what are the 3 phases of swallowing
1) oral phase: mastication
2) oropharyngeal phase: elevation floor of mouth and tongue to push bolus into oropharnx
3) pharyngeo-esophageal phase: bolus propolled down esophagus
divisions of pharynx
nasopharynx
oropharynx
larynx
nasopharynx location and communication
posterior to the nasal cavity
communicates with nasal cavity via choanae
communicates with middle ear cavity via auditory tube
communicates with oropharynx via PHARYNGEAL ISTHMUS
oropharynx location and communication
posterior to oral cavity
communicates with oral cavity via faucial isthmus
communicates with nasopharynx via pharyngeal isthmus
laryngeopharynx located ___
communicates with oropharynx at the level of what
communicates with larynx via what
posterior to larynx
hyoid
laryngeal aditus
what is the piriform recess
innervated by what?
posterior and lateral to arytenoid cartilages in laryngeopharynx
-epithelium innervated by internal branch of superior laryngeal nerve
stylopharyngeus muscle is a ___ of the pharynx
-location and innervation?
arises from the styloid process and inserts on wall btwn superior and middle constrictors
innervated by SVE of the glossophargyngeal n
superior constrictor muscle location
attached laterally to pterygomandibular raphe near third molar
middle constrictor location
attached laterally to hyoid and posteriorly to the midline pharyngeal raphe
inferior constrictor location
laterally to oblique line of thyroid and cricoid cartilage
-horizontal fibers comprise cricopharyngeus muscle used during pharngeal speach
what is killums triangle
transition between inferior constrictor mucsle and cricopharyngeus muscle
zenker’s diverticulum
herniation of the mucosal lining of the esophagus between cricopharyngeal m and inferior constrictor muscle
-may be weakened area due to transition from skeletal to smooth m
buccopharyngeal fascia
subdivision of pretracheal fascia, covers outer surface of buccinator muscle and pharynx
-part that covers middle constrictor contains pharyngeal plexus
retropharyngeal space location and relevance
between buccopharyngeal fascia and prevertebral fascia
- continuous from the base of the skull to the mediastinum
- infections can spread through regions here
- in cervical fusion of vertebrae, anterior bodies of cervical vertebra are approached here
innervation of the pharynx
sensory: GVA from the pharyngeal branch of glossopharyngeal n, convey afferent info for GAG reflex
motor: SVE from the pharyngeal branch of the vagus nerve
branches of nerve IX in pharynx and what they do (3)
1) pharyngeal branch to the pharyngeal plexus
2) sensory GVA to mucosa of post 1/3 tongue and pharynx, SVA to taste buds of post 1/3 tongue
3) motor (SVE) to stylopharyngeus muscle
Gag relex nerves involved
IX send afferents in
X send efferents to cause reflex
-assisted by intercostal, phrenic, and abdominal nerves
superior laryngeal nerve is a branch off of what nerve
the vagus nerve
the thyroid laminae form the ___ anteriorly
superior horn continous with ___ and forms ___
inferior horn articulates with ___ ___ and makes ___ __
laryngeal prominence
hyoid bone, thyrohyoid ligament
cricoid cartilage, cricothyroid joint
arytenoid cartilages location, vocal and muscular process
pyramidal shaped on superior edge of cricoid cartilage
- vocal process attached to vocal ligament of vocal cord
- muscular process attached to posteior and lateral cricoarytenoids
arytenoid cartilages and phonateion and respiration
phonation: tension of vocal folds
respiration: slide laterally to open rima glottidis
piriform recesses ______ if the patient says “a-a-a” in a low voice. secretions may gather here but should disappear on swallowing. if they do not then patient has ___ sign which suggests ___
slightly dilate
pooling
obstruction or paralysis of upper esophagus
valleculae epiglottica location
seperated by
bound laterally by
recess between tongue and epiglottis
- separated from each other by median glossoepidglottic fold
- bound laterally by lateral glossoepiglottic folds
where is the blade often placed during intubation
opens what?
in the valleculae epiglottica, moved forward and theis moves tongue and epiglottis forward too
-opens laryngeal aditus
the thyrohyoid membrane is piereced by what
internal branch of the superior laryngeal nerve
superior laryngeal artery
what muscle of the larynx is the only abductor of the vocal cords
posterior cricoarytenoid muscle
what muscles of the larynx are adductors of the vocal cords
lateral cricoarytenoid m
arytenoideus
how to test cricothyroid muscle and what happens to width of membrane
have patient say eeee in a high pitched voice
causes contraction and decrease in the cricothyroid membrane
what innervates the cricothyroid muscle
external branch of the superior laryngeal nerve
after the RLN corsses the ___ and enters the ___ it is called the ____. conveys ___ fibers to laryngeal muscles except ____
cricothyroid joint, inferior laryngeal nerve
SVE cricothyroid muscle
at what level does the oropharynx communicate with the laryngeopharynx
CV6
layers of the pharyngeal wall from in to out
1) muccosa layer
2) pseudostratified and stratified non keratinized epithelia
3) submucosa layer
4) pharyngeobasilar fascia: forms inner layer of muscular fascia
5) inner elevators of pharynx
6) pharyngeal constrictor muscles
7) Buccopharyngeal fascia
what is the chief sensory nerve to the interior of the larynx
-what kind of fibers
the internal branch of the superior laryngeal nerve
GVA fibers
what can someone get if the laryngeal cough reflex is not working
aspiration pneumonia
what nerve inervates the cricothyroid muscle
external branch of the superior laryngeal nerve
after the recurrent laryngeal nerve crosses the _____ joint and enters the larynx it is called _____
-supplies what fibers
cricothyroid joint, inferior laryngeal nerve
-supplies laryngeal muscles except cricothyroid muscle
what does paralysis of the recurrent laryngeal nerve cause
hoarseness and dysphagia
the superior laryngeal nerve is the chief sensory nerve to what?
interior of the larynx and piriform recess
laryngeal expiration reflex afferent component
internal branch of superior laryngeal nerve innervates receptors, afferents enter medulla with vagus nerve and terminate at NTS
laryngeal expiration reflex efferent component
recurrent laryngeal, intercostal and abdominal nerves activate muscles and cause expiratory coughing