Anatomy (Mouth and Throat) Flashcards by Daniel Part

What are the boundaries of the mouth?

Upper and lower teeth
Floor of mouth
Oropharynx
Hard + soft palate

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What causes ‘tongue tie’?

An overly short lingual frenulum:

- Tongue bound to gingivae of lower incisors

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Where are the sublingual papillae located and what is there function?

On the floor of the mouth:
- On either side of the frenulum
Openings of submandibular salivary gland ducts

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Where are the lingual veins located?

Ventral surface of the tongue

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What are the three major pairs of salivary glands?

Parotid
Submandibular
Sublingual

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Where are minor salivary glands located?

Lips
Cheeks
Palate

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What is the path of the parotid duct?

Crosses masseter
Pierces medially through buccinator
Opens on parotid papilla on buccal mucosa

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What is the path of the submandibular duct?

Deep to mucosa of the mouth floor

Opens on sublingual papillae

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What is the path of the sublingual duct?

On sublingual folds

Numerous ducts per gland

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What nerves supply the salivary glands?

PNS axons from chorda tympani (CN VII):
     - Sublingual
     - Submandibular
PNS axons from CN IX:
     - Parotid
     - (Also auriculotemporal branch of CN V3)

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What is the structure and nerve supply of the anterior 2/3 of the tongue?

Lies horizontally in the oral cavity
Nerve supply:
- General sensory -> CN V3
- Special sensory -> CN VII (chorda tympani)

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What is the structure and nerve supply of the posterior 2/3 of the tongue?

Vertical (Not in oral cavity)
Nerve supply:
- General and special sensory -> CN IX

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What is the foramen caecum and where does it lie?

Origin of thyroid

At apex of terminal groove

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What do the extrinsic tongue muscles do?

Change position of tongue during:

 - Mastication
 - Swallowing
 - Speech

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What are the extrinsic tongue muscles and what nerve supplies them?

CN X:
     - Palatoglossus
CN XII:
     - Styloglossus
     - Hyoglossus
     - Genioglossus

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Where are the intrinsic tongue muscles found and what do they do?

Located in the tongue:
- Dorsally
- Posteriorly
Modify tongue shape during function

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How does the hypoglossal nerve connect to the CNS?

Has many rootlets -> Attach to medulla oblongata

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What is the intracranial course of the hypoglossal nerve?

Passes anteriorly to the hypoglossal canal

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What is the base of skull foramen course of the hypoglossal nerve?

Occipital bone

Hypoglossal canal is on the anterior wall of foramen magnum

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What is the extracranial course of CN XII?

Descends in neck lateral to the carotid sheath
At level of hyoid:
- Passes anteriorly (lateral to loop of lingual a.)
- Towards lateral aspect of the tongue

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How can we test the hypoglossal nerve? What feature indicate two normal CN XIIs, and what feature suggests one CN XII is damaged?

Ask to stick tongue STRAIGHT out:

 - Normal -> Tip in midline
 - One damaged -> Tip pointing to side of damaged n.

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What does the dorsal lingual artery supply?

Posterior part of tongue

Roof of tongue

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What does the deep lingual artery supply?

Anterior tongue

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What does the sublingual artery supply?

Sublingual gland

Floor of mouth

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What allows the CN V2 to pass into the mouth?

Palatine foraminae in the hard palate

What does the levator veli palatini do and what nerve supplies it?

Lifts soft palate superiorly -> CN X

What does the tensor veli palatini do and what nerve supplies it?

Tenses soft palate -> CN V3

What does the palatoglossus do and what nerve supplies it?

Depresses palate inferiorly/Elevates tongue superiorly -> CN X

What does the palatopharyngeus do and what nerve supplies it?

It is the longitudinal muscle of the pharynx: | - Attaches between palate and larynx -> CN X

What is the 5th pair of soft palate muscles?

Musculus uvulae

What are the functions of the soft palate?

``` Stop food entering nose during swallowing Direct air into nose/mouth during: - Speech - Sneezing - Coughing - Vomiting Close off oropharynx during gag reflex ```

How can we test CN X and CN V3?

Ask patient to say "Ahh...": - Normal -> Uvula lifts straight in midline - Abnormal -> Uvula pulled away from damaged side

What are the three circular muscles of the pharynx and what is their function?

Constrictor muscles: - Superior - Middle - Inferior

What layer of pharyngeal muscles are the circular muscles?

External

Are the circular pharyngeal muscles voluntary or involuntary?

Voluntarily

How could the circular pharyngeal muscles contractions be described?

Sequential

What nerve supplies the circular pharyngeal muscles?

Branches of CN X: | - Pharyngeal branch

Where do the circular pharyngeal muscles insert?

Midline raphe

Where does the stylopharyngeus muscle originate and what nerve supplies it?

Origin -> Styloid process | Nerve -> CN IX

Where does the palatopharyngeus muscle originate and what nerve supplies it?

Origin -> Hard palate | Nerve -> Pharyngeal branch of CN X

Where does the salpinopharyngeus muscle originate and what nerve supplies it?

Origin -> Cartilage of pharyngotympanic tube | Nerve -> Pharyngeal branch of CN X

Where do the longitudinal pharyngeal muscles insert and what is their function?

Posterior border of thyroid cartilage | Elevate pharynx and larynx

Where are the palatine tonsils located?

Tonsilar fossa/sinus

Where is the lingual tonsil located?

In mucosa of the posterior third of the tongue

Where is the pharyngeal tonsil located and what is its alternate name?

In mucosa of the roof of the nasopharynx | Adenoid

Where are the tubal tonsils located?

In mucosa of eustachian tube opening

What is the lymphatic drainage of the oral cavity?

Submental LNs -> Tip of tongue Retopharyngeal LNs (in retopharyngeal space) Jugulodigastic LN drains palatine tonsil

What are the lay man's 'tonsils'?

Palatine tonsils

What are the differences between lymph nodes in infection and cancer?

``` Infection: - Painful - Soft + Smooth - Not fixed - Improve with treatment Cancer: - Painles - Hard + Irregular - Fixed - Do not improve ```

What fascia contains the larynx?

Pretrachial fascia: | - Visceral layer

What layer lies anterior to the fasica containing the larynx?

Very thin muscular layer: - Strap muscles - Accessory muscles of breathing

Between what spinal levels is the larynx?

C4-C6

How does the larynx remain patent?

Cartilages suspended from hyoid

What prevents foreign bodies entering the larynx?

Vocal folds | Vough reflex

What is cricoid pressure, what does it do, what does it prevent and allow?

``` Pressing on cricoid cartilage: - Compresses oesophagus against body of C6 Closes oesophagus: - Prevents aspiration Leaves larynx open: - Allows ventilation ```

Where do the vocal cords attach between?

Thyroid cartilage -> Vocal processes of arytenoid cartilages

Where does air move through to get into the larynx?

Rima glottidis

What do the cuneiform and corniculate cartilages do?

Support laryngeal outlet: | - Do not move vocal cords

Where is the blade of a laryngoscope inserted?

Vallecula: | - Space between tongue + epiglottis

What is the mucosa of the larynx?

Mainly respiratory | Vocal cords -> Stratified squamous

What do the cilia in the larynx do?

Sweep mucous superiorly to be swallowed: | - Mucociliary escalator

Where are the false and true vocal cords located relative to each other?

``` False vocal cords: - Superiorly - Vestibular folds True vocal cords: - Inferiorly - Vocal folds ```

What is the sensory (and motor) innervation to the larynx?

``` Superior to vocal cords: - Superior laryngeal branch of CN X Inferior to vocal fold: - Recurrent laryngeal > Continues as inferior laryngeal nerve ```

What nerve fibres supply the intrinsic laryngeal muscles?

Somatic motor branches of CN X

What is the function of the cricothyroid muscle?

Tenses vocal cords 'Nods' thyroid cartilage anteriorly: - At cricothyroid joints -> Stretches vocal cords

What is the function of the thryo-arytenoid muscles?

Relaxes vocal cords | Pulls arytenoid cartilages towards thyroid cartilages

What is the function of the lateral crico-arytenoid muscles?

Adduct vocal cords Rotate arytenoid cartilages: - Vocal processes come together in midline

What is the function of the arytenoid muscles?

Adduct vocal cords Assist arytenoid cartillages to gently close rima glottidis Sphincter function: - If crico-thryoid also contracts -> Tigh closure

What are the two types of the arytenoid muscles?

Transverse | Oblique

What is the function of the posterior crico-arytenoid muscles?

Abduct vocal cords | Rotate arytenoid cartilages to move vocal processes laterally -> Widens rima glottidis

What muscles control inspiration?

Diaphragm and/or intercostal muscles

What muscles control controlled expiration?

Contraction of anterolateral abdominal wall muscles: | - Increase pressure to larynx

What affects the pitch of phonation?

Length and tension of vocal cords | Size of rima glottidis

What happens in the production of oral sounds?

1. Soft palate tenses (CN V3) and elevates (CN X) 2. Nasopharynx closed 3. Air directed into oral cavity 4. Tongue (CN XII) and teeth/lips (CN VII) interrupt sound 5. Produces most vowels and consonants

What happens in the production of nasal sounds?

1. Soft palate tenses (CN V3) and descends (CN X) 2. Oropharynx closed 3. Air directed into nose 4. Produces sounds depending on tongue (CN XII) and teeth/lips (CN VII) - 'm' sound - 'n' sound - '-ing' sound

How can we clinically test CN X?

``` Ask patient to swallow water: - Watch larynx move - Do they sputter? Listen to them speak -> Hoarse voice? Ask patient to cough; is it: - Normal - Powerful ```

Anatomy (Mouth and Throat) Flashcards

(76 cards)