pharynx and swallowing

Question 1

the pharynx

Answer 1

1) fibromuscular tube
2) open anteriorly
3) extent
- base of skull
- cricoid cartilage (C6)
4) continuous with the esophagus

Question 2

pharynx relation to skull base

Answer 2

1) attachment to the pharyngobasilar fascia to skull base
2) jugular foramen (CN 9-12) internal carotid artery, sympathetic trunk

Question 3

fascial spaces in the neck

Answer 3

1) pharynx / esophagus
2) retropharyngeal space:
- between buccopharyngeal anteriorly (part of pretracheal fascia) and prevertebral fascia posteriorly
3) three constrictors is superficial
4) pharyngobasilar membrane

Question 4

regions

Answer 4

1) nasopharynx
- via choanae
2) oropharynx
3) laryngopharynx (hypopharynx)

systems:
-respiratory
- digestive

Question 5

nasopharynx

Answer 5

1) from skull base to soft palate

Question 6

oropharynx

Answer 6

1) soft palate to epiglottis
2) constrictor muscles posteriorly
3) oral cavity anteriorly

Question 7

laryngopharynx

Answer 7

1) epiglottis to cricoid cartilage
2) epiglottis superiorly
3) cricoid inferiorly

Question 8

relationships

Answer 8

1) lateral
- carotid sheath and contents
2) CN IX, XI, XII
- CN IX innervates stylopharyngeus *will be on exam
3) sympathetic trunk
- superior cervical ganglion

Question 9

layers of the wall

Answer 9

1) mucosa
2) submucosa
3) muscularis
- outer circular
- inner longitudinal
4) adventitia
- buccopharyngeal fascia
5) pterygomandibular raphe
6) prevertebral fascia and space??

Question 10

constrictor muscles

Answer 10

1) superior, middle, inferior
2) insertion is pharyngeal raphe
3) action
- constrict sequentially during swallowing

Question 11

superior constrictor

Answer 11

1) hamulus of pterygoid bone
2) pteryogomandibular raphae

Question 12

middle cosntrictor

Answer 12

1) hyoid bone
2) stylohyoid ligament

Question 13

inferior constrictor

Answer 13

1) thyroid and cricoid cartilages
2) cricopharyngeus (upoer esophageal sphincter)

Question 14

stylopharyngeus

Answer 14

1) styloid process
2) merges to palatopharyngeus

Question 15

palatopharyngeus

Answer 15

1) hard palate
2) thyroid cartilage

Question 16

salpingopharyngeus

Answer 16

1) pharyngotympanic tube

Question 17

longitudinal muscles

Answer 17

1) elevate the pharynx during swalling

Question 18

gap 1

Answer 18

1) above superior constrictor
2) auditory (eustachian, pharyngotympanic tube)
3) levator palatini passes over top of

Question 19

gap 2

Answer 19

2) stylopharyngeus
3) CNIX

Question 20

gap 3

Answer 20

1) between middle and inferior constrictors (thyrohyoid membrane)
2) internal laryngeal nerve
3) superior laryngeal artery and vein

Question 21

gap 4

Answer 21

1) below inferior constrictor
2) recurrent laryngeal nerve
3) inferior laryngeal artery

Question 22

internal pharynx

Answer 22

1) nasopharynx
2) oropharynx
3) laryngopharynx

Question 23

nasopharynx features

Answer 23

1) pharyngeal tonsils (adenoids)
2) opening of eustachian tube
- below torus tubarius
3) sapingopharyngeus- has a fold of mucosa above it
4) posterior choanae

Question 24

pharyngotympanic tube

Answer 24

1) salpingopharyngeus is stretched by yawning and swallowing
2) the eustachian tube opens and passes into the middle ear

Question 25

1st pharyngeal pouch

Answer 25

1) middle ear and auditory tube 2) trigeminal nerve innervates

Question 26

studyd the arches

Answer 26

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Question 27

oropharynx contents

Answer 27

1) soft palate (velum) 2) posterior tongue (lingual tonsil) 2) fauces (oropharyngeal isthmus) - palatine tonsil - palatoglossal arch - palatopharyngeal arch 4) tonsillar ring (of waldeyer)

Question 28

oral view of fauces

Answer 28

1) palatoglossal arch 2) palatopharyngeal arch 3) bed of tonsils between

Question 29

laryngopharynx/hypophaynx

Answer 29

1) epiglottis 2) laryngeal inlet 2) cricoid cartilage 4) piriform recess / fossa - things can be lodged here

Question 30

oropharynx is the point of airway and foodway

Answer 30

1) two valves to protect airway - soft palate - epiglottis

Question 31

pathologies of oropharynx

Answer 31

1) mouth breathers - long face syndrome - obstruction from pharyngeal tonsil 2) insufficiency of two valves - aspiration may lead to pneumonia 3) hypotonia of tongue and pharyngeal musculature - apneic episodes - can be due to swollen adenoids

Question 32

inhaled aerosols

Answer 32

1) inhaled drugs will go to target in lungs, but only 10% 2) the rest is in digestive system - systemic issues

Question 33

piriform recess

Answer 33

1) the vallecula lie on the sides of frenulum (from tongue to epiglottis) 2) piriform recess

Question 34

innervation

Answer 34

1) pharyngeal plexus (GSA) - CN IX - CN X - sympathetic 2) motor (GSE) - CN IX to stylopharyngeus (exception) - CN X to all other pharyngeal muscles (CNXI via X)

Question 35

superior and recurrent laryngeal nerve

Answer 35

1) to innervate larynx 2) motor and sensory

Question 36

GSA

Answer 36

1) CN V1 and V2 - nasal cavity 2) CN IX - oropharynx 3) CN X -laryngopharynx - gag reflex

Question 37

bloos supply is regional

Answer 37

1) branches of facial artery - ascending palatine a. - tonsillar a. 2) branches of ext. carotid - ascending pharyngeal a. - superior thyroid a. 3) inferior thyroid a. from thyrocervical trunk 4) venous drainage to internal jugular v

Question 38

swallowing(deglutition)

Answer 38

1) coordinated set of muscle contractions 2) can be initiated voluntarily but mostly automatic (up to 1000 swallows per day) 3) 20 muscles and 5 cranial nerves (V, VII, IX, X, XII) involved 4) central pattern generator (swallowing center) is in the medulla

Question 39

oral phase

Answer 39

1) stage 1 (voluntary) - jaws closed, lips, cheeks compressed, tongue raised (pushes bolus into oropharynx) 2) CN XII

Question 40

pharyngeal phase (2 and 3)

Answer 40

1) soft palate elevates to seal off nasopharynx 2) the pharynx/larynx (stylopharyngeus, palatoglossus, suprahyoid muscle) raises to close the lower airway 3) larynx closed by epiglottis, constrictors contract sequentially (superior, middle, inferior) *involuntary

Question 41

esophageal phase

Answer 41

1) cricopharyngeal relaxes 2) bolus enters esophagus 3) peristalsis propels it on, airway reopens

Question 42

Dysphagia

Answer 42

1) difficulty swallowing 2) 6.2 million americans over 60 3) possible causes - dysfunction of neural pathways - muscle damage - structural (tumors, gastroesophageal junction tumor) 4) adverse consequences - malnutrition - aspiration pneumonia