7. Pharynx and Larynx

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What IS the pharynx?: A muscular tube, open anteriorly, situated behind the nasal cavities + oral cavity + larynx; continuous w/ esophagus.
What 2 sytstems use the pharynx?: Digestive and Respiratory
What are the 3 divisions of the pharynx?: 1. Nasopharynx
2. Oropharynx
3. Laryngopharynx
What are the boundaries of the nasopharynx?: -Above the soft palate
-Behind the choane
What does the Nasopharynx consist of?: -Roof
-Posterior wall
-Lateral walls
(open anteriorly)
What opening resides in the lateral walls of the nasopharynx?: Auditory canal
What structure is just superior to the auditory opening?: Torus tubarius - a tubal elevation
What structures is just inferior to the auditory opening?: Salpingopharyngeus muscle - within a mucosal fold.
What other muscle is inferior to the auditory opening?: Levator veli palatini
What is the function of levator veli palatini?: It lifts the soft palate in swallowing to seal off the pharygeal isthmus.
What IS the pharyngeal isthmus?: The open, horizontal plane between the nasopharynx and oropharynx.
How does the pharyngeal isthmus close during swallowing? (2 mechanisms): 1. The soft palate elevates
2. Superior constrictor mm contract
What immune system structures are located in the nasopharynx?: Nasopharyngeal tonsils/Adenoids
What are the adenoids?: MALT - lymphatic tissue in the mucosa of the upper part of the midline nasopharynx.
What 3 structures make up Waldeyer's ring?: 1. Nasopharyngeal tonsils
2. Palatine tonsils
3. Lingual tonsil
What are the boundaries of the oropharynx?: -Below the soft palate
-Above the epiglottis
What 2 features are important re: the oropharynx?: -Oropharyngeal isthmus
-Palatine tonsils
What is the oropharyngeal isthmus?: The open coronal plane between the oral cavity and oropharynx.
Where are the palatine tonsils located?: Between palatoglossal and palatopharyngeal arches.
What is teh most common cause of swelling in the neck?: Tonsillitis - when lymphatics from the tonsills drain into jugulodigastric lymph nodes and make them swell.
What are the boundaries of the laryngopharynx?: -Superior border of epiglottis
-Inferior border of cricoid cartilage
What important feature is found within the laryngopharynx?: The Piriform Fossae
Where are the piriform fossae?: on either side of the laryngeal inlet
What are the piriform fossae's -Medial boundaries? -Lateral boundaries?: Medial = aryepiglottic folds
Lateral = thyrohyoid membrane and thyroid cartilage
What pierces the thyrohyoid cartilage to enter the piriform fossae?: Internal branch of the superior laryngeal nerve
How many pairs of muscles are in the pharynx? What are they?: 6:
-Superior, middle, and inferior pharyngeal constrictors
-Stylopharyngeus
-Salpingopharyngeus
-Palatopharyngeus
What are the attachments of the superior pharyngeal constrictor (3)?: 1. Pterygoid hamulus (sphenoid)
2. Pterygomandibular raphe
3. Median pharyngeal raphe
What is the pterygomandibular raphe?: The line separating Buccinator muscle from sup. pharyng. constrictor.
What is the median pharyngeal raphe?: Where the paired pharyngeal muscles meet posteriorly in the midline.
What bridges the gap between superior pharyngeal constrictor and the base of the skull?: Pharyngobasilar fascia
What passes through the pharyngobasilar fascia?: The pharyngotympanic tube.
What separates superior ph. constrictor from middle?: -Stylopharyngeus muscle
-CN IX
What lies externally to the superior pharyngeal constrictor? (5 things): 1. Ascending pharyngeal a.
2. Pharyngeal venous plexus
3. CN IX
4. Lingual nerve
5. Medial pterygoid muscle
What innervates the superior pharyngeal constrictor?: Pharyngeal plexus of CN X
What are the 2 functions/actions of superior pharyng. constrictr?: 1. Helps close pharyng. isthmus
2. Pushes food bolus/liquid past the epiglottis
The pharyngeal plexus of CN X innervates ALL pharyngeal muscles EXCEPT:: Stylopharyngeus
What innervates stylopharyngeus?: CN IX - it's the one exception of all the pharyngeal mm.
What are the attachments of the middle pharyngeal constrictor? (3): 1. Hyoid bone (greater/lesser cornu)
2. Stylohyoid ligament
3. Median pharyngeal raphe
What separates the middle from lower pharyngeal constrictor?: Internal laryngeal nerve and Superior thyroid artery
What innerates middle pharygneal constrictor?: CN X
What is the action of middle pharyngeal constrictor?: Pushes a bolus of food or liquid past the epiglottis
The inferior pharyngeal constrictor has 2 parts; what are they?: 1. Thyropharyngeus
2. Cricopharyngeus
What are the attachments of the inferior pharyngeal constrictor?: 1. Cricoid/thyroid cartilages
2. Median pharyngeal raphe
3. Inferior fibers blend with esophageal fibers.
What pierces the lower part of the inferior pharyng. constrictor?: The external laryngeal n.
What is the overall action of the inferior ph. constrictor?: To expel food from the pharynx into the esophagus.
What are the actions of inferior pharyngeal constrictors individual parts?: 1. Thyropharyngeus propels bolus during swallowing
2. Cricopharyngeus acts as a sphincter in swallowing.
What are the 3 attachments of Stylopharyngeus?: 1. Styloid process
2. Merges w/ constrictor fibers
3. Thyroid cartilage
Where is stylopharyngeus located in the pharynx?: Between the super and middle constrictors, with CN IX.
What is the action of stylopharyngeus?: It elevates the larynx during speech and swallowing.
What is Salpingopharyngeus attached to?: -Inferior border of eustachian tube cartilage
-Blends w/ palatopharyngeus m.
What is the action of Salpingopharyngeus?: Elevation of the upper pharyngeal wall during swallowing.
What are the attachments of Palatopharyngeus?: 1. Posterior border of hard palate
2. Mucosa of soft palate
3. Blends w/ salpingopharyngeus
What is the function of Palatopharyngeus?: -Shortens pharynx in swallowing
-Constricts palatopharyng arch
One motor nerve innervates all pharyngeal muscles except 2:: Cn X
EXCEPTIONS:
1. Stylopharyngeus - CN IX
2. Tensor veli palatini - CN V3
What nerves compose the pharyngeal plexus?: CN 9, 10, and sympathetic fibers
What gives sensory innervation to the upper pharynx?: CN IX and CN V2
What gives sensory innervation to the lower pharynx?: CN X
What 2 pathologies are commonly associated w/ the pharynx?: 1. Pharyngitis
2. Dysphagia
What are symptoms of pharyngitis?: -Scratchy/sore throat
-Fever, red throat, edema
What bacteria is responsible for 15% of all pharyngitis cases?: Strep A
What is dysphagia?: Difficulty in swallowing.
What is the function of the larynx?: Voice production
What makes up the skeleton of the larynx?: Cartilages interconnected by ligaments and fibrous membranes
What 6 cartilages make up the larynx? Which are pairs?: TCACCE
1. Thyroid
2. Cricoid
3. Arytenoid (pair)
4. Corniculate (pair)
5. Cuneiform (pair)
6. Epiglottic
What kind of cartilage are the Thyroid/Cricoid/Arytenoids? What kind are the other 3?: First 3: hyaline

Last 3: elastic
What is the thyroid cartilage structure like?: Two laminae fused anteriorly at laryngeal prominence.
What is a major difference in the thyroid cartilage of males and females?: Males - 90' angle

Females - 120' angle
What are 3 features to remember about the Thyroid cartilage?: 1. Superior cornua
2. Inferior cornua
3. Oblique line
What does the inferior cornua of the thyroid cartilage articulate with?: Cricoid cartilage via Synovial joint
What does the oblique line on the Thyroid cartilage exist for?: The attachment of 3 muscles
What 3 muscles attach to oblique line of Thyroid cartilage?: 1. Inferior constrictor
2. Sternothyroid
3. Thyrohyoid
What is special about the cricoid cartilage?: It's the only laryngeal cartilage that forms a COMPLETE ring.
What 2 structures articulate with the cricoid cartilage?: 1. Inferior cornua of thyroid cartilage - at the junction of arch and lamina
2. Arytenoid cartilages
Are the arytenoids completely hyaline cartilage?: No; partially elastic too.
Where are the arytenoids situated?: Atop the superior border of the cricoid cartilage lamina
What are 4 features on the arytenoids?: 1. Base - articulation w/ cricoid cartilage
2. Apex - superior articulates w/ cuneiform cartilages
3. Muscular processes (laterl)
4. Vocal process (anterior)
What 2 muscles attach to the muscular process on arytenoids?: 1. Lateral cricoarytenoids
2. Posterior cricoarytenoids
What attaches to the vocal process of the arytenoids?: the vocal ligament
Where are the corniculate cartilages?: Situated atop superior surface of arytenoids
Within what FOLD are both the corniculate and cuneiform cartilages?: Aryepiglottic
How is the epiglottic cartilage attached to the thyroid laminae?: Via the thyroepiglottic ligament which connects the tapered inferior end of epiglottis to the thyroid laminae.
What does the Cricotracheal ligament connect?: Cricoid cartilage to first tracheal ring
What is the thyrohyoid membrane for?: To connect the superior border of thyroid cartilage to the hyoid bone.
What is the thicker median portion of the thyrohyoid membrane called?: The thyrohyoid ligament
Where are the cricothyroid membranes?: Between cricoid cartilages and inferior margin of thyroid cartilage.
How many Cricothyroid Ligaments are there?: 3:
-one anterior
-two lateral
What is an alternate term for th 2 lateral cricothyroid ligaments?: Cricovocal membranes
What do the lateral cricothyroid ligaments extend between?: The cricoid cartilage & the vocal ligament.
What are the vocal ligaments?: The thickend superior margins of the cricoval membranes (lateral cricothyroid liagments)
What is conus elasticus?: Cricovocal membrane + vocal ligaments
For the vocal ligaments what is: -Anterior attachment? -Posterior attachment?: Ant: junction of thyroid cartilage laminae

Post: vocal processes of the arytenoid cartilages
What covers the vocal ligament?: The vocal fold
What does the vocal fold consist of? (3 things): Mucous membrane covering:
1. Cricovocal membrane
2. Vocal ligament
3. Vocalis muscle
What is the quadrangular membrane?: Submucosal sheet of connective tissue extending from arytenoid cartilages to epiglottis
What is the inferior free edge of the quadrangular membrane?: The vestibular ligament
What covers the vestibular ligament?: The vestibular fold
What is the rima glottidis?: The space between the vocal folds
What is the vestibule of the larynx?: The space superior to the vestibular folds
What is the ventricle of the larynx?: The space btwn the vestibular folds and the vocal folds
What is the infraglottic cavity?: The space inferior to the vocal folds
What connects the epiglottis to the tongue and pharynx?: Glossoepiglottic folds
What term denotes small depressions between the glossoepiglottic folds between the tongue and epiglottis?: Valleculae
What is the Aditus laryngis?: The laryngeal inlet
What are the folds of mucous membrane extending from the arytenoid cartilages to the epiglottis called?: Aryepiglottic folds
What is the name of the lateral recess in the laryngopharynx wall?: Piriform fossa
How many muscles are in the larynx? Whats the acronym?: 7: Crunch 2 times and owe a paperclip to a lucky cider vinegar
What muscles are referred to by the acronym Crunch Two Times And Owe A PaperClip To A Lucky Cider Vinegar?: CrunchTwo = Cricothyroids
TimesAnd = Transverse arytenoid
OweA = Oblique arytenoids
PaperClip = Posterior cricoarytenoids
ToA = thyroarytenoids
LuckyCider = lateral cricoarytenoids
Vinegar = Vocalis
Where are the cricothyroids located?: On the external surface of the larynx between the thyroid cartilage and cricoid cartilage
What innervates the cricothyroids?: The external laryngeal nerve
What is the action of the cricothyroids?: To tilt the thyroid cartilage anteriorly thus elongating and tightening the vocal ligaments
What is unique about the transverse arytenoid?: It is the only unpaired muscle of the larynx.
What is the transverse arytenoid like in structure?: A broad band of muscle; extends horizontally from one arytenoid cartilage to the other.
What is the action of the transverse arytenoid?: Pulls the arytenoid cartilages toward each other (medially) closing the posterior rima glot.
Describe the oblique arytenoids:: -Superficial to transverse arytenoid muscles
-2 muscle bundles, connect to arytenoid cartilages and blend with the aryepiglottic m.
How do the oblique arytenoids relate to each other?: Cross in an X pattern
What is the action of the oblique arytenoids?: They modify the laryngeal inlet to vary the rima glot.
Describe the posterior cricoarytenoids attachments:: -Muscular processes of arytenoid cartilages
-Posterior part of cricoid cartilage
What are the actions of the posterior cricoarytenoids (3)?: 1. Pull muscular processes posteriorly
2. Abduct vocal folds
3. OPEN rima glot
Why are the posterior cricoarytenoids special?: THEY ARE THEY ONLY LARYNGEAL MUSCLES THAT OPEN THE RIMA GLOT!
Describe the thyroarytenoids in terms of where they arise and insert:: -Arise from posterior surface of the thyroid cartilage
-Insert onto arytenoid cartilages
What is the action of the thyroarytenoids?: They pull the arytenoid cartilages anteriorly
What does pulling the arytenoid cartilages anteriorly accomplish?: It shortens the vocal ligaments and decreases voice pitch.
What muscles do the opposite of the the thyroarytenoids?: Cricothyroids - by tilting the thyroid cartilage anteriorly
How does tilting the thyroid cartilage anteriorly increase the voice pitch?: It elongates and tightens the vocal ligments.
What are the attachment points of the lateral cricoarytenoids?: -Muscular processes of the arytenoid cartilages
-Lateral part of cricoid cartilage
What are the 3 actions of the lateral cricoarytenoids?: 1. Pull muscular processes anteriorly
2. Adduct vocal folds
3. Close rima glottidis
What is the vocalis muscle made up of really?: The inferior fibers of the thyroarytenoid muscles
Where does the vocalis muscle -arise -insert: -Arises from the vocal ligament
-Inserts on the vocal processes of the arytenoid cartilages
What is the action of the vocalis muscle?: Minor adjustments in the vocal ligaments
What 2 main nerves provide innervation to the larynx? What nerve fibers are in these?: 1. Superior laryngeal n.
2. Recurrent laryngeal n.
-Both sensory and motor
What type of innervation is carried by internal laryng. n?: Sensory and ANS
What specifically is innervated by internal laryngeal nerve? How does it get there?: -Laryngeal mucosa superior to the vocal folds
-Internal laryngeal nerve pierces thyrohyoid membrane along with superior laryngeal artery.
What type of reflex would be conveyed by the internal laryngeal nerve?: Cough - like if water goes down the wrong pipe.
What does the EXTERNAL laryngeal nerve innervate, with what type of fibers?: Motor innervation; to
-Inferior constrictor muscle
-CRICOTHYROID muscle
What does the Recurrent laryngeal nerve give motor innervation to?: -All intrinsic laryngeal muscles
EXCEPT CRICOTHYROID
Where does the recurrent laryngeal nerve provide sensory innervation?: To the laryngeal mucosa inferior to the vocal folds.
What arteries supply blood to the larynx? (2): 1. Superior thyroid artery -> superior laryngeal a. branch
2. Inferior thyroid artery -> inferior laryngeal a. branch
What are 4 pathologic conditions associated with the larynx?: 1. Epiglottitis
2. Laryngitis
3. Croup
4. Phonation problems
What is epiglottitis?: Inflammation of the soft tissues above the vocal folds
Is epiglottitis usually chronic or acute?: Acute - rapid onset of Sx.
What is laryngitis?: Hoarseness - mostly viral induced
What is croup?: An upper resp tract infection that results in subglottic edema.
What is a common symptom of croup?: seal bark cough

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