ANATOMY FINAL PDF - Respiration Exam Notes

EXAM 1 - RESPIRATION The anatomy of Respiration The respiratory system - Provides oxygen to every cell of the body and eliminates carbon dioxide - A respiratory cycle includes inhalation and exhalation - Exhalation provides the air that forms voice and speech - provides energy for s...

EXAM 1 - RESPIRATION The anatomy of Respiration The respiratory system - Provides oxygen to every cell of the body and eliminates carbon dioxide - A respiratory cycle includes inhalation and exhalation - Exhalation provides the air that forms voice and speech - provides energy for speech Support for respiration - Vertebral column provides support and protection - 7 cervical vertebrae - 12 thoracic vertebrae - 5 lumbar vertebrae - 5 sacral vertebrae - fused - 4 coccygeal vertebrae - fused Foramen magnum - Hole in the back of the skull that allows the brain stem to continue into the spinal cord Atlas C1 - Holds up the skull - No spinous process - Facet for dens of axis (C2) - allows head to turn - Transverse foramen - only seen in cervical vertebrae for the blood vessels to supply blood to the brain - Lamina - where the front and back meet - Superior articular facet - where the skull articulates - Anterior tubercle - Inferior articular facet - for Axis C2 Axis C2 - Articulates with C1 to allow the head to turn - Beginning of the bifid spinous process - continues to C6 - Dens (odontoid process) - Superior articular facet - Pedicle - Transverse process - Lamina - Transverse foramen - body/corpus - Inferior articular facet Cervical Vertebrae C7 - Start of singular spinous process - continues till the end of the lumbar vertebrae - body/corpus - Transverse foramen - Vertebral foramen - Transverse process - Lamina - Superior articular facet - Inferior articular facet Vertebral foramen - opening for the spinal cord found throughout the spinal column Transverse foramen - found only in cervical vertebrae - opening for nerves and blood vessels Intervertebral foramen - openings between adjacent vertebrae that allow spinal nerves to exit the spinal cord Thoracic vertebrae - Spinous process - Transverse process - Superior articular facet - Inferior articular facet - Inferior costal facet - Superior costal facet - Transverse costal facet - Pedicle - Corpus Lumbar vertebrae - Corpus - largest body - Lamina - Superior and inferior articular facets - Spinous process - Transverse process - Vertebral foramen Sacrum - First sacral foramen - opening for spinal nerves - Fused - Sit of fusion between sacral vertebrae - Facet for coccyx Coccyx - Fused - Directed downward and anteriorly - No function Spinal cord - Continuous from brainstem to L1/L2 - Part of CNS - Passes through vertebral foramen - Spinal nerves come off spinal cord via intervertebral foramen - Damage to the spinal cord - The higher the damage, the more serious - C3,4,5 innervate the diaphragm - if damaged can die - Ends at the conus medullaris - The nerves below the conus medullaris are a part of the cauda equina (horse’s tail) Spinal nerves - Help to protect spinal cord - Part of the peripheral nervous system - Sends signals to the rest of the body - Cervical C1-8 - Thoracic T1 - 12 - Lumbar L1-5 - Sacral S1-5 - Coccyx C1-4 - Spinal nerves C1 - 7 are above the corresponding vertebrae - Spinal nerves C8 below are below the corresponding vertebrae Rib Cage - All 12 ribs connect to the thoracic vertebrae - Lungs are attached to the rib cage through pleural linkage - 7 true ribs - connect directly to the sternum - 3 false ribs - connect indirectly to the sternum via rib 7 - 2 floating ribs - only attach the the vertebral column - Vertebral column is the posterior attachment - Sternum is the anterior attachment Sternum - 3 main sections - Manubrium - Body - Xiphoid process - Suprasternal notch - notch in the middle of the top of the manubrium - Clavicular notch - connects to the clavicle - Facet for articulation with costal cartilage from rib - Manubro-sternal angle Chondral - cartilaginous portion of the rib near the sternal attachment - The rest of the rib is bone Parts of a rib  - Head - attached to inferior and superior costal facets - Neck - Tubercle - attaches to the transverse costal facet - Angle - Shaft Pectoral girdle - Comprised of the clavicle and scapula - Anterior attachment at the sternoclavicular joint - Posterior attachment is muscular - Provides a rigid structure for muscles to pull against - Adds additional support for respiration Pelvic girdle - Ilium - large hip bone - Pubic bones - Pubis - one on the superior side of the pubic bone - Ischium - inferior side of pubic bone - Pubic symphysis - partially moveable joint between right and left pubic bones - Two hip bones join posteriorly at the sacroiliac joints and anteriorly at the pubic symphysis Respiratory system - Primary function - gas exchange to support life - Communication with external environment via respiratory passages - Oral and nasal cavities - Larynx - Trachea - Branching in lungs - Secondary function is to provide energy for speech production - Valving - closing off the airway - Velopharyngeal port - closed during eating, drinking, and most speech sounds except for nasal sounds - Vocal folds - open during normal breathings, closed/vibrating during speech, closed during eating/drinking - Abducted - vocal folds come apart - Adducted - vocal folds come together Expansion of thoracic cavity - Inspiration (inhalation) - Expand thoracic cavity (chest and lungs) - Increase lung volume - Decreased air pressure in the lungs - Air is drawn into the lungs to equalize pressure with the outside air - Expiration (exhalation) - Contract thoracic cavity - Decrease lung volume  - Increased pressure in the lungs - Air is expelled from lungs to equalize pressure Lungs - Right lung - 3 lobes (superior, middle, and inferior) - 2 fissures (horizontal and oblique fissure) - Left lung - 2 lobes (superior and inferior) - 1 fissure (oblique fissure) - Cardiac notch - Hilum - where the right and left primary bronchi enters the lungs - Mediastinum - space between the lungs which contains the heart, esophagus, trachea, phrenic and cardiac nerves, and lymph nodes - Apex - top of lung - Base - bottom of lung Trachea - Composed of 16-20 hyaline cartilage rings with fibroelastic membranes, connected by a continuous mucus membrane - Originates from the inferior surface of the larynx - Bifurcates (splits) at a point called the carina - becomes the right and left primary bronchi Airway branching - Trachea - Right and left primary bronchi (split at carina) - enter into the lung at hilum - 5 secondary bronchi (3 in right lung, 2 in left lung) - Bronchioles - Terminal bronchioles - last and smallest branches - Alveolar ducts - Alveolar sacs - Why so many branches? - more surface area for gas exchange Alveoli - Terminal bronchioles divide into alveolar ducts - which contains the alveolar sacs - Alveoli are surrounded by a network of capillaries - where gas exchange occurs - Place for gas exchange - Membrane is permeable to both oxygen and carbon dioxide - Each alveolus is about 200-300 microns in diameter Gas exchange throughout the body - Circulation - Oxygenate blood leaves the heart via the aorta and delivers through the artery system to the body - Oxygen is absorbed from the capillary beds to be used in cellular respiration for the body to function  - Carbon dioxide is the byproduct or waste from cellular respiration and it is absorbed back into the blood via the capillaries - Blood is now deoxygenated and returned to the heart via the vena cava - Deoxygenated blood is pumped from the heart to the lungs through the pulmonary artery - Carbon dioxide is exchanged for oxygen via gas exchange - Oxygen come in through inhalation and carbon dioxide is released back via exhalation - Oxygenated blood is returned to the heart via the pulmonary vein and the cycle continues Pleurae (pleural membranes) - Parietal (costal) pleura - Lines the inner surface of the thoracic cavity (rib cage) - Visceral pleura - Lines the outer surface of the lungs - The two pleurae are continuous, connecting at the hilum space between pleura is called the pleural cavity - Areas: costal, diaphragmatic, mediastinal, apical - Functions - Provide fiction-free lung and thoracic surfaces - Surfactant reduces surface tension - Protection - Link lungs to walls of thorax “pleural linkage” Pathologies associated with the lungs - Emphysema - Asthma - Bronchitis - Gerd - Aspiration pneumonia - Pleurisy - Pneumothorax Muscles of Respiration Diaphragm - Primary muscle of inspiration - always involved no matter how big or small the breath is - Separates abdominal and thoracic cavities - Dome shaped - Structures - Central tendon - Aponeurosis from which muscle fibers radiate - Cannot contract by itself - Muscular portions - Sternal - attaches to xiphoid process  - Costal - attaches to inner surface of cartilage of ribs 7 - 12 - Vertebral - attached to upper lumbar vertebrae (corpus of L1, transverse process of L1-5) - Innervation = phrenic nerve originating from C3,4,5 Holes in the diaphragm - Foramen vena cava - Esophageal hiatus - Abdominal aorta Tidal breathing - Quiet breathing - Can be accomplished using only the diaphragm - Both active and passive forces at work - Active force: when the muscles are involved - Passive force: no muscle contractions involved - Inhalation is active exhalation is passive Accessory muscles of inspiration - Function - inspiration beyond tidal breathing - Expand thoracic cavity in anteroposterior (front and back) and lateral (horizontal) dimensions by elevating the ribs (and the lungs follow) External intercostals - 11 pairs that run between the ribs - Involved in inhalation - Course downwards and inwards - Originate from the inferior surface of ribs 1-11 - Insert into the superior surface of ribs 2-12 medially - Innervated by T1-T11 Muscles of the back - Serratus posterior superior muscle - Elevates ribs 2-5 - Levator costarum longus muscle - Bypass rib below and insert into next rib down - longer - Levator costarum brevis muscle - Assist in elevating the ribs Neck - Sternocleidomastoid - Originated on mastoid process of temporal bone - Sternal head inserts into manubrium - Clavicular head inserts into the clavicle - Elevates sternum and by association the ribcage - Scalenes (anterior, medius, posterior) - Elevate ribs 1 and 2 Chest - Pectoralis major - Elevates sternum and therefore increases transverse (lateral/horizontal) dimension of ribcage  - Pectoralis minor - Increases transverse dimension of ribcage Expiration - The volume of the thoracic cavity decreases - When the thorax contracts it does so in 3 planes - Top to bottom - vertically - diaphragm - Side to side - horizontally - interior intercostal muscles - Front to back - anteroposteriorly - interior intercostal muscles - Pressure within the lungs increases = air exits the lungs - Expiration is passive - no muscle contraction at rest - The passive forces are - Elasticity of the lungs - lungs always want to shrink - Recoil of the rib cage - rib cage wants to expand to a point - During breathing beyond tidal, expiration is aided by muscles that - Push abdominal contents up into the diaphragm causing it to ascend - Pull the ribs down - Net effect = reduced volume in lungs, increased pressure = air to be exhaled Muscles of forced expiration Internal intercostals - Primary muscle of forced exhalation - Deep to external intercostals - Originate on the inferior margin of ribs 1- 11 - Insert into rib immediately below laterally - Run almost at right angles with external intercostal muscles - Innervated by T2-T11 - Depress ribs Innermost intercostals - Muscle of forced exhalation - Originate on the inferior margin of the ribs 1-11 - Insert into rib immediately below laterally - Deep to internal intercostals - Course parallel to internal intercostals - Depress ribs Abdominal muscles of expiration - Abdominal aponeurosis - has various attachments for muscles - a large tendon that connects the muscles that are in different layers - Runs from the xiphoid process to the pubic symphysis - Its midline in the linea alba - Lateral edges is the linea semilunaris - At midline abdominal aponeurosis is thinnest - as it courses laterally, it becomes 2 layers - Sheath for rectus abdominis and then 3 layers formins sheath for abdominal muscles - Rectus abdominis - External oblique  - Internal oblique - Transverse abdominis - All work as a unit to compress contents of abdominal cavity, exerting pressure upward on the diaphragm Latissimus dorsi - Accessory muscle of expiration - Courses up - Stabilizes posterior wall for expiration Serratus posterior inferior muscle - Accessory muscle of expiration - Courses down and assists in rib depression Physiology of Respiration Volumes and pressures - Volumes is the quantity of three-dimensional space enclosed by some closed boundary - Units: liters, milliliters, cubic centimeters, gallons, etc. - Pressure - force per unit area - Units - 1 pascal, 1 newton per square meter - Pressure is inversely proportional to volume - Increase in volume of a syringe results in a decrease in pressure fluid goes into the syringe Measures of pressure - Measuring pressure by the ability to displace a liquid in a tube (u tube manometer) - Units in cm H20 or cm Hg - Subglottal pressure - the pressure beneath the vocal folds - It takes 5 cm H20 maintained beneath the vocal fold to phonate/vibrate - A person breathes into the tube, the distance between the left and right side of the tube is measured in centimeters and indicates the pressure Respiratory cycles - 1 cycle = 1 inspiration + 1 expiration - Adults - 12 cycles per minutes - 1 cycles takes 5 seconds - Newborns - 30/32 cycles per minute - Males have higher lung volumes and capacities than females - Tidal volume is 500 cc - 600 cc for males - 450 cc for females - Average of 500 cc - Total lung capacity is - 6000 in males - 4200 in females Capacities and volumes - Volumes partition the respiratory system to get an accurate estimate of the amount of air each component can hold - Capacities refer to function combinations of volumes that express physiological limited Volumes - Tidal volumes - amount of air used when using the diaphragm - Inspiratory reserve volume - amount of air we can breathe in after tidal breathing - Expiratory reserve volume - exhalation beyond tidal expiration - Residual volume - the amount of air left in lungs after forced exhalation - Dead air - the air leftover in bronchioles of lungs after we exhale everything we can - makes up residual volume Capacities - Vital capacity = IRV + ERV + TV - Functional residual capacity = ERV + RV - Total lung capacity = IC + FRC - Inspiratory capacity = TV + IRV Respiratory pressures - Subglottal - beneath the vocal folds, positive, 5cm H20 required for phonation - Intrapleural - always negative - more negative during inhalation - Alveolar - lung pressure - Exhalation - positive - Inhalation - negative Purple graph - Point A - Maximum expiration - 0% VC - still have residual volume - Lungs exerting very little pressure (want to be small) - Rib cage exert strong recoil to expand thorax - Inspiration is passive to resting expiratory level (point B) - Point B - Resting expiratory level = 38% vital capacity - Tidal breathing begins here - Elasticity of lungs and recoil of rib cage exerting equal forces - Inspiration to 55% (tidal breathing 17% of VC) requires contraction of diaphragm only - expiration is active - Point C - 55% VC - Rib cage is not exerting any force - Elasticity of the lungs squeezing air out - Further inspiration required contraction of diaphragm and external intercostals - Expiration is passive until resting expiratory level - 38% VC - point B  - Point D - Maximum inspiration - 100% VC - lungs are full - Lungs wants to squeeze air out and rib cage wants to return to size at 55% VC - Expiration to point B is passive Timing of speech - 50/50 for normal breathing (non-speech) - 10/90 inspiration expiration during speech Inspiratory checking - A technique that help control the airflow out of the larynx - slows down expiration - Muscles of exhalation are put to use gradually to control air flow - They are used to keep subglottal pressure that same during speech - If subglottal pressure changes during speech this will result in the speech either becoming louder or softer EXAM 2 THE LARYNX The Larynx Function of the larynx - Airway protection - from food and water via the epiglottis - Phonation via vocal folds - Abdominal fixation - when you compress your abdominals, you vocal folds close Vocal tract and larynx structures - Vocal tract - Nasal cavity - Oral cavity - Tongue - Larynx structures - Supraglottis - space above vocal folds - Vocal folds - vibrate to produce phonation - Glottis - space between vocal folds - Subglottis - space below vocal folds - Epiglottis - attaches in supraglottis space - Hyoid bone - attachment to epiglottis and muscles of jaw and tongue - Thyroid cartilage - anterior attachment of vocal folds, posterior articulation with cricoid cartilage - Cricoid cartilage - complete ring, articulated with thyroid and arytenoid cartilages - Arytenoid cartilage - two cartilages which glide along the posterior cricoid and attach to posterior ends of vocal folds vis the vocal process The hyoid bone - important parts - Greater cornu - Lesser cornu - Corpus - Stylohyoid attachment - Omohyoid attachment - Sternohyoid attachment - Mylohyoid attachment - Geniohyoid attachment - Hyoepiglottic ligament - Digastricus attachment The thyroid cartilage - important parts - Superior cornu - Inferior cornu - Laryngeal prominence - Triticial cartilage - Thyroepiglottic ligament - Thyrovocalis attachment - Thyromuscularis attachment. The cricoid cartilage - important parts - Facet for arytenoid - Arch - Facet for thyroid (inferior cornu) Arytenoid cartilages - important parts - Corniculate cartilage - Vocal process - Muscular process - 3 types of movement: rock, glide, rotate Epiglottis - Comprised of elastic cartilage - attaches to thyroid cartilage and hyoid bone - First level of airway protection - Closes off respiratory system when we swallow - Not involved in phonation Laryngeal membranes and ligaments - Laryngeal passageway is a constricted tube of smooth mucus membranes - Between hyoid and thyroid - Lateral thyrohyoid ligament - contains triticial cartilage - where hyoid and thyroid connected at the greater and superior cornu - Thyrohyoid membrane - connects hyoid to thyroid - Aryepiglottic folds - Course from sides of epiglottis to the apex of the arytenoids  - Contains cuneiform cartilage for support - Located at the top of the quadrangular membrane - Form into vestibular folds (false vocal folds) - Hyoepiglottic ligament - Thyroepiglottic ligament - Cricotracheal membrane/ligament - Cricothyroid ligament Intrinsic membranes - Quadrangular membranes (supraglottic space) - Layer of connective tissue running from arytenoids to epiglottis and thyroid cartilage - Forms the false vocal folds - Superior margins are aryepiglottic folds - Conus elasticus (subglottal space) - Includes vocal ligament (within vocal folds), cricothyroid ligament and cricovocal membrane - Runs from thyroid through cricoid Cavities - Glottis - between vocal folds - The vocal folds attach to the thyroid cartilage at the anterior commissure - The posterior commissure is mobile, as the vocal folds attach to the arytenoids - Subglottis - below the vocal folds, extending to the inferior border of the cricoid cartilage - This is where subglottal pressure builds for speech production - Aka subglottal atrium infraglottis - Pyriform sinus - between aryepiglottic folds and lamina of thyroid cartilage - Vestibule - supraglottic region - False vocal folds - mucosal folds superior to the true glottis - separated from true vocal folds by the ventricle - Ventricles - mucosal lines sac, variable in size which separated the supraglottis from the glottis - Valleculae - space between tongue and the epiglottis Adduction and abduction - Motion of the arytenoids effects abduction or adduction of the larynx - The bulk of the vocal fold is made up of muscle covered by mucosa - The free edge is characterized by stratified squamous epithelium - The vocal folds abduct for inspiration and adduct for phonation and coughing Vagus Nerve (CN X) - most extensive of the cranial nerves - Arises from the medulla oblongata (brainstem) - Sensory, motor, and autonomic functions - Three branches  - Pharyngeal plexus/branch - motor info to pharynx and velum - Superior laryngeal nerve - sensory info from inside larynx and motor info for cricothyroid muscle - Recurrent laryngeal nerve - innervates all other intrinsic muscles of the larynx Intrinsic laryngeal muscles - Muscles that have both origin and insertion on laryngeal cartilages - Control abduction/adduction of the vocal folds and tightness of the vocal folds - Innervation is by vagus nerve (CN X) Tensors - Cricothyroid muscles - Pars recta - Pars oblique - Nerve innervation - SLN of vagus nerve - Action - controls pitch by lengthening and tensing the vocal folds by tilting the thyroid cartilage forward and increasing the distance between thyroid and arytenoid cartilages - Thyroarytenoid muscles - Muscles of the vocal folds - Divided into two different sections - Thyrovocalis - medial thyroarytenoid - Origin thyroid, insertion vocal process - Innervated by recurrent laryngeal branch of CN X - action : laryngeal tensor - Thyromuscularis - lateral thyroarytenoid - Innervation: recurrent laryngeal branch of CN X - Action: laryngeal relaxer - Origin thyroid, insertion muscle process Pitch control - Accomplished by tightening and loosening the vocal folds - Primary muscle involved is the cricothyroid (pars recta and pars oblique) - Secondary muscles are the thyroarytenoid muscles (thyrovocalis and thyromuscularis) - These muscles help regulate pitch (fine tuning) - further tenses or relaxes pitch Laryngeal adductors - Lateral cricoarytenoid - Origin cricoid, insertion arytenoids - Innervation - recurrent laryngeal branch of vagus nerve - Action - adducts vocal folds by medially rotating arytenoid cartilage - Interarytenoids - Comprised of two separate muscle groups  - Transverse interarytenoids - Innervation - recurrent laryngeal branch of vagus nerve (X) - Action - adducts arytenoid cartilage - closes glottis - Oblique interarytenoids - Innervation - recurrent laryngeal branch of the vagus nerve - Action - adducts arytenoid cartilage (closes glottis) Laryngeal abductors - Posterior cricoarytenoid (PCA) - Innervation - recurrent laryngeal branch of vagus nerve (X) - Action - abducts and laterally rotates arytenoid cartilage Extrinsic laryngeal muscles - Have one of their attachments within the laryngeal cartilages and the other outside the larynx - They fall into two categories - The laryngeal elevators - suprahyoid muscles (originate above hyoid bone) - The laryngeal depressors - infrahyoid muscles (originate below the hyoid bone) - The laryngeal elevators raise the larynx by pulling the hyoid bone up - The laryngeal depressors lower the larynx Elevators - Stylohyoid - Runs from the styloid process (projections from temporal bone) to the hyoid - Draws hyoid back and up - Digastricus - has 2 divisions separated by an intermediate tendon - Anterior belly - runs from the mandible to the hyoid bone - Pulls the hyoid bone forward and up - Posterior belly - runs from the mastoid process to the hyoid - Pulls the hyoid bone up and back - Geniohyoid - runs from the mandible to the hyoid - Draws hyoid bone forward and up - Mylohyoid - runs from mandible to the hyoid - Draws bone forward and up Depressors - Sternohyoid - runs from the sternum to the hyoid - Lowers the hyoid bone - Sternothyroid - runs from the sternum to the thyroid - Pulls thyroid cartilage down - Omohyoid - runs from scapula to hyoid - Lowers hyoid bone Vocal fold composition - Epithelial layer - top layer - Lamina propria - 3 layers - Superficial layer - elastic - Reinke’s space - Intermediate layer - elastic - vocal ligament - Deep layer - collagen - vocal ligament - Thyroarytenoid muscles - Thyrovocalis - Thyromuscularis cover/transition/body physiology - Mechanical properties of top 2 layers (epithelium and Reinke’s space) are controlled passively - By Bernoulli effect and elasticity of vocal folds - First two layers most important for vibration - Mechanical properties of intermediate and deep levels of lamina propria and thyroid arytenoid muscles are control passively and actively - By elasticity (passive) and muscle contraction (active) - Help control pitch Non-speech vocal fold functions - Coughing - Reflexive or voluntary - Deep inhalation through widely abducted vocal folds - Rensing and tight adduction of the vocal folds - Elevation of larynx - Positive subglottal pressure - Expels irritating object - Vocal folds slam together and release pressure - Throat clearing - Related to coughing, but not as violent or stressful to the vocal folds - Allows mucus to be cleared - Allows mucus to be cleared - Both excessive coughing and throat clearing can cause vocal fold strain - Both can be used to initiate phonation if there is muscular weakness - Abdominal fixation - Air is captured in thorax to provide the muscles with an extra structure from which to push or pull - Take in large amount of air - Clamp vocal folds shut and maintain rigid thorax - Force is applied to legs or arms wherever needed - If some air escapes we hear grunting - These functions serve biological needs and provide us with the background for useful clinical intervention techniques Phonation - 3 steps  - pre-phonation/attack - 2 requirements: subglottal pressure, and adducted vocal folds - Pre-phonation phase - Vocal folds are brought from an abducted position to an adducted or partially adducted position - Adduction is brought by the adductor muscles (lateral cricoarytenoid and interarytenoids) - Attack phase - Begins with the vocal folds in the adducted position - Requires subglottal pressure - Complete adduction is not required for initiating phonation however sufficient subglottal pressure is requires - Three types of attacks: breathy, simultaneous, and glottal Turbulence - Without the vocal folds, air would pass unimpeded out of the lungs into the oral cavity - The adduction of vocal folds results in air having to make a detour around the vocal folds - The result of the detour leads us to the bernoulli effect - Air flow travels through partially adducted vocal folds creating a hissing sound - Occurs during fricatives, whispering, and breathy voice Maintaining phonation - The bernoulli effect - After the attack phase, the air stream pushes itself in an upward direction - As the air stream is passing through a narrow construction, the velocity increases - A negative pressure develops between the medial edges and sucks them towards each other - Thus if the air stream move through or if the subglottal pressure is adequate, one would generate phonation - Myoelastic-aerodynamic theory of vocal fold vibration - Where there is slow flow in fluid or air, you will find increased pressure - Where there is increased flow in a fluid or air, you will find decreased pressure Vocalfold opening/closing during phonation - Vocal folds are closed - Air pressure begins to set inferior aspect of vocal folds into vibration - Vocal folds continue to open inferiorly to superiorly - Vocal folds totally close - volume increase created negative pressure - Bernoulli effect and elasticity kick in and vocal folds begin to close inferiorly to superiorly - Vocal folds continue to close - Vocal folds total close Termination of phonation - Phonation is terminated when: - The vocal folds are abducted - At the end of an utterance, the vocal folds are fully abducted - During continuous speech, the vocal folds are abducted sufficiently as needed to produce voiceless sounds Abduction and adduction during continuous speech - Phonation must occur for vowels and voiced sounds - phonation must be terminated for voiceless sounds Fundamental frequencies - lowest frequency of vocal fold vibration - Adult males - 130-150 Hz - Adult females - 190 Hz - Children - 220-300 Hz Frequency - mass, length, tension - In a vibrating system, frequency is determined by 3 parameters - Mass - Length - Tension - Increasing the length of the vocal folds - Mass - constant - Length - longer - Tension - increased - Net effect - higher pitch - Decreasing the length of the vocal folds - Mass - constant - Length - shorter - Tension - decreased - Net effect - lower pitch Vocal registers - Modal register - Used for everyday conversation - Normal pattern of vibration - Vocal folds open and close from inferior to superior - Requires 3-5 cm h2o subglottal pressure - Glottal fry - sick voice - Lowest frequency of vibration 30-90 Hz - Requires low subglottal pressure ~2 cm h2o - Low tension in vocalis muscle to keep vibrating - portion of vocal folds flaccid - Lateral portion of folds is tensed to increase thickness of vocal folds - Falsetto - Highest register of phonation 300-600 Hz  - Vocal folds lengthen and become extremely thin - Posterior portion of vocal folds are held shut, so only anterior portion vibrates along a narrow opening - Overlap between modal and falsetto registers - Whispering - Partial adduction of vocal folds to cause turbulence but not enough to allow phonation - Can be stressful on vocal folds because it is not economical and can cause vocal fatigue Source filter theory - Source: vocal folds/larynx - Filter: vocal tract Types of sounds - Simple periodic - Repeating in time - Pure tones are simple periodic sounds consisting of only one frequency - Complex periodic - Typical of what is produced by our larynx and many instruments - Repeating combinations of multiple pure tones - Our voices can be described as having a fundamental frequency and a series of harmonics - Vowels are periodic - source is the vocal folds - filter is the vocal tract Resonant frequency - Frequency of sound to which the cavity most effectively responds - The filter allows some frequencies to pass through and rejects others - The larger the cavity - the lower the resonant frequency - The smaller the cavity - the higher the resonant frequency The role of the vocal tract - the filter - 2 sections based on placement of the tongue - Movement of the tongue creates changes in the relative sizes of the oral and pharyngeal cavities - It is the relative sizes of these two cavities that determine what vowel is produced Formants - During vowel production we shape our vocal tracts, primarily using the tongue, such that certain frequencies resonate better than others in the different compartments - depends on the size of the cavity - F0 = fundamental frequency = first harmonic - F1 = frequency of first formant = 300 - 1000 Hz - pharyngeal cavity - F2 = frequency of the second formant 850 - 1250 Hz - oral cavity - F1 and F2 give vowels their perceptual characteristics Viewing speech - Specta - show frequency on the x-axis and intensity on the y-axis FINAL EXAM Bones of the Skull The articulators - Moveable - Mandible - Tongue - Velum - Cheeks - Pharynx - Larynx - Immovable - Hard palate - Alveolar ridge - Teeth Cranial sutures - Suture: joints that are immovable - connects 2 bones - Sagittal suture - at midline, between 2 parietal bones - Lambdoidal suture - between occipital and parietal bones - Coronal suture - between frontal and parietal bones  - Parietomastoid suture - between parietal and temporal bones - Occipitomastoid suture (squamous suture) - between temporal and occipital bones Frontal bone - Zygomatic process: where frontal and zygomatic bones meet - Orbital portion - Nasal portion - where nasal bone and frontal bone touch - Coronal suture Temporal bone - Mandibular fossa articulates with the condylar process of the mandible - Temporomandibular joint - Structure of the middle and inner ear are contained within the temporal bone - Styloid process provides attachment for stylohyoid Parietal bone - Paired bones - Connected at midline by sagittal suture - Separated from occipital bone by lambdoidal suture - Separates from temporal bone by squamosal suture (aka parietomastoid suture) Occipital bone - Forms base of the skull - Foramen magnum provides opening for spinal cord - Condyles mark resting point of C1 - Separated from parietal bones by lambdoidal suture - Separated from temporal bones by by occipitomastoid suture (aka squamous suture) Zygomatic bones - The cheekbone - connects 3 bones: frontal, temporal, and maxillary bones - Orbital surface - help forms eye socket Sphenoid bone - Provides attachment for many of the muscles of mastication - Contains many openings for blood vessels and nerves - Greater wing: outer portion of sphenoid bone - Most of the bone is not seen from the outside Ethmoid bone - Deep unpaired bone - Helps to form the orbit (eye socket) as well as the base of the skull - Contains many openings for blood vessels and nerves - Helps to form the nasal cavity (septum) The mandible - Symphysis (point of fusion) - where right and left jaw fuse after birth - if left with gap results in cleft chin - Mental foramen - Mandibular foramen - All foramen are openings for CN V (trigeminal) - Corpus (body) - Ramus (branch) - Condylar process - Coronoid process - Mandibular notch - Dental alveoli - where teeth sit - Mylohyoid line - attachment for mylohyoid Nasal septum - Separates left and right nostrils - 2 bones, 1 cartilage - Vomer - Septal cartilage - Perpendicular plate of ethmoid bone Nasal bones - Small bones making up superior nasal surface - 2 bones left and right - Articulate with frontal bones, maxillae and ethmoid bone (deep)  - Nasal conchae - inside nasal passage - Inferior, middle, superior - 3 conchae - Thick mucosal lining helps warm and humidify air Nasal conchae - Small bones that help create shell like chambers in the nasal cavity - Inferior, middle, superior - Separates nasal cavity from nasopharynx - These shells are lines with mucosal membranes and heavily vascularized, allowing air to be warmed before entering the lower respiratory system - Contain cilia which helps clean the nasal passage Dentition - Adults have 32 teeth - 8 teeth per quadrant - Children have 20 teeth - 5 teeth per quadrant - Children do not have either bicuspid or the 3rd molars - Incisors - designed for cutting - Cuspid (canine) - designed for tearing - First and second bicuspids or premolars - Molars designed for grinding Surface of the teeth - Buccal - outside - contact buccal wall - Medial - closer to midline when viewed from front - Distal - farthest from midline when viewed from front - Lingual - inside - surface facing tongue Dental development - Central incisors emerge first (lower first at about 6 months) - Then lateral incisors (upper, then lower) - Then molars and cuspids (15-20 mo) - 2nd molars around 2-3 years of age - Shedding of deciduous teeth begins around 6 years of age (permanent teeth begin to erupt) - Shedding continues until about 12 yrs - Wisdom teeth (3rd molars) present by age 17 Occlusion patterns - Occlusion - bringing lower and upper teeth into contact - how the teeth meet each other - Class I occlusion - normal bite - upper incisors project a few millimeters beyond lower incisors - Class II malocclusion - mandible is relatively retracted compared to the maxillae (overbite)  - Class III malocclusion - mandible is relatively advanced compared to maxillae (underbite) The maxilla - Paired bones - Important landmarks - Frontal process - Zygomatic process - Anterior nasal spine - Alveolar process - Infraorbital foramen Maxilla features - ¾ is palatine process of the maxilla - ¼ horizontal plate of the palatine bone - Separated by transverse palatine suture - 2 palatine processes are separated by the intermaxillary suture (median palatine suture) - Incisive foramen - conduit for nasopalatine nerve (branch of CN V) - Premaxillary suture - separated premaxilla from palatine process - Anterior - premaxilla - Posterior - palatine process - Separated lateral incisors from cuspids - Point of clefting - may include lip, alveolar bone and premaxillary suture Palatine bones - Palatine bones - Posterior ¼ of hard palate is palatine bone - Posterior nasal spine, continuation of anterior nasal spine - Perpendicular plate makes up posterior wall of nasal cavity - Vomer  - Unpaired bone making up inferior and posterior portions of nasal septum - Divider between 2 nasal cavities Cleft lip/palate - One child in approximately 700 is born with a facial cleft - Opening that does not allow a person to close their oral/nasal cavity - Speech will be hyper nasalized - Cleft lip - Premaxillary suture does not fully close during development - Unilateral incomplete - one side of maxilla going up into the lip - Unilateral complete - goes through lip and nose - Bilateral complete - on both sides - Cleft palate - Cleft palate - clefting in intermaxillary suture - Complete unilateral cleft lip and palate - clefting in premaxillary and intermaxillary suture Cavities of the Vocal Tract and Muscles of the Mandible and Face Cavities of the vocal tract - Oral cavity - Extends from the mouth to the faucial pillars - Lateral margins are teeth and alveolar ridge - Prominent landmarks include hard palate, rugae - Palatine tonsils may be seen between the faucial pillars - Buccal cavity - Lateral to oral cavity  - Nasal cavity - Superior to hard palate - Connects to nasopharynx via conchae - Pharyngeal cavity - Extends from the vocal folds to the region behind the nasal cavity - Contains muscles that are active in swallowing and closing the velum - 3 divisions - Oropharynx - Velopharyngeal port - opening between oro and nasopharynx - Immediately posterior to the faucial pillar - Bounded above by the velum - Bounded below by the hyoid bone - Lingual tonsils-base of tongue - Nasopharynx - Space above the velum - Contains opening for Eustachian tube - Connects to middle ear - equalizes pressure - Also contains tonsils (adenoids) - Laryngopharynx - Extends from the hyoid bone to the esophagus - Bounded anteriorly by epiglottis Tonsils - Made of lymph tissues - Part of immune systems - Grow until about age 8 - 3 types - Palatine - between faucial pillars in oral cavity - Pharyngeal (adenoids) - in nasopharynx - Lingual - in oropharynx at base of tongue Tonsillitis - Swelling of the tonsils often related to infection - Can caused denasalized speech - Swelling of adenoids can also block eustachian tube and contribute to middle ear infections Muscles of the mandible (CN V - trigeminal) - Elevators - all CN V - Masseter - Temporalis - Medial pterygoid - Depressors - Digastricus (anterior and posterior) - Anterior CN V  - Posterior CN VII - Mylohyoid CN V - Geniohyoid CN VII - Protruder - Lateral pterygoid Important muscles of the face - Orbicularis oris - around the lips, purse the lips - Buccinator - muscles of cheeks - Risorius - smiling muscle - Zygomatic major - smiling muscle - Levator labii superioris - lifts lip straight up - Levator anguli oris - lift lip up at an angle - Depressor labii inferioris - pulls lips straight down - Depressor anguli oris - pulls lips down at an angle - All innervated by CN VII Orbicularis oris - Surrounds lips - Pulls the lips closer together - Innervated by CN VII Buccinator (Bugler’s muscle) - Large muscle - Deep to the risorius - Primarily involved in mastication - Moves food to grinding surfaces of molars - Innervated by CN VII Risorius - Dominant muscle of the cheeks - Retracts the corners of the mouth - Facilitates smiling and grinning - Innervated by CN VII Zygomatic major - More oblique course than zygomatic minor - Elevates and retracts lips for smiling - Innervated by CN VII Levator labii superioris - Elevates the upper lip to help open mouth - Innervated by CN VII Levator anguli oris - Raises the corners of our mouth - Innervated by CN VII Depressor anguli oris - Depress the corners of the mouth - Helps to compress upper lip against lower lip - Innervated by CN VII Depressor labii inferioris - Antagonist of levator labii superioris - Depresses lower lip - Innervated by CN VII Muscles and innervations-tongue velum Tongue - important landmarks - Has unilateral innervation - Dorsum - superior surface - Tip (apex - Oral surface - resides in the oral cavity - Pharyngeal surface - resides in the oropharynx - Medial (central) sulcus - separates L and R sides of tongue - Lingual papillae - small irregular promises - Terminal sulcus - divides oral and pharyngeal surfaced - Foramen cecum - deep recess in terminal sulcus - Lingual tonsils - lie beneath pharyngeal surface - Taste buds - Cover surface of tongue (in papillae) - Taste innervations - Anterior ⅔ of tongue - CN VII - Posterior ⅓ of tongue - CN IX Inferior of tongue - Rich blood supply - Lingual frenulum - tongue tie if too tight - Anchors tongue - Sublingual folds - Contains sublingual salivary glands - Lateral to frenulum on inner surface of mandible are submandibular salivary glands Muscles of the tongue - Intrinsic muscles - Responsible for precise articulatory coordination (fine movements) - Superior and inferior longitudinal muscles - Control tongue tip - Transverse and vertical muscles - Control edges of the tongue - Extrinsic muscles - Move the tongue as a whole unit (gross movements) - Genioglossus - main mover of tongue - Palatoglossus - helps pull tongue up - anterior faucial pillar muscle - Hyoglossus - helps pull tongue down - Except for palatoglossus (innervated by CN X) all are innervated by CN XII Genioglossus - Very large muscle courses from mandible to tip and dorsum of the tongue (prime mover of the tongue) - Anterior fiber contraction aids in retraction of the tongue - Posterior fiber contraction helps pull tongue forward - Contraction of both fibers results in the tongue being pulled to the floor of the mouth Hyoglossus and palatoglossus - Antagonists of each other with respect to actions on tongue - Hyoglossus - Extends from hyoid bone into the sides of the tongue - Pulls sides of tongue down - Palatoglossus - Also a muscle of the velum - Makes up part of anterior faucial pillar - Innervated by CN X - List sides of tongue up Muscles of the velum - The velum is a combination of muscle, palatal aponeurosis, nerves and blood supply, covered in mucus membrane - For most of speech, velum is actively elevated (VP port closed) - Only /m/, /n/, and /ng/ sound require that the velum be depressed (VP port open) - Levator veli palatini - Makes up bulk of soft palate - Primary elevator of the soft palate - Innervated by CN X - Musculus uvulae - Contraction of uvular shortens the soft palate, bunching it up - Innervated by CN X and XI - Tensor veli palatini - Tenses and flattens the soft palate - Dilates the Eustachian tube allowing it to aerate - Innervated by CN V