HNS 3 Flashcards
(172 cards)
1
Q
label this diagram
A
2
Q
What nerve are doctors testing when asking a patient to open their mouth (ah)?
A
Vagus nerve
3
Q
Which cranial nerve provides motor functions to the uvula?
A
Vagus nerve
4
Q
What would you expect to see of the uvula if vagus nerve functioning normally (when testing it clinically)?
A
Uvula should go straight up the midline
5
Q
A lesion to the right vagal nerve of the uvula results in what deviation?
A
Deviation to the opposing side
6
Q
What does a deviation of the uvula to one side suggest?
A
Problem with one of the vagus nerves
Uvula deviates away from the side where the lesion is
7
Q
What pharynx is posterior to the oral cavity?
A
Oropharynx
Can see posterior wall of oropharynx behind the uvula in image shown
8
Q
What is the palatoglossal fold?
A
Most anterior fold of tissue at back of mouth
From the palate at the top of the mouth down to the tongue
9
Q
What is the palatopharyngeal fold?
A
Posterior to the palatoglossal fold
From the palette to the pharynx
10
Q
What is the palatine tonsil?
A
In between the palatoglossal fold and the palatopharyngeal fold
11
Q
What do the tonsils give you an idea of?
A
If there’s been infection or inflammation
12
Q
Label the diagram and what view of the head is it?
A
Mid-saggital view
13
Q
How does the hard palate assist eating?
A
Tongue is used to move food up against the hard palate to start breaking it down
14
Q
What hangs from the soft palate?
A
The uvula
15
Q
What 3 structures form the pharynx?
A
Nasopharynx
Oropharynx
Laryngopharynx
16
Q
Function of the epiglottis?
A
Retroflexes over laryngeal inlet when you swallow food, preventing food going down into airways
Allows food to travel down back of pharynx down to oesophagus
17
Q
Label this diagram
A
18
Q
Where does the tongue sit?
A
Buccal cavity
19
Q
What does the epiglottis cover?
A
Laryngeal inlet
20
Q
What is the piriform fossa?
A
Area has quite a strong sensory innervation where you can get bits of bones stuck
Channel that directs solid & liquids from oral cavity around the raised laryngeal inlet and into the oesophagus
Sensitive are that can cause distress to someone that gets something caught there
21
Q
What are the muscles of the pharynx?
A
Superior, middle and inferior constrictors
22
Q
Which 2 nerves form the pharyngeal plexus and what does it provide?
A
Glossopharyngeal and vagus nerves (strong sensory innervation)
Strong sensory innervation to the muscles of the pharynx
23
Q
Which nerve controls the motor functions of the constrictors?
A
Vagus nerve (CN10) + accessory nerve (XI)
24
Q
What is the action of swallowing?
A
Coordinated sequential contraction of superior, middle and inferior constrictors
Allows coordinated contraction of food bolus from mouth down to oesophagus
25
What are the 3 main salivary glands within the oral cavity?
Submandibular
Sublingual
Parotid
26
What are salivary glands?
Glands that secrete amylase into the oral cavity.
Small glands reside within the submucosa or mucosa of the oral epithelial lining the tongue, palate, cheeks + lips
27
Explain the first part of digestive process
Breakdown of food in the mouth enzymatically. Produce saliva from 3 pairs of salivary glands: parotid, submandibular and sublingual.
28
What is the biggest salivary gland?
The parotid gland
29
Pathway of saliva through parotid gland?
Saliva fro the parotid gland passes through the parotid duct + passes into upper part of the mouth, passes through the boccinator muscle + opens up next to the second upper molar in the mouth
30
What is the consistency of the saliva produced by the parotid?
Thin + mainly serous
31
What is the parotid gland innervated by?
CN IX -\> glossopharyngeal nerve
32
What are sublingual and submandibular glands innervated by?
Facial nerve
33
What saliva is produced by submandibular gland?
very thin serous saliva
34
What type of saliva is produced by sublingual glands?
Mucous saliva
35
Where does the tongue sit?
In the buccal cavity
36
Which nerve controls the function of the intrinsic muscles of the tongue?
Hypoglossal nerve
37
What does the hypoglossal nerve supply?
Intrinsic muscles and extrinsic muscles of tongue
38
Which extrinsic muscles of the tongue does this nerve supply?
Palatoglossus (from palate to tongue)
Styloglossus (from styloid process and base of skull all the way to tongue)
Genioglossus (from mandible to tongue)
39
How to test cranial nerve 12 (hypoglossal nerve)?
Ask patient to stick their tongue out + genioglossus contracts and tongue protracts out of the mouth
## Footnote
If there is a problem with one of the hypoglossal nerves, the tongue will deviate in the direction of the site of lesion (i.e. if tongue deviates to left there is a lesion in the left hypoglossal nerve)
40
Where are the submandibular glands?
Reside within the floor of the mouth, secrete saliva into the mouth through submandibular ducts
41
Where do the sublingual glands reside in relation to the tongue?
Inferior to the tongue
42
Where are the parotid glands?
Reside between the skin and masseter muscle, proximal to the ears
43
Where does the parotid duct enter into the oral cavity?
Penetrates the buccinator muscle, which is located near the second upper molar tooth
44
What are the 4 main extrinsic muscles of the tongue?
Genioglossus
Hypoglossus
Styloglossus
Palatoglossus
45
Which extrinsic tongue muscle protrudes the tongue out of the oral cavity, and depresses the centre?
Genioglossus
46
What is the function of the hyoglossus?
Depresses and retracts the tongue
47
What is the function of the genioglossus?
Muscle responsible for protruding the tongue
48
What is the function of the styloglossus?
Elevates + retracts the tongue
49
What is the function of the palatoglossus?
Elevates the posterior portion of the tongue
50
Which nerve is for touch sensation of the anterior two thirds of the tongue?
Trigeminal nerve
51
Which nerve is for touch sensation of the posterior 1/3rd of the tongue?
Glossopharyngeal provides sensory touch sensation
52
Which nerve is for taste of the anterior 2/3rds of the tongue?
Facial nerve
53
Which nerve is for taste of the posterior 1/3rd of the tongue?
glossopharyngeal
54
Where do both of these nerves send fibers back to?
Send fibers back to the nucleus solitarius in the brainstem (our taste perception centre)
55
Which cranial nerve innervates the epiglottis?
Vagus nerve (internal laryngeal nerve -\> branch of the superior laryngeal nerve from the vagus nerve)
56
Which parts of the tongue detect different tastes (salty, bitter, sweet etc.)
Salty - front (anterior part of the tongue)
Bitter - back (posterior part of tongue)
sweet - front (anterior part of tongue)
sour - lateral part of the tongue
umami - hard to define taste; all over the tongue
57
A lesion in the hypoglossal nerve results in a tongue deviation towards?
Towards the lesion
58
What is food and liquid and chewed and formed into?
Bolus
59
What are the 4 main phases of swallowing?
Oral preparatory phase
Oral transit phase
Pharyngeal phase (1&2)
Oesophageal phase
60
What happens during the oral preparatory phase?
Food/liquid chewed → Bolus.
Bolus held on centre of tongue
To do this we have the lip, jaw, tongue and the palate [Dentition as well]. This stage is a voluntary task.
61
What nerves innervate the oral preparatory phase?
Cranial nerves number 5, 7, 9, 10 + 12
62
What happens during the oral transit phase?
Bolus propelled to back of mouth.
Palate seals entrance to nasal cavity (soft palate is raised → Stops food from going into the back of the nose).
Lip, jaw, tongue and palate sensory and motor function needed. Still a voluntary process (airway still opened)
Cranial nerves V, VII, IX, X and XII (same as first phase of swallowing)
63
What is triggered when the bolus reaches the faucial arches at the back of the mouth?
First part of pharyngeal phase
64
Is the airway open during the oral transit phase?
Yes
65
When does the airway close?
Pharyngeal phase 1
66
Which palate during the swallowing phase seals off the nasopharynx?
Soft palate
67
Outline the mechanism of pharyngeal phase 1
Palate stays elevated.
Tongue retracts to push the bolus of food into the pharynx. This requires the tongue, palate and laryngeal sensory and motor function needed.
The airway is closed at this point.
No voluntary control; Reflex control
68
What nerves innervate the pharyngeal phase 1?
Cranial nerves 9, 10 + 12
69
Outline the mechanism of pharyngeal 2 phase
Bolus propelled through pharynx
Tonge, palate and laryngeal sensory and motor function needed.
Reflex control
Involves cranial nerves IX, X and XII.
Airways are closed by epiglottis (retroflexes over laryngeal inlet), vocal cords and arytenoid action → Prevents food going into upper airway.
70
What cranial nerves innervate the pharyngeal phase 2?
cranial nerves 9, 10 + 12
71
Outline the mechanism of oesophageal phase
Oesophagus opens, airway still closed, breath held.
Bolus is propelled through oesophagus → Reflex control
Cranial nerves IX and X involved.
Respiration then resumes with an exhalation → Clears any food particles from airway entrance.
72
What nerves innervate the oesophageal phase?
Cranial nerves 9 + 10
73
What is a videofluoroscopy?
Patient given bolus of barium; visualise as it passes from mouth into pharynx + down to oesophagus
74
What are the features of a normal swallow?
Transit through mouth: 1 sec
Pharyngeal transit: 1-2 sec
No residue in mouth/pharynx
No spillage from lips or into airway.
75
What is an ataxic swallow?
Uncoordinated tongue retraction (due to cerebellar haematoma) to propel food. Quite difficult to propel food into pharynx
Delayed airway closure → Food enters airway.
Natural reaction is a cough, but the cough is delayed and ineffective to clear airway; hence food goes into the lung (aspirated into lung)
76
What is a cerebellar haematoma + what does it make it difficult to do?
Bleed affecting the cerebellum
Coordinated muscle action has been impaired means it's quite difficult to retract the tongue + propel food into pharynx
77
What happens with the cerebellar haematoma and aspiration?
Some is aspirated into the lung
78
Why does the bolus aspirate into the lungs during a cerebellar haemotoma?
Delayed and ineffective cough to clear airway
79
What can be done to reduce aspiration of bolus for patients with a cerebellar haematoma?
Flexed neck during swallow
80
What can an excised (removed) acoustic neuroma leave the patient with?
Lower motor neurone lesion
81
What does a lower motor neurone lesion?
Ipsilateral paresis (partial paralysis) in pharynx, larynx and tongue.
Problems in bolus propulsion (weak bolus propulsion)
Failure of airway to close
82
How can you treat lower motor neurone lesion?
Rotate head to direct the bolus down the strong side of the pharynx and this helps to the airway to closure as well.
83
How does Parkinson's disease cause swallow difficulty?
Difficult in initiating a swallow, repetitive tongue movements -\> Linked with muscle rigidity , unable to lower the back of the tongue
84
How can a speech therapist do to help patient with Parkinson's Disease?
Train patient for an effective swallow → Active range of motion exercises of lips and tongue.
85
What happens when you have a normal voice and swallow? What can be seen using a fibreoptic endoscope?
Vocal cords adduct to produce voice and close airway.
Saliva is cleared in a single swallow and doesn't accumulate. Water swallowed \<1 second.
No residue in pharynx or in trachea.
86
What do you do when a patient's airway is compromised?
Intubation - tube needs to be introduced into the upper airway
87
Describe the structure of the larynx?
Hollow structure composed of cartilages, membranes and muscles.
88
What is the main function of the larynx?
Is a sphincter to close the lower respiratory tract and an instrument to produce sound
89
Which bone is the larynx suspended from?
Hyoid bone
90
Label the diagram of the pharynx
91
What does the trachea sit in the pharynx?
Inferiorly
92
Functions of the larynx?
Acts as a valve - top of airway and allows air in + out of the airway
Sound producer - Air passing past the vocal folds
93
Which nerve supplies most of the motor and sensory innervation to the larynx?
Vagus nerve
94
Label the diagram
95
Which laryngeal cartilage is the most inferior?
Cricoid cartilage
96
What cartilage articulates with the cricoid?
Arytenoid cartilages
97
What is the biggest cartilage involved in the larynx?
Thyroid cartilage
98
What is the common name for the laryngeal prominence?
Adam's apple
99
What is the posterior broad region of the cricoid cartilage?
The lamina
100
What is the anterior region of the cricoid cartilage?
Narrow arch of the cricoid cartilage
101
Where are the 2 attachment facets on the cricoid cartilage which articulate with the arytenoid cartilage?
Posteriorly on the lamina
102
Which cartilage articulates with the lateral articulation facets on the cricoid facets?
Medial surface of the thyroid horn of the thyroid cartilage
103
Which two structures form a superior point of fusion of the thyroid cartilage?
Right and left lamina
104
Which structure is formed upon the fusion of the right and left lamina anteriorly?
Laryngeal prominence
105
Which bone are the superior horns of the thyroid cartilage attached to?
Hyoid bone
106
Which structure do the inferior horns of the thyroid cartilage articulate with?
Cricoid cartilage
107
Which ligament attaches the epiglottis to the thyroid cartilage?
Thyro-epiglottic ligament
108
Which paired cartilage are pyramidal shaped and reside on the superoposteriar articular facets of the cricoid cartilage?
Arytenoid cartilages
109
What is the area above the vocal folds called?
Vestibule
110
What is beneath the vestibule?
Infrared glottic space
111
What is laterally and superior to the vocal folds?
Vestibular fold
112
What is the vestibular fold?
False vocal cords and superior to the vocal folds
113
Label this diagram + what view is this
114
What structure is at the back of the tongue?
Epiglottis (retroflex + close off airway during swallowing)
115
Which group of larynx muscles are the most important in terms of the vocal cords?
Arytenoid muscle
116
Contraction of which muscles will open up/adduct the vocal folds?
Posterior cricoarytenoid muscles
117
Function of the cricothyroid muscle?
Lengthens and stretches the vocal fold (tensor)
118
Contraction of which muscles will close (abduct) the vocal folds?
Lateral cricoarytenoid muscles
119
What nerve innervates the circothyroid muscle?
Superior laryngeal branch of vagus nerve
120
What does contraction of the cricothyroid muscle do?
Tense vocal folds, and will change the pitch of the noise produced by airflow between them
121
What is the function of the oblique arytenoid muscle?
Narrows the laryngeal inlet
122
What is the function of the transverse arytenoid muscle ?
In coordination with the oblique arytenoid muscle, the transverse muscle pulls the arytenoid cartilage closes together -\> Closure of the posterior glottis
123
Which muscle opens the glottis, and separates the vocal folds?
Posterior cricoarytenoid
124
Protective mechanisms for the airway + explanation?
Swallowing (epiglottis retroflexes over opening of airway + stops food going into airway)
Gag reflex (stops you swallowing something you don't want to); glossopharyngeal nerve is underlying this reflex.
Sneezing
Coughing
125
Which nerve controls the gag reflex?
Glossopharyngeal nerve
126
What are the 2 protective mechanisms involving expulsion of air at some speed?
Sneezing and coughing
127
How does sneezing protect the airway?
Expel air through nose to try and clear the obstructions or irritations in the nose
128
How does coughing protect the airways?
Reflex action to remove food away from trachea out through the oral cavity
129
How is the larynx innervated?
By branches of the vagus nerve:
- Superior laryngeal nerve (internal laryngeal nerve + external laryngeal nerve)
- Recurrent laryngeal nerve
130
What is the pathway of the recurrent laryngeal nerve?
Last branches of recurrent laryngeal nerve passes down into the thorax + comes back into the larynx
131
Label this diagram
132
If there is a lesion before any vagal branches arise, what does the patient present with?
Complete paralysis of the larynx
133
If there is a lesion in the internal and external branches of the superior laryngeal nerve, what happens in each case?
Internal - Lesion causes loss of sensation above the vocal folds.
External - Lesion causes paralysis to the cricothyroid muscle.
134
If there is a lesion in the recurrent laryngeal nerve what does the patient present with?
Paralysis of all the muscles of the larynx apart from the cricothyroid and loss of sensation below the vocal folds.
135
Label this diagram of the thyroid gland
136
What is the function of the external branch of the superior laryngeal nerve?
Supplies the cricothyroid muscle
137
What gland is closely associated with the larynx?
Thyroid gland
138
What sits in the middle of the 2 thyroid glands?
Isthmus
139
Which nerve runs very close to the thyroid?
Recurrent laryngeal nerve
140
Why can thyroid surgey be dangerous (thyroidectomy)?
Surgeons have to be careful not to damage the recurrent laryngeal nerve or they could risk paralysing the larynx.
141
Which nerve provides motor function to the cricothyroid muscle?
External branch of the superior laryngeal nerve
142
What is the thyroid isthmus?
Connects the lateral lobes
143
What is the first branch of the external carotid artery?
Superior thyroid artery
144
What is the first branch of the external carotid artery?
Superior thyroid artery
145
Where does the facial vein drain into?
Into the internal jugular vein
146
What is the most prominent superficial vein of the head and neck?
External jugular vein (lies on the surface of sternocleidomastoid)
147
What do the opthalmic veins drain back into + why is it a potential route of infection?
Cavernous sinus
Potential route of infection back into the cranial cavity so the infection around the orbit
148
Label this deep view of veins on diagram
149
Where does the pterygoid plexus of deep veins drain ultimately into?
Internal jugular vein
150
What is the function of the pterygoid plexus?
Collect the blood from the palate, nasal cavity, paranasal sinuses, nasopharynx and auditory tube
151
Label this diagram of the neck
152
Which 2 veins are potential routes for putting in a central line to monitor central venous pressure?
Interior jugular vein (most common site of introduction of a central line)
Subclavian vein (be wary of the subclavian artery, something you don't want to hit with the needle)
153
What are the 5 main superficial lymph nodes?
Submandibular
Submental
Occipital
Mastoid
Parotid
154
What are the submandibular nodes?
Inferior to the body of the mandible, and associated with the facial artery
155
What are the submental nodes?
Inferior and posterior to the chin
156
Where are the occipital lymph nodes located?
Located posterior to the head at the lateral border of the trapezium muscle, collects lymph from the occipital region of the scalp
157
Which lymph nodes are posterior to the ear, residing on the insertion of the sternocleidomastoid muscle into the mastoid process?
Mastoid nodes
158
Where are the parotid nodes located?
Superficially to the parotid gland, collects lymph from the nasal cavity, the external acoustic meatus, the tympanic cavity and the lateral borders of the orbit
159
What are the deep cervical lymph nodes?
Collection of lymph nodes that form a chain along the internal jugular vein. Divided into upper and lower groups where intermediate tendon of the omohyoid muscle crosses the common carotid artery & the internal jugular vein.
160
Label the diagram of the nodes
161
Label this diagram
162
Label this diagram
163
Where are the constrictors of the pharynx in this diagram?
164
What muscle is highlighted here and what does it do?
Cricothyroid muscle
Tense vocal folds, and will change the pitch of the noise produced by airflow between them
Only tensor muscle of the larynx aiding with phonation. It is innervated by the superior laryngeal nerve.
165
What muscle is highlighted here?
Cricothyroid muscle
Tense vocal folds, and will change the pitch of the noise produced by airflow between them
Only tensor muscle of the larynx aiding with phonation. It is innervated by the superior laryngeal nerve.
166
What muscle is highlighted here and what does it do?
Oblique arytenoid muscle
Narrows the laryngeal inlet
167
What muscle is highlighted here and what does it do?
Oblique arytenoid
Narrows the laryngeal inlet
168
What does the highlighted muscle do?
In coordination with the oblique arytenoid muscle, the transverse muscle pulls the arytenoid cartilage closes together -\> Closure of the posterior glottis
Transverse arytenoid
169
What does the highlighted muscle do?
Posterior cricoarytenoid
opens the glottis, and separates the vocal folds
170
What does the highlighted muscle do?
Posterior cricoarytenoid
opens the glottis, and separates the vocal folds
171
What does the highlighted muscle do?
close (abduct) the vocal folds
Lateral cricoarytenoid
172
