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

sillar 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) Salpingopharyngeal Vertical; Covers salpinopharyngeal muscles; Lat wall vertebrae and attached to hyoid by thyrohyoid
Speech Entails respiration, phonation and articulation; 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 Oropharynx ligament (median cricothyroid ligament), 1st tracheal
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
Boundaries Ant – Pos 1/3 of tongue, Base of epiglottis, Border of epiglottis; Ant – laryngeal inlet; Pos – root of tongue
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 Structures Arytenoid Paired, 3-sided pyramidal; Joins w/ lat parts of sup
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
passage of food into nasal cavity Opened – muscles at back proj down; Closed –
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
Posterior Deep layer of pharyngeal constrictors – Inf pharyngeal
IX) Corniculate Located pos of aryepiglottic fold, on top of arytenoid
Pharyngeal Wall constrictors – level of larynx and nasophraynx
Glossopharyngeal Innervates Pos tongue for taste and pain, Portions Cartilages tower; Attaches to apices of arytenoid cartilage
Vallecula Fossa vet epiglottis and base of tongue
Nerve (CN IX) of oropharynx Cuneiform Located bet epiglottis and arytenoid; Act as spacer;
Waldeyer’s Collection of lymph tissue that form ringed arrangement;
Vagus Nerve (CN X) Innervates all Muscles of pharynx and soft palate, Cartilages Does not directly attach; Not always present
Tonsillar Ring Composed of Adenoid, Palatine tonsil, Lingual tonsil,
except stylopharyngeus and tensor veli palatini Vocal Folds Control sound prod; Contains Vocal ligament and
Tubal tonsils, Lateral pharyngeal bands; 1st line of
Maxillary Nerve (CN Innervates Mucus membrane of anterior, Superior Vocalis muscle; Sharped edged folds
defense vs. microorganisms
V2) nasopharynx
Vocal Ligaments Junction of laminae of thyroid cartilage → Vocal Mylohyoid O –Mylohyoid line of Nerve to mylohyoid; Zones of Penetrating Neck Trauma
processes of arytenoid cartilage; Conus elasticus mandible Branch of inferior
encloses tracheal inlet except for rima glottidis I - Mylohyoid raphe and body alveolar nerve Zone Location Structures at Risk
Lateral Extension of conus elasticus bet vocal folds and sup of hyoid Zone 1 Root of neck; Cervical pleura; Apices of lungs;
Cricothyroid border of cricoid Geniohyoid O – Inferior mental spine of C1 via hypoglossal Clavicles/manubrium Thyroid & parathyroid glands;
Ligament mandible → Inf border of Trachea; Esophagus; Common
Glottis Vocal apparatus; Makes up vocal folds and process w/ I – Body of hyoid cricoid cartilage carotid arteries; Jugular veins;
rima glottis Stylohyoid O – Styloid process of Stylohyoid branch of Cervical region of vertebral
Intrinsic Muscles temporal bone facial nerve column
Focal point: Arytenoid cartilages (Rotate, adduct, abduct and move ant/pos I - Body of hyoid Zone 2 Cricoid cartilage → Superior poles of thyroid gland;
on sloping shoulder of cricoid cartilage) Digastric O – (Ant) Digastric fossa of Ant – Nerve to Angle of mandible Thyroid and cricoid cartilages;
Innervations External Laryngeal Nerve – Cricothyroid; Internal mandible; (Pos) Mastoid mylohyoid, Branch of Larynx; Laryngopharynx; Carotid
Laryngeal Nerve – Everything else notch of temp bone inf alveolar nerve; arteries; Jugular veins;
Laryngeal Inlet Opened – Thyroepiglottis; Closed – Aryepiglottis I – Intermediate tendon to Pos – Digastric Esophagus; Cervical region of
Rima Glottidis Dialted – Posterior cricoarytenoid; Assisted – Lateral body and greater horn of (preparotid) branch of vertebral column
cricoarytenoid; Closed – Inter-arytenoid hyoid facial nerve Zone 3 Angles of mandible Salivary glands; Oral and nasal
Vocal Cords Altered and tensed by vocalis; Lengthened – Innervation superiorly cavities; Oropharynx;
Cricothyroid; Shortened - Thyroarytenoid Superior Laryngeal Arises fr/ inferior vagal ganglion at superior end of Nasopharynx
Adductors Nerve carotid triangle
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 Clinical Correlates
arytenoid External Laryngeal Motor to cricothyroid; Smaller; Accompanies laryngeal
Transverse and O – 1 arytenoid cartilage Adducts arytenoid Nerve branch of inf thyroid artery; Descends pos to Cancer of Oropharynx May manifest as ear pain; Ear is
Oblique Arytenoids I – Contralateral arytenoid cartilage sternothyroid muscle in company of sup thyroid A innervated by trigeminal nerve (CN
Abductors Recurrent Terminates as inferior laryngeal nerve; Sensory – V)
Posterior Crico- O – Pos surface of lamina of Abducts vocal fold Laryngeal Nerve mucus membrane below vocal cords; Motor – all Injury to Vagus and Dysfunction in swallowing and voice;
arytenoid cricoid cartilage intrinsic muscles of larynx, except for cricothyroid and Glossopharyngeal Nerves If patient can swallow but has hoarse
I – Muscular process of part of arytenoid muscles; R loops around R subclav A voice, lesion may be in more distal
arytenoid cartilage Inferior Laryngeal Primary motor nerve; Enters larynx by passing deep to branch of vagus nerve
Sphincters Nerve inf border of inf pharyngeal constrictor and med to Injury to Recurrent Laryngeal Nerves Risk during neck surgery; Right – Inf
Closes laryngeal inlet (protective); Brings aryepiglottic folds together and pulls lamina of thyroid cartilage thyroid A and branches; Hoarseness
arytenoid cartilage towards epiglottis (strongest reflex) Anterior branch of Innervates lat crico-arytenoid, thryo-arytenoid, vocalis, of voice – sign of unilateral injury;
Aryepiglottic O – Arytenoid cartilage Recurrent laryngeal Inf Laryngeal aryepiglottic and thyro-epiglottic Temporary disturbance in voice and
I - Epiglottis nerve; Closes Nerve laryngeal spasm may also occur
vestibule of larynx Posterior branch of Innervates pos crico-arytenoid, transverse and oblique Injury to Laryngeal Nerve Paralysis of vocal folds = unable to
during swallow Inf Laryngeal arytenoid adduct to meet normal vocal fold →
Tensors Nerve poor voice
Pitch of voice is raised; Pulls thyroid cartilage toward arch of cricoid cartilage Blood Supply Dysplasia of Vocal Fold Transformation from respiratory
Cricothyroid O – AL part of cricoid Ext laryngeal nerve; Superior Laryngeal Supplies internal surface of larynx epithelium to squamous due to
cartilage Stretches and tenses Artery smoking or acid reflux; Uncontrolled
I – Inf margin and inf horn of vocal ligament Cricothyroid Artery Supplies cricothyroid muscle mitosis
thyroid cartilage Inferior Laryngeal Supplies mucus membrane and inferior muscles Fractures of Laryngeal Skeleton Result from blows received in sports
Relaxers Artery or compression by shoulder strap
Lower pitch of voice; Pulls arytenoid cartilages toward thyroid angle Superior Laryngeal Joins superior thyroid vein Drains to internal during accident; Produce
Thyro-artenoid O – Lower hald of pos aspect Relaxes vocal Vein jugular vein submucous hemorrhage and edema,
of angle of thyroid laminae ligament Inferior Laryngeal Joins inferior thyroid vein Drains to left respiratory obstruction, hoarseness
and cricothyroid ligament Vein brachiocephalic vein and sometimes temporary inability to
I – AL arytenoid surface speak
Vocalis O – Lat surface of vocal Relaxes pos vocal Cricothyrotomy Extreme emergencies; Insert large
process of arytenoid cartilage ligament while Body Cover Theory of Production bore needle thru cricothyroid
I – Ipsilateral vocal ligament maintain tension in ligament to permit fast entry of air;
anterior part Faster than tracheostomy and
Body cover composition of deep Dictate frequency of voice
Extrinsic Muscles layer of lamina propria/vocal cervical spine manipulation is usually
Infrahyoid unnecessary
ligament and vocalis muscle
Depresses hyoid and larynx Superficial layer of lamina propria Dictate character of voice Tracheostomy Upper airway obstruction/ respiratory
Sternohyoid O – Manubrium and medial C1-C3 and epithelium failure; Opening made in trachea bet
1st and 2nd tracheal rings; Inferior
end of clavicle Voice can be produced w/out moving Because of Bernoulli effect – air
I – Body of hyoid thyroid veins, Thyroid ima artery,
arytenoids passing thru lumen → cause larynx
Left brachiocephalic vein, Jugular
Omohyoid O – Manubrium and medial C1-C3 to close
venous arch, Pleurae, Thymus
end of clavicle Reinke’s Space Bet vocal ligament and vocalis;
I - Body of hyoid Cancer of Larynx Persons who smoke cigarettes;
Where mucosa and lamina propria
Enlarged pretracheal or paratracheal
Sternothyroid O – Pos surface of C2-C3 can glide; Vibrates; Mucosal wave
lymph nodes; Laryngectomy and
manubrium w/c will result to character of voice
vocal rehab may be performed
I – Oblique line of thyroid cart True Vocal Cords (Glottis, Glottic Produce voice; Squamous NK
Foreign Bodies in Laryngopharynx Sharp food objects may pierce
Thyrohyoid O – Oblique line of thyroid C1 via hypoglossal Fold) epithelium; Varying levels of stiffness
mucus membrane of piriform fossae
cart provided by vocal ligament and
and injure internal laryngeal nerve;
I - Inf border of body and vocalis
Numbness of laryngeal mucous
greater horn of hyoid Vocal ligament String-like; Hard CT at edge of true
membrane (as far as vocal folds)
Suprahyoid vocal cord
Elevates hyoid and larynx