1
Q
the pharynx is a combined passage for?
A
food and air
2
Q
what level is the end of the pharynx and the beginning of the esophagus and trachea?
A
C6
3
Q
the soft palate separates what?
A
nasopharynx and oropharynx
4
Q
the trachea is anterior to what?
A
the esophagus
5
Q
layers of the pharynx from outside-in
A
- buccopharangeal fascia
- musculosa (skeletal muscles: 3 semi-circular and 3 longitudinal)
- pharyngobasilar fascia (submucosa)
- mucosa
6
Q
buccopharangeal fascia
A
- loose CT that covers the exterior of the pharynx
- continuous with the areolar fascia overlying buccinator muscle
- contains pharyngeal plexus of veins (IJV) and nerves (IX sensory; X motor)
7
Q
3 semicircular muscles
A
superior, middle, and inferior constrictors
8
Q
3 longitudinal muscles
A
stylopharyngeus, palatopharyngeus, salpingeopharyngeus
9
Q
insertion of pharyngeal muscles
A
pharyngeal tuberosity
10
Q
superior constrictor
A
- origin: pterygoid hamulus and pterygomandibular raphe
2. insertion: fans out in semicircle and meets in opposite side muscle in midline (pharyngeal) raphe
11
Q
middle constrictor
A
- origin: stylohyoid ligamnet and hyoid bone
- insertion: fans out in semicircle and meets the opposite side muscle in midline (pharyngeal) raphe. Fibers overlap those of the superior constrictor
12
Q
inferior constrictor
A
- origin: oblique line on the side of the thyroid cartilage and cricoid cartilage posterior to the cricothyroid muscle
- insertion: semicircle and meets the opposite side muscle in midline (pharyngeal) raphe. Fibers overlap those of superior and middle constrictors. Inferior fibers are horizontal and continuous with the upper esophagus (cricopharyngeus)
13
Q
what innervates the 3 constrictors?
A
pharyngeal plexus of vagus
14
Q
what contracts and relaxes during swallowing?
A
- constrictors contract sequentially –> peristaltic wave
- cricopharyngeus is constantly contracted to prevent air flow into esophagus BUT relaxes during swallowing
15
Q
palatopharyngeus muscle
A
- origin: lateral edges of the palatal aponeurosis
- insertion: posterolateral wall of pharynx, tip of hyoid bone, posterior edge of thyroid cartilage
- raises the pharynx and larynx during swallowing
- supplied by vagus nerve
16
Q
the vagus nerve innervates all of the longitudinal muscles except?
A
stylopharyngeus muscle – innervated by IX
17
Q
salpingopharyngeus muscle
A
- origin: opening of auditory tube
- insertion: merges into palatopharyngeus
- raises pharynx and larynx during swallowing
- supplied by vagus
18
Q
what muscle allows food to go to pharynx and not nasal cavity?
A
tensor palatine and LEVATOR PALATINE
19
Q
stylopharyngeus muscle
A
- origin: medial aspect of styloid process and passes medially thru the overlap between the superior and middle constrictors
- insertion: same as palatopharyngeus (two muscles merge
- raises pharynx and larynx during swallowing
- supplied by glossopharyngeal nerve (CN IX)
20
Q
gap bw skull base and superior constrictor
A
- pharyngobasilar fascia.
- passing thru– levator and tensor palatini ms, audiotry tube, ascending palatine artery (of facial)
21
Q
gap bw superior and middle
A
stylopharyngeus ms, CN IX, CN XII, lingual artery, hyoglossus muscle
22
Q
between middle and inferior constrictor
A
- passing thru thyrohyoid membrane
- internal laryngeal branch of superior laryngeal nerve (CN X), and superior laryngeal branch of superior thyroid artery (ext. carotid)
23
Q
between inferior and esophagus
A
recurrent laryngeal nerve and inferior laryngeal branch of the inferior thyroid artery
24
Q
nasopharynx
A
above soft palate, respiratory ep
25
oropharynx
bounded by soft palate and epiglottis
26
laryngopharynx
epiglottis level to the opening of the esophagus
27
where is the opening of the auditory tube?
nasopharynx
28
the opening of the auditory tube is reinforced by?
u-shaped cartilage
29
whats posterior to the auditory tube opening?
salpingopharyngeal fold
30
what's posterior to the salpingopharyngeal fold?
pharyngeal recess
31
where are the nasopharyngeal tonsils?
roof and posterior wall of nasopharynx
| hypertrophy may block the auditory tubes
32
what seals the opening bw the oropharynx and nasopharynx?
contraction of the soft palate
- during swallowing and phonation
- can also seal opening bw oral cavity and oropharynx during sucking
33
anterior pillar
palatoglossal arch
| from soft palate to side of tongue and has palatoglossus muscle underneath
34
posterior pillar
palatopharyngeal arch
| from soft palate to posterior wall of the pharynx and has the palatopharyngeus muscle underneath
35
what lie in between the anterior and posterior pillars?
palatine tonsils
36
tonsillar bed
deep to tonsils:
| pharyngobasilar fascia, muscles, stylohyoid ligament, glossopharyngeal nerve
37
during tonsillectomy, where would the bleeding come from?
- tonsillar artery
- ascending palatine (facial)--primary
- dorsal lingual (lingual)
- ascending pharyngeal (ext carotid)
- lesser paltine (descending palatine--maxillary
38
laryngopharynx
from tip of epiglottis to beginning of esophagus (C6)
39
what does the epiglottis do?
seals the laryngeal opening when the pharynx and larynx are elevated upwards during swallowing
40
glossoepiglottic folds
3 mucosal folds between the epiglottis and posterior tongue
41
valleculae
small right and left depressions between the three glossoepigottic folds
42
pyriform recess
vertical gutter on the lateral side of the laryngopharynx between the lateral glossoepiglottic fold and lateral pharyngeal wall--> food passage on both sides of larynx
43
pharyngobasilar fascia (submucosa)
tough membrane that anchors the pharynx to the base of the skull in a U-shaped attachment
-medial pterygoid plate--> anterior border of the carotid canal --> pharyngeal tubercle
44
arterial supply to the pharynx
- ascending pharyngeal
- superior thyroid
- inferior thyroid
- ascending palatine
- dorsal lingual
- lesser palatine
45
vein supply of pharynx
- pharyngeal venus plexus
- communicates with the pterygoid venous plexus
- drains into the internal jugular vein
46
sensory nerve supply to pharynx
- glossopharyngeal (IX)--MAIN
- maxillary (V2)--soft palate and tonsillar fossa (lesser palatine nerve and roof (pharyngeal branch)
- internal branch of superior laryngeal branch of vagus (X)--> area surrounding laryngeal inlet
47
Sympathetic nerve supply to pharynx
Superior cervical ganglion
48
Parasympathetic supply to pharynx
All pharyngeal muscles are supplied by VAGUS (CN X) except the stylopharyngeus (CN IX)
49
Where is the pharyngeal plexus?
External surface of pharynx on the middle constrictor
50
Formation of pharyngeal plexus
1. Motor root from vagus except stylopharyngeus which is supplied by special branch from glossopharyngeal and to palatine muscles except for TENSOR palatine which is supplied by branch from mandibular (v3)
2. Sensory root from glossopharyngeal mainly to prophesy cells and laryngopharynx
3. Sympathetic root from SCG to the blood vessels (vasomotor)
51
Taste
Facial: ant 2/3 and soft palate
Glossopharyngeal (IX) : post 1/3
Vagus (X): epiglottis
52
All palatine muscles are supplied by —— except ——
All are supplied by X except tensor (V3)
53
All intrinsic laryngeal muscles are supplied by —- except —-
All intrinsic laryngeal muscles are supplied by recurrent laryngeal nerve except Chico thyroid
54
All infra hyoid muscles are supplied by —- except ——
All are supplied by ansa cervicalis except thyrohyoid (C1 via hypoglossal nerve)
55
What nerves are involved in the gag reflex?
Sensory— glossopharyngeal (IX)
| Motor—vagus (X)
56
Bulbar palsy
LMN lesion in CN IX, X, XI, and XII
deviation of uvula away from the affected side
No movement or gag reflex on the affected side
57
Boundaries of retropharyngeal space
```
Superior: skull base
Inferior: superior mediastinum (including major blood vessels of the heart)
Anterior: buccopharyngeal fascia
Posterior: alar (pre-vertebral) fascia
Lateral: carotid sheath
```
58
Phases of swallowing
1. Prep: formation of bolts
2. Oral: pushing the bolts back to the oropharynx
3. Pharyngeal: pushing the bolts down to the esophagus
4. Esophageal: pushing the bolus down into the stomach
59
Pharyngeal phase
- receptors in soft palate and oropharynx stimulate deglutition center in medulla and lower pons
- soft palate elevated to seal nasopharyngeal and prevent nasopharyngeal regurgitation
- pharyngeal constrictors contract and cricopharyngeus opens and immediately closes and the larynx is shut down
- during pharyngeal phase— chewing, breathing, coughing, vomiting are inhibited
60
Esophageal phase
- peristaltic movement
- bolus travels down the esophagus terminating into the stomach
- esophagus becomes expanded only at level of bolus
- submucosa contains lot of mucus glands—liquify and lube
cranio exam 4
flashcards
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