Anatomy - Pharynx And Larynx

Front 1

Describe the divisions of the pharynx and their boundaries:

Back 1

Nasopharynx: from base of skull to soft palate;
Oropharynx: from soft palate to epiglottis;
Laryngopharynx: from epiglottis to cricoid cartilage.

Front 2

Function of the eustachian tube:

Back 2

Connects the nasopharynx to the tympanic cavity, allows equalisation of pressure of middle ear and external atmosphere for free movement.

Front 3

Which parts of the eustachian tube are cartilaginous/bony?

Back 3

Bony part: posterolateral 1/3, lies within petrous part of the temporal bone;

Cartilaginous part: anterolateral 2/3, opens into nasopharynx, normally closed.

Front 4

Which muscles (nerve supply) act on the eustachian tube and which part do they act on? What action induces these muscles?

Back 4

Tensor veli palatini (CN V3), tensor tympani (CN V3), levator veli palatini (CN X, pharyngeal plexus), salpingopharyngeus (CN X, pharyngeal plexus);

Act on cartilaginous part of eustachian tube;

Swallowing/yawning.

Front 5

Salpingopharyngeus forms what structure in the nasopharynx?

Back 5

Salpingopharyngeal fold.

Front 6

What can cause blockage of the eustachian tube in the nasopharynx?

Back 6

Swollen pharyngeal tonsils (adenoiditis).

Front 7

Pharyngeal recess is a:

Back 7

Lateral extension of the nasopharynx.

Front 8

Clinical significance of the pharyngeal recess:

Back 8

Common site of nasopharyngeal cancer - may present as epistaxis.

Front 9

Oropharynx opens from oral cavity through _____, formed by:

Back 9

Oropharyngeal isthmus; soft palate, tongue, palatopharyngeal folds.

Front 10

Oropharynx at what level?

Back 10

C2-C3.

Front 11

Laryngopharynx at what level?

Back 11

C4-C6.

Front 12

Palatine tonsils lie in:

Back 12

Tonsillar fossa, between palatoglossal and palatopharyngeal arches.

Front 13

Space anterior to epiglottis and its significance?

Back 13

Vallecula; food trap.

Front 14

What inlet on the anterior wall of the laryngopharynx?

Back 14

Laryngeal inlet.

Front 15

Space beside the laryngeal inlet and its clinical significance. What separates this space from the laryngeal inlet?

Back 15

Piriform recess; food trap; aryepiglottic fold.

Front 16

Muscles of the pharynx:

Back 16

Like GIT, outer circular, inner longitudinal;

Outer circular muscles: superior, middle and inferior constrictor muscles;

Inner longitudinal muscles: palatopharyngeus; salpingopharyngeus; stylopharyngeus.

Front 17

Actions of the muscles of the pharynx:

Back 17

Outer circular muscles: collectively for peristalsis;
Inner longitudinal muscles: elevate larynx and shorten pharynx (e.g. to receive food/speak).

Front 18

Nerve supply of pharyngeal muscles:

Back 18

All except stylopharyngeus muscle: CN X (pharyngeal plexus);

Stylopharyngeus: CN IX.

Front 19

Describe the process of swallowing/deglutition and the muscles involved, as well as their nerve supply:

Back 19

1. Oral phase (voluntary):
Bolus of food compressed against tensed soft palate and pushed into the oropharynx;
Tongue muscles: styloglossus (CN XII), palatoglossus (CN X);
Soft palate muscles: tensor veli palatini (CN V3);

2. Pharyngeal phase (involuntary):
Soft palate elevates to close off nasopharynx, larynx is elevated and closed by the epiglottis;
Soft palate muscles: levator veli palatini (CN X);
Pharyngeal muscles: palatopharyngeus, salpingopharyngeus (CN X), stylopharyngeus (CN IX);
Laryngeal muscles: aryepiglottic, thyrohyoid, intraarytenoid (CN X, recurrent laryngeal nerve).

3. Esophageal phase (involuntary):
Food bolus runs over epiglottis, forced down laryngopharynx and into the esophagus;
Pharyngeal muscles: superior, middle and inferior constrictor muscles (CN X), inferior constrictor muscle has a cricopharyngeal component that acts as an upper esophageal sphincter.

Front 20

The pharyngeal plexus of CN X supplies:

Back 20

All the soft palate and pharyngeal muscles except: tensor veli palatini (CN V3); stylopharyngeus (CN IX).

Front 21

Motor innervation of CN IX:

Back 21

Only stylopharyngeus.

Front 22

Sensory supply of the pharynx:

Back 22

CN IX.

Front 23

Level of larynx:

Back 23

C3-C6.

Front 24

Adam's apple is also the:

Back 24

Laryngeal prominence.

Front 25

What is so special about the cricoid cartilage?

Back 25

Complete ring, signet ring shaped, taller posteriorly.

Front 26

Arytenoid cartilage has which two processes? What do they attach with?

Back 26

Vocal process: vocal ligament and vocalis muscles;
Muscular process: lateral and posterior cricoarytenoid muscles.

Front 27

Arytenoid are related to which small cartilages?

Back 27

Corniculate (articulates with apex of arytenoid); cuneiform (does not articulate with any other bone).

Front 28

Describe the false and true vocal cords:

Back 28

False vocal cord: vestibular fold, formed by mucosal layer over vestibular ligaments;
True vocal cord: vocal fold, formed by mucosal layer over vocal ligaments.

Front 29

Attachments of vocal ligaments:

Back 29

Vocal process of the arytenoid cartilage to the posterior surface of lamina of thyroid cartilage.

Front 30

What is the space between the two folds?

Back 30

Laryngeal ventricle/sinus, with glands to lubricate them.

Front 31

The vocal folds divide the larynx into:

Back 31

Superiorly: vestibule; Inferiorly: infraglottic cavity.

Front 32

Folds visible in a laryngoscopic view, from superior to inferior:

Back 32

Aryepiglottic fold; vestibular fold (rima vestibuli); vocal fold (rima glottis).

Front 33

The epiglottis is attached to the posterior tongue by:

Back 33

2 lateral and 1 median glossoepiglottic folds.

Front 34

Arterial supply and venous drainage of the larynx:

Back 34

Arteries: Superior laryngeal artery (from superior thyroid artery from external carotid artery);
Inferior laryngeal artery (from inferior thyroid artery from subclavian artery);

Veins: Superior laryngeal vein (to IJV); Inferior laryngeal vein (to brachiocephalic).

Front 35

Sensory and motor supply to larynx:

Back 35

All CN X;
Sensory: Internal laryngeal nerve (above vocal folds); inferior laryngeal nerve (below vocal folds);

Motor: All except cricothyroid innervated by inferior laryngeal nerve, branch of recurrent laryngeal nerve; cricothyroid innervated by external laryngeal nerve.

Front 36

Superior laryngeal artery closely related to which nerve?

Back 36

Internal laryngeal nerve.

Front 37

Inferior laryngeal artery closely related to which nerve?

Back 37

Inferior laryngeal nerve.

Front 38

What happens if recurrent laryngeal nerve is injured:

Back 38

All muscles affected except cricothyroid - hoarse voice, loss of sensation below vocal cords.

Front 39

What happens if external laryngeal nerve is injured:

Back 39

Cricothyroid affected - weak voice as cricothyroid tenses the vocal ligaments.

Front 40

What happens if internal laryngeal nerve is injured:

Back 40

Loss of sensation above vocal cords, protective mechanism to keep foreign bodies out inactive.

Front 41

Which muscle in the larynx is the only abductor?

Back 41

Posterior cricoarytenoid.

Front 42

Which muscles in the larynx adduct the vocal folds?

Back 42

Transverse and oblique arytenoids, oblique fibres continue as ariepiglottic muscles, lateral cricoarytenoid.

Front 43

Which muscles in the larynx relax the vocal folds?

Back 43

Thyroarytenoid and vocalis.

Front 44

What does the cricothyroid do?

Back 44

Tenses vocal cord, tilts thyroid anteriorly.

Front 45

Which part of the external acoustic meatus produces earwax?

Back 45

Ceruminous glands in the subcutaneous tissue of the lateral 1/3 of the external acoustic meatus produce cerumen.

Front 46

Sensory supply of the external auricle:

Back 46

Anterosuperior: auriculotemporal nerve (CN V3);
Anteroinferior: great auricular nerve (C2-3);
Posterior: lesser occipital nerve (C2);
Minor contributions from CN VII and CN X.

Front 47

Function of the tympanic membrane:

Back 47

Transfer sound vibrations from air to ossicles.

Front 48

Sensory of tympanic membrane:

Back 48

Outer surface follows external ear (auriculotemporal nerve, CN V3); Inner surface follows internal ear (glossopharyngeal nerve, CN IX).

Front 49

Usually the cone of light is directed:

Back 49

Anteroinferiorly.

Front 50

Middle ear is also called the:

Back 50

Tympanic cavity.

Front 51

Describe the transmission of sound from tympanic membrane to inner ear:

Back 51

Tympanic membrane - handle of malleus - incus - base of stapes - oval window.

Front 52

Malleus, incus and stapes are called:

Back 52

Ossicles.

Front 53

Reflex action of which muscles allows for dampening of vibrations? What are their nerve supplies?

Back 53

Stapedius: attached to stapes (CN VII);
Tensor tympani: attached to handle of malleus (CN V3).

Front 54

Relations of the middle ear:

Back 54

Floor: Internal jugular vein;
Roof: Epitympanic recess, tegmen tympani (bone), middle cranial fossa and temporal lobe;
Anterior: eustachian tube, internal carotid artery;
Posterior: aditus to the mastoid sinus;
Medial: 1st basal turn of the cochlear, oval and round windows, tympanic plexus, prominence of facial canal containing facial nerve;
Lateral: Tympanic membrane, chorda tympani nerve.

Front 55

Nerves in the middle ear:

Back 55

Tympanic nerve (CN IX) forming tympanic plexus (supplies sensory innervation to middle ear), which gives off lesser petrosal nerve (parasympathetics of parotid gland);

Facial nerve (CN VII) giving off greater petrosal nerve (parasympathetic of lacrimal gland), nerve to stapedius, chorda tympani.

Front 56

Chorda tympani passes through middle ear to where?

Back 56

Infratemporal fossa (through petrotympanic fissure) to join lingual nerve.