Podcast
Questions and Answers
Which anatomical structure marks the anterior extent of the pharynx?
Which anatomical structure marks the anterior extent of the pharynx?
- Cranial base
- C6 vertebra's inferior border
- Cricoid cartilage's inferior border (correct)
- Hyoid bone
Which anatomical structure is located posterior to the nasopharynx?
Which anatomical structure is located posterior to the nasopharynx?
- Nasal cavity (correct)
- Larynx
- Mouth
- Soft palate
What type of channel is the pharynx?
What type of channel is the pharynx?
- Solely an airway for respiration
- Solely a pathway for food
- A selective channel directing only liquids
- A common pathway for both air and food (correct)
Where does the pharynx narrow as it approaches its inferior end?
Where does the pharynx narrow as it approaches its inferior end?
Which of the following describes the location of the oropharynx?
Which of the following describes the location of the oropharynx?
Which part of the pharynx contains abundant lymphoid tissue that forms the tonsils?
Which part of the pharynx contains abundant lymphoid tissue that forms the tonsils?
What anatomical feature marks the posterior extension of the nasal cavity into the nasopharynx?
What anatomical feature marks the posterior extension of the nasal cavity into the nasopharynx?
The roof of the nasopharynx forms a continuous surface inferior to which structure?
The roof of the nasopharynx forms a continuous surface inferior to which structure?
What term refers to the pharyngeal tonsil when it becomes enlarged?
What term refers to the pharyngeal tonsil when it becomes enlarged?
Which structure is associated with tubal tonsils in the nasopharynx?
Which structure is associated with tubal tonsils in the nasopharynx?
Which muscle is covered by the mucous membrane in the nasopharynx?
Which muscle is covered by the mucous membrane in the nasopharynx?
Obstruction of air passage results from inflammation of which structure?
Obstruction of air passage results from inflammation of which structure?
What is the superior boundary of the oropharynx?
What is the superior boundary of the oropharynx?
The oral arches (palatoglossal and palatopharyngeal) form what boundary of the oropharynx?
The oral arches (palatoglossal and palatopharyngeal) form what boundary of the oropharynx?
What is the pharyngeal isthmus?
What is the pharyngeal isthmus?
What anatomical structure gives way from the oral cavity to the oropharynx?
What anatomical structure gives way from the oral cavity to the oropharynx?
What is the area between the palatopharyngeal and palatoglossal arches known as?
What is the area between the palatopharyngeal and palatoglossal arches known as?
From which anatomical structure does bleeding most commonly arise during a tonsillectomy?
From which anatomical structure does bleeding most commonly arise during a tonsillectomy?
Which nerve is most vulnerable to injury during a tonsillectomy?
Which nerve is most vulnerable to injury during a tonsillectomy?
What marks the superior starting point of the laryngopharynx?
What marks the superior starting point of the laryngopharynx?
The laryngopharynx is anterior to which vertebrae?
The laryngopharynx is anterior to which vertebrae?
What is the narrowest part of the pharynx?
What is the narrowest part of the pharynx?
Which structure communicates with the larynx through the laryngeal inlet?
Which structure communicates with the larynx through the laryngeal inlet?
What are the small depressions on each side of the laryngeal inlet within the laryngopharynx called?
What are the small depressions on each side of the laryngeal inlet within the laryngopharynx called?
Which nerve is vulnerable when sharp objects become lodged in the piriform fossa?
Which nerve is vulnerable when sharp objects become lodged in the piriform fossa?
During swallowing, which stage is ‘voluntary’?
During swallowing, which stage is ‘voluntary’?
What happens during stage 2 (pharyngeal) of swallowing?
What happens during stage 2 (pharyngeal) of swallowing?
Which cranial nerve provides the sole motor innervation to the stylopharyngeus muscle?
Which cranial nerve provides the sole motor innervation to the stylopharyngeus muscle?
Which of the following arteries does NOT directly contribute to the primary blood supply of the pharynx?
Which of the following arteries does NOT directly contribute to the primary blood supply of the pharynx?
A patient presents with diminished sensation in the nasopharynx following a surgical procedure. Which nerve is MOST likely to have been affected, considering it provides sensory fibers specifically to this region in addition to the glossopharyngeal nerve?
A patient presents with diminished sensation in the nasopharynx following a surgical procedure. Which nerve is MOST likely to have been affected, considering it provides sensory fibers specifically to this region in addition to the glossopharyngeal nerve?
Which of the following structures marks the inferior border of the pharynx?
Which of the following structures marks the inferior border of the pharynx?
Where is the pharynx located in relation to the deep cervical fascia?
Where is the pharynx located in relation to the deep cervical fascia?
The pharynx serves as a passageway for which of the following?
The pharynx serves as a passageway for which of the following?
Which of the following is the superior boundary of the nasopharynx?
Which of the following is the superior boundary of the nasopharynx?
If the pharyngeal tonsil becomes enlarged, what is it commonly referred to as?
If the pharyngeal tonsil becomes enlarged, what is it commonly referred to as?
What is the name of the structure within the nasopharynx that contains tubal tonsils?
What is the name of the structure within the nasopharynx that contains tubal tonsils?
Which muscle in the nasopharynx is covered by mucous membrane?
Which muscle in the nasopharynx is covered by mucous membrane?
Obstruction of the nasal cavity air passage is a result of inflammation of which structure?
Obstruction of the nasal cavity air passage is a result of inflammation of which structure?
Which structure forms the superior boundary of the oropharynx?
Which structure forms the superior boundary of the oropharynx?
What structures form the lateral boundaries of the oropharynx?
What structures form the lateral boundaries of the oropharynx?
What term describes the passage from the nasopharynx to the oropharynx?
What term describes the passage from the nasopharynx to the oropharynx?
The fauces mark the transition from which structure to the oropharynx?
The fauces mark the transition from which structure to the oropharynx?
Which anatomical space is located between the palatopharyngeal and palatoglossal arches?
Which anatomical space is located between the palatopharyngeal and palatoglossal arches?
Bleeding during a tonsillectomy most commonly arises from which structure?
Bleeding during a tonsillectomy most commonly arises from which structure?
What is the inferior border of the laryngopharynx?
What is the inferior border of the laryngopharynx?
What structures form the posterior and lateral walls of the laryngopharynx?
What structures form the posterior and lateral walls of the laryngopharynx?
Which small depressions are located on either side of the laryngeal inlet within the laryngopharynx?
Which small depressions are located on either side of the laryngeal inlet within the laryngopharynx?
Which nerve is most susceptible to injury when sharp objects are lodged in the piriform fossa?
Which nerve is most susceptible to injury when sharp objects are lodged in the piriform fossa?
During swallowing, which stage involves the bolus being pushed from the mouth into the oropharynx?
During swallowing, which stage involves the bolus being pushed from the mouth into the oropharynx?
A patient exhibits difficulty elevating the larynx during swallowing. Dysfunction of which muscle layer is MOST likely the cause?
A patient exhibits difficulty elevating the larynx during swallowing. Dysfunction of which muscle layer is MOST likely the cause?
The sequential relaxation and contraction of which muscles propels the bolus into the esophagus during swallowing?
The sequential relaxation and contraction of which muscles propels the bolus into the esophagus during swallowing?
Which of the following statements accurately describes the relationship between the constrictor muscles and the pharyngobasilar fascia?
Which of the following statements accurately describes the relationship between the constrictor muscles and the pharyngobasilar fascia?
Which nerve provides motor innervation for all pharyngeal muscles except the stylopharyngeus?
Which nerve provides motor innervation for all pharyngeal muscles except the stylopharyngeus?
Which of the following nerves provides the primary sensory innervation to the majority of the pharynx?
Which of the following nerves provides the primary sensory innervation to the majority of the pharynx?
Which artery provides the primary blood supply to the pharynx?
Which artery provides the primary blood supply to the pharynx?
A surgeon is performing a tonsillectomy. Damage to which nerve poses the greatest risk of impacting general sensation in the posterior 1/3 of the tongue?
A surgeon is performing a tonsillectomy. Damage to which nerve poses the greatest risk of impacting general sensation in the posterior 1/3 of the tongue?
A patient presents with dysphagia (difficulty swallowing) following a motor vehicle accident. Imaging reveals damage to the pharyngeal plexus. Which combination of cranial nerve impairments would MOST likely result in this patient's symptoms?
A patient presents with dysphagia (difficulty swallowing) following a motor vehicle accident. Imaging reveals damage to the pharyngeal plexus. Which combination of cranial nerve impairments would MOST likely result in this patient's symptoms?
Adenoiditis, characterized by inflammation of the adenoids, can lead to which of the following complications?
Adenoiditis, characterized by inflammation of the adenoids, can lead to which of the following complications?
Which vertebral levels correspond to the typical location of the larynx in the anterior neck?
Which vertebral levels correspond to the typical location of the larynx in the anterior neck?
What is the approximate length of the larynx in adult humans?
What is the approximate length of the larynx in adult humans?
How many single cartilages contribute to the structure of the larynx?
How many single cartilages contribute to the structure of the larynx?
The arytenoid, corniculate, and cuneiform cartilages exist in what form?
The arytenoid, corniculate, and cuneiform cartilages exist in what form?
Around what age do the cartilages of the larynx typically begin to ossify?
Around what age do the cartilages of the larynx typically begin to ossify?
Which of the following cartilages has a 'superior thyroid notch'?
Which of the following cartilages has a 'superior thyroid notch'?
With which structure does the inferior horn of the thyroid cartilage articulate?
With which structure does the inferior horn of the thyroid cartilage articulate?
Which of the following characteristics is unique to the cricoid cartilage?
Which of the following characteristics is unique to the cricoid cartilage?
Which laryngeal ligament connects the epiglottis to the thyroid cartilage?
Which laryngeal ligament connects the epiglottis to the thyroid cartilage?
What is the primary purpose of a cricothyrotomy?
What is the primary purpose of a cricothyrotomy?
Which laryngeal membrane has two free margins that form the aryepiglottic fold superiorly and the vestibular ligament inferiorly?
Which laryngeal membrane has two free margins that form the aryepiglottic fold superiorly and the vestibular ligament inferiorly?
What structure is formed by the free superior margin of the conus elasticus?
What structure is formed by the free superior margin of the conus elasticus?
What anatomical structure defines the aperture between the vestibular folds?
What anatomical structure defines the aperture between the vestibular folds?
Which region of the larynx is located between the vestibular and vocal folds?
Which region of the larynx is located between the vestibular and vocal folds?
What term describes the space between the epiglottis and the posterior aspect of the tongue?
What term describes the space between the epiglottis and the posterior aspect of the tongue?
Which description accurately reflects the shape of the rima glottidis during phonation?
Which description accurately reflects the shape of the rima glottidis during phonation?
What primary factor determines the pitch of an individual's voice?
What primary factor determines the pitch of an individual's voice?
Which of the following lists only extrinsic muscles of the larynx?
Which of the following lists only extrinsic muscles of the larynx?
What action do the crycothyroid muscles perform on the thyroid cartilage during vocalization?
What action do the crycothyroid muscles perform on the thyroid cartilage during vocalization?
What effect do the thyroarytenoid muscles have on the vocal ligaments?
What effect do the thyroarytenoid muscles have on the vocal ligaments?
Which muscle is the only abductor of the vocal cords?
Which muscle is the only abductor of the vocal cords?
Which nerve exclusively innervates the cricothyroid muscle?
Which nerve exclusively innervates the cricothyroid muscle?
Which anatomical region provides sensory and parasympathetic innervation above the vocal cords?
Which anatomical region provides sensory and parasympathetic innervation above the vocal cords?
Which of these arteries directly supplies blood to the larynx?
Which of these arteries directly supplies blood to the larynx?
The superior laryngeal arteries enter the larynx along with which nerve?
The superior laryngeal arteries enter the larynx along with which nerve?
Where do the superior laryngeal veins primarily drain?
Where do the superior laryngeal veins primarily drain?
If a foreign body is lodged in the rima glottidis, what is the MOST likely consequence?
If a foreign body is lodged in the rima glottidis, what is the MOST likely consequence?
What is the primary purpose of the Heimlich maneuver in the context of laryngeal obstruction?
What is the primary purpose of the Heimlich maneuver in the context of laryngeal obstruction?
What is the function of the corniculate and cuneiform cartilages in relation to the aryepiglottic folds?
What is the function of the corniculate and cuneiform cartilages in relation to the aryepiglottic folds?
A patient presents with a hoarse voice after a viral infection. While examining the larynx, you note that all intrinsic muscles are functioning normally EXCEPT one, which appears paralyzed. Given the innervation patterns of the larynx, which nerve is MOST likely affected?
A patient presents with a hoarse voice after a viral infection. While examining the larynx, you note that all intrinsic muscles are functioning normally EXCEPT one, which appears paralyzed. Given the innervation patterns of the larynx, which nerve is MOST likely affected?
A surgeon accidentally severs a nerve during a thyroidectomy. Post-operatively, the patient is unable to produce high-pitched sounds. Which nerve was MOST likely damaged?
A surgeon accidentally severs a nerve during a thyroidectomy. Post-operatively, the patient is unable to produce high-pitched sounds. Which nerve was MOST likely damaged?
A patient presents to the ER after aspirating a small piece of food. The object becomes lodged in the piriform fossa. Which nerve is MOST susceptible to injury from compression by the foreign object in this location?
A patient presents to the ER after aspirating a small piece of food. The object becomes lodged in the piriform fossa. Which nerve is MOST susceptible to injury from compression by the foreign object in this location?
During a complicated surgical neck dissection, a surgeon inadvertently ligates a vessel providing primary blood supply to the larynx resulting in its ischemia. Which artery was MOST likely ligated to cause this outcome?
During a complicated surgical neck dissection, a surgeon inadvertently ligates a vessel providing primary blood supply to the larynx resulting in its ischemia. Which artery was MOST likely ligated to cause this outcome?
A 68-year-old patient who has smoked heavily for 50 years presents with worsening hoarseness, and imaging confirms a tumor that has severely damaged the intrinsic laryngeal muscles on one side. Even if the tumor is successfully treated, which of the following long-term outcomes is MOST likely, given the anatomy and function of the affected area?
A 68-year-old patient who has smoked heavily for 50 years presents with worsening hoarseness, and imaging confirms a tumor that has severely damaged the intrinsic laryngeal muscles on one side. Even if the tumor is successfully treated, which of the following long-term outcomes is MOST likely, given the anatomy and function of the affected area?
A sound engineer notes that a singer is struggling to reach high notes during a recording session. Understanding laryngeal anatomy, damage to what specific ligament might MOST directly contribute to the singer's vocal difficulties?
A sound engineer notes that a singer is struggling to reach high notes during a recording session. Understanding laryngeal anatomy, damage to what specific ligament might MOST directly contribute to the singer's vocal difficulties?
At which vertebral levels is the larynx typically located in adults?
At which vertebral levels is the larynx typically located in adults?
Which of the following best describes the primary function of the larynx?
Which of the following best describes the primary function of the larynx?
How many total cartilages form the framework of the larynx?
How many total cartilages form the framework of the larynx?
Which of the following is NOT a single (unpaired) cartilage of the larynx?
Which of the following is NOT a single (unpaired) cartilage of the larynx?
Around what age does ossification of the laryngeal cartilages typically begin?
Around what age does ossification of the laryngeal cartilages typically begin?
Which of the following features is characteristic of the thyroid cartilage?
Which of the following features is characteristic of the thyroid cartilage?
Which cartilage articulates with the inferior horn of the thyroid cartilage?
Which cartilage articulates with the inferior horn of the thyroid cartilage?
Which of the following is a unique characteristic of the cricoid cartilage?
Which of the following is a unique characteristic of the cricoid cartilage?
Which laryngeal ligament directly connects the epiglottis to the thyroid cartilage?
Which laryngeal ligament directly connects the epiglottis to the thyroid cartilage?
What is the primary indication for performing a cricothyrotomy?
What is the primary indication for performing a cricothyrotomy?
The free superior margin of the conus elasticus forms which structure?
The free superior margin of the conus elasticus forms which structure?
Which structure defines the opening between the vestibular folds?
Which structure defines the opening between the vestibular folds?
What is the vallecula?
What is the vallecula?
During phonation, which of the following best approximates the shape of the rima glottidis?
During phonation, which of the following best approximates the shape of the rima glottidis?
What is the primary factor that determines the pitch of a person's voice?
What is the primary factor that determines the pitch of a person's voice?
Which of the following lists contains exclusively extrinsic laryngeal muscles?
Which of the following lists contains exclusively extrinsic laryngeal muscles?
What key action do the cricothyroid muscles perform during vocalization?
What key action do the cricothyroid muscles perform during vocalization?
Which of the following describes the sensory innervation above the vocal cords?
Which of the following describes the sensory innervation above the vocal cords?
Which artery provides direct blood supply to the larynx?
Which artery provides direct blood supply to the larynx?
If a foreign body gets lodged in the rima glottidis, what is the MOST likely immediate consequence?
If a foreign body gets lodged in the rima glottidis, what is the MOST likely immediate consequence?
What is the primary function of the Heimlich maneuver related to laryngeal obstruction?
What is the primary function of the Heimlich maneuver related to laryngeal obstruction?
Which statement best describes the function of the corniculate and cuneiform cartilages in the larynx?
Which statement best describes the function of the corniculate and cuneiform cartilages in the larynx?
Damage to which nerve would MOST likely result in the inability to produce high-pitched sounds?
Damage to which nerve would MOST likely result in the inability to produce high-pitched sounds?
Compression of which nerve in the piriform fossa is most likely to cause impaired sensation in the larynx above the vocal folds?
Compression of which nerve in the piriform fossa is most likely to cause impaired sensation in the larynx above the vocal folds?
A surgeon inadvertently ligates a vessel during a thyroidectomy, resulting in laryngeal ischemia. Which vessel, if ligated, would MOST likely cause this outcome?
A surgeon inadvertently ligates a vessel during a thyroidectomy, resulting in laryngeal ischemia. Which vessel, if ligated, would MOST likely cause this outcome?
After a motor vehicle accident, a patient has difficulty swallowing and maintaining an open airway, and imaging reveals a fracture of the hyoid bone. Which of the following long-term outcomes is MOST likely, considering the anatomy and the function of the affected structures?
After a motor vehicle accident, a patient has difficulty swallowing and maintaining an open airway, and imaging reveals a fracture of the hyoid bone. Which of the following long-term outcomes is MOST likely, considering the anatomy and the function of the affected structures?
Damage to what specific ligament might MOST directly contribute to a singer's impaired ability to reach high notes?
Damage to what specific ligament might MOST directly contribute to a singer's impaired ability to reach high notes?
Which of the following statements is the MOST accurate regarding sensory innervation of the piriform fossa and its clinical implications?
Which of the following statements is the MOST accurate regarding sensory innervation of the piriform fossa and its clinical implications?
A lesion in the brainstem affects the nucleus ambiguus. Given the structures innervated by cranial nerves originating from this nucleus, which combined set of sensory and motor deficits would MOST likely be observed?
A lesion in the brainstem affects the nucleus ambiguus. Given the structures innervated by cranial nerves originating from this nucleus, which combined set of sensory and motor deficits would MOST likely be observed?
An extremely rare genetic mutation results in the absence of elastic fibers within the conus elasticus. Which specific change would MOST likely be observed in the function of the larynx?
An extremely rare genetic mutation results in the absence of elastic fibers within the conus elasticus. Which specific change would MOST likely be observed in the function of the larynx?
Flashcards
Pharynx Location & Function
Pharynx Location & Function
Extends from the cranial base to the inferior border of the cricoid cartilage (anteriorly) and C6 vertebra (posteriorly). Common channel for air and food.
Choanae
Choanae
Posterior extension of the nasal cavity through two paired openings.
Nasopharynx location
Nasopharynx location
Posterior to the nose and superior to the soft palate.
Oropharynx location
Oropharynx location
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Laryngopharynx location
Laryngopharynx location
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Adenoiditis
Adenoiditis
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Fauces
Fauces
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Pharyngeal isthmus
Pharyngeal isthmus
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Tonsillectomy
Tonsillectomy
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Glossopharyngeal nerve (CN IX)
Glossopharyngeal nerve (CN IX)
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Laryngopharynx
Laryngopharynx
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Piriform fossa
Piriform fossa
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Pharynx muscle layers
Pharynx muscle layers
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Skeletal Muscle
Skeletal Muscle
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Circular pharyngeal muscles
Circular pharyngeal muscles
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Longitudinal pharyngeal muscles
Longitudinal pharyngeal muscles
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Circular layer
Circular layer
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Strong internal fascial lining
Strong internal fascial lining
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Swallowing Stages
Swallowing Stages
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Swallowing Stage 1
Swallowing Stage 1
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Swallowing Stage 2
Swallowing Stage 2
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Swallowing Stage 3
Swallowing Stage 3
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Pharynx nerve supply
Pharynx nerve supply
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Nerve for Stylopharyngeus Muscle
Nerve for Stylopharyngeus Muscle
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Pharyngeal branches of vagus nerve (CN X)
Pharyngeal branches of vagus nerve (CN X)
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Sensory fibers
Sensory fibers
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Pharynx Arterial Supply
Pharynx Arterial Supply
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Aterial Blood To Pharynx
Aterial Blood To Pharynx
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Pharynx Venous Drainage
Pharynx Venous Drainage
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Pharynx posterior wall
Pharynx posterior wall
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Tonsils
Tonsils
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Nasopharynx Roof/Posterior Wall
Nasopharynx Roof/Posterior Wall
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Pharyngeal Tonsil
Pharyngeal Tonsil
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Pharynx Constriction
Pharynx Constriction
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Longitudinal Layer Function
Longitudinal Layer Function
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Inferior Thyroid Veins
Inferior Thyroid Veins
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Pharyngeal Venous Plexus
Pharyngeal Venous Plexus
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Palatine Tonsils Drainage
Palatine Tonsils Drainage
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Sensory fibers function
Sensory fibers function
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Larynx Location
Larynx Location
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Larynx Function
Larynx Function
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Larynx Patency
Larynx Patency
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Larynx Size
Larynx Size
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Laryngeal Cartilages
Laryngeal Cartilages
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Thyroid Cartilage
Thyroid Cartilage
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Cricothyroid Joint
Cricothyroid Joint
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Cricoid Cartilage
Cricoid Cartilage
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Arytenoid Cartilages
Arytenoid Cartilages
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Quadrangular Membrane
Quadrangular Membrane
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Conus Elasticus:
Conus Elasticus:
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Rima Vestibuli
Rima Vestibuli
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Rima Glottidis
Rima Glottidis
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Vestibule (Larynx)
Vestibule (Larynx)
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Ventricle (Larynx)
Ventricle (Larynx)
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Infraglottic Cavity
Infraglottic Cavity
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Normal Larynx Appearance
Normal Larynx Appearance
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Vallecula
Vallecula
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Rima Glottidis Shape (Normal Breathing)
Rima Glottidis Shape (Normal Breathing)
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Rima Glottidis Shape (Forced Respiration)
Rima Glottidis Shape (Forced Respiration)
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Rima Glottidis Shape (Phonation)
Rima Glottidis Shape (Phonation)
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Rima Glottidis Shape (Whispering)
Rima Glottidis Shape (Whispering)
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Vocal Fold Function
Vocal Fold Function
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Voice Pitch Variation
Voice Pitch Variation
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Sound Modulation
Sound Modulation
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Extrinsic Laryngeal Muscles
Extrinsic Laryngeal Muscles
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Abductors & Adductors
Abductors & Adductors
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Abductors
Abductors
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Crycothyroids Muscle: Action
Crycothyroids Muscle: Action
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Laryngeal Nerve Innervation
Laryngeal Nerve Innervation
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Internal Laryngeal Nerve
Internal Laryngeal Nerve
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Recurrent Laryngeal Nerve
Recurrent Laryngeal Nerve
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Arterial Supply (Larynx)
Arterial Supply (Larynx)
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Venous Drainage (Larynx)
Venous Drainage (Larynx)
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Cricothyrotomy
Cricothyrotomy
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Tracheotomy
Tracheotomy
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Sphincters
Sphincters
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Thyroarytenoids Muscle: Action
Thyroarytenoids Muscle: Action
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Lateral Cricoarytenoids Muscle: Action
Lateral Cricoarytenoids Muscle: Action
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Vestibule
Vestibule
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Posterior Cricoarytenoids
Posterior Cricoarytenoids
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Transverse & Oblique Arytenoids
Transverse & Oblique Arytenoids
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Study Notes
Location and Functions
- Located in the anterior neck at the level of the C3-C6 vertebrae.
- Connects the oropharynx with the trachea.
- Designed for voice production and houses the organ of phonation.
- Guards the air passages during swallowing.
- Maintains a patent (open) airway for breathing.
- About 4-5 cm (2 inches) in adults.
- In children, it is shorter and slightly more superior in the neck.
Cartilages and Joints
- There are nine cartilages in the larynx.
- These cartilages are connected by membranes and ligaments.
- Three laryngeal cartilages are single including the thyroid, cricoid, and epiglottic cartilages.
- Three are paired including the arytenoid, corniculate, and cuneiform cartilages.
- Laryngeal cartilages start to ossify around 25 years of age and become visible in radiographs by 65 years.
- Corniculate and cuneiform cartilages are sesamoid cartilages that support the edges of various folds.
Thyroid Cartilage
- The thyroid cartilage is open posteriorly.
- It has two large lamina; the posterior border of each lamina projects superiorly and inferiorly as horns.
- This cartilage forms the prominence of the Adam's apple, known as the laryngeal prominence.
- The thyroid cartilage has a superior notch, the superior thyroid notch.
- There is an oblique line on the thyroid cartilage that serves as an attachment for the thyrohyoid and sternothyroid muscles.
- The inferior horn of the thyroid cartilage articulates with the lateral surface of the cricoid cartilage, forming the cricothyroid joint (synovial).
- The main movement of the cricothyroid joint is rotation or gliding of the thyroid cartilage, changing the tension across the vocal folds.
Cricoid Cartilage
- The cricoid cartilage is a completely closed ring.
- It is thicker and stronger than the thyroid cartilage.
- The cricoid cartilage has a posterior wide lamina and anterior narrow arch.
- There are articular facets on the cricoid cartilage for the thyroid and the arytenoid cartilages.
Arytenoid Cartilages
- Arytenoid cartilages are three-sided and pyramidal shaped with a base and apex.
- Each arytenoid cartilage has an apex (superior), a vocal process (anterior), and a muscular process (lateral).
- The apex of the arytenoid cartilage sustains the corniculate cartilage.
- These cartilages slide (laterally or medially) or rock (anterior or posteriorly) on the superior and posterior edge of the cricoid cartilage.
- Sliding or rocking of the arytenoid cartilages approximates, tenses, or relaxes the vocal folds or cords.
Membranes, Ligaments and Folds
- The thyroepiglottic ligament connects the thyroid cartilage to the epiglottis.
- Hyoepiglottic ligament connects the hyoid to the epiglottis
- The thyrohyoid membrane connects the thyroid cartilage to the hyoid.
- The median cricothyroid ligament connects the cricoid and thyroid cartilages.
- The lateral cricothyroid ligament contributes to the conus elasticus.
- The vocal ligament is the free superior margin of the conus elasticus.
- A tracheotomy is a surgical incision that creates an opening (tracheostomy) in the neck to place a tube into the cervical trachea, below the vocal cords, to allow air to enter the lungs.
- A cricothyrotomy involves an emergency incision made through the skin and the cricothyroid membrane.
- A cricothyrotomy establishes an open (patent) airway during life-threatening situations.
- The quadrangular membrane spans between the arytenoid and epiglottic cartilages with two free margins: the aryepiglottic fold (superiorly) and the vestibular ligaments/fold (inferiorly).
- The cuneiform and corniculate cartilages provide support to the free margin of the aryepiglottic folds.
- Conus Elasticus spans between the superior border of the cricoid cartilage and the anterior midline internal aspect of the thyroid cartilage, and the vocal process of the arytenoid cartilages.
- The conus elasticus has a free margin superiorly, the vocal ligament (fold).
- It forms a tent-shaped cover of the tracheal inlet.
- Rima vestibuli refers to the aperture between the vestibular folds, which are the false vocal cords.
- Rima glottidis is the aperture between the vocal folds, which are the true vocal cords.
- The laryngeal cavity is divided into three regions: vestibule, ventricle, and infraglottic cavity.
- The vestibule lies between the laryngeal inlet and the vestibular folds.
- The ventricle is between the vestibular and vocal folds.
- The infraglottic cavity spans between the vocal folds and the inferior border of the cricoid cartilage, and is continuous with the lumen of the trachea.
Phonation
- During normal phonation, vestibular folds are pink in color.
- Vocal folds are pearly white.
- The rima vestibuli is superior and always wider than the rima glottidis.
- The vallecula is the space between the epiglottis and the posterior aspect of the tongue.
- The shape of the rima glottidis varies across different functions.
- In normal respiration, the rima glottidis has a narrow and wedge shape.
- In forced respiration, the rima glottidis takes a wide and kite shape.
- During phonation, it is slit-like and closely approximated.
- During whispering, there's an opening at its posterior end.
- The vocal folds or cords control sound production.
- They produce audible vibrations when their free margins are closely apposed, and air is forcibly expired through the rima glottidis intermittently.
- Pitch of the voice can change as a result of variations in the length of the vocal cords, tension across them, width of the rima glottidis, and intensity of expiratory effort.
- The pitch of women's voices is generally higher than men's because of a shorter length in women's cords.
- Modulation of the sound produced is influenced by the size and position of the pharynx, soft palate, tongue, teeth, and lips.
Muscles
- Extrinsic muscles move the hyoid bone, thus moving the larynx as a whole.
- Extrinsic muscles can act as elevators, raising the larynx, or depressors, lowering the larynx.
- The elevators include the geniohyoid, digastric, thyrohyoid, mylohyoid, and stylohyoid muscles.
- The depressors include the sternohyoid, sternothyroid, and omohyoid muscles.
- Intrinsic muscles include abductors, adductors, sphincters, tensors, and relaxers.
- Abductors and Adductors move vocal folds to open and close rima glottidis with posterior cricoarytenoids (abductors/open) and lateral cricoarytenoids (adductors/close).
- Sphincters close the laryngeal inlet during swallowing, are the transverse arytenoids, oblique arytenoids, aryepiglottics, and thyroepiglottics.
- Tensors are the crycothyroids, and the vocalis. The vocalis can also be referred to as thyroarytenoid
- Relaxers includes the thyroarytenoids, and vocalis.
- Crycothyroids pull the prominence of the thyroid cartilage anteriorly and inferiorly, lengthening and increasing the tension of the vocal ligament, thus raising voice pitch.
- Thyroarytenoids pull the arytenoid cartilages anteriorly, relaxing the vocal ligament and lowering voice pitch.
- Posterior Cricoarytenoids pull the muscular process of the arytenoid cartilages posteriorly
- This movement rotates the vocal process laterally to widen the rima glottidis, and are the only abductors or openers of the vocal cords.
- Lateral Cricoarytenoids pull the muscular process of the arytenoid cartilages anteriorly
- This action rotates the vocal process medially to narrow the rima glottidis, closing the vocal cords.
- Transverse and Oblique Arytenoids narrow the rima glottidis to close the vocal cords by approximating the arytenoid cartilages.
Nerves
- All intrinsic muscles, except the cricothyroid, are innervated by the recurrent laryngeal nerve.
- The cricothyroid is innervated by the external laryngeal nerve, a branch of the superior laryngeal nerve.
- Both the recurrent and superior laryngeal nerves are branches of the vagus nerve (CN X).
- Damage to these nerves can result in hoarseness or loss of the voice.
- The Recurrent laryngeal nerve innervates all intrinsic muscles, except the cricothyroid
- The External laryngeal nerve innervates the cricothyroid and the inferior pharyngeal constrictor muscles
- The Recurrent laryngeal nerve becomes the Inferior laryngeal nerve once it enters the larynx.
- The Internal laryngeal nerve provides sensory and parasympathetic innervation above the vocal cords.
- Recurrent laryngeal nerve provides sensory and parasympathetic innervation below the vocal cords.
- Branches of the internal laryngeal nerve can be found in the piriform fossa, where they can be exposed to damage from extraneous objects that may become lodged in this area.
Vascularization
- Blood is supplied to the larynx by the superior and inferior laryngeal arteries.
- Each artery is a branch of the corresponding thyroid artery.
- The superior laryngeal arteries run with the internal branch of the superior laryngeal nerves and enter the larynx through the thyrohyoid membrane.
- The inferior laryngeal arteries run with the inferior laryngeal nerves, the end branches of the recurrent laryngeal nerves.
- Venous drainage is through the superior and inferior laryngeal veins.
- Each vein is a tributary of the corresponding thyroid vein.
- The superior laryngeal veins drain to the superior thyroid veins, which then drain to the internal jugular vein.
- The inferior laryngeal veins drain to the inferior thyroid veins, which drain to the brachiocephalic and internal jugular veins.
Clinical Note
- Foreign bodies aspirated into the laryngeal inlet often become trapped in the area of the vestibule.
- Violent coughing occurs in an attempt to expel the object.
- If the object becomes lodged in the rima glottidis, the laryngeal opening is obstructed, leading to chocking as no air can enter the trachea.
- The Heimlich maneuver can help quickly dislodge the obstruction, by forcing air from the lungs out through the pharynx.
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