Head and Neck RCA 3

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Author:
vickrum
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302439
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Head and Neck RCA 3
Updated:
2015-10-01 05:43:28
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MICN301
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Larynx etc
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  1. Label the compartments;
    • Nasal cavities
    • Oral cavity
    • Larynx
    • - Trachea
    • Pharynx
    • - Oesophagus
  2. Describe the features of the oropharynx
    • The Oropharynx connects with the oral cavity through the oropharyngeal isthmus (isthmus = a narrowing). It extends from the soft palate to the upper border of epiglottic cartilage of the larynx
    • Soft palate
    • Palatopharyngeal arch
    • Uvula
    • Palatoglossal arch
    • Palatine tonsil: when infected known as "tonsilitis"
    • *Arch interchangeable with folds
  3. Describe the histology and features of the pharynx
    • Histology;
    • - the upper part is lined by respiratory-type epithelium
    • - the lower two parts are lined by stratified squamous epithelium (i.e. specialized for wear and tear – they are part of the digestive tract)
    • #
    • The nasopharynx connects with the nasal cavities by two large posterior nasal apertures (choanae)
    • Auditory tube (eustachian tube): opens on to its lateral wall (pharyngeal opening of eustachian tube)
    • – posterior to the opening of AT is a hood-like tubal elevation (produced by the cartilaginous part of eustachian tube)
    • (Naso)pharyngeal tonsil ("adenoids" in children): a collection of lymphoid tissue in the mucosa of the roof and posterior wall
    • - adenoiditis if inflammed
    • Tubal elevation: associated with the eustachian tube, behind which/in the posterior aspect is a mass of lymphoid tissue called;
    • - the tubal tonsil
    • Extrinsic muscles: mainly move the tongue but can also alter its shape. There are 4 pairs;
    • - Palatoglossus muscle : elevates the posterior tongue, constricts the pharynx
    • *Palatoglossus is the only tongue muscle supplied by the pharyngeal branch of vagus through the pharyngeal plexus, the rest are supplied by hypoglossus*
    • - Hyoglossus muscle : depresses the tongue
    • - Styloglossus muscle : draws the sides of the tongue upwards and the whole tongue back
    • - Genioglossus muscle : depresses and extends the tongue
    • Two muscle make up the floor of the oral cavity (+ connective tissue);
    • - Geniohyoid muscle
    • - Mylohyoid muscle (cut)
  4. Describe the features of the laryngopharynx
    • Epiglottis
    • Aryepiglottic fold
    • Piriform fossa (recess)
    • Laryngeal inlet (aditus)
    • Function: Altering length and tension in vocal cords determines the pitch and quality of the voice
  5. Name these features of the Larynx. Where does the larynx lay relative to vertebrae?
    • Hyoid bone: at the level of C3
    • Thyrohyoid membrane: superior attachment of the larynx to the hyoid bone
    • Thyroid cartilage : large and forms the adam's apple at the level of C4
    • - synovial joints where separate cartilage meet
    • Arytenoid cartilages
    • Cricothyroid membrane; (a.k.a. vocal membrane)
    • - upper free edge that extends from thyroid cartilage (close to the midline) backwards to vocal process of arytenoid cartilage forms the vocal ligament
    • - Covered by mucous membrane to form the vocal fold
    • Cricoid cartilage: at the level of C6
    • Cricotracheal ligament: inferior attachment of the larynx to the first cartilage of the trachea
    • * The larynx is related posteriorly to C3-6 vertebrae. Cricoid cartilage palpatable at C6
  6. Name the Cartilages and associated structures of Larynx
    • Epiglottic cartilage: Nerves and blood vessels pass through foramina in epiglottic cartilage
    • Hyoid bone
    • Thyrohyoid membrane
    • Thyroid cartilage
    • Arytenoid cartilages: with vocal ligament at inferior end
    • - vocal cord: upper border of Cricothyroid membrane forms the vocal fold
    • Cricothyroid membrane: forms vocal fold when covered by mucous membrane
    • Cricoid cartilage
    • Trachea
    • * Epiglottic cartilage not seen, but attached to the laryngeal prominence
  7. Label the parts of the thyroid, cricoid and arytenoid cartilages 


    • Right and left lamina of the thyroid cartilage
    • Superior horn of the thyroid cartilage
    • Inferior horn of the thyroid cartilage
    • Laryngeal prominence of the thyroid cartilage
    • Lamina of the cricoid cartilage
    • Arch of the cricoid cartilage
    • Vocal process of the arytenoid cartilage
  8. Name the membranes and associated structures of Larynx
    • Quadrangular membrane: a thin submucosal sheet of connective tissue
    • - attached to the arytenoid cartilage and to the lateral border of the epiglottic cartilage and laryngeal prominence
    • - Upper border is at aryepiglottic fold
    • Vestibular ligament: lower border of quadrangular membrane
    • - covered by mucous membrane to form the vestibular fold
    • Arytenoid cartilage
    • Cricothyroid membrane: attached inferiorly to the arch of the cricoid cartilage, anteriorly to the laryngeal prominence (posterior aspect) and posteriorly to the arytenoid cartilage (vocal process)
    • Vocal ligament: upper border of cricothyroid ligament
  9. Name the membranes and associated structures of Larynx
    • Quadrangular membrane
    • Epiglottis
    • Vocal ligament: = true vocal cords
    • Cricothyroid membrane
    • Vestibular ligament: = false vocal cords
    • - covered by mucous membrane to form the vestibular fold
    • Upper border of quadrangular membrane: helps form aryepiglottic fold
  10. Name these structures of the normal larynx on inspiration
    • Epiglottis
    • Vocal fold (true cords): positions and tensions in the vocal folds can be varied by intrinsic muscles of the larynx
    • - acting at cricoarytenoid joints (synovial) to bring about rotation/ separation of arytenoid cartilages,
    • - or acting at cricothyroid joints (synovial) to permit tilting of Thyroid C relative to Cricoid C
    • Ventricular folds (false cords)
    • - Adduction of the vocal and vestibular folds traps the air below and makes possible an increase of intrathoracic pressure (as in coughing) or of intraabdominal pressure (as in urination and defecation)
    • Ary-epiglottic fold
    • Trachea
    • Piriform fossa
    • Esophagus
    • Rima glottidis: the size of the interval between the vocal folds
    • - Sound is produced by expired air rushing past the vocal folds. The length and tension of the vocal folds controls the pitch (frequency) and quality (timbre) of voice
  11. Label the features of a coronal section through the larynx
    • Epiglottis
    • - anterior to the laryngeal inlet (a.k.a. the aditus)
    • Three cavity regions;
    • - Vestibule: between aditus and vestibular cords
    • - Ventricle: between vestibular cords and vocal cords
    • - Infraglottic region: below the vocal cords
    • Vestibular folds
    • Vocal folds; gap between the vocal cords is called the rima glottidis
    • Thyroid cartilage and Cricoid cartilage
    • Thyroid gland
  12. Muscles of the larynx;
    Name the muscle, origin, insertion, innervation and action
    • Cricothyroid
    • - Origin; anterolateral part of cricoid cartilage
    • - Insertion; inferior margin of thyroid cartilage
    • - Innervation; external laryngeal nerve - (all the other intrinsic muscles are innervated by recurrent laryngeal nerve)
    • - Actions; stretches and tenses vocal fold
    • Thyro-arytenoid muscle
    • - Origin; posterior surface of thyroid cartilage
    • - Insertion; muscular process of arytenoid cartilage
    • - Actions; relaxes vocal fold
    • Lateral crico-arytenoid muscle
    • - Origin; arch of cricoid cartilage
    • - Insertion; muscular process of arytenoid cartilage
    • - Actions; adducts vocal fold
    • Transverse and oblique arytenoid muscle
    • - Path; Transverse runs between arytenoids. Oblique is superficial to above, running from muscular process of one arytenoid to the apex of the other
    • - Actions; these muscles aid in adduction by drawing the arytenoids together
    • Ary-epiglottic muscle
    • - Path; oblique arytenoids are continues as this larger sheet of muscle to the side of the epiglottis
    • - Actions; this muscle together with the interarytenoids and the epiglottis itself, acts as a sphincter, narrowing the opening into the larynx (laryngeal aditus), and preventing swallowed material from entering it
    • Posterior crico-arytenoid muscle
    • - Origin; posterior surface of cricoid cartilage
    • - Insertion; muscular process of arytenoid cartilage
    • - Actions; abducts vocal fold
  13. Name the muscle, origin, insertion, innervation and action
    • Cricothyroid
    • - Origin; anterolateral part of cricoid cartilage
    • - Insertion; inferior margin of thyroid cartilage
    • - Innervation; external laryngeal nerve - (all the other intrinsic muscles are innervated by recurrent laryngeal nerve)
    • - Actions; stretches and tenses vocal fold
    • Thyro-arytenoid muscle
    • - Origin; posterior surface of thyroid cartilage
    • - Insertion; muscular process of arytenoid cartilage
    • - Actions; relaxes vocal fold
    • Lateral crico-arytenoid muscle
    • - Origin; arch of cricoid cartilage
    • - Insertion; muscular process of arytenoid cartilage
    • - Actions; adducts vocal fold
    • Transverse and oblique arytenoid muscle
    • - Path; Transverse runs between arytenoids. Oblique is superficial to above, running from muscular process of one arytenoid to the apex of the other
    • - Actions; these muscles aid in adduction by drawing the arytenoids together
    • Posterior crico-arytenoid muscle
    • - Origin; posterior surface of cricoid cartilage
    • - Insertion; muscular process of arytenoid cartilage
    • - Actions; abducts vocal fold
  14. Name the muscle, origin, insertion, innervation and action
    • Cricothyroid
    • - Origin; anterolateral part of cricoid cartilage
    • - Insertion; inferior margin of thyroid cartilage
    • - Innervation; external laryngeal nerve - (all the other intrinsic muscles are innervated by recurrent laryngeal nerve)
    • - Actions; stretches and tenses vocal fold
    • Transverse and oblique arytenoid muscle
    • - Path; Transverse runs between arytenoids. Oblique is superficial to above, running from muscular process of one arytenoid to the apex of the other
    • - Actions; these muscles aid in adduction by drawing the arytenoids together
    • Posterior crico-arytenoid muscle
    • - Origin; posterior surface of cricoid cartilage
    • - Insertion; muscular process of arytenoid cartilage
    • - Actions; abducts vocal fold
  15. Name the muscle, origin, insertion, innervation and action
    • Transverse and oblique arytenoid muscle
    • - Path; Transverse runs between arytenoids. Oblique is superficial to above, running from muscular process of one arytenoid to the apex of the other
    • - Actions; these muscles aid in adduction by drawing the arytenoids together
    • Ary-epiglottic muscle
    • - Path; oblique arytenoids are continues as this larger sheet of muscle to the side of the epiglottis
    • - Actions; this muscle together with the interarytenoids and the epiglottis itself, acts as a sphincter, narrowing the opening into the larynx (laryngeal aditus), and preventing swallowed material from entering it
    • Posterior crico-arytenoid muscle
    • - Origin; posterior surface of cricoid cartilage
    • - Insertion; muscular process of arytenoid cartilage
    • - Actions; abducts vocal fold
  16. Describe and list the laryngeal nerves

    • Laryngeal nerves: Derived from the vagus nerve (X)
    • - Through the internal and external branches of the superior laryngeal and recurrent laryngeal nerves.
    • Superior laryngeal nerve: Arise high in the neck and divides into two branches;
    • Internal laryngeal nerve: Pierces the thyrohyoid membrane
    • - supplies sensory to the laryngeal mucosa superior to vocal folds
    • External laryngeal nerve
    • - Descends with the superior thyroid artery and supplies the cricothyroid muscle
    • Recurrent laryngeal nerve: Left originates in thorax & Right in root of the neck
    • - Ascends in the groove between trachea and esophagus
    • - Intimately related to the medial surface of thyroid gland
    • Function: supplies all intrinsic muscles of the larynx except cricothyroid
    • - Also supplies sensory to the laryngeal mucous membrane inferior to vocal folds
  17. Name the ORANGE and PINK muscles, and give their origin, insertion, innervation and action
    • Muscles which make up the floor of the oral cavity include;
    • #
    • Geniohyoid muscle: Located superior to mylohyoid muscles
    • - Origin; inferior mental spine of mandible to body of hyoid bone
    • - Innervation; C1 via the hypoglossal nerve (XII)
    • - Action; elevates hyoid bone, depresses mandible
    • Mylohyoid muscle
    • - Origin: mylohyoid line of mandible
    • - Insertion; raphe and body of hyoid
    • - Innervation; mylohyoid nerve, branch of the inferior alveolar n. (V3)
    • - Actions; elevates hyoid bone, floor of the mouth, and tongue OR with hyoid fixed depresses the mandible
  18. Name these nerves + functions
    • Lingual nerve: Arises from the mandibular nerve (V3)
    • - Runs inferiorly between the medial pterygoid and the ramus of mandible, anterior to inferior alveolar nerve
    • - Runs on the hyoglossus muscle, and supplies general sensation to mucosa of anterior two-thirds of the tongue & floor of the oral cavity
    • Chorda tympani nerve: Branch of the facial nerve (VII)
    • - Joins the lingual nerve and runs anteriorly in its sheath
    • - Function: Supplies (a) special sensation (taste) to the anterior two-thirds of the tongue and (b) parasympathetic fibres to submandibular ganglion
    • Inferior alveolar nerve: Arises from the mandibular nerve (V3)
    • - Runs inferiorly between the medial pterygoid muscle and the ramus of mandible
    • - Enter the mandible through the mandibular foramen
    • - Runs forward in the mandibular canal supplying sensory to the lower teeth

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