Marion Miñano OS 204 Portfolio Note 6 Pharynx & Larynx Tonsillar Nerves Derived fr/ tonsillar plexus of nerves;

nsillar plexus of nerves; Formed fr/

branches of glossopharyngeal and vagus nerves
Divisions of Pharynx and Larynx Blood Supply Hypopharynx
Tonsillar Branch of Sup pharyngeal constrictor muscle → Inf pole of Pos to larynx; Pharynx divides into larynx and esophagus
Division General Function Location Facial Artery palatine tonsil; Arterial twigs from Asc palatine A, Boundaries Pos – Bodies of C4-C6; Pos and Lat – Middle and inf
Nasopharynx Respiratory; Pos extension of nasal Lingual A, Desc palatine A, Ascending pharyngeal A pharyngeal constrictors; Internal – Palatophrayngeus &
Sometimes has nasal cavities; Level of External Palatine Soft palate → Lat surface of tonsil → Pharyngeal Stylopharyngeus
discharge sphenoid bone →soft Vein venous plexus → Int jug V Structures
palate Tonsillar Lymphatic Pass lat and inf to lymph nodes (near angle of Laryngeal Inlet Anterior wall; Enables comm bet laryngopharynx and
Oropharynx Digestive; Food and air Soft palate, base of Vessels mandible and jugulodigastric node) larynx
pass thru epiglottis, pos to Jugulodigastric/ Tonsilitis Piriform Fossa Depression of laryngopharyngeal cavity on either side of
tongue; Ant – Pos Tonsillar node laryngeal inlet; Lat bounded by med surfaces of thyroid
tongue; Pos – Pharyngeal Formed by palatine, lingual and pharyngeal tonsils; cartilage and thyrohyoid membrane
Pharyngeal mucosa Lymphatic Ring AI – lingual tonsil in pos part of tongue; Lat – Aryepiglottic Separates pisiform fossa fr/ laryngeal inlet
Larynx Breathing; Protection; Epiglottis → palatine and tubal tonsils; Pos and sup – Fold
Voice production Cricoid/subglottic pharyngeal tonsil
region; Housed in bony
cartilage Larynx
Hypopharynx Guides food into Behind and lat to Nasopharynx
esophagus larynx Passageway for air only; Pos – nose; Sup – soft palate Functions Located in anterior neck; Connects oropharynx w/
Boundaries Sup – soft palate; Inf – Base of tongue, Lat - trachea; Guards air passages to maintain airway;
Palatoglossal and palatopharyngeal arches Complex organ of voice production
Pharynx Structures Subdivisions Supraglottic (Area below tongue based above true
Adenoids Enlarged tonsil in mucus membrane of roof and pos vocal folds) - Epiglottis, Arytenoid, Aryepiglottic fold,
Functions wall of nasopharynx; Role in immunology in children; Vestibular fold
Swallowing Hyoid bone goes up → Larynx closes (epiglottis Usually absent in adults but present in cases of Glottic (Gap bet vocal folds) – Ventricle, Vocal fold,
covers inlet) → Hypophraynx → Cervical esophagus inflammation Ant and pos commissure
Phases of 1. Oral – mouth → oropharynx Eustachian Tubes Floor of nose coincides lat w/ Esutachian tube; Joins Subglottic (Below vocal fold until lower border of
Swallowing 2. Pharyngeal – food pushed by tongue middle ear to nasopharynx; Drainage and ventilation cricoid cartilage) – beyond is trachea
→soft palate elevated (closes of middle ear Laryngeal Skeleton
nasopharynx) → Pharynx → Larynx Nasopharyngeal Highly variable amount of lymphoid tissue Hyoid Bone U-shaped; Does not articulate w/ any other; Suspends
elevated Mucosa and anchors larynx; 3 unpaired: TEC, 3 paired:
3. Esophageal – Pushed to esophagus Nasal Choanae Paired opening bet nasal cavity and nasopharynx ArCoCu
Phonation Vocal cords apposed together → Vibration → Pharyngeal Tonsils “Adenoids” when enlarged; Mucus membrane of roof Unpaired/Single Cartilages
Sound; Requires power fr/ lungs, larynx as vibrator and pos wall of nasopharynx Thyroid Cartilage Largest; w/ sup and inf horns; Sup part lies opp C4
and a resonator (nose and nasal cavity) Salpingopharyngea Vertical; Covers salpinopharyngeal muscles; Lat wall vertebrae and attached to hyoid by thyrohyoid
Speech Entails respiration, phonation and articulation; l Fold of nasopharynx, inf to pharyngotympanic tube membrane
Consonants – tongue and palate; Vowels – vocal Uvula Middle of nasopharyngeal floor; Mallampati score Thyroid Membrane Made of CT; Thinner lat sides pierced by int laryngeal
cords w/ some resonance in nasal and oral cavity; (ease of intubation) – predicted using uvula size nerve and A; Drains into supraglottic; Ligaments –
Requires coordination and muscle control median thyrohyoid (thick), lateral thyrohyoid
Tubal Tonsil Collection of lymphoid tissue; Near nasopharyngeal
Muscles opening of pharyngotympanic tube Cricothyroid Joints Inferior horns of thyroid cart + Lat surface of cricoid
External Layer Pharyngeal Recess Slit-like proj located pos to torus of pharyngotympanic cartilage; Rotation and gliding = allows changes in
Constrict pharyngeal walls; Horizontal tube and salpingophrayngeal fold length of vocal fold
Superior Constrictors Pharyngeal branch of vagus (CN X); Pharyngeal Cricoid Cartilage Signet ring; Only compete ring to encircle airway;
plexus Thicker and stronger than thyroid; Attaches to cricoid
Middle Constrictors Pharyngeal branch of vagus (CN X); Pharyngeal ligament (median cricothyroid ligament), 1st tracheal
Oropharynx
plexus; Branches of external recurrent laryngeal ring (cricotracheal ligament)
Pos to oral cavity; Soft palate → Sup border of epiglottis; Comm w/ mouth via
nerve of vagus Epiglottic Cartilage Thin, leaf like; Only elastic cartilage; Flexibility to
OP isthmus
Inferior Constrictors Pharyngeal branch of vagus (CN X); Pharyngeal epiglottis; Ant – laryngeal inlet; Pos – root of tongue
Boundaries Ant – Pos 1/3 of tongue, Base of epiglottis, Border of
plexus; Branches of external recurrent laryngeal and hyoid; Attaches to thyroid laminae (thyro-epiglottic
head and soft palate; Pos – Pos pharyngeal wall; Lat –
nerve of vagus ligament), w/ hypo-epicglottic ligament
Ant and pos tonsillar pillars; Sup – Soft palate; Inf – Sup
Internal Layer border of epiglottis Paired Cartilages
Suspend hyoid; Elevates pharynx and larynx; Vertical Arytenoid Paired, 3-sided pyramidal; Joins w/ lat parts of sup
Structures
Palatopharyngeus Pharyngeal branch of vagus nerve (CN X); Cartilages border of cricoid cartilage; On top of cricoid cartilage;
Soft palate Elevated pos and sup against pharyngeal wall; Prevent
Pharyngeal plexus Opened – muscles at back proj down; Closed –
passage of food into nasal cavity
Salpingopharyngeus Pharyngeal branch of vagus nerve (CN X); muscles at side and front
Anterior and Palatoglossal – ant pillar; Palatopharyngeal – pos pillar
Pharyngeal plexus Apex Bears corniculate cartilage; Attaches to aryepiglottic
Posterior
Stylopharyngeus Glossopharyngeal nerve (CN IX) Tonsillar Pillars fold
Innervation Palatine Tonsils Masses of lymph tissue on each side of oropharynx; Loc Vocal Process Provides pos attachment for vocal ligament
Pharyngeal plexus of Pharyngeal branches of vagus and in tonsillar fossa bet ant and pos tonsillar pillars Muscular Process Lever for pos and lat cricoarytenoid muscles
nerves glossopharyngeal nerves, sympathetic branches fr/ Lingual Tonsils Masses of lymph tissue at base of tongue Cricoarytenoid Located bet bases of arytenoid cartilages and
superior cervical ganglion; Motor – fr/ vagus nerve Joint superolateral surf of lamina of cricoid cartilages;
Base of Tongue
(CN X); Sensory – fr/ glossopharyngeal nerve (CN Permits movement of arytenoid cartilages
IX) Posterior Deep layer of pharyngeal constrictors – Inf pharyngeal Corniculate Located pos of aryepiglottic fold, on top of arytenoid
Glossopharyngeal Innervates Pos tongue for taste and pain, Portions Pharyngeal Wall constrictors – level of larynx and nasophraynx Cartilages tower; Attaches to apices of arytenoid cartilage
Nerve (CN IX) of oropharynx Vallecula Fossa vet epiglottis and base of tongue Cuneiform Located bet epiglottis and arytenoid; Act as spacer;
Vagus Nerve (CN X) Innervates all Muscles of pharynx and soft palate, Waldeyer’s Collection of lymph tissue that form ringed arrangement; Cartilages Does not directly attach; Not always present
except stylopharyngeus and tensor veli palatini Tonsillar Ring Composed of Adenoid, Palatine tonsil, Lingual tonsil, Vocal Folds Control sound prod; Contains Vocal ligament and
Maxillary Nerve (CN Innervates Mucus membrane of anterior, Superior Tubal tonsils, Lateral pharyngeal bands; 1 st line of Vocalis muscle; Sharped edged folds
V2) nasopharynx defense vs. microorganisms Vocal Ligaments Junction of laminae of thyroid cartilage → Vocal
 processes of arytenoid cartilage; Conus elasticus mandible Branch of inferior Zones of Penetrating Neck Trauma
encloses tracheal inlet except for rima glottidis I - Mylohyoid raphe and body alveolar nerve
Lateral Extension of conus elasticus bet vocal folds and sup of hyoid Zone Location Structures at Risk
Cricothyroid border of cricoid Geniohyoid O – Inferior mental spine of C1 via hypoglossal Zone 1 Root of neck; Cervical pleura; Apices of lungs;
Ligament mandible Clavicles/manubriu Thyroid & parathyroid glands;
Glottis Vocal apparatus; Makes up vocal folds and process w/ I – Body of hyoid m → Inf border of Trachea; Esophagus; Common
rima glottis Stylohyoid O – Styloid process of Stylohyoid branch of cricoid cartilage carotid arteries; Jugular veins;
Intrinsic Muscles temporal bone facial nerve Cervical region of vertebral
Focal point: Arytenoid cartilages (Rotate, adduct, abduct and move ant/pos I - Body of hyoid column
on sloping shoulder of cricoid cartilage) Digastric O – (Ant) Digastric fossa of Ant – Nerve to Zone 2 Cricoid cartilage → Superior poles of thyroid gland;
Innervations External Laryngeal Nerve – Cricothyroid; Internal mandible; (Pos) Mastoid mylohyoid, Branch of Angle of mandible Thyroid and cricoid cartilages;
Laryngeal Nerve – Everything else notch of temp bone inf alveolar nerve; Larynx; Laryngopharynx; Carotid
Laryngeal Inlet Opened – Thyroepiglottis; Closed – Aryepiglottis I – Intermediate tendon to Pos – Digastric arteries; Jugular veins;
Rima Glottidis Dialted – Posterior cricoarytenoid; Assisted – Lateral body and greater horn of (preparotid) branch of Esophagus; Cervical region of
cricoarytenoid; Closed – Inter-arytenoid hyoid facial nerve vertebral column
Vocal Cords Altered and tensed by vocalis; Lengthened – Innervation Zone 3 Angles of mandible Salivary glands; Oral and nasal
Cricothyroid; Shortened - Thyroarytenoid Superior Laryngeal Arises fr/ inferior vagal ganglion at superior end of superiorly cavities; Oropharynx;
Adductors Nerve carotid triangle Nasopharynx
Lateral Crico- O – Arch of cricoid cartilage Adducts vocal folds Internal Laryngeal Sensory; Larger; Pierces thyrohyoid membrane w/
arythenoid I – Vocal process of Nerve superior laryngeal A
arytenoid External Laryngeal Motor to cricothyroid; Smaller; Accompanies laryngeal Clinical Correlates
Transverse and O – 1 arytenoid cartilage Adducts arytenoid Nerve branch of inf thyroid artery; Descends pos to
Oblique Arytenoids I – Contralateral arytenoid cartilage sternothyroid muscle in company of sup thyroid A Cancer of Oropharynx May manifest as ear pain; Ear is
Abductors Recurrent Terminates as inferior laryngeal nerve; Sensory – innervated by trigeminal nerve (CN
Posterior Crico- O – Pos surface of lamina of Abducts vocal fold Laryngeal Nerve mucus membrane below vocal cords; Motor – all V)
arytenoid cricoid cartilage intrinsic muscles of larynx, except for cricothyroid and Injury to Vagus and Dysfunction in swallowing and voice;
I – Muscular process of part of arytenoid muscles; R loops around R subclav A Glossopharyngeal Nerves If patient can swallow but has hoarse
arytenoid cartilage Inferior Laryngeal Primary motor nerve; Enters larynx by passing deep to voice, lesion may be in more distal
Sphincters Nerve inf border of inf pharyngeal constrictor and med to branch of vagus nerve
Closes laryngeal inlet (protective); Brings aryepiglottic folds together and pulls lamina of thyroid cartilage Injury to Recurrent Laryngeal Nerves Risk during neck surgery; Right – Inf
arytenoid cartilage towards epiglottis (strongest reflex) Anterior branch of Innervates lat crico-arytenoid, thryo-arytenoid, vocalis, thyroid A and branches; Hoarseness
Aryepiglottic O – Arytenoid cartilage Recurrent laryngeal Inf Laryngeal aryepiglottic and thyro-epiglottic of voice – sign of unilateral injury;
I - Epiglottis nerve; Closes Nerve Temporary disturbance in voice and
vestibule of larynx Posterior branch of Innervates pos crico-arytenoid, transverse and oblique laryngeal spasm may also occur
during swallow Inf Laryngeal arytenoid Injury to Laryngeal Nerve Paralysis of vocal folds = unable to
Tensors Nerve adduct to meet normal vocal fold →
Pitch of voice is raised; Pulls thyroid cartilage toward arch of cricoid cartilage Blood Supply poor voice
Cricothyroid O – AL part of cricoid Ext laryngeal nerve; Superior Laryngeal Supplies internal surface of larynx Dysplasia of Vocal Fold Transformation from respiratory
cartilage Stretches and tenses Artery epithelium to squamous due to
I – Inf margin and inf horn of vocal ligament Cricothyroid Artery Supplies cricothyroid muscle smoking or acid reflux; Uncontrolled
thyroid cartilage Inferior Laryngeal Supplies mucus membrane and inferior muscles mitosis
Relaxers Artery Fractures of Laryngeal Skeleton Result from blows received in sports
Lower pitch of voice; Pulls arytenoid cartilages toward thyroid angle Superior Laryngeal Joins superior thyroid vein Drains to internal or compression by shoulder strap
Thyro-artenoid O – Lower hald of pos aspect Relaxes vocal Vein jugular vein during accident; Produce
of angle of thyroid laminae ligament Inferior Laryngeal Joins inferior thyroid vein Drains to left submucous hemorrhage and edema,
and cricothyroid ligament Vein brachiocephalic vein respiratory obstruction, hoarseness
I – AL arytenoid surface and sometimes temporary inability to
Vocalis O – Lat surface of vocal Relaxes pos vocal speak
process of arytenoid cartilage ligament while Body Cover Theory of Production Cricothyrotomy Extreme emergencies; Insert large
I – Ipsilateral vocal ligament maintain tension in bore needle thru cricothyroid
anterior part Body cover composition of deep Dictate frequency of voice ligament to permit fast entry of air;
Extrinsic Muscles Faster than tracheostomy and
layer of lamina propria/vocal
Infrahyoid ligament and vocalis muscle cervical spine manipulation is usually
Depresses hyoid and larynx unnecessary
Superficial layer of lamina propria Dictate character of voice
Sternohyoid O – Manubrium and medial C1-C3 and epithelium Tracheostomy Upper airway obstruction/ respiratory
end of clavicle failure; Opening made in trachea bet
Voice can be produced w/out moving Because of Bernoulli effect – air
I – Body of hyoid 1st and 2nd tracheal rings; Inferior
arytenoids passing thru lumen → cause larynx
thyroid veins, Thyroid ima artery,
Omohyoid O – Manubrium and medial C1-C3 to close
Left brachiocephalic vein, Jugular
end of clavicle Reinke’s Space Bet vocal ligament and vocalis;
venous arch, Pleurae, Thymus
I - Body of hyoid Where mucosa and lamina propria
Cancer of Larynx Persons who smoke cigarettes;
Sternothyroid O – Pos surface of C2-C3 can glide; Vibrates; Mucosal wave
Enlarged pretracheal or paratracheal
manubrium w/c will result to character of voice
lymph nodes; Laryngectomy and
I – Oblique line of thyroid cart True Vocal Cords (Glottis, Glottic Produce voice; Squamous NK
vocal rehab may be performed
Thyrohyoid O – Oblique line of thyroid C1 via hypoglossal Fold) epithelium; Varying levels of stiffness
Foreign Bodies in Laryngopharynx Sharp food objects may pierce
cart provided by vocal ligament and
mucus membrane of piriform fossae
I - Inf border of body and vocalis
and injure internal laryngeal nerve;
greater horn of hyoid Vocal ligament String-like; Hard CT at edge of true
Numbness of laryngeal mucous
Suprahyoid vocal cord
membrane (as far as vocal folds)
Elevates hyoid and larynx
Mylohyoid O –Mylohyoid line of Nerve to mylohyoid;