Anatomy 9 & 10 Flashcards
(130 cards)
1
Q
larynx functions
A
- allows air passage in and out of the trachea
- protective sphincter preventing foreign bodies entering airway
- speech production (phonation)
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Q
larynx located at level
A
- C3-C6
- from tip of epiglottis to inferior border of cricoid cartilage
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Q
larynx anatomical relations
A
- superiorly opens into laryngopharynx
- epiglottis
- inferiorly continues into the trachea
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Q
main laryngeal cartilages
A
- epiglottis (only one elastic all others hyaline)
- cricoid cartilage (only complete ring)
- thyroid cartilage
- arytenoid cartilage
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Q
cricothyroid joint type and function
A
- synovial joint
- allows for rotation and gliding of thyroid cartilage
- results in changes in length of vocal folds which changes pitch
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epiglottis connects/type/function
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- connects to thyroid cartilage via thyro-epiglottic ligament
- connects to hyoid via hyoepiglottic ligament
- elastic cartilage
- closes airway during swallowing
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Q
arytenoid cartilage description and articulations
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- paired hyaline cartilage of the larynx
- found posteriorly
- articulates with cricoid cartilage inferiorly
- apex articulates with corniculate cartilage and aryepiglottic fold
- vocal process (anterior process of the cartilage) provides posterior attachment for vocal ligament
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crico-arytenoid joint function
A
- permit arytenoid cartilages to slide towards/away from another, tilt, and rotate
- important for tensing and relaxing vocal folds during voice production
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Q
intrinsic ligaments and membranes of the larynx
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- quadrangular membrane
- cricothyroid ligament
- vocal ligament
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Q
extrinsic ligaments and membranes of larynx
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- thyrohyoid membrane
- thickened anteriorly and posteriorly to form median and lateral thyrohyoid ligaments
- cricothyroid ligament
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quadrangular membrane of larynx attachments/type of tissue/forms
A
- superiorly extends between arytenoid and epiglottis
- inferiorly extends between arytenoid and thyroid cartilage and the free inferior margin = vestibular ligament
- submucosal CT
- vestibular ligament covered loosely by mucosa to form vestibular fold
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cricothyroid ligament of larynx attachments/type of tissue/forms
A
- from cricoid to thyroid cartilage
- from vocal process of arytenoid to thyroid cartilage
- superior free edge of cricothyroid ligament forms vocal ligament
- vocal ligament forms the submucosal part of vocal folds
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Q
what constitutes vestibular ligament and vocal ligament
A
- quadrangular membrane attachment from arytenoid cartilage to thyroid cartilage forms vestibular ligament
- crycothyroid ligament from vocal process of arytenoid to thyroid cartilage forms vocal ligament
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Q
describe thyrohyoid membrane
A
- spans the space between thyroid cartilage and hyoid bone
- thickened anteriorly and posteriorly as median and lateral thyroid ligaments
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Q
laryngeal folds
A
- ary-epiglottic fold
- vestibular fold
- vocal fold
- mucous membranes creating folds over free edges of ligaments/membrane
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Q
aryepiglottic fold description and function
A
- mucosa overlying superior free edge of quadrangular membrane
- extends from arytenoid cartilage to epiglottis
- forms the laryngeal inlet which is the protective sphincter of the larynx
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Q
vestibular fold description
space between this and laryngeal inlet called
A
- formed over the inferior free edge of quadrangular membrane which extends from arytenoid to thyroid cartilage
- space between vestibular fold and laryngeal inlet called vestibule
- play little or no part in voice production
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Q
vocal fold description, space between name, and function
A
- formed over superior free edge of cricothyroid ligament which extends from vocal process of arytenoid and thyroid cartilage
- mucous membrane overlying
- space between vocal folds called rima glottis
- rima glottis + vocal folds + vocal process = glottis
- control sound production from the larynx and serve as the main inspiratory sphincter of larynx when tightly close
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Q
intrinsic laryngeal muscles functions
A
- open or close the rima glottis (abductors/adductors)
- alter the tension of the vocal folds (tensors/relaxors)
- open or close the laryngeal inlet (sphincter muscles)
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Q
extrinsic laryngeal muscle functions
A
- infrahyoids depress the hyoid and larynx
- suprahyoids and stylopharyngeus elevate the hyoid and larynx
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Q
muscles which open and close the rima glottis
A
- posterior cricoarytenoid is the only muscle to abduct the vocal folds = opening the rima glottidis
- transverse arytenoid muscle and lateral crico-arytenoid muscles close the rima glottidis
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Q
muscles which alter tension of vocal fold and effect of shortening/lengthening
A
- cricothryoid muscle lengthens
- thyroarytenoid muscle shortens
- lengthened vocal cords = higher pitch
- shortened vocal folds = lower pitch
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Q
muscles which open/close laryngeal inlet
A
- closure by oblique arytenoid muscle
- opening by descent of the larynx mainly by elastic recoil
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Q
larynx motor nerve supply
A
- all by recurrent laryngeal nerve with one exception
- cricothyroid supplied by external branch of superior laryngeal nerve
- all are branches of vagus nerve
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larynx sensory nerve supply
* above the vocal folds = internal branch of superior laryngeal nerve
* below vocal folds = recurrent laryngeal nerve
* all are branches of vagus nerve
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larynx role in breathing
* forced inspiration: rima glottis more wideley opened by posterior cricoarytenoid
* quiet respiration: a triangular "open" rima glottis
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larynx role in speech production
* vocal folds are adducted (closed)
* rima glottis closed
* air is forced through causing vibration
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larynx role in effort closure and swallowing
* vocal and vestibular folds are adducted (closed)
* rima glottis is closed
* vestibular folds which are open in speech production and inhalation also close off vestibule (extra airway protection)
* epiglottis swings down to arytenoids
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valsalva manouvre
* any forced expiration against a closed airway
* cough
* sneeze
* strain during bowel movement
* weight lifting
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describe the nasal cavity and its boundaries
* paired left and right nasal cavities
* separated by nasal septum
* separated from oral cavity by hard palate
* nares are anterior opening
* choanae are posterior openings which open into nasopharynx
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what receptors does nasal cavity contain
olfactory receptors
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what comprises the external nose
* bone
* cartilage
* muscle
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bones of the external nose
* nasal bones
* frontal process of maxilla
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cartilage of external nose
* septal cartilage
* major alar cartilage
* minor alar cartilage
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muscles of external nose
* overlies the bone and cartilage
* nasalis
* levator labii superioris alaeque nasi
* depressor septi nasi
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floor of nasal cavity formed by
* palatine process of maxilla
* horizontal plate of palatine bones
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features of floor of nasal cavity
* nares
* incisive canals
* nasal crest: ridge formed at connection of paired maxilla and palatine bones and attachment of vomer
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nasal septum main components
* septal cartilage
* perpendicular plate of ethmoid bone
* vomer
* forms the medial wall of the nasal cavities
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septal deviation description/cause/symptoms/tx
* septum is displaced away from midline
* caused by injury or birth defect
* one side of nasal cavity obstructed
* can cause snoring, difficulty breathing through nose or nosebleeds
* corrected surgically
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roof of nasal cavity formed by
* cribiform plate of ethmoid bone
* nasal bones
* nasal spine of frontal bone
* spehnoid bone
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describe ethmoid bone in relation to nasal cavity
* cribiform plate in midline has many holes which allow CNI nerves into the nasal cavity from brain
* perpendicular plate also in midline which forms part of nasal septum
* left and right ethmoidal labrynth either side which has superior and middle conchae
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lateral wall of nasal cavity formed by
* nasal bone
* ethmoid bone: superior and middle conchae from ethmoidal labrynth
* lacrimal bone
* maxilla
* inferior concha
* palatine bone
* sphenoid bone
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what underlies nasal conchae and function
* middle, superior and inferior conchae have corresponding meatus underlying
* creates various airstreams
* increases surface area between lateral wall and respired air
* facilitates engagement with epithelium
* allows for moisturisation, purification and warming of air
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nerves found/innervating nasal cavity
* olfactory nerve **CNVI**
* **anterior ethmoidal nerve** branch of opthalmic nerve CNV1
* maxillar nerve CNV2 branches: **anterior superior alveolar nerve**, **infraorbital nerve** nasal branch, nasopalatine nerve, posterior superior/inferior lateral nasal nerves
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parasympathetic supply of nasal cavity
* axons from salvatory nucleus in brainstem
* carried in greater petrosal nerve of CNVII to pterygopalatine ganglion
* post-ganglionic fibres carried within maxillary nerve branches CNV2
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sympathetic supply of nasal cavity
* axons from sympathetic trunk ascend in the internal carotid plexus
* travel to pterygopalatine ganglion via deep petrosal nerve
* post-ganglionic axons carried in maxillary nerve branches
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arterial supply of nasal cavity
* from maxillary artery: sphenopalatine and greater palatine branches
* from facial artery: superior labial and lateral nasal branches
* from ICA/opthalmic artery: anterior ethmoidal and posterior ethmoidal branches
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which area in nasal cavity susceptible to nosebleeds and why
* anterior septal region
* arterial supply of nose form many anastomoses in this region
* nosebleeds can commonly occur
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venous drainage of nose
* veins that folllow maxillary artery (spehnopalatine and greater palatine) drain to pterygoid plexus
* veins that follow facial artery (superior labial and lateral nasal) drain to facial vein
* veins that follow ethmoidal arteries drain to cavernous sinus
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paranasal sinuses names and epithelium
* ethmoidal cells in ethmoid labrynth
* maxillary sinus
* frontal sinus
* sphenoid sinus
* lined with respiratory epithelium (ciliated columnar)
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ethmoidal cells drain to
* anterior cells drain into infundulum in middle meatus (opening of frontonasal duct)
* middle cells drain into middle meatus
* posterior cells drain into superior meatus
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maxillary sinus drains to
* middle meatus
* at semilunar hiatus
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frontal sinus drains to
* middle meatus
* at infundulum (continuation of frontonasal duct)
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sphenoid sinus drains to
* sphenoethmoidal recess
* superiorly/posteriorly in nasal cavity
* only sinus not to drain into lateral wall
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upper respiratory infections symptoms suggesting paranasal sinus involvement
* discomfort
* headaches
* radiating pain into maxillary teeth
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teeth and maxillary sinus clinical context
* maxillary molar teeth in close relation to maxillary sinus
* extraction could lead to oro-antral communication
* infection could case toothache sensation as mucous membrane in maxillary sinus and maxillary teeth have same innervation
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margin of the orbit formed by
* frontal bone superiorly
* zygomatic bone laterally
* maxilla inferomedially
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Bones of the orbit
-frontal
-lacrimal
-maxilla
-ethmoid
-zygomatic
-greater and lesser wing of sphenoid
-palatine bone
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Openings into the orbit
-optic canal
-superior orbital fissure
-inferior orbital fissure
-nasolacrimal canal
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What goes into optic canal and inferior orbital fissure
Optic canal- optic nerve and ophthalmic artery
Inferior orbital fissure- inferior opthalmic vein
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What goes into superior orbital fissure
-superior opthalmic vein
-CNIII superior and inferior branch
-CNIV
-CNV1 frontal, lacrimal and nasociliary branch
-CNVI
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What is name of fat in orbit and function
-retrobulbar fat
- supporting the eyeball
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Optic nerve course and clinical relevance
-optic tract meet and form optic chiasm
- optic chiasm lies superior and anterior to pituitary gland
- enters optic canal
- expansion of pituitary (tumour etc) presses of optic chiasm causing visual filed defects such as tunnel vision
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Structures of the optic nerve
-meninges: dura, arachnoid and pia mater which extend to sclera
- central retinal artery and vein
- subarachnoid space filled with CSF
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Clinical relevance of optic nerve
-central retinalmartery can become occluded causing amaurosis fugax (temp loss of vision) sometimes permanent
- increased intracranial pressure slows retinal venous drainage via central retinal vein and can cause papilloedema
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What is papilloedema/cause/appearance
-swelling of the optic disc (which attaches CNII to eyeball)
- caused by increased intracranial pressure which slows venous drainage via central retinal vein
- through ophthalmoscope retina looks fuzzy and fluffy aka lack of clear outlines
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Visual field defect affecting the optic nerve on one side
-sight to that eye will be lost
-other eye works fine
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Visual field defect issue at optic chiasm
-tunnel vision
- fibres which cross over here supply lateral vision to contralateral eye
- lateral side of each visual field is lost
- only medial sides of visual field function
-called bitemporal hemianopia
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Visual field defect lesion at optic tract
-medial side of the affected side loss of vision
-lateral side of contralateral side affected
-another form of hemianopia
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Orbicularis oculi actions/innervation/malfunction leads to
-close eyelids gently/involuntarily (palpebral part)
-close eyelids tightly/voluntarily (orbital part)
-innervated by temporal and zygomatic branches of CNVII
-malfunction leads to sagging of lower eyelid, inability to blink so tears cannot be spread over eyelid
-leakage of tears and dry eyes can potentially cause ulceration
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Lacrimal apparatus location and tear production
-lacrimal gland in upper lateral corner of the orbit
- tears secreted into conjunctival sac and continually washed across the eye by blinking of the eyelids
- blinking by orbicularis oculi so function of CNVII essential to keep corners and conjunctiva moist
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Describe drainage of tears
- pool at the medial angle of the eye where lacrimal caruncle lies
- drain via lacrimal puncta (two little holes in both superior and inferior eyelids)
- drain into canaliculi and then to lacrimal sac to nasolacrimal duct
-nasolacrimal duct drains into inferior nasal meatus
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Lacrimal gland parasympathetic supply
- preganglionic parasympathetic fibres from CNVII
- travel in greater petrosal nerve and then nerve of pterygoid canal to reach pterygopalatine ganglia
- postganglionic fibres travel with zygomatic branch of CNV2 to reach lacrimal gland
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Extraocular muscles
-superior, medial, lateral and inferior rectus
-superior and inferior oblique
-levator palpebrae superioris
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levator palpebrae superioris function and muscle fibre types
-allows us to open eyelid and keep it open
-smooth and striated muscle fibres
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Superior oblique attaches to eye via
-tendon
-tendon changes direction and is at an angle to actual muscle
-runs through a pulley called trochlea
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4 recti of the eye functions
-medial rectus pulls eye medially
-lateral rectus pulls eye laterally
-superior rectus pulls eye upwards and medially
-inferior rectus pulls eye downwards and medially
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2 obliques of the eye function
-superior oblique pulls eye downwards and outwards
-inferior oblique pulls eye upwards and outwards
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Motor nerve supply of extraocular muscles
-LR6 lateral rectus abducens CNVI
-SO4 superior oblique trochlear CNIV
-all others occulumotor CNIII
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Occulomotor nerve branches and muscles supplied
-superior branch supplies levator palpebrae superioris, SR
-inferior branch supplies MR, IR, IO
-carries parasympathetic fibres for pupil constriction
-carries sympathetic fibres to smooth muscle component of levator palpebrae superioris
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CNIII palsy leads to
-dilated pupil (as CNIII carries parasympathetic fibres for pupil constriction)
-ptosis due to complete loss of levator palpebrae superioris (dropping of eyelid)
-eye is turned downwards and outwards due to SO and LR still in tact
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Iris contains
-sphincter pupillae under parasympathetic supply CNIII
- dilator pupillae under sympathetic supply
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Humour secreted by/absorbed by and clinical importance
- aqueous humour secreted by ciliary body
- absorbed by scleral venous sinus
- if issue with drainage of humour can lead to build up of drainage and pressure and may cause glaucoma
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Describe lens accomodation
-in absence of parasympathetic nerve stimulation ciliary muscle is relaxed and zonular fibres under tension which stretches lens to refract light for distant vision
-parasympathetic stimulation causes ciliary muscle to contract and zonular fibres relax so lens becomes more spherical to refract light for near vision
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osteology of the ear
* petrous temporal bone
* internal acoustic meatus
* stylomastoid foramen
* external acoustic meatus
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what separates external ear from middle ear
tympanic membrane
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external ear overview
composition/function
* auricle and external acoustic meatus
* composed of cartilage and bone
* leads sound waves to tympanic membrane
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middle ear overview
function and connection
* ossicles mechanically transmitting sound
* connected to pharynx by auditory tube
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internal ear overview of function
* semi-circular canals for motion
* cochlea for hearing
* converting mechanical signals to electrical to be carried by CNVIII
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auricle of ear composition/function/other name
* composed of elastic cartilage
* catches and funnels sound into external acoustic meatus
* sometimes called the pinna
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external ear nerve supply
* greater auricular nerve supplies helix, antihelix and lobule
* auriculotemporal nerve supplies tragus and crus of antihelix
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external acoustic meatus length/composition/epidermis/dermis
* 2.5cm long
* cartilagenous lateral 1/3 and bony medial 2/3
* epidermis is stratified squamous epithelium
* dermis contains hair follicles, glands, ceruminous glands that secrete ear wax, blood vessels and nerves
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tympanic membrane location/held by
* in external ear separating external ear from middle ear
* held within temporal bone by fibrocartilgenous ring
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tympanic membrane clinical considerations
* examined with otoscope
* presence of cone of light means no fluid accumulation or similar pathology behind tympanic membrane
* light caused by light from otoscope
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middle ear location/contains/relations/muscles
* in pterous part of temporal bone
* contains ossicles of the ear
* relations with chorda tympani and nasopharynx
* 2 muscles: tensor tympani and stapedius
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ossicles name/function
* malleus
* incus
* stapes
* increase force and decrease amplitude of vibrations from tympanic mebrane
* mechanically transmit sound
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middle ear anatomical relations and clinical relevance
* thin roof of bone between middle ear and middle cranial fossa so risk of infection spread
* chorda tympani
* ICA
* IJV
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middle ear infections name/cause/clinical implications
* otitis media
* often caused by obstructions to auditory tube
* chronic infections may damage ossicles resulting in conductive deafness
* infection may spread to mastoid air cells causing mastoiditis...can be quite painful
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pathology of vestibulocochlear nerve effect on CNVII
* may require surgery at internal acoustic meatus which potentially endangers CNVII
* example: scwannoma benign tumour of nerve cell effecting CNVIII
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stapedius function
dampens the movement of the stapes
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what constitutes bony labrynth of middle ear
* vestibule
* cochlea
* semicircular canal
* contaaining fluid called perilymph and endolymph
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vestibulocochlear nerve divisions and function
* vestibular part for sensation of motion/equilibrium/balance
* cochlear part for the sensation of hearing
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damage to cochlear part of CNVIII vs damage to mechanical transmission
* neural hearing loss
* damage to mechanical transmission = conductive loss
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damage to vestibular part of CNVIII signs/symptoms
* ataxia: poor muscle control causing clumsy movements
* vertigo: sensation that you or envirionment is moving or spinning
* nausea
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