Head & Neck / Larynx & Pharynx Anatomy Flashcards
(281 cards)
1
Q
Name the foramen through which the structure passes:
- Meningeal branch of V3
- Terminal branch of V2
- V3 and accessory meningeal artery
- Sphenopalatine artery
- III, IV, VI, Vl
- V2
A
- Meningeal branch of V3: Foramen spinosum
- Terminal branch of V2: Infraorbital foramen
- V3 and accessory meningeal artery: Foramen ovale
- Sphenopalatine artery: Sphenopalatine foramen
- III, IV, VI, Vl: Superior orbital fissure
- V2: Foramen rotundum.
2
Q
Where does Stenson’s duct arise from in relation to the zygoma
A
1.5 em inferior to the zygoma.
3
Q
What % of the population has a thyroidea ima artery
A
10%.
4
Q
What is the normal resting pressure of the lower esophageal sphincter (LES)
A
10-40 mm Hg.
5
Q
What is the distance from the incisor teeth to the cricopharyngeus in adults
A
16 em.
6
Q
What are the nine cartilages of the larynx
A
3 unpaired: thyroid, cricoid, epiglottis; 3 paired: arytenoids, comiculates, cuneiforms.
7
Q
What are the treatment options for Frey’s syndrome
A
3% scopolamine cream, section Jacobson’s nerve, sternocleidomastoid muscle flap, interpose fascia lata between skin and gland.
8
Q
What is the distance from the incisor teeth to the cardia of the stomach in adults
A
40 em.
9
Q
How much saliva is produced per day
A
500 - 1500 cc.
10
Q
Where is the facial nerve trunk located in relation to the tympanomastoid suture line
A
6 - 8 mm anteroinferior (between the suture line and the styloid process).
11
Q
How much of the blood supply to the brain is normally provided by the internal carotid arteries
A
80°/o.
12
Q
What is the angle of the thyroid cartilage at the anterior commissure in men and women
A
90 degrees in men; 120 degrees in women.
13
Q
What nerve parallels the superficial temporal vessels
A
A uric ulotempora l nerve.
14
Q
How do the vocal folds move during quiet respiration
A
Adduct during expiration and abduct during inspiration.
15
Q
What is the threshold for the laryngeal adductor reflex response in normal patients
A
Air pulse stimulus less than 4 mm Hg.
16
Q
What structures form the common facial vein
A
Anterior retromandibular and facial veins.
17
Q
Where does the stylomastoid foramen lie in relation to the origin of the posterior belly of the digastric muscle
A
Anterior.
18
Q
How far is the pes anserinus from the stylomastoid foramen
A
Approximately 1.3 em.
19
Q
Where is Auerbach’s plexus in the esophagus
A
Between the longitudinal and circular muscle fibers.
20
Q
Where do pharyngoesophageai/Zenker’s diverticula occur
A
Between the oblique and transverse fibers of the inferior constrictor (Killian’s dehiscence), most commonly on the left, and between the cricopharyngeus and the esophagus (Killian-Jamieson area).
21
Q
What is the plane of dissection for raising flaps during parotidectomy and how can one identify this more easily
A
Between the SMAS and the superficial layer of the deep fascia… identify the platysma first and work superiorly.
22
Q
What is a stye
A
Blockage of the sebaceous or sweat glands surrounding the eyelashes.
23
Q
What vessels are in direct contact with the anterior trachea
A
Brachiocephalic artery and the left brachiocephalic vein.
24
Q
What is the only sensory nerve arising from the anterior division of V3
A
Buccal nerve.
25
What branch of the facial nerve travels with Stenson's duct
Buccal.
26
What muscle does Stenson's duct pierce
Buccinator.
27
What is the vertebral level of the hyoid in adults
C3.
28
What is the vertebral level of the cricoid in adults
C6.
29
What problem results from blockage of the Meibomian glands
Chalazion.
30
What is the only complete cartilage ring of the respiratory tract
Cricoid.
31
What finding on barium swallow is classic for cricopharyngeal dysfunction
Cricopharyngeal bar.
32
What does the external branch innervate
Cricothyroid muscle.
33
What is the membrane between the cricoid cartilage and the first tracheal ring
Cricotracheal membrane.
34
What is shimmer
Cycle-to-cycle variation in the amplitude of the glottal pulse.
35
What is jitter
Cycle-to-cycle variation in the frequency of the glottal pulse.
36
What is the origin of the superior tarsal muscle (of Muller)
Deep side of the levator palpebrae superioris.
37
What defines the anterior-posterior glottic diameter
Distance from the anterior commissure to the posterior border of the cricoid cartilage.
38
What is damping
Elevation of pitch by narrowing the glottic aperture.
39
What test is used to diagnose a Mallory-Weiss tear
Endoscopy (contrast studies are not beneficial as the tear is only mucosal).
40
Which layers of the vocal cord are primarily responsible for TVC vibration
Epithelium and superficial layer of the lamina propria.
41
What is another term for "inion?''
External occipital protuberance.
42
T/F: Enlargement of the preauricular lymph nodes is indicative of parotid pathology
False... these nodes enlarge from inflammation or metastasizing tumors from the scalp.
43
What muscle descends to insert upon the hyoid
Geniohyoid.
44
What type of joint is the TMJ
Ginglymoarthrodial (hinge/sliding) joint.
45
What is Frey's syndrome
Gustatory sweating, secondary to cross-reinnervation of the divided auriculotemporal nerve with cutaneous nerves, after parotidectomy.
46
What is the normal resting pressure of the upper esophageal sphincter (UES)
I 00 mm Hg in the anteroposterior orientation;
47
What are 6 ways to identify the facial nerve trunk during parotidectomy
Identification of the tympanomastoid suture line, tragal pointer, posterior belly of the digastric, or styloid process; tracing a distal branch retrograde or tracing the proximal portion forward by drilling out the mastoid segment.
48
From which branchial arch does the stylohyoid muscle arise
II.
49
What structures pass through the superior orbital fissure
III, IV, VI, VI, superior ophthalmic vein.
50
Which branchial arches is the larynx derived from
III, IV, VI.
51
Where does the retromandibular vein lie in relation to the facial nerve
In most people, it courses deep to both trunks of the facial nerve. In up to I O% of people, the vein crosses either trunk laterally.
52
What is the effect of beta-adrenergic blockers on LES
Increase LES pressure.
53
What structures pass through the mandibular foramen
Inferior alveolar artery and nerve.
54
What part of the thyroid cartilage articulates with the cricoid cartilage
Inferior cornu.
55
Which skeletal muscles are innervated by the inferior division of III
Inferior oblique, inferior rectus, medial rectus muscles.
56
What is the blood supply to the esophagus
Inferior thyroid artery (branch of the thyrocervical trunk), 2 - 3 branches directly from the thoracic aorta, and the esophageal branch of the left gastric artery.
57
What is the venous drainage of the esophagus
Inferior thyroid vein, azygous and hemiazygous veins (into the IVC ), and esophageal veins (into the coronary vein and eventually the portal vein).
58
Where does the superior laryngeal artery lie in relation to the superior laryngeal nerve
Inferior.
59
What is the terminal branch of V2
Infraorbital nerve.
60
What are the 2 branches of the superior laryngeal nerve
Internal and external.
61
Which of these supplies sensation to the larynx above the glottis
Internal branch.
62
What structures are found in the poststyloid compartment of the parapharyngeal space
Internal jugular vein, internal carotid artery, IX, X, XI, XII.
63
What nerve provides sensory innervation to the pyriform recess of the larynx
Internal laryngeal branch of the superior laryngeal nerve.
64
Where does Stenson's duct open intraorally
Just opposite the 2"d upper molar.
65
What is the name of the fleshy, pink mound of tissue in the medial canthus
Lacrimal caruncle.
66
Which muscles does the anterior branch of the recurrent laryngeal nerve innervate
Lateral cricoarytenoid, thyroarytenoid, vocalis muscles.
67
What muscle protracts the mandible
Lateral pterygoid muscle.
68
What factors determine pitch
Length, tension, and cross-sectional mass of vocal folds; frequency of vibration.
69
Where is the tear most commonly located
Lower esophagus or cardia of the stomach.
70
What structures define the thoracic inlet
Manubrium, I st ribs, and the body of C I.
71
What separates the two valleculae associated with the tongue and the epiglottis
Median glosso-epiglottic fold.
72
What is the common insertion of the three pharyngeal constrictors
Median pharyngeal raphe.
73
What nerve and vessel pass through the foramen spinosum
Middle meningeal artery and meningeal branch of V3.
74
What are the anatomic correlations to hoarseness and breathiness
Mucosal irregularity causes hoarseness; incomplete glottic closure causes breathiness.
75
What is dysphonia plicae ventricularis
Muffled hoarseness secondary to approximation of false vocal folds during phonation.
76
What structures are found in the prestyloid compartment of the parapharyngeal space
Muscles (stylopharyngeus, styloglossus, and stylohyoid), fat.
77
What are the 3 layers of the esophageal mucosa
Muscularis mucosa, lamina propria, epithelium.
78
From what nerve do the anterior and posterior ethmoidal nerves arise
Nasociliary nerve.
79
What nerve usually passes from lateral to medial over the optic nerve
Nasociliary.
80
What three motor branches does the facial nerve give off just after exiting the stylomastoid foramen
Nerve to posterior belly of the digastric, nerve to the stylohyoid, nerve to the postauricular muscle.
81
Which lymph nodes drain tumors from the parotid gland
Nodes just inferior to the gland adjacent to the sternocleidomastoid muscle and the external jugular vein.
82
Which muscles anchor and elevate the larynx
Omohyoid, sternohyoid, sternothyroid muscles.
83
Periosteum and periorbita meet at the orbital margin and continue into the eyelids as what
Orbital septum.
84
What is the name of the point at which the facial nerve divides into the upper and lower divisions
Pes anserinus.
85
What is the only abductor of the vocal cords
Posterior cricoarytenoid muscle.
86
What is the major venous drainage of the parotid gland
Posterior facial vein.
87
What structures form the external jugular vein
Posterior retromandibular and posterior auricular veins.
88
What is the blood supply to the upper molars
Posterior superior alveolar artery.
89
Describe the pathway of parasympathetic innervation to the parotid gland
Preganglionic parasympathetic fibers leave the inferior salivatory nucleus via the glossopharyngeal nerve, pass through the jugular foramen, travel through the middle ear (as Jacobson's nerve), then travel along the floor of the middle cranial fossa (as the lesser petrosal nerve) to the otic ganglion; postganglionic parasympathetic fibers leave the otic ganglion via the auriculotemporal branch of V3 and travel to the parotid gland.
90
What are the 2 types of squamous epithelium lining the TVCs
Pseudostratified columnar (superiorly and inferiorly) and stratified nonkeratinizing squamous (at the contact points of the TVCs).
91
What is the name of the opening through which the maxillary artery passes after giving rise to infraorbital and posterior superior alveolar branches
Pterygomaxillary fissure.
92
What are the 3 phases of speech
Pulmonary, laryngeal, oral.
93
What are the 2 types of diverticula
Pulsion and traction.
94
Which of these is associated with high intraluminal pressure
Pulsion.
95
Which of these is Zenker's diverticulum
Pulsion.
96
What are the three primary parameters of voice
Quality, loudness, pitch.
97
What is the efficacy of ranitidine 150 mg BID compared to proton pump inhibitors in the healing of esophagitis
Ranitidine: 35 - 65% efficacy. Proton pump inhibitors: 95% efficacy.
98
What nerve provides sensory innervation to the infraglottic space
Recurrent laryngeal nerve.
99
What is the function of the auriculotemporal nerve
Sensation of the scalp, auricle and carries postganglionic parasympathetic nerves from the otic ganglion to the parotid gland to stimulate secretions.
100
What are the layers of the eyelid from superficial to deep
Skin, subcutaneous tissue, voluntary muscle, orbital septum, tarsal plate, smooth muscle, and conjunctiva.
101
The pterygoid plates are part of which bone
Sphenoid.
102
What is the name of the maxillary artery after it passes through the pterygomaxillary fissure
Sphenopalatine artery.
103
What are the layers of the vocal fold from superior to deep
Squamous epithelium, Reinke's space (superior layer of lamina propria), intermediate and deep layers of the lamina propria (comprising the vocal ligament), thyroarytenoid muscle.
104
What membrane separates the parotid gland from the submandibular gland
Stylomandibular membrane.
105
What 2 structures pass between the superior and middle pharyngeal constrictors
Stylopharyngeus muscle and IX.
106
What factors determine voice loudness
Subglottic air pressure, glottal resistance, rate of airflow, amplitude of vibration.
107
Where is Meissner's plexus in the esophagus
Submucosa.
108
Which layer of lymph nodes has the most nodes (superficial or deep)
Superficial.
109
What blood vessel travels with the internal branch
Superior laryngeal artery.
110
What muscle inserts on the disk of the TMJ
Superior part of the lateral pterygoid muscle.
111
Which muscles are innervated by the superior division of III
Superior rectus and levator palpebrae superioris muscles.
112
Where are the cell bodies of the motor fibers of the chorda tympani nerve
Superior salivatory nucleus.
113
What are the 3 areas of esophageal narrowing
Superiorly, from the cricopharyngeus; inferiorly, where the esophagus enters the cardia; and in the middle, where the left mainstem bronchus and the aorta cross anteriorly.
114
In what directions are the muscle fibers of the inferior constrictor oriented
Superiorly, in an oblique fashion; inferiorly, in a transverse fashion.
115
What are the boundaries of the parotid compartment
Superiorly, the zygoma; posteriorly, the external auditory canal; anteriorly, the masseter muscle; inferiorly, the styloid process, carotid artery, jugular vessels, styloid muscles.
116
What is the most common cause of esophageal perforation
Surgical instrumentation.
117
What determines voice quality
Symmetry of vocal fold vibration.
118
What is the vertebral level of the carina in adults
T4 - T5.
119
What glands are contained within the tarsal plates
Tarsal glands (Meibomian).
120
Where are the left and right vagus nerves in relation to the esophagus
The left is anterior and the right is posterior.
121
What is unique about the lymphatic drainage of the parotid gland
The lymph nodes are contained within the gland, and it is the only salivary gland with two layers of lymph nodes.
122
How does the saliva produced from the parotid gland differ from that of the sublingual gland
The saliva from the parotid is serous, high in enzymes and low in mucin; that from the sublingual gland is primarily composed of mucin.
123
Which muscle comprises part of the vocal fold
Thyroarytenoid muscle.
124
What membrane must the internal branch penetrate
Thyrohyoid.
125
What is the function of the cricothyroid muscle
To lengthen the vocal fold and increase pitch.
126
What artery provides most of the blood supply to the palatine tonsil
Tonsillar branch of the facial artery.
127
What is the only unpaired muscle of the larynx
Transverse arytenoid muscle.
128
What is the blood supply to the parotid gland
Transverse facial artery, a branch of the superficial temporal artery.
129
T/F: The esophagus does not have a serosa
True.
130
T/F: The incidence of foreign body aspiration is equal between the right and left bronchus in children
True; the left bronchus is not as obliquely angled as in the adult.
131
What is the most consistent landmark for identification of the facial nerve trunk
Tympanomastoid suture line.
132
How does the musculature of the upper 1/3 esophagus differ from the lower 2/3
Upper 1/3 is striated; lower 2/3 is smooth.
133
What passes through the foramen rotundum
V2.
134
What is the name of the lower free margin of the quadrangular membrane
Vestibular fold.
135
What is the name of the space between the cheeks and the teeth
Vestibule.
136
What is the name of the upper free margin of the conus elasticus
Vocal ligament.
137
What is "donkey breathing?"
Vocalization during inspiration.
138
What test is used to diagnose Boerhaave syndrome
Water-soluble contrast esophagram (tear is transmural).
139
With one exception, all the muscles of the pharynx are innervated by what nerve
X.
140
T /F: Saliva promotes the calcification of teeth
TRUE
141
What is the average fundamental frequency for a child? Adult female? Adult male?
250 Hz; 200 Hz; 120 Hz.
142
What is the average maximum phonation time for an adult male? Adult female?
17-35 seconds; 12-26 seconds.
143
What is the average tracheal wall mucosal capillary pressure?
20-30 mm Hg.
144
What percent of neonates less than 5 days old have a functioning cough reflex?
25%.
145
What percent of the population has a thyroidea ima artery?
3-10%.
146
What is the maximum range of fundamental frequency for the human voice?
36-1760 Hz.
147
What is the average decibel level of the human voice?
65-75 dB.
148
What is the angle of the thyroid cartilage at the anterior commissure in men and women?
80 degrees in men; 120 degrees in women.
149
What is the Bernoulli principle?
A column of air flowing through a conduit produces a partial vacuum or negative pressure at the margins of the column that increases as the rate of flow increases.
150
How do the vocal folds move during quiet respiration?
Adduct during expiration and abduct during inspiration.
151
What prevents air from escaping through the glottis during the cough reflex?
Adduction and turning down of the false vocal cords (FVC).
152
Which portion of the larynx has sparse lymphatic drainage?
Anterior glottis (epithelium of the 'IVC).
153
What vessels are in direct contact with the anterior trachea?
Brachiocephalic artery and the left brachiocephalic vein.
154
What is the vertebral level of the hyoid in adults?
C3.
155
What is the vertebral level of the cricoid in adults?
C6.
156
What is the sequence of events during the glottic closure reflex?
Closure of the true vocal cords (TVC), followed by closure of the FVC, followed by adduction of the aryepiglottic folds.
157
What anatomic structures inhibit malignant invasion by laryngeal cancers?
Conus elasticus, quadrangular membrane, thyrohyoid membrane, cricothyroid membrane, and internal perichondrium of the thyroid lamina.
158
What is the only complete cartilage ring of the respiratory tract?
Cricoid.
159
What does the external branch innervate?
Cricothyroid muscle.
160
Which laryngeal muscle is primarly responsible for pitch elevation?
Cricothyroid.
161
What is the membrane between the cricoid cartilage and the first tracheal ring?
Cricotracheal membrane.
162
What are the boundaries of the preepiglottic space?
Epiglottic cartilage posteriorly, thyrohyoid membrane and hyoid bone anteriorly, and hyoepiglottic ligament superiorly.
163
What structures are considered part of the supraglottis?
Epiglottis, false vocal cords, aryepiglottic folds, and arytenoids.
164
Which layers of the vocal cord are primarily responsible for TVC vibration?
Epithelium and superficial layer of the lamina propria.
165
What anatomic feature of the epiglottis facilitates extension of carcinoma into the preepiglottic space?
Fenestrations/ dehiscences.
166
What muscle descends to insert upon the hyoid?
Geniohyoid.
167
From which branchial arch does the stylohyoid muscle arise?
II.
168
Which branchial arches is the larynx derived from?
III, IV, and VI.
169
How does the position of the larynx differ between neonates and adults?
In the neonate, the larynx is positioned more anterosuperiorly, lying at the level of C2-C3, with the cricoid lying at C3-C4. In the adult, the larynx lies at the level of Cs and the cricoid at C7.
170
What part of the thyroid cartilage articulates with the cricoid cartilage?
Inferior cornu.
171
Where does the superior laryngeal artery lie in relation to the superior laryngeal nerve?
Inferior.
172
What are the two branches of the superior laryngeal nerve?
Internal and external.
173
Which of these supplies sensation to the larynx above the glottis?
Internal branch.
174
What nerve provides sensory innervation to the pyriform recess of the larynx?
Internal laryngeal branch of the superior laryngeal nerve.
175
What is the significance of a thyroidea ima artery to a head and neck surgeon?
It can cause excess bleeding while performing a tracheostomy.
176
Which muscles does the anterior branch of the recurrent laryngeal nerve innervate?
Lateral cricoarytenoid, thyroarytenoid, and vocalis muscles.
177
What is laryngospasm?
Maladaptive and exaggerated glottic closure reflex.
178
What separates the two valleculae associated with the tongue and the epiglottis?
Median glossa-epiglottic fold.
179
What are the anatomic correlations to hoarseness and breathiness?
Mucosal irregularity causes hoarseness; incomplete glottic closure causes breathiness.
180
Which muscles anchor and elevate the larynx?
Omohyoid, sternohyoid, and sternothyroid muscles.
181
What is the only abductor of the vocal cords?
Posterior cricoarytenoid muscle.
182
What are the two types of squamous epithelium lining the true vocal cords?
Pseudostratified columnar (superiorly and inferiorly) and stratified nonkeratinizing squamous (at the contact points of the TVCs).
183
What are the three phases of speech?
Pulmonary, laryngeal, and oral.
184
What nerve provides sensory innervation to the infraglottic space?
Recurrent laryngeal nerve.
185
What is the significance of Broyle's tendon?
Serves as a pathway for tumor extension into the thyroid cartilage.
186
What are the layers of the vocal fold from superior to deep?
Squamous epithelium, Reinke's space (superior layer of lamina propria), intermediate and deep layers of the lamina propria (comprising the vocal ligament), and thyroarytenoid muscle.
187
What blood vessel travels with the internal branch?
Superior laryngeal artery.
188
Unlike the glottic closure reflex, laryngospasm is mediated solely by stimulation of what nerve?
Superior laryngeal nerve.
189
What is the vertebral level of the carina in adults?
T4-T5.
190
What is the Venturi effect?
The acceleration of flow as a current of air or liquid enters a narrowed passage.
191
What are the nine cartilages of the larynx?
Three unpaired: thyroid, cricoid, and epiglottis.Three paired: arytenoids, corniculates, and cuneiforms.
192
What muscle adducts the false vocal cords and aryepiglottic folds?
Thyroarytenoid muscle.
193
What membrane must the internal branch penetrate?
Thyrohyoid.
194
What is the function of the cricothyroid muscle?
To lengthen the vocal fold and increase pitch.
195
What is the only unpaired muscle of the larynx?
Transverse arytenoid muscle.
196
True/False: Embryologically, the supraglottis and glottis are separate entities
True.
197
True/False: Compared to the gag reflex, the cough reflex correlates better with a newborn's ability to eat safely.
True.
198
What is the name of the lower free margin of the quadrangular membrane?
Vestibular fold.
199
What is the name of the upper free margin of the conus elasticus?
Vocal ligament.
200
What is Broyles' tendon?
Vocalis muscle tendon that inserts into the thyroid cartilage.
201
At what age gestation can an infant suckle feed?
34 weeks.
202
At what age should children be able to respond to their name and understand simple words?
6-10 months.
203
All the muscles participating in the oral phase of swallowing are striated Muscles using _______ for neurotransmission via \_\_\_\_\_receptors.
Acetylcholine; nicotinic.
204
How many words should a child aged 24-36 months be able to say?
Fifty.
205
What nerve mediates taste sensation from the circumvallate papillae?
IX.
206
What is the common insertion of the three pharyngeal constrictors?
Median pharyngeal raphe.
207
A patient complains of not being able to taste. Upon further questioning, he admits to being able to taste salt crystals, sugar crystals, lemon juice and coffee but nothing else.What is the primary problem?
Olfactory loss.
208
What is the plica triangularis?
Point at which the palatine and lingual tonsils meet.
209
Taste sensation is relayed by\_\_\_ fibers from the anterior 2/3 of the tongue via the\_\_\_\_ nerve, from the posterior 1/3 of the tongue via the\_\_\_\_\_ nerve, and from the epiglottis via the\_\_\_\_ nerve, with these fibers terminating in the\_\_\_\_\_\_\_\_.
Special visceral afferent; chorda tympani; lingual; vagus; nucleus tractus solitarius
210
How does infant swallowing differ from adult swallowing?
The pharyngeal phase of swallowing in infants is faster and more frequent.
211
What is the sequence of events during a normal swallow?
1. Oral phase: Food is chewed and mixed with saliva.
2. Oropharyngeal phase: The food bolus is propelled posteriorly.
3•Pharyngeal phase: The soft palate elevates, glottis closes, pharyngeal constrictors contract, and the cricopharyngeus relaxes.
4•Esophageal phase: The bolus is propelled into the stomach by peristaltic waves.
212
In what percent of the population does the carotid artery lie deep to the floor of the tonsillar fossa?
1%.
213
How long do taste sensory cells live?
200-300 hours.
214
At what age should children be able to say multiword sentences?
36 months.
215
When does the primary palate develop?
4-5 weeks gestation.
216
When does the secondary palate develop?
8-9 weeks gestation.
217
What is the normal thickness of the soft palate in adults?
About 12 mm; gets thinner laterally.
218
What immunoglobulin is produced by the tonsils?
Antigen-specific secretory IgA.
219
How does the secondary palate develop?
As a medial ingrowth of the lateral maxillae with fusion in the midline.
220
How does the primary palate develop?
As a mesodermal and ectodermal proliferation of the frontonasal and maxillary processes.
221
At which points is the normal vermillion the widest?
At the peaks of Cupid's bow.
222
True/False: A cleft lip is always associated with a cleft alveolus.
False; a cleft alveolus is always associated with a cleft lip.
223
Which group of papillae on the tongue lacks taste buds?
Filiform.
224
What structure marks the boundary between the anterior 2/3 of the tongue and its posterior 1/3?
Foramen cecum.
225
What are the four extrinsic muscles of the tongue?
Genioglossus, hyoglossus, styloglossus, and palatoglossus.
226
What divides the palate into the primary and secondary palates?
Incisive foramen.
227
Why is the tongue a muscular hydrostat?
It is a structure with incompressible muscles and no skeletal support that is capable of movement. Changes in the shape of the muscle do not change its volume.
228
During embryologic development, what causes a cleft lip?
Lack of mesodermal proliferation results in an incomplete epithelial bridge.
229
What artery runs through the incisive foramen?
Lesser palatine artery.
230
What is Gerlach's tonsil?
Lymphoid tissue arising from the fossa of Rosenmiiller that extends into the eustachian tube.
231
What structures form the hard palate?
Maxilla, horizontal process of the palatine bone, and the pterygoid plates.
232
Which muscles form the anterior and posterior tonsillar pillars?
Palatoglossus and palatopharyngeus, respectively.
233
What muscles form the soft palate?
palatopharyngeus, salpingopharyngeus, levator and tensor veli palatini, muscular uvula, palatoglossus, and superior constrictor muscles.
234
What muscle functionally divides the oral cavity from the oropharynx?
Palatopharyngeus.
235
What are the embryologic origins of the anterior 2/3 and posterior t/3 of the tongue?
The anterior 2/3 of the tongue develops from the 1st branchial arch and the posterior 1/3 of the tongue develops from the 3rd and 4th branchial arches.
236
What artery provides most of the blood supply to the palatine tonsil?
Tonsillar branch of the facial artery.
237
True/False: At no time in the development of the normal primary palate is there a separation.
True.
238
True/False: The four taste qualities can be perceived by all the taste buds.
True.
239
True/False: Boluses placed on the posterior tongue trigger swallowing at a lower volume than the anterior tongue.
True.
240
What are the three groups of intrinsic muscles of the tongue?
Vertical, transverse, and longitudinal.
241
What is the name of the space between the cheeks and the teeth?
Vestibule.
242
How is the quality of taste determined?
Via the central nervous system from the discharge pattern across all the sensory nerve fibers sensitive to the substance.
243
How is the intensity of taste determined?
Via the central nervous system from the frequency of discharge across all the sensory nerve fibers sensitive to the substance.
244
Which three cranial nerves mediate taste?
VII, IX, and X.
245
It is derived from the 4th branchial arch and its innervation comes from the nucleus ambiguous.
Don’t know
246
What are the boundaries of the parapharyngeal space?
**Inferior** - Hyoid bone. **Superior** - Petrous bone. **Medial** - Soft palate, tonsils, and superior pharyngeal constrictor. **Lateral** - Medial pterygoid muscle, ramus of the mandible, and posterior belly of the digastric.Dorsal- Vertebral column and paravertebral muscles. Ventral - Pterygomandibular raphe.
247
Which structures separate the hypopharynx from the larynx?
Aryepiglottic folds.
248
Where is the fossa of Rosenmuller?
Just posterior-superior to the torus tubarius of the eustachian tube orifice.
249
What structure in the hypopharynx marks the location of the cricoarytenoid joint?
Piriform apex.
250
What are the three subsites of the hypopharynx?
Pyriform sinus, postcricoid area, and posterior pharyngeal wall.
251
What space does the parapharyngeal space communicate with dorsally?
Retropharyngeal space.
252
What are the boundaries of the pyriform fossa?
Superiorly, the inferior margin of the hyoid; anteriorly, the junction of the anterior and posterior halves of the thyroid cartilage; posteriorly, the posterior edge of the thyroid cartilage; apex, the cricoarytenoid joint.
253
What is the average resting pressure of the remainder of the esophagus?
-5 mm Hg for the body of the esophagus and 10-40 mm Hg for the lower esophageal sphincter.
254
By what age is the adenoid pad mostly atrophied?
Age 7 or 8.
255
What kind of epithelium lines the nasopharynx?
At birth, pseudostratified columnar epithelium; by age 10, the majority is replaced by stratified squamous epithelium. The lateral portion does not change, and the area where these two types meet is lined by transitional epithelium.
256
Where is Auerbach's plexus in the esophagus?
Between the longitudinal and circular muscle fibers.
257
What structures are found in the pos1styloid compartment of the parapharyngealspace?
Carotid sheath, IX, X, XII, and cervical sympathetic chain.
258
What are the boundaries of the cervical esophagus?
Cricopharyngeus muscle to sternal notch.
259
True/False: Oral and pharyngeal transit times of the bolus are not affected by bolus volume or bolus viscosity.
False; as volume and viscosity of the bolus increase, transit time increases.
260
True/False: At rest, the cricopharyngeus muscle is relaxed.
False; the cricopharyngeus muscle has a resting pressure of 100 mm Hg in the anteriorposterior direction and so mm Hg in the right and left lateral direction.
261
Which foramina of the skull lie in close proximity to the nasopharynx?
Foramen lacerum, carotid canal, foramen spinosum, foramen ovale, foramen rotundum, hypoglossal canal, and jugular foramen.
262
What is the venous drainage of the cervical esophagus?
Inferior thyroid vein.
263
What is the relationship of the fossa of Rosenmiiller to the parapharyngealspace?
It lies at the convergence of the fascial planes that separate the parapharyngeal space into its three compartments (prestyloid, retrostyloid, and retropharyngeal).
264
What effect does chin tucking have on swallowing?
It pushes the base of tongue and epiglottis anteriorly, causes the airway to narrow.
265
What are the six valves of the upper digestive tract that function during swallowing?
Lips, tongue, velum to back of tongue (glossopalatal valve), velopharynx, larynx, and upper esophageal sphincter.
266
What effect does smoking have on lower esophageal sphincter pressure?
Lowers it.
267
What structures are found in the prestyloid compartment of the parapharyngeal space?
Medial pterygoid muscle, fat, lymphatics, minor nerves, and vessels.
268
What are the layers of the posterior pharyngeal wall, from superficial to deep?
Mucosa, constrictor muscles, longus colli, retropharyngeal space, prevertebral fascia.
269
What are the three layers of the esophageal mucosa?
Muscularis mucosa, lamina propria, and epithelium.
270
Retained secretions in the hypopharynx that fail to clear with swallowing indicate a \_\_\_\_\_\_disorder when thickened and mucoid and a. ______ when frothy or foamy.
Neurological; structural.disorder
271
What effect do beta-adrenergic blockers have on lower esophageal sphincter pressure?
Raise it.
272
What two structures pass between the superior and middle pharyngeal constrictors?
Stylopharyngeus muscle and IX.
273
Where is Meissner's plexus in the esophagus?
Submucosa.
274
What are the three areas of esophageal narrowing?
Superiorly, from the cricopharyngeus; inferiorly, where the esophagus enters the cardia; and in the middle, where the left mainstem bronchus and the aorta cross anteriorly.
275
In what directions are the muscle fibers of the inferior constrictor oriented?
Superiorly, in an oblique fashion; inferiorly, in a transverse fashion.
276
Where are the left and right vagus nerves in relation to the esophagus?
The left is anterior and the right is posterior.
277
What is the arterial supply to the cervical esophagus?
Thyroid branch of the thyrocervical trunk.
278
True/False: Unlike the rest of the gastrointestinal tract, the esophagus does not have a serosa.
True.
279
True/False: Regardless of bolus volume, airway closure and cricopharyngeal opening always occur within 0.03 seconds of each other.
True.
280
How does the musculature of the upper 1/3 esophagus differ from the lower 2/3?
Upper 1/3 is striated; lower 2/3 is smooth.
281
What effect does bolus volume have on the temporal relationship of the oral and pharyngeal stages of swallowing?
With small volumes, the oral phase preceeds the pharyngeal stage, but with larger volumes (1o cc or more), the stages occur simultaneously.
