite not being the cranial nerve associated with PA1?

A

It passes into the arch through the middle ear

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28
Q

What gives special sensory innervation to the root of the tongue?

A

Glossopharyngeal

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29
Q

Why is the motor innervation of the tongue provided by the hypoglossal nerve?

A

Intrinsic and extrinsic myogenic precursors arise in occipital somites and migrate to the tongue, taking their innervation with them

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30
Q

What marks the border between the body and root of the tongue?

A

Sulca terminalis

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31
Q

Where does the primordium of the thyroid gland arise?

A

In the floor of the pharynx between tuberculum impar and copula

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32
Q

How is the origin of the thyroid gland seen in the adult?

A

Foramen cecum

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33
Q

Describe the descent of the thyroid primordium.

A

In front of pharyngeal gut tube, hyoid bone and laryngeal cartilages connected to the tongue by the thyroglossal duct

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34
Q

What does the thyroglossal duct connect?

A

Isthmus of thyroid with tongue

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35
Q

What forms the pyramidal lobe of the thyroid gland seen in 50% of the population?

A

Remnant of thyroglossal duct at isthmus

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36
Q

When does the thyroid gland reach its final position?

A

7th week

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37
Q

When does the thyroid gland become functional?

A

End of the 3rd month

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38
Q

What provides follicular cells to the thyroid gland?

A

Thyroid diverticulum

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39
Q

What provides parafollicular cells to the thyroid gland?

A

Ultimobranchial body of 4th PA

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40
Q

What is a thyroglossal cyst?

A

Fluid filled pouch found anywhere along the thyroglossal duct due to failure of closure

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41
Q

Where in the neck will a thyroglossal cyst present?

A

Near or in the midline

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42
Q

Where are 50% of thyroglossal cysts found?

A

Close of just inferior to the hyoid bone

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43
Q

What is a thyroglossal fistula?

A

Connection of a thyroglossal cyst to the outside by a fistulas canal

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44
Q

What is a thyroglossal cysts usually secondary to?

A

Cyst rupture

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45
Q

What is aberrant thyroid tissue?

A

Functioning thyroid tissue found anywhere along the line of descent that is subject to the same diseases as the thyroid itself

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46
Q

Where is aberrant thyroid tissue commonly found?

A

Just behind foramen cecum

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47
Q

Why does neural crest cell defects cause both craniofacial and cardiac abnormalities?

A

They are essential for craniofacial and normal conotruncal endocardial cushion development

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48
Q

What cardiac abnormalities are commonly seen in neural crest cell defects?

A

Persistent turn us arteriosus, tetralogy of Fallot, transposition of the great vessels

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49
Q

Neural crest cells are a particularly vulnerable population of cells. What are they easily killed by?

A

Alcohol, retinoic acid

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50
Q

What is Treacher-Collins syndrome?

A

Autosomal dominant condition causing hypoplasia of the mandible and facial bones, down slanting palpebral fissure, lower eyelid colobomas and malformed external ears

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51
Q

What is the genetic defect in Di-George syndrome?

A

Deletion of long arm of chromosome 22

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52
Q

Describe the spectrum of disorders seen in Di-George syndrome.

A

Congenital heart defects, mild facial dysmorphology, learning disabilities and frequent infections

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53
Q

Why do Di-George patients suffer from frequent infections?

A

Thymic hypo-/aplasia disrupting T-cell mediated responses

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54
Q

Why might hypocalcaemic seizures be seen in Di-George syndrome?

A

Parathyroid dysfunction due to disruption of endodermal-mesenchymal interaction

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55
Q

What is CATCH-22?

A 
Deletion of long arm of chromosome 22 causing:
Cardiac abnormality
Abnormal fancies
Thymic aplasia
Cleft palate
Hypocalcaemia/ hypoparathyroidism
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56
Q

What is the defect in CHARGE Syndrome?

A

CHD7 heterozygous mutation causing impaired production of multipotent neural crest cells

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57
Q

How does CHARGE Syndrome present?

A

Coloboma, heart defect, atresia of choanae, retardation of growth and development, genital hypoplasia, ear defects

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58
Q

What are the cellular implications for CHARGE syndrome?

A

Deficiency of mesoderm formation and neural crest cell dysfunction

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59
Q

What is the type of genital hypoplasia seen in CHARGE syndrome?

A

Hypogonadotrophic hypogonadism

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60
Q

What is the general implication for embryological development in CHARGE syndrome?

A

Arrest of embryological differentiation in the 2nd month

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61
Q

What is the pharynx?

A

Muscular tube hanging from the skull to the opening of the oesophagus

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62
Q

What anatomical landmark can be used to identify the opening of the oesophagus?

A

Cricoid cartilage

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63
Q

What gives motor innervation to the pharynx?

A

CNVII, IX, X and XII

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64
Q

What provides sensory innervation to the oropharynx?

A

CNV2

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65
Q

What is the sensory innervation of the oropharynx?

A

CNIX

66
Q

What is the sensory innervation to the laryngopharynx?

A

CNXII

67
Q

What are the borders of the nasopharynx?

A

Superior: skull base
Inferior: level of soft palate
Anterior: posterior choanae
Posterior: nasopharyngeal tonsil and C1 vertebral body

68
Q

What is the function of the nasopharynx?

A

Condition inspired air

69
Q

What lines the nasopharynx?

A

Ciliated stratified squamous epithelium

70
Q

What are the contents of the nasopharynx?

A

Nasopharyngeal tonsil, Eustachian tube orifice, tubal tonsil

71
Q

Where is the tubal tonsil located?

A

In the submucosa of the lateral wall of the pharynx at the Eustachian tube orifice

72
Q

What landmark can be used to identify the level of the C1 vertebra?

A

Hard palate

73
Q

What landmarks can be used to identify the C2 and C3 vertebral levels?

A

Angle of mandible and hyoid bone

74
Q

What landmarks can be used to identify the levels of C4-6 vertebrae?

A

Upper thyroid cartilage, lower thyroid cartilage, cricoid cartilage

75
Q

What are the borders of the oropharynx?

A

Superior: level of soft palate
Inferior: superior edge of epiglottis
Anterior: oral cavity
Posterior: C2 and C3 vertebral bodies

76
Q

What is the function of the oropharynx?

A

Digestion

77
Q

What lines the oropharynx?

A

Stratified squamous epithelium

78
Q

What are the contents of the oropharynx?

A

Palatine tonsils, anterior and posterior pillars

79
Q

What are the palatine tonsils?

A

Collections of lymphoid tissue encapsulated by squamous epithelium with crypts that form part of Waldeyer’s ring

80
Q

What forms the submucosal tonsillar bed of the palatine tonsils?

A

Superior pharyngeal constrictor and pharyngobasilar fascia

81
Q

Why do the palatine tonsils not fill the tonsillar sinus in adults?

A

Due to post-puberty atrophy

82
Q

What gives innervation to the palatine tonsils?

A

CNV2 and CNIX

83
Q

What gives arterial supply to the palatine tonsils?

A

Tonsillar branch of facial, lingual, ascending palatine and ascending pharyngeal

84
Q

What gives venous drainage to the palatine tonsils?

A

Pharyngeal plexus and para tonsillar vein

85
Q

Where does lymphatic drainage of the palatine tonsils flow?

A

Pierces superior constrictor to reach jugulo-digastric

86
Q

What forms the anterior pillar in the oropharynx?

A

Palatoglossal muscle between the buccal cavity and oropharynx fusing with the lateral wall of the tongue

87
Q

What forms the posterior pillar in the oropharynx?

A

Palatopharyngeus muscle blending with the constrictor muscles of the pharynx wall

88
Q

What gives arterial supply to the pharynx?

A

Superior thyroid, ascending pharyngeal, ascending and descending palatine, branches of lingual, facial and maxillary

89
Q

What provides venous drainage to the pharynx?

A

Pharyngeal venous plexus into the IJV

90
Q

What are the borders of the laryngopharynx?

A

Superior: superior edge of epiglottis
Inferior: level of inferior edge of cricoid cartilage
Anterior: larynx
Posterior: C3-6 vertebral bodies

91
Q

What is the function of the laryngopharynx?

A

Open inferior to the oesophagus and larynx

92
Q

What lines the laryngopharynx?

A

Stratified squamous epithelium

93
Q

What forms the paoterior and lateral walls of the laryngopharynx?

A

Externally middle and inferior constrictor muscles, internally Palatopharyngeus and stylopharyngeus

94
Q

What forms the Piriform fossa?

A

Ary-epiglottic fold, thyroid cartilage, thyrohyoid membrane

95
Q

Where is the Piriform fossa located?

A

Either side of the laryngeal inlet

96
Q

What is the clinical relevance of the Piriform fossa?

A

Internal and recurrently laryngeal nerves run deep to it and are vulnerable to damage if a foreign body becomes lodged

97
Q

What does the median raphe provide?

A

Point of attachment for constrictor muscles of pharynx

98
Q

Give the arrangement of the external circular layer of the pharynx from superior to inferior.

A

Pharyngobasilar fascia, superior constrictor, greater hyoid bone, middle constrictor and inferior constrictor

99
Q

What are the facial layers of the external circular layer of the pharynx?

A

Strong internal pharyngobasilar fascia and thin external buccopharyngeal fascia

100
Q

What is the buccopharyngeal layer of fascia continuous with?

A

Pretracheal layer of deep cervical fascia

101
Q

What is the function of the external circular layer muscles in the pharynx?

A

Sequentially contract involuntarily to propel food to oesophagus

102
Q

Which muscles form the internal longitudinal layer of the pharynx?

A

Salpingopharyngeus, Palatopharyngeus and stylopharyngeus

103
Q

Which structures pass in the gap superior to the superior constrictor muscles of the pharynx?

A

Levator veli palatini, ET, ascending palatine artery

104
Q

Which structures pass in the gap superior to the middle constrictor muscles of the pharynx?

A

Stylopharyngeus, CNIX, stylohyoid ligament

105
Q

Which structures pass in the gap superior to the inferior constrictor muscles of the pharynx?

A

Internal laryngeal nerve, superior laryngeal artery and vein

106
Q

Which structures pass in the gap inferior to the inferior constrictor muscles of the pharynx?

A

RLN, inferior laryngeal artery

107
Q

Where is the pharyngeal nerve plexus found?

A

Lying mainly on middle constrictor

108
Q

What forms the pharyngeal plexus?

A

CNIX and X with sympathetic branches from the superior cervical ganglion

109
Q

What are the 3 phases of swallowing?

A

Oral, pharyngeal and oesophageal

110
Q

Describe the oral phase of swallowing.

A

Voluntary, bolus compressed against palate by tongue and pushed to oropharynx by tongue and soft palate musclature

111
Q

Describe the pharyngeal phase of swallowing.

A

Involuntary and soft palate rises to seal of laryngopharynx from naso- and oropharynx whilst the pharynx widens and shortens

112
Q

What muscles are involved in the pharyngeal phase of swallowing?

A

Suprahyoid and longitudinal pharyngeal muscles

113
Q

What is the action of the muscles in the pharyngeal phase of swallowing?

A

Elevate larynx

114
Q

Describe the oesophageal phase of swallowing.

A

Involuntary sequential contraction of all 3 pharyngeal constrictor muscles to create peristaltic ridge

115
Q

What protects the larynx during swallowing?

A

Overhanging tongue, epiglottis and vocal cords

116
Q

What is the problem with the arrangement of the pharynx with respect to the oesophagus and larynx?

A

Food and air have to cross over in oropharynx to enter correct structure

117
Q

What do the nasopharyngeal tonsils produce?

A

IgA, IgG and IgM

118
Q

When are the adenoids maximal in size?

A

Between 3 and 8 y.o.

119
Q

What causes enlargement of the adenoids?

A

Viral or bacterial infection

120
Q

What are the consequences of adenoid enlargement?

A

Nasal obstruction, ET obstruction

121
Q

What can nasal obstruction lead to?

A

Mouth breathing causing feeding difficulty, hyponasal speech, snoring, obstructive sleep apnoea

122
Q

What can ET obstruction lead to?

A

Recurrent otitis media, chronic otitis media with effusion

123
Q

What is obstructive sleep apnoea?

A

Spectrum from mild snoring to OSA due to partial/complete airway obstruction causing turbulent airflow

124
Q

What are the S/S of OSA?

A

Daytime tiredness, hypoxia, increased CVS strain

125
Q

How can the adenoids be visualised?

A

Post-nasal space X-ray, post-nasal mirror, fibre optic endoscope, in theatre

126
Q

What are post nasal space X-rays no longer used to visualise the tonsils?

A

Radiation exposure to children

127
Q

What are the possible complications of adenoidectomy?

A

Bleeding, Atlanto-occipital joint dislocation due to infection, ET stenosis

128
Q

What is the 5-year survival rate for nasopharyngeal carcinoma?

A

80%

129
Q

Where are nasopharyngeal carcinomas most commonly found?

A

Lateral nasopharyngeal recess

130
Q

What is associated with the undifferentiated form of nasopharyngeal carcinoma?

A

EBV infection

131
Q

What are the risk factors for nasopharyngeal carcinoma?

A

Chinese ancestry, EBV exposure, heavy alcohol intake

132
Q

What are the S/S of nasopharyngeal carcinoma?

A

Nasal obstruction, blood-tinged discharge, tinnitus, sore throat, unilateral conductive hearing loss

133
Q

Does naopharyngeal carcinoma usually present early or late?

A

Late

134
Q

How is nasopharyngeal carcinoma managed?

A

Staged by TNM and treated with radiotherapy (limited role for chemotherapy and surgery)

135
Q

Why is tonsillectomy no longer carried out as frequently as it was historically?

A

Disorders of palatine tonsils tend to lessen in severity and frequency as they atrophy with age

136
Q

What are the indications for tonsillectomy?

A

Recurrent tonsilitis (5/year in the last 2 years), previous peritonsillar abscess, suspected cancer, OSA

137
Q

What techniques can be used in tonsillectomy?

A

Cold steel instruments, guillotine, electrosurgery, diathermy, radio wave

138
Q

What are the complications associated with tonsillectomy?

A

General anaesthetic risks, primary and secondary bleeding, infection

139
Q

Which vessel does primary bleeding in tonsillectomy usually arise from?

A

Tonsillar branch of facial artery

140
Q

Which vessel does secondary bleeding in tonsillectomy usually arise from?

A

External palatine vein

141
Q

What is pharyngeal pouch?

A

Relatively rare position herniation of pharyngeal mucosa through Kilian’s dehiscence

142
Q

Where is Kilian’s dehiscence?

A

Between superior thyropharyngeus and inferior cricopharyngeus parts of infirm constrictor muscle of pharynx

143
Q

What is the pathogenesis of pharyngeal pouch?

A

In swallowing the cricopharyngeus does not relax as the thyropharyngeus contracts causing an increase in intrapharyngeal pressure –> midline true diverticulum

144
Q

What are the consequences of pharyngeal pouch?

A

Accumulation of food leading to dysphasia, regurgitation, halitosis,and even aspiration of pouch contents

145
Q

What population is pharyngeal pouch typically seen in?

A

Elderly

146
Q

What causes clinical challenges to the patency of the airway in children compared to the adult?

A

Head:body ratio, small face and mandible, large tongue and adenoids, soft and short trachea, high SA:weight ratio, lower respiratory reserve, high metabolic rate, complaint chest walls

147
Q

How can the patency of the airway in children be examined?

A

Effort of respiration, pallor, cyanosis, haemangioma, auscultation, palpation, flexible nasal endoscopy, microlaryngoscopy, bronchoscopy

148
Q

What causes the funnel shape of the airway in the child in comparison to the adult?

A

Narrow and underdeveloped cricoid cartilage

149
Q

How does acute epiglottis present?

A

Septic, pyrexia, classic Tripod position: leaning forward and drooling

150
Q

What are the usually causative agents of acute epiglottitis?

A

H influenzae, staphylococci, beta-haemolytic streptococci or pneumococci

151
Q

Which age group does acute epiglottitis typically affect?

A

2-7 y.o.

152
Q

How is acute epiglottitis treated?

A

Secure airway, take bloods and throat swabs, broad spectrum Abx (ceftriaxone) and steroids

153
Q

What is the pathogenesis of laryngotracheobronchitis (croup)?

A

Initial viral infection of throat –> infective oedema narrowing subglottis –> harsh (barking) subglottis cough and stridor

154
Q

How is mild croup treated?

A

Oral Abx and steam inhalation

155
Q

How is moderate-severe croup treated?

A

IV Abx, humidified O2, adrenaline nebuliser

156
Q

What is the leading cause of death in 1-3 y.o., especially in males?

A

Foreign body in airway

157
Q

How does a foreign body in the airway typically present?

A

Hx of unwitnessed episode of choking, coughing or aging with foreign body –> vague S/S

158
Q

What does radiology in foreign body in the airway investigation look for?

A

Opacity of object, segmental/lobar lung collapse, local emphysema and air trapping

159
Q

How are foreign bodies and associated complications managed?

A

Remove item by bronchoscopy and use steroid and inhaled bronchodilators if there is oedema as a result

160
Q

What is laryngomalacia?

A

Congenital dynamic lesion of laryngeal cartilage causing collapse of supra glottic structures on inspiration resulting in congenital stridor

161
Q

What is the most common cause of congenital stridor?

A

Laryngomalacia

162
Q

What are the Tx options for laryngomalacia?

A

Conservative or aryepiglottoplasty

Semester 4 (33 decks)

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