Gross: Naso- & Oropharynx, Larynx II (BB_134)

superior pharyngeal constrictors

(1) - helps to propel food into the esophagus

Glossopharyngeal nerve

(1) 1. Innervates the stylopharyngeus muscle. 2. Provides sensory supply to most of the mucous membrane of the pharynx (aided by branches of the maxillary

suprahyoid muscles

(1) - extrinsic muscle of the larynx - Elevators of the hyoid bone and larynx; the hyoid bone and larynx are raised during swallowing.

superior horns

(1) - part of the thyroid cartilage, Elongations of cartilage extending from the laminae. - are attached to the hyoid bone by the thyrohyoid membrane.

Vestibule/supraglottic region

(1) Area of larynx superior to vestibular folds. (2) Contains the epiglottis, aryepiglottic folds and false vocal cords. (3) The space or trough that extends laterally between the vestibular and vocal folds is called the ventricle of the larynx.

Glottis

(1) Refers to the true vocal cords and the rima glottidis. (2) Passage for air-flow between the two vocal folds is called the rima glottidis. (3) Rima glottidis is a common place for aspirated objects to become lodged and cause choking

middle pharyngeal constrictors

(2) - helps to propel food into the esophagus

infrahyoid muscles

(2) - extrinsic muscle of the larynx -the strap muscles - Depressors of the hyoid bone and larynx; the hyoid bone and larynx are lowered following the swallowing reflex

inferior horns

(2) - part of the thyroid cartilage, Elongations of cartilage extending from the laminae. - articulate with the cricoid cartilage.

Vagus nerve

(2) 1. Pharyngeal and laryngeal branches a. Innervates all the skeletal muscles of the pharynx except the stylopharyngeus.

inferior pharyngeal constrictors

(3) - helps to propel food into the esophagus - its inferior fibers called the cricopahryngeus blend with the cicular fibers of the esophagus forming the narrowest portion of the pharynx

thyroarytenoid

(a) These muscles attach to the inside surface of the thyroid cartilage and to the arytenoid cartilage. (b) The muscles pull the arytenoid cartilages closer to the thyroid cartilage and therefore *decrease the tension on the vocal cords*

vocalis muscle

(a) This muscle is the deep portion of the thyroarytenoid muscle. (b) It is thought to *relax* portions of the vocal cords as in *whispering and during phonation and singing*

cricothyroids

(a) these are attached to the anterolateral surface of the arch of the cricoid cartilage and to the inferior edge of the thyroid cartilage (b) pull the thyroid cartilage anteriorly and inferiorly in a rocking action, thereby *increasing the tension on the vocal cords.*

Subglottic region (infraglottic)

(area in the larynx below true vocal cords).

thyrohyoid membrane

- Attaches upper aspect of thyroid cartilage to the hyoid bone. - The membrane is pierced by the internal laryngeal n. (br. of the superior laryngeal branch of the vagus nerve and the superior laryngeal a. (br. from superior thyroid a.).

oblique arytenoid

- Close the rima glottidis and tighten the aryepiglottic fold during swallowing.

Pharyngeal constrictor muscles

- Composed of superior, middle and inferior constrictors - these act in unison to propel food into the esophagus - they are supplied by the CN IX (sensory) and CN X (motor), these nerve form a plexus here (pharyngeal plexus)

aortopulmonary window

- LRL branches from the vagus here - is a radiological mediastinal space seen on frontal and lateral chest x-rays. - lies between the arch of the aorta and the pulmonary arteries - abnormal enlargement of LN can be seen here on CXR or CT, can compress the LRL = hoarsness - these traverse it: left phrenic nerve, left recurrent laryngeal nerve, left vagus nerve, ligamentum arteriosum, fat, and lymph nodes.

epiglottis

- Leaf-shaped cartilage that is attached to the hyoid bone by the hyoepiglottic ligament - closes off the larynx during swallowing (is pressed against the back of the tongue) - attached to the back of the tongue by the median and two lateral epiglottic folds, these folds create teo vlleys called epiglottic vallecuale

Pharynx

- Muscular tube extending from the base of the skull superiorly to the esophagus inferiorly. - Possesses posterior and lateral walls but no anterior wall because it is directly continuous anteriorly with the nasal cavity, the oral cavity, and the larynx - divided into three parts: naso, oro and laryngo

arytenoids

- Pair of pyramid-shaped cartilages that sit on the cricoid cartilage - vocal ligaments are attached to them - can be moved by the posterior and lateral circoarytenoid muscles

rima glottidis

- Passage for air-flow between the two vocal folds is called the... - is a common place for aspirated objects to become lodged and cause choking.

Laryngopharynx

- Posterior wall is continuous with the oropharynx. - Anterior wall is composed mainly of the larynx. - piriform recess are channels that direct solids and liquids into the esophagus

pharyngeal tonsils

- Posterior wall of nasopahrynx contains a condensation of lymphoid tissue - called adenoids when enlarged

nasopharynx

- Region of pharynx posterior to nose and superior to soft palate; lies just inferior to the base of the skull. - contiunous with the nasal cavity via the choanae - posterior wall has the pahryngeal tonsils - lateral wall contains opening to the auditory tube - the soft palate forms the floor - the auditory tube connects this with the middle ear - the mucous membrane of it is contnuous thru the middle ear and into the mastoid cells = can get infection which spreads = mastoiditis or moitits media

ventricle

- The space or trough that extends laterally between the vestibular and vocal folds is called the

right and left lamina

- The two large shield-shaped plates of cartilage that form the laryngeal prominence in the thyroid cartilage

Recurrent laryngeal nerve

- These nerves ascend in the groove between the esophagus and trachea after looping around the ligamentum arteriosum on the left or the subclavian artery on the right. - They supply the pharynx, esophagus and trachea with sensory and parasympathetic fibers as they ascend to the larynx - The nerves travel in close relation to the inferior thyroid a. behind the thyroid gland, thus the nerves are at risk during thyroidectomies. - provide motor innervation to all intrinsic muscles except the cricothyroid. - The nerves are sensory and parasympathetic to area below the vocal cords

corniculate

- These small cartilages are nodules in the aryepiglottic folds. - has horn like projections

cuneiform

- These small cartilages are nodules in the aryepiglottic folds. - wedge shaped

aryepiglottic m

- Tightens the aryepiglottic folds in the process of swallowing

thyroid notch

- V-shaped notch immediately above the laryngeal prominence

laryngeal prominence

- adams apple - right and left lamina come together to form it - in men is more pronounced because the angle between the two laminae is more acute in men (90 degrees) than in women (120 degrees)

palatoglossal muscles

- alogn with the associated fold it marks the boundary between the oropahrynx and the oral cavity

palatoglossal folds

- alogn with the associated muscle it marks the boundary between the oropahrynx and the oral cavity

posterior cricoarytenoids

- are abductors of the folds. (a) these muscles extend from the posterior surface of the cricoid lamina to the muscular process of the arytenoid cartilage (b) Theywiden the space between the two vocal cords; i.e. abduct the vocal cords - *open the rima glottidis*.

lateral cricoarytenoids

- are adductors of the vocal fold. - these muscles extend from the arch of the cricoid cartilage to the muscular process of the arytenoid cartilage - They adduct the vocal cords - *close the rima glottidis* by decreasing the space between the vocal cords.

bilateral vocal cord paralysis

- ariway compromise whcih can range from unnoticible too dyspnea and stridor - voice quality is only mildy affected is just the RLN are involved - thyroidectomy is the most commonc ause

lateral glossoepiglottic folds

- attach the epiglottis to the base of the tongue along with the medial counterpart

median glossoepiglottic fold

- attaches the epiglottis to the base of the tongue along with the lateral counterparts

valleculae epiglotticae

- between the glossoepiglotic folds - each "little valley" represents an area where food may lodge during swallowing

tensor veli palatini

- cn V3 - one of 3 muscles that tense and elevate the soft palate during swallowing to close off the nasal cavity from the nasopharynx. - one of the muscles that inserts into the cartilaginous portion of the audtiory tube and open it

musculus uvuli

- cn x - one of 3 muscles that tense and elevate the soft palate during swallowing to close off the nasal cavity from the nasopharynx.

levator veli palatini

- cn x - one of 3 muscles that tense and elevate the soft palate during swallowing to close off the nasal cavity from the nasopharynx. - one of the muscles that inserts into the cartilaginous portion of the audtiory tube and open it

Auditory tube

- contained in the lateral wall of the nasopahrynx - opening is surrounded by the torus tubarius - Connects the nasopharynx with the middle ear. - Responsible for maintenance of a similar pressure on the inner surface of the tympanic membrane as exists on its outer surface - has a medial cartilage portion and a lateral bony part - salpingopharyngeus m., tensor veli palatini and levator veli palatini m insert into the cartilaginous portion and open the tube

unilateral vocal cord paralysis

- cords cant meet midline = cant develop subglottic pressure needed to speak - see hoarseness, breathiness, easy fatigibility, voice or pitch change - more common than bialteral - is due to malignancy most commonly followed by surgical injury

Joints of the larynx

- cricothyroid joint -> cricoid cartilage meets the inferior horns of the thyroid cartilage, allows for rotation and gliding of the thyroid cartilage relative to the cricoid - circoarytenoid joints -> permit sliding and rotation of the arytenoid cartilages relative to the cricoid

Superior laryngeal nerve

- divides into two branches (internal and external laryngeal nerve)

isthmus faucium

- entrance to the throat

transverse arytenoid

- extends between the posterior surfaces of the two arytenoid cartilages. - they function to adduct the vocal cord - Close the rima glottidis.

Vestibular folds

- false vocal cords - lie superior to the vocal folds and extend from the thyroid cartilage to the arytenoid cartilages. - function as part of the protective mechanism to close off the larynx during swallowing but apparently play little or no part in voice production

soft palate

- forms the floor of the nasopahrynx - Contains several pairs of muscles: tensor veli palatini (CN V3), levator veli palatini and musculus uvuli (both CN X) which tense and elevate the __ __during swallowing to close off the nasal cavity from the nasopharynx. - with injury to cnV this cannot elevate and uvula deviates away from the side of the lesion

Larynx

- functions as a valve to prevent food from entering respiratory passages and in voice production - composed of cartilages connected by membranes and ligaments - is composed of 3 large unpaired cartilages (cricoid, thyroid, epiglottis) and 3 smaller paired ones (arytenoids, corniculate, cuneiform)

cricothyroid membrane

- helps attach the cricoid cartilage to the thyroid cartilage - tracheostomy can be done thru here

Palatine tonsils

- in the tonsillar fossa between the palatoglossal and palatopharyngeal arches - Lymphatics from the tonsils end in nodes near the angle of the mandible (upper deep cervicals); one in particular is called the jugulodigastric node

tracheostomy (tracheotomy)

- is an opening surgically created through the neck into the trachea. It is commonly done in an operating room under general anesthesia. A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. - there are two types, a surgical and an emergency

vocal ligament

- is attached to vocal process of each arytenoid cartilage. - are covered with mucous membrane are then called the vocal folds or vocal cords - extends from the thyroid cartilage anteriorly to the vocal process of the arytenoid cartilage posteriorly. - forms the skeleton for the vocal fold (vocal cord).

Left recurrent laryngeal nerve

- is initially a chest structure; it loops around the ligamentum arteriosum and aortic arch. - branches from the left vagus at the aortopulmonary window, enlarged LN here can compress this leading to alryngeal dysfunction symptoms such as hoarseness

Piriform recesses

- lie outside of the anterolateral walls of the larynx and are part of the laryngopharynx. - are common place for food to become trapped

jugulodigastric node

- lympahtics from the palatine tonsils end in this node near the angle of the mandible

epiglottic valleculae

- median and two lateral glosso-epiglottic folds. create two valleys called the... - Food slides through them during swallowing. Objects, such as fish bones, may become lodged in them

cricopahryngeus

- most inferior fibers of the inferior constrictor function separately and it blends with the circular fibers of the esophagus forming the narrowest portion of the pharynx. - acts as a sphincter which must be relaxed in order to swallow; failure to accomplish this relaxation can lead to inhalation of foodstuffs and eventually to acute respiratory infections

vocal cords (vocal folds)

- mucsous membrane that covers the vocal ligaments - concerned with sound production

cough reflex

- occurs when the internal laryngeal n is irritated

salpingopharyngeus m

- one of the muscles that inserts into the cartilaginous portion of the audtiory tube and open it

internal laryngeal n

- pierces the thyrrohyoid membrane - br. of the superior laryngeal branch of the vagus nerve

oropharynx

- posterior to oral cavity - palatoglossal folds covering the palatoglossal muscles form an arch = marks boundary between this and oral cavity - posterior 1/3 of the tongue resides here (has the lingual tonsils) - epiglottis is attached to the base of the tongue by the median glossoepiglottic fold and the two lateral glossoepiglottic folds, between them ins the vallecular epiglotticae - palatine tonsils Lie in the tonsillar fossa between the palatoglossal and palatopharyngeal arches, lympahtics end in nodes like the jugulodigastric

thyroid cartilage

- right and left laminae are shield plates of cartilage that form the laryngeal prominence - thyroid notch is a notch that lies above the laryngeal prominence - superior and inferior horns are elongations from the laminae - thyrohyoid membrane connects this cartilage to the hyoid bone

cricoid cartilage

- signet ring appearance - only complete cartilaginous ring in the respiratory system - Has a broad posterior lamina and a narrow anterior arch portion - Attached to thyroid cartilage by cricothyroid membrane and to 1 st tracheal ring by cricotracheal ligament. - tracheostomy is done through this cartilage or thru the cricothyroid membrane

intrinsic muscles of the larynx

- those inside the larynx - concerned with moving parts of the larynx - are innervated by the recurrent laryngeal nerves except for the cricothyroid which is innervated by the external laryngeal n. - muscles that close the inlet during swallowing -> tranverse arytenoid, oblique arytenoid and aryepiglottic - adductors of the VFs -> lateral cricoarytenoids - abductors of the VF -> posterior crocoarytenoids - tensors of the vocal cords -> cricothyroids - realxers of the VC -> thyroaryteboid and vocalis muscle

Extrinsic muscles of the larynx

- those outside the larynx - move the larynx as a whole - suprahyoid and infrahyoid

torus tubarius

- tubal elevation - Opening of the auditry tube is surrounded by the cartilaginous portion of the auditroy tube called the __ __ - salpingopahryngeal fold and muscle take origin from it, muscle elevates the pahrynx during swallowing - levator veli palatini also takes origin from it and elevates the soft palate during swallowing - both of these muscles open the eustachian tube as well due to their insertion into this cartilage

pharyngeal plexus

The vagus and glossopharyngeal nerves join together as they innervate the pharynx to form the

Piriform recess

a. Hollow area between the arytenoid cartilages and aryepiglottic folds medially and the side wall of the pharynx laterally. b. Normally,it forms channels that direct solids and liquids from the oral cavity around the raised laryngeal inlet and into the esophagus. c. This is an area where swallowed items such as fish bones etc., tend to lodge

internal laryngeal n

a. Pierces the thyrohyoid membrane to enter the interior of the upper part of the larynx. b. The nerve is sensory and parasympathetic to the vestibule or supraglottic region - the area above vocal cords. c. Irritation of this nerve is responsible for the cough reflex

external laryngeal n

a. This nerve travels in close relation to the superior thyroid a. b. Pierces the inferior pharyngeal constrictor muscle (supplies this muscle) and innervates the cricothyroid m

emergency tracheotomy

i) This is done only in emergency situations and can be performed quite rapidly. An incision is made through the cricothyroid membrane. This emergency procedure is officially called a cricothyroidotomy

Surgical tracheotomy

i) takes more time and is usually done in an operating room. An incision is made in the skin overlying the trachea. An incision is made through the second and third tracheal rings.

vagus (CN X)

via its laryngeal branches provides motor, sensory and parasympathetic innervation to the larynx