8 Flashcards
(47 cards)
1
Q
If a patient has left sided facial palsy, what facial nerve is affected?
A
Left facial nerve
2
Q
Name 3 conditions involving structures or areas of the ear that can present with otolagia (i.e. otological causes of ear pain)
A
- acute otitis media
- otitis externa
- perichondritis
- otitis media with effusion
3
Q
What are the lateral walls of the oral cavity and what is their function?
A
- buccinator
- keeps food between teeth when chewing
4
Q
What forms the roof of the oral cavity?
A
-hard and soft palate
5
Q
What are the anterior and posterior ends of the oral cavity?
A
- anterior: oral fissure (bounded by lips)
- posterior: oropharyngeal isthmus
6
Q
What is the oropharyngeal isthmus?
A
- an arch formed by the soft palate above, and the tongue below
- sides of the isthmus contain palatoglossus and palatopharyngeal muscles (which also make arches)
- they contract during chewing in order to pull the soft palate down towards the back of the tongue, closing the oropharyngeal isthmus so that food remains in the oral cavity
- see 2019-oral cavity slide 3
7
Q
What is located in the palatine tonsil and what is its function?
A
- part of the lymphoid tissues of Waldeyer’s ring
- easily visible
- is inflamed during tonsillitis
8
Q
What are the intrinsic muscles of the tongue and what are they innervated by?
A
- 4 paired muscles
- lie within tongue and run longitudinally, vertically and transversely
- act to alter shape of tongue
- motor innervation by CN XII (hypoglossal)
9
Q
What are the four extrinsic muscle of the tongue and what are they innervated by?
A
- act to change the position of the tongue such as protraction, retraction, side-to-side
- Genioglossus: protraction, CN XII, test this muscle when asking patients to stick tongue out
- Hypoglossus: CN XII
- Styloglossus: CN XII
- Palatoglossus: CN X
- see 2019-oral cavity slide 4
10
Q
What are the sensory divisions to the tongue?
A
Anterior 2/3
- Sensation: trigeminal Vc (lingual branch)
- Taste: facial (Chorda tympani)
Posterior 2/3
-sensation and taste: glossopharyngeal
11
Q
Where does the submandibular gland release saliva?
A
- gland connect to oral cavity via the Wharton duct which is located at bottom of lingual frenulum
- see 2019-oral cavity slide 6
12
Q
What is the vestibule?
A
- lateral area between teeth and lips
- gum area
13
Q
Where does the parotid gland release saliva?
A
- releases into Stensen duct
- saliva enters vestibule
14
Q
Where does the sublingual gland release saliva?
A
- only produces 3-5% of saliva
- smallest and most diffuse of the major salivary glands
- 8-20 excretory ducts per gland
15
Q
What is sialolithiasis?
A
- stones formed in the ducts drain the salivary glands
- most are located in the submandibur glands
- dehydration, reduced salivary flow
- most stones less than 1cm diameter
- symptoms stimulated by eating: pain in gland, swelling, infection
- diagnosis: history, x-ray, sialogram
16
Q
What is tonsillitis?
A
- inflammation of the palatine tonsils
- can cause fever
- sore throat
- pain/difficulty swallowing
- cervical lymph nodes
- bad breath
- viral causes are most common
- bacterial causes in up to 40% cases, most commonly by strep pyogenes
17
Q
What is a peritonsillar abscess?
A
- aka Quinsy
- severe throat pain
- fever
- bad breath
- drooling
- difficulty opening mouth
- can follow on from an untreated or partially treated tonsillitis
- can arise on its own from aerobic and anaerobic bacteria
- can potentially cause epiglottitis
18
Q
What is the pharynx?
A
- muscular tube starting from base of skull and extending down to level C6
- forms part of digestive tract
19
Q
What are the 3 parts of the pharynx?
A
- Nasopharynx
- Otopharynx
- Laryngopharynx
20
Q
Describe the nasopharynx
A
- lies superior to soft palate
- lies inferior to base of scull
- posterior border: C1, C2
- anterior: nasal cavity
- contains pharyngeal tonsils (adenoids) and some lymphoid tissue
- see 2019-oral cavity slide 13
21
Q
Describe the pharyngeal tonsils (adenoids) when they are enlarged
A
- can block ET which will cause recurrent/persistent middle ear infections
- snoring/sleep apnoea
- sleeping with mouth open; may cause change in face shape
- chronic sinusitis (sore throat)
- nasal tone to voice
- see 2019-oral cavity slide 15
22
Q
Describe the oropharynx
A
- second of the 3 parts
- superior border: soft palate
- inferior border: epiglottis
- anterior border: oral cavity
- posterior border: C2, C3
- palatine fossils lie on either side of oropharynx between the palatoglossal and palatopharyngeal arches
- see 2019 oral cavity slide 15-16
23
Q
Describe the laryngopharynx
A
- final part of pharynx
- superior border: oropharynx and epiglottis
- inferior border: oesophagus and cricoid cartilage
- anterior border: larynx
- posterior border: C4 to C6
- contains the piriformi fossa
- see 2019-oral cavity slide 17-19
24
Q
What are the 3 longitudinal muscles that elevate the pharynx and larynx during swallowing?
A
- stylopharyngeus
- palatopharyngeus
- salpingopharangeus
25
Describe the stylopharyngeus
- extends from styloid process to posterior border of thyroid cartilage
- innervated by CN IX (glossopharyngeal)
26
Describe the palatopharyngeus
- extends from hard palate to posterior border of thyroid cartilage
- innervated by pharyngeal branch of vagus nerve (CN X)
- see 2019-oral cavity slide 20
27
Describe the salpingopharyngeus
- extends from the cartilaginous part of ET to merge with palatopharyngeus
- innervated by pharyngeal branch of vagus CN X
28
What are pharyngeal constrictors? List the 3 main ones
- circular muscles that constrict walls of pharynx when swallowing
- superior, middle and inferior pharyngeal constrictors
29
Describe the three pharyngeal constrictors
Superior pharyngeal constrictor
-origin: pterygomandibular raphe
Middle pharyngeal constrictor
-origin: hyoid bone
Inferior pharyngeal constrictor
-has 2 parts:
-thyropharyngeal (origin: thyroid cartilage)
-cricopharyngeal (Origin: cricoid cartilage)
-slight weakness between the 2 parts known as Killians dehiscence
- all innervated by vagus nerve
- see 2019-oral cavity slide 22-23
30
What is a pharyngeal pouch?
- posteromedial (false) diverticulum between the two parts of the inferior pharyngeal constrictor (Killians dehiscence)
- when there is a rise in pressure between the two parts, causing the pharyngeal mucosa to herniate through Killians dehiscence forming a pharyngeal pouch
- probably due to: failure of UOS to relax, abnormal timing of swelling
- will get bad breath, regurgitation of food, occasional choking on fluids and general difficulty swallowing since all the substances fall into the pouch and are stuck there
- see 2019-oral cavity slide 24-25
31
Describe the motor and sensory supply of the pharynx
- majority of nerve supply is from pharyngeal plexus
- pharyngeal plexus is located on surface of middle pharyngeal constrictor
- formed by branches of vagus, glossopharyngeal and cervical sympathetic nerves from the superior cervical ganglion
Motor
-CN X innervated all muscles EXCEPT stylopharyngeus (glossopharyngeal CN IX)
Sensory
- Nasopharynx innervated by maxillary branch of CN Vb
- Oropharynx innervated by CN IX
- laryngopharynx innervated by CN X
32
Describe the first phase of swallowing
Stage 1 (oral)
- voluntary
- prep phase: make bolus
- transit phase: bolus compressed against palate and pushed into oropharynx by tongue and soft palate
33
Describe the second phase of swallowing
Stage 2 (pharyngeal)
- involuntary
- tongue positioned against hard palate so that food cannot re-enter mouth (CN XII)
- soft palate elevated sealing off nasopharynx (tensor palatine CN Vc, levator palatine CN X); opens ET tube
- suprahyoid (CN Vc, CN VII, CN XII) and longitudinal muscles (CN IX, CN X) shorten; pharynx widens and shortens to receive bolus and larynx is elevated and sealed off by vocal folds
- epiglottis closes over larynx
- bolus moves through pharynx by sequential contraction of constrictors
- relaxation of UOS
34
Describe the third stage of swallowing
Stage 3 (oesophageal)
- involuntary
- upper striated muscle of oesophagus (CN X)
- lower smooth muscle
35
Describe dysphagia
-difficulty swallowing
Symptoms
- coughing and choking
- sialorrhoea (drooling)
- recurrent pneumonia
- change in voice/speech (wet voice)
- nasal regurgitation
-see 2019-oral cavity slide 35-36
36
What happens if there is an injury to CN IX or X in the oral cavity?
Obvious
- absent gag reflex
- uvula deviated away from lesion (LMN)
Bit more subtle
- dysphagia
- taste impairment (posterior tongue)
- loss of sensation To oropharynx
- caused by: medullary infarct, jugular foramen issue (fracture)
-see 2019-oral cavity slide 37
37
What happens if CN XII is injured in the oral cavity?
- wasted tongue
- stick tongue out: tongue may deviate
- damage to nerve itself so tongue points to side of lesion
- muscle wasting
- fasiculations
- see 2019-oral cavity slide 38
38
What is the preform fossa a potential site for?
- foreign bodies
| - pharyngeal cancers
39
What are some non-otological causes of otalgia?
- nose and sinuses (CN V)
- Oesophagus (CN X)
- cervical spine (C2 and C3)
- larynx and hypopharynx (CN X)
- oropharynx (CN IX)
- tongue (CN V)
- TMJ, parotid and teeth (CN V)
40
What are epistaxis?
- common in very young and very old
- often minor and can usually be self-treated
- many arterial branches contribute to supply of nasal septum
- significant anastomotic point: Little’s Area (one on either side of nasal septum); origin of most nose bleeds (90%
- sphenopalatine artery is the source for minority of bleeds
- blood tends to be at a higher pressure and is posteriorly located so harder to reach/more serious
41
What is GASPS?
- Greater palatine artery (branch of maxillary therefore ECA)
- Anterior ethmoidal artery (branch of opthalmic therefore ICA)
- Superior labial artery (branch of opthalmic therefore ECA)
- Posterior ethmoidal artery (branch of opthalmic)
- Sphenopalatine artery (branch of maxillary therefore ECA)
- look at session 8 Mx epistaxis slide 3
42
What do you do to stop a nose bleed?
- lean forward and pinch soft part of nose
| - dont pinch nasal bone because you’ll just pinch bone, no effect
43
How can you manage epistaxis?
-simple first aid: direct pressure
If that fails...
-attempt simple CAUTERY (if visible bleeding point)/topical vasoconstrictors
If that fails...
-anterior packing (nasal tampons)
If fails...
-posterior packing (surgical intervention such as SPA ligation)
44
What physical features of the nasal cavity allow for slowing of inspired air?
Why might it be helpful to slow the flow of inspired air?
- irregular lateral walls cause turbulence of air flow (conchae)
- to filter the air and humidify and warm the air
45
Which sinus is the most commonly affected sinus in sinusitis? Explain why this sinus is most commonly involved and what symptoms and signs a patient would likely present with.
- maxillary
- because location of opening is high on the wall of the nasal cavity
- blocked nose, rhinorrhea, headache and facial pain
46
Why might a patient with maxillary sinusitis complain of toothache?
-Roots of teeth are very close to the maxillary sinus
47
Why does CSF leak through the nose in a basilar skull fracture?
- leaking through the displaced crista galli
| - CSF leaking from ethmoid bone
