Flashcards in Pterygopalatine Fossa-Sievert Deck (121):
What is the opening to the pharynx called?
Where is the vestibule found?
from the aditus to the vestibular folds (false vocal cords)
Where is the ventricle found?
b/w the false & true vocal cords
What is the fcn of the false vocal cords?
protective in nature as they overly the true vocal cords
Where is the infraglottic cavity?
this is found below the true vocal folds; extends down to the inferior cricoid cartilage
What do you find below the infraglottic cavity?
Ventricles are an important space for what?
Describe what happens to the aditus when you swallow.
the larynx is pulled up
the tongue is pushed back
the epiglottis is pushed down closer to the cricoid cartilage
aditus closes (tho not completely)
What type of covering does the larynx have?
a mucosal lining
The cartilage that makes up the larynx is held together by what ?
What is the space called b/w the epiglottis & the tongue (back)?
Describe the structure of the thyroid cartilage.
It is a 2/3 protective covering that is incomplete in the posterior aspect.
What are the arytenoids?
these are processes that are found posteriorly sitting on top of the cricoid cartilage
What are the 2 processes that are found on the arytenoids?
the vocal process & muscular process
What is the function of the vocal process of the arytenoid?
there is a ligament on this vocal process that extends anteriorly to the thyroid & makes up a part of the true vocal cords
What is the function of the muscular process of the arytenoid?
it has muscles attached to it that are capable of opening or closing the vocal cords
Describe the structure & location of the cricoid cartilage.
this is located inferior to the thyroid cartilage. It is a complete cartilagenous ring. It is taller in the back than it is in the front. Mullet.
Describe the structure of the membrane that connects the thyroid cartilage & cricoid cartilage.
cricothyroid membrane. it has a mucosal lining & elastic core
T/F The cricoid & thyroid are capable of moving w/ respect to one another.
TRUE! They are rocking forwards or backwards w/ respect to one another
How do the cricoid & thyroid cartilages rock backwards on each other?
via the cricothyroid joint--synovial.
they rock on a transverse axis.
What is the membrane called that runs between the hyoid bone & the thyroid cartilage? there is an important hole in this-what is it called?
**hole: for passage of the internal branch of the superior laryngeal nerve (branch of CN10).
What happens to the vocal ligament that is attached to the arytenoid when you rock the thyroid cartilage back & forth?
Rock the thyroid cartilage forward--ligament becomes tight.
Rock the thyroid cartilage back--ligament becomes loose.
What is the difference b/w male & female vocal ligaments?
Women have shorter vocal ligaments than men. Thus, they have higher voices.
What are 2 important synovial joints that you find in the larynx?
1. b/w the cricoid & thyroid cartilages.
2. b/w the arytenoid & the cricoid.
What type of joint is the arytenoid/cricoid joint? Which movements are possible?
capable of rotation & gliding.
T/F The elastic core of the cricothyroid membrane is a part of the vocal cord.
Describe the quadrangular membrane.
it has a mucosal lining
it is sorta found on the back of the epiglottis...it also extends towards the arytenoids
What special thing does the inferior aspect of the quadrangular membrane contribute to?
the false vocal cord
What is the fcn of the quadrangular membrane?
this membrane keeps food from getting into the piriform recess & aditus
the muscle that lines this has a pursestring effect, closing the aditus.
The conus elasticus contributes to something important-what is it? Also...what is it a part of?
contributes to the true vocal cord & vocal ligament
a part of the cricothyroid cartilage
What is found b/w the true & false vocal cords?
also called rima glottidis
We have talked about the epiglottis...but what is the glottis?
glottis=rima glottidis + true vocal cord
Which part of the thyroid cartilage articulates with the cricoid cartilage...this makes up the synovial joint?
the inferior cornu of the thyroid cartilage articulates w/ the cricoid cartilage.
The rocking movement that happens at the cricothyroid joint happens on which axis?
What is the innervation of the cricothyroid muscle? Why does this make this muscle unique?
branch of vagus, external branch of the superior laryngeal nerve.
only laryngeal muscle not innervated by the recurrent laryngeal nerve
What is the action of the cricothyroid muscle?
it moves the arytenoids posteriorly & tightens the vocal ligaments (adds tension)
adducts the vocal ligaments slightly
What is the significance of the adduction of the vocal ligaments upon contraction of the cricothyroid muscle?
if you lost the recurrent laryngeal nerve...
then you have this cricothyroid muscle causing all this tension...get adduction of the vocal ligaments
can close off your airway.
Describe the cricoarytenoid joint.
it is a synovial joint with a delicate capsular ligament.
**movement at this joint results in adbuction or adduction of the vocal ligaments
What are the movements that are possible at the cricoarytenoid joint?
gliding movements of abduction/adduction-horizontal plane
What is the major abductor of the vocal folds? On which axis does this rotation occur?
via lateral & posterior cricoarytenoid muscles.
**these attach to the muscular process of the arytenoid to the posterior cricoid
What are the major adductors of the vocal folds?
What is a major tensor of the vocal folds?
What causes relaxation of the vocal folds?
**from arytenoid to thyroid cartilage...pulling ary closer to the cartilage causes relaxation.
this muscle is a part of the true vocal fold
Which syndrome causes a lesion in the mammillary bodies? What are the major symptoms of this?
confusion, opthalmoplegia, ataxia
The transverse arytenoid & oblique arytenoid have similar positions in what way? They are responsible for what type of movements?
both are attached b/w the arytenoids
responsible for gliding movements
What are the muscles of the laryngeal inlet? What is their effect?
**they both act as a purse string to close the aditus
Describe the structure & location of the oblique arytenoids.
they have a thin muscle mass in the ary-epiglottic fold
kind of swings to the other side
this fold is defined by the quadrangular membrane
ophthalmoplegia is what?
weakness of one of the extra ocular muscles
T/F The aryepiglottis & the thyroarytenoids have a purse string effect on the aditus...closing it completely to keep food particles out of the larynx.
False. The aryepiglottis & the thyroepiglottis do have a purse string effect on the aditus...but they do not close it completely. It is true that it is protective
What is the fcn of the vocalis muscle?
it assists the thyroarytenoid in relaxing the vocal ligaments. THe vocalis is much more important than that tho...it determines the pitch of your voice.
If the vocal ligament is tightened-higher voice. This muscle can selectively tighten certain segments.
T/F All of the vocal cord movers are abductors except for the posterior cricoarytenoid muscle.
False. They are all adductors except for the posterior cricoartyenoid muscle which is an abductor.
All of the muscles of the larynx are innervated by the recurrent laryngeal nerve, except for one muscle. Which muscle & what is its innervation?
Except for the cricothyroid muscle. This is innervated by the external branch of the superior laryngeal nerve (off of CN10).
Once again, what would happen if the recurrent laryngeal nerve were nicked in surgery (the most suspectible nerve in this region)?
then the only muscle of the larynx that would be functioning on that side would be the cricothyroid muscle. This would cause tightening & a reduced airway & a hoarse voice. If it were bilateral-->would cause complete closure of the ligaments.
The internal branch of the superior laryngeal nerve pierces which membrane?
the thyrohyoid membrane.
The cough reflex is in on ___ & out on ____.
In on 10. Out on phrenic & sometimes 10.
What is the sensory innervation of the larynx above the vocal folds?
above the vocal folds:
superior laryngeal nerve
What is the sensory innervation of the larynx below the vocal folds?
below the vocal folds:
recurrent laryngeal nerve
What are the 2 sources of blood supply to the larynx?
superior laryngeal artery
inferior laryngeal artery
Describe the source & course of the superior laryngeal artery.
This branches off of the superior thyroid artery. The superior thyroid artery is a branch of the external carotid artery.
The superior laryngeal artery also pierces thru the hold in the thyrohyoid membrane with the internal branch of the superior laryngeal nerve.
Describe the source & course of the inferior laryngeal artery.
The inferior laryngeal artery comes from the inferior thyroid artery. Inferior thyroid artery comes off of the thyrocervical trunk.
The inferior laryngeal artery follows the course of the recurrent laryngeal nerve.
Describe the basics of swallowing.
You have to elevate the larynx.
You have to push the tongue back.
You have to force the epiglottis back.
You use the supra & infra hyoid muscles.
You use the pharyngeal constrictors (down to the cricopharyngeus).
Describe the journey of the bolus of food in swallowing.
bolus goes around the lateral sides of the epiglottis & into the piriform recess.
the smaller aditus prevents food & liquids from entering the larynx.
Describe the types of contractions in the pharynx.
It is sequential contraction & relaxation of successively lower portions of the pharynx. After the cricopharyngeus...get wave of contraction in the esophagus.
On imaging the pharynx & the larynx appear differently. Describe their differences. Note: this is important when thinking about foreign objects placement.
Pharynx: more medial-->lateral direction
Larynx: longer axis in anterior-posterior direction.
What are 2 important developmental structures that kind of get the ball rolling with the development of the nasal cavity? Where does each come from?
1. Medial Nasal Prominence
**mesenchyme of pharyngeal arches or a mass of mesenchyme that is in the front of the forebrain.
2. Olfactory Placode
**inductive effects of the forebrain form the placode.
Describe the basics of how one cavity becomes 2 in nasal cavity development.
start out with 2 cavities separated by the oronasal membrane (connect to the medial nasal prominence).
The membrane breaks down & you have 1 big cavity.
Get the conchae & palate to separate into 2 cavities again.
What is one fairly common thing that can go wrong with nasal cavity development?
Originally in development of the nasal cavity...there are only 3 prominences. What are they?
Frontonasal Prominence (includes the medial & lateral nasal prominences).
Which of these 3 prominences don't have many defects associated with it?
the mandibular prominence
Nasal pits become what?
Which prominences must fuse together during development?
the frontonasal prominence.
medial & lateral nasal prominences.
Which developmental structures make up the upper lip? If this gets messed up-->what do you have?
part of the medial nasal prominence
How do you get an oblique cleft? What else might be damaged if you get this?
Oblique Cleft: defect where the maxillary & lateral nasal prominences should have fused.
**prevents closure of the nasolacrimal duct
The philtrum of the upper lip, the incisor portion of the upper jaw and the triangular primary palate back to the incisive canal are formed by what?
the fusion of the 2 medial nasal prominences.
What is found anterior to the incisive canal?
the primary palate & the upper lip
What is found posterior to the incisive canal?
hard palate (secondary palate) & nasal septum
What forms the primary palate & upper lip?
the 2 fused medial nasal prominences.
What forms the hard palate?
the palatine shelves of the maxillary prominence
What forms the nasal septum?
the frontonasal prominence
Where is the most common place to form a cleft?
b/w the primary palate & secondary palate
as in b/w the products of the medial nasal prominence & maxillary prominence
**called a maxillary cleft lip
Is cleft lip more common in males or females? Is it maternal age dependent?
More common in males.
Maternal age dependent.
**this is a fairly common defect
How common is isolated cleft palate? Is it more common in males or females? Is it maternal age dependent?
It is less common.
It is more common in females.
Not related to maternal age.
Called isolated b/c no cleft lip.
**see hole in their palate when they open their mouth.
What is the worst kind of cleft to have?
Midline cleft is the worst.
Usu NTD problem & accompanied by MR.
Caused by lack of fusion b/w the 2 medial nasal prominences & palatine shelves.
Review: any defect in the vicinity of the primary palate is due to what?
failure to fuse the medial nasal & maxillary prominences.
this can cause cleft lip & cleft primary palate
Cleft secondary palate is due to which problem?
fusion failure of the palatine shelves of the maxillary prominence
How do you get oblique clefts? What is left exposed with this type?
get from fusion failure b/w maxillary & lateral nasal prominences
it exposes the nasolacrimal duct
Which bones make up the lateral wall of the nasal cavity?
What is found beneath each conchae?
Underneath the inferior conchae is the inferior meatus. Same for middle & superior.
What are the conchae covered in? What are they also called? What is their function?
covered in a mucous membrane
also called turbinates
fcn: humidify & cleanse air.
Which meatus is the largest?
the inferior meatus underneath the inferior conchae is the largest.
What is an important opening into the inferior meatus?
the nasolacrimal duct
There is a WHOLE lot going on in the middle meatus. What's the deal?
**the semilunar hiatus drains into the middle meatus.
**the posterior inferior aspect of the semilunar hiatus has an opening that drains the maxillary sinus into the middle meatus.
**bulla is there too (bulge) that has openings for ethmoid air cells
Tell me more about the semilunar hiatus.
so...it drains the frontal sinus into the middle meatus. It of course has an opening for the drainage of the maxillary sinus.
If you are looking at coronal sections of the face...when do you start seeing the sphenoid air sinus?
not until you are pretty posterior b/c it is located in the back of the orbit
What is the position of the maxillary sinus to the middle meatus opening...what do this require?
the maxillary sinus is actually inferior to the middle meatus opening. This means that it is necessary to have cilia in the sinus to beat towards the opening. Helps with drainage.
What is the state of the sinuses in a newborn?
they are not present
When do the sinuses finally start developing?
start at 1 yo & finish at 21 yo
What makes up the medial wall of the nasal cavity?
perpendicular plate of the ethmoid bone
**also nasal septum
Describe the blood supply to the medial wall of the nasal cavity.
Ethmoidal arteries supply superior anterior portion. These are branches off of the opthalmic artery.
Facial branches supply the more inferior part.
Sphenopalatine branch of the maxillary artery supplies this region too after coming out of the pterygopalatine fossa.
Which types of nosebleeds are easy to stop? Which kinds are hard to stop?
Easy to stop: ones from the facial artery
Hard to stop: ones from the ethmoidal arteries
Describe the nerve innervation of the lateral nasal cavity.
anterior ethmoidal nerves (branches of V1)
nasal branches (branches of V2-via pterygopalatine ganglion & palatine nerves)
What other special nerves are chillin' in the lateral nasal cavity?
olfactory nerves (off the olfactory bulb)
they pierce thru the cribriform plate of the ethmoid bone.
So...the pterygopalatine ganglion is like the place to be. Who all jumps on that bus?
**V2 comes off the trigeminal ganglion & goes thru the foramen rotundum. *Then sensory fibers jump off of V2 & hop onto the pterygopalatine ganglion.
**There are also greater & deep petrosal nerves that go thru the pterygoid canal & combine to form the nerve of the pterygoid canal. They hop on the pterygopalatine ganglion too!
So...the pterygopalatine ganglion gives back a bunch of fun prizes. Which nerves hop off this ganglion?
nasal branches jump off.
then greater & lesser palatine nerves also hop off!!
So..just to clarify...the nasal branches that supply the lateral nasal cavity come from 2 places. Which 2 places?
the pterygopalatine ganglion & the greater palatine nerve.
**ultimately they are branches of V2!!
What special thing does the greater petrosal nerve carry?
preganglionic parasympathetics for the lacrimal gland
Which things are carried on the anterior ethmoidal nerves?
sensory fibers for the mucous lining of the lateral & medial nasal cavities....& ALSO parasympathetics for the mucous glands!
Describe the nerve innervation of the medial nasal wall.
anterior ethmoidal branch (V1)
nasopalatine nerve (branch of V2 coming off of the pterygopalatine ganglion)
After the nasopalatine nerve supplies the medial nasal cavity what does it do?
it goes thru the incisive foramen & supplies parts of the palate
**remember that the incisive foramen separates the primary & secondary palates.
What is contained in the pterygopalatine fossa?
maxillary nerve (V2)
What does the pterygopalatine fossa supply via arterial supply & innervation?
skin of face
Describe what needs to enter in the pterygopalatine fossa. What goes in the box? : )
V2 via foramen rotundum
Maxillary Artery via Pterygomaxillary Fissure
Greater & Deep Petrosal Nerves via pterygoid canal
What are the greater & deep petrosal nerves called when they are in the pterygoid canal?
they combine & form the nerve of the pterygoid canal
Parasympathetics & sympathetics are carried by the petrosal nerves that go into the pterygoid canal. Which ones are carried on each nerve?
Greater Petrosal Nerve: Parasympathetics
Deep Petrosal Nerve: Sympathetics
What needs to come out of the pterygopalatine fossa?
Infraorbital nerve thru the inferior orbital fissure
Sphenopalatine artery thru the sphenopalatine foramen
Greater & lesser palatine nerves thru the palatine canal
What does V2 give off before it becomes the infraorbital nerve & goes thru the inferior orbital fissure?
It gives off the posterior, middle, anterior superior alveolar nerves. They supply the upper teeth.
What does the greater palatine nerve supply?
the hard palate (anterior)
What does the lesser palatine nerve supply?
the soft palate (posterior)
What exactly comes off the pterygopalatine ganglion?
greater & lesser palatine nerves
lateral nasal branches
What happens to the nasopalatine nerve?
it supplies the medial nasal wall & goes thru the incisive foramen to innervate a little bit of the palate.