Pharynx and larynx

Question 1

What protects the pharynx?

Answer 1

epiglottis

Question 2

What is pharynx posterior to?

Answer 2

nasal and oral cavity, larynx

Question 3

What are the layers of the pharynx from inside out?

Answer 3

mucus membrane
submucosa
pharyngo-basilar facia (fills gaps in walls of pharynx and is attached to base of skull)

Question 4

Where is the buccopharyngeal fascia?

Answer 4

layer behind muscles of the pharynx infront of retropharyngeal space and prevertebral facia

meets buccinator muscle

Question 5

What happens if the retropharyngeal space is puctured?

Answer 5

can go to heart

continous with thorax

Question 6

What are the constrictors?

Answer 6

superior
middle
inferior (insert on thyroid cartiledge)

3 styrofoam cups overlapping

squeeze bolus towards esophagus

Question 7

What happens when swallowing>

Answer 7

elevators lift pharynx to receive bolus

simultneous laryngeal elevation for closure and airway protection during swallowing

Question 8

What nerve innervates most muscles of pharynx?

Answer 8

X

except for stylopharyngeous (IX) and oropharynx- tensor veli palatini = V

Question 9

what is the most important blood supply to pharynx?

Answer 9

ascending pharyngeal from external cartoid A

ascending palatine and tonsilar of facial, pharyngeal branches and descending palatine of maxillary

Question 10

What happens if the soft palate collapses?

Answer 10

sleep apnea

falls down, cant breathe when horizontal

Question 11

Constrictors

Answer 11

Origin: Cricopharyngeus: lateral aspect of arch of cricoid cartilage. Thyropharyngeus: oblique line of laminar of thyroid cartilage and fibrous cricothyroid arch

Insertion: Cricopharyngeus: continuous with muscle of opposite side, behind pharynx. Thyropharyngeus : lower pharyngeal raphe

Action: Aids swallowing . Cricopharyngeus acts as upper esophageal sphincter

Nerve: Pharyngeal plexus (IX, X and sympathetic) via pharyngeal branch of X with its motor fibers from cranial accessory (XI)

Question 12

stylopharyngeous

Answer 12

origin: medial aspect of styloid process

Insertion: posterolateral border of thyroid cartilage

action: elevates larynx and pharynx. aids swallowing

Nerve: muscular branch of glossopharyngeal nerve IX

Question 13

levator veli palatini

Answer 13

origin: Apex of inferior surface of petrous temporal bone and medial rim of auditory tube
insertion: palatine aponeurosis

Action: elevates, retracts and lateral deviates soft palate. May open auditory tube on swallowing.

Question 14

tensor veli palatini

Answer 14

origin: scaphoid fossa and medial aspect of spine of sphenoid bone
insertion: palatine aponeurosis (via pully of pterygoid hamulus)
action: tenses soft palate prior to elevation
nerve: nerve to medial pterygoid (main trunk of mandibular nerve) (V)

Question 15

buccinator

Answer 15

origin: External alveolar margins of maxilla and mandible by molar teeth, to maxillary tubercle and pterygoid hamulus and posterior mylohyoid line respectively, then via pterygomandibular raphe between bones
insertion: Decussates at modiolus of mouth and interdigitates with opposite side
action: Aids mastication, tenses cheeks in blowing and whistling, aids closure of mouth
nerve: Buccal branch of facial nerve (VII)

Question 16

mylohyoid

Answer 16

origin: Mylohyoid line on internal aspect of mandible
insertion: Anterior three quarters : midline raphe. posterior quarter: superior border of body of hyoid bone
action: Elevates hyoid bone, supports and raises floor of mouth. Aids in mastication and swallowing
nerve: Mylohyoid nerve (V)

Question 17

hyoglossus

Answer 17

no sensory

origin: Superior border of greater cornu of hyoid bone
insertion: Lateral sides of tongue
action: Depresses tongue
nerve: Hypoglossal nerve (XII)

Question 18

cricothyroid

Answer 18

Action: lengthens and tenses vocal cords by tilting thyroid cartilage forwards

Nerve: external branch of supieriorlaryngeal branch of vagus nerve X

Question 19

What is the prefered location for trach?

Answer 19

cricothyroid b/c less blood

Question 20

What is the only complete ring in trachea?

Answer 20

cricoid

all others are horseshoe C shaped

Question 21

What nerve is the stripe on the barber pole and what muscle does it sit on top of?

Answer 21

IX

stylopharyngeus-> stylohyoid and styloglossus

Question 22

What happens if sympathetic chain is cut?

Answer 22

Horner’s

Question 23

What is the superior laryngeal nerve a branch of?

Answer 23

Vagus X

Question 24

What does internal laryngeal nerve pierec?

Answer 24

thyrohyoid- sensation to vocal cord

Question 25

What artery is the baroreceptor?

Answer 25

common carotid artery 9

Question 26

What happens if the hyoid is fractured?

Answer 26

strangulation

Question 27

What happens with a bilateral cut to recurrent laryngeal?

Answer 27

posterior carocoidaretynoid paralyzed can't open vocal cords because only abductor die

Question 28

Where hyoglossus located?

Answer 28

Between CN 12 and lingual artery

Question 29

What is between the jugular and common carotid?

Answer 29

vagus X

Question 30

What innervates cricothyroid?

Answer 30

external laryngeal

Question 31

What 2 nerves branch off the vagus?

Answer 31

superior larygneal and recurrent laryngeal

Question 32

what does the supieror laryngeal split to>

Answer 32

internal and external laryngeal

Question 33

What does the internal laryngeal innervate?

Answer 33

sensory above the cords

Question 34

What does the exertnal laryngeal innervate?

Answer 34

cricothyroid

Question 35

What does the recurrent laryngeal innervate?

Answer 35

sensory below the cords and all other muscles (posterior cricothyroid, lateral cricoarytenoid, transverse and oblique arytenoids, vocalis, thyroarytenoid)

Question 36

What is the only abductor of the cords?

Answer 36

Cricoarytenoid

Question 37

What is the blood supply for the larynx?

Answer 37

via superior laryngeal of superior thyroid and inferior laryneal of inferior thyroid same as thyroid!

Question 38

What is the laryngeal skeleton?

Answer 38

3 single thyroid cartilage, cricoid catilae, epiglottis + 3 paired (6) corniculate, cuneiform, arytenoid cartilage + 2 joints synovial cricothyroid cicoarytenoid

Question 39

Over what vertebrae does the larynx extend?

Answer 39

C3-C6

Question 40

When does the pharynx become the esophogus?

Answer 40

C6 lower border

Question 41

What is the body guard of the body?

Answer 41

larynx- guard air way especially during swallowing

Question 42

What is the larynx continous with?

Answer 42

laryngopharynx superior | trachea below C6

Question 43

Where does food get stuck when you clear throat?

Answer 43

valleculae

Question 44

Is the angle of the thyroid cartilage the same in men and women?

Answer 44

no! 90-120 degrees Angle different for males and females- ladies voice different from male voice men = adams apple

Question 45

What is the onky complete ring in the respiratory system?

Answer 45

cricoid cartilage rest are C shaped closed by trachealis

Question 46

What is the joint that connects the cricoid and the thyroid?

Answer 46

cricothyroid joint

Question 47

What does the epiglottis attach to?

Answer 47

back of hyoid bone by hyo-epiglottis ligament anterior surface has taste buds

Question 48

What pierces the thyrohyoid membrane?

Answer 48

pierced by the internal laryngeal nerve & superior laryngeal vessels nerve and blood for upper larynx

Question 49

Where do the arytenoid cartilages sit?

Answer 49

2 pyramids on top of cricoid cartilage cricoarytenoid joint 2 processes- muscular and vocal apex articulates with corniculate cartilage

Question 50

Where are the conriculate and cuneiform cartilages (nodules?)

Answer 50

embedded in aryepiglottic fold

Question 51

What are the two extrinsic membrane/ligaments?

Answer 51

thryohyoid membrane circotracheal ligament

Question 52

What are the two intrinsic membrane/ligaments?

Answer 52

1) quadrangular membrane (2) stretched between epiglottis and arytenoids -upper = aryepiglottic fold -lower= vestublar ligament (FALSE vocal cord) 2) crico-thyroid ligament (1) - upper = vocal ligament (true vocal cord) from angle of thyroid cartilage to vocal process of arytenoid

Question 53

What is the false vocal fold?

Answer 53

vestibular ligament lower quadrangular membrane

Question 54

What is the true vocal fold?

Answer 54

vocal ligament off upper free border of cricothyroid ligament

Question 55

What is the rima glottis?

Answer 55

space between vocal folds If adducted, closed rima glottidis If abducted, open rima glottidis

Question 56

When should a cricothyrotomy be done?

Answer 56

After failure of valsalva maneuver when foreign body inhaled last result to access airway- pierce between cricoid and thyroid- if you move cricoid or thyroid you stretch vocal cord

Question 57

where is the most likely place for foreign body to be?

Answer 57

Piriform fossa (yellow) remove of item may damage superior part of larynx- sensory- the branches of internal laryngeal nerve which lead to loss of sensation of the upper ½ of Larynx. found in laryngeal inlet (either side of aryepiglottic fold)

Question 58

Cricothyroid

Answer 58

ONLY TENSOR/stretcher of vocal ligament external laryngeal nerve from CN X (exception)

Question 59

Posterior cricoarytenoid

Answer 59

ONLY ABductor of vocal cords ONLY opener of rima glottis recurrent laryngeal from X

Question 60

Lateral cricoarytenoid

Answer 60

ADDuctor of vocal folds recurrent laryngeal from X

Question 61

Transverse and oblique arytenoid

Answer 61

adductor of arytenoid cartilage adduct intercarilaginous portion of vocal cords, close posterior rima glottidis) recurrent laryngeal from X

Question 62

What muscle is the exception that all laryngeal muscles are innervated by reccurrent laryngeal from X?

Answer 62

Cricothyroid = external laryngeal from X develops from 4th arch (not 6th)

Question 63

Thryo-arytenoid and vocalis

Answer 63

Relaxes vocal ligament recurrent laryngeal

Question 64

What muscle whispers?

Answer 64

vocalis

Question 65

What divides the larynx into upper and lower parts?

Answer 65

vocal cords = watershed

Question 66

What is the blood supply and sensory nerve to upper larynx?

Answer 66

superior laryngeal artery of superior thyroid artery internal laryngeal nerve of superior laryngeal Vagus X both PENETRATE thyrohyoid membrane superior thyroid = first branch of external carotid

Question 67

What is the blood supply and sensory nerve to lower larynx?

Answer 67

inferior laryngeal artery of inferior thyroid artery recurrent laryngeal nerve of vagus X

Question 68

What are the 3 pairs of laryngeal structures?

Answer 68

internal laryngeal n + superior laryngeal A External laryngeal n + superior thyroid A recurrent laryngeal n + inferior laryngeal A

Question 69

Why should surgeon be careful during thyroidectomy?

Answer 69

blood supply of thyroid gland is close related to nerve supply of larynx so be careful of nerves

Question 70

Where do the two recurrent nerves turn?

Answer 70

(goes to heart but turns around) Right recurrent turns at right subclavian Left recurrent turns at arch of aorta