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Region 7: Oral Cavity and Larynx Oral Cavity --vestibule: smaller external portion *roof: hard and soft palates *tongue occupies most of the oral cavity *Floor of sublingual region contains: a. lingual frenulum (anchors tongue to the floor) b. sublingual folds (either side of frenulum) c. sublingual carnuncles (each side of frenulum containing opening of the submandibular/Wharton’s ducts Palate --hard palate (bony palate) *formed by palatine processes of maxillae (anterior) and horizontal plates of the palatine bones (posterior) *contains greater palatine vessels, greater palatine and nasopalatine nerves --soft palate *fibromuscular tissue suspended from the posterior edge of the hard palate *continuous laterally w/ palatoglossal and palatopharyngeal arches *sensory inn by lesser palatine n. *uvula projects downward n median plane *Muscles of the soft palate a. Levator veli Palatini --O: cartilage of auditory tube --I: upper surface of palatine aponeurosis --Inn: cranial portion of accessory n. through vagus and pharyngeal plexus b. tensor veli palatini --O: scaphoid fossa at base of medial pterygoid plate --its tendon goes around pterygoid hamulus --I: tendons of opp. sides expand and attach to posterior border of hard palate (forming palatine aponeurosis) --Inn: mandibular n. c. palatopharyngeus --O: posterior border of palatine aponeurosis --occupies palatopharyngeal arch --Inn: cranial portion of accessory n. through vagus and pharyngeal plexus d. palatoglossus muscle --O: inferior surface of palatine aponeurosis --I: mucous mem. of tongue --Inn: cranial portion of accessory n. through vagus and pharyngeal plexus e. musculus uvulae --O: palatine aponeurosis ----Inn: cranial portion of accessory n. through vagus and pharyngeal plexus *Sensory Innervation: lesser palatine nerve Tongue --apex/tip: rests against incisor teeth --dorsum: related to palate *Sulcus terminalis (v shaped groove divided into anterior (2/3 oral part) and posterior (1/3 pharyngeal part) *Circumvallate papillae: arranged in a row in front of the sulcus terminalis (contains taste buds) *faramen cecum: located in mid-point of sulcus --inferior surface of tongue attached to floor of mouth by lingual frenulum --Extrinsic Muscles of the Tongue a. Genioglossus *O: immediately above geniohyoid *Act: protracts the tongue b. Hyoglossus *hypoglossal and lingual nerves pass superficial/lateral to it *Act: depresses the tongue c. Styloglossus *I: into lateral and inferior aspect of tongue *Act: retracts the tongue --Intrinsic muscles of the tongue a. longitudinal b. vertical c. transverse --Innervation *Motor: all muscles (except palatoglossus) hypoglossal nerve *General Sensation: a. anterior 2/3: lingual nerve (from CN V) b. posterior 1/3: glossopharyngeal n. (CN IX) *Taste: a. anterior 2/3: facial n. through chorda tympani n. b. posterior 13: glossopharyngeal n. (CN IX) --Blood Supply *lingual artery Larynx --Cartilages of the Larynx a. Thyroid cartilage (shield like shape) *composed of right and left laminae *laryngeal prominence (adam’s apple) *superior thyroid notch *superior cornu/horn: attached to greater horn of hyoid bone *inferior cornu/horn: articulates with the cricoid cartilage *oblique line: crosses the lateral surface of the laminae, gives attachments to sternothyroid, thyrohyoid and inf. constrictor mm. b. Cricoid cartilage (signet ring shape) *at level of C6 *attached above to the thyroid cartilage by the cricothyroid ligament c. Epiglottis cartilage (leaf shape) *in front of laryngeal inlet *b/w epiglottis and base of tongue are spaces called valleculae d. Arytenoid cartilages (pyramidal shape and 2 of them) *base is articulated with the upper border of the lamina of the cricoid cartilage *apex supports the corniculate cartilage *base projects anteriorly as vocal process that gies attachment to the vocal ligament *lateral projection of the base has the muscular process e. Corniculate cartlages *situated on the apices of the arytenoid cartilages f. Cuneiform Cartilages *located in aryepiglottic fold --Membranes and Ligaments of the Larynx a. thyrohyoid membrane *connects thyroid cartilage to hyoid bone *membrane pierced by internal laryngeal n. and superior laryngeal a. b. cricothyroid ligament *connects arch of cricoid to thyroid cartilage *in acute respiratory obstruction, cricothyroid lig. is separated by piercing it with a sharp instrument to make a temporary airway c. conus elasticus *arises from the upper border of the arch of the cricoid cartilage and runs medially and upward *anteriorly, its upper margins are attached to inner surface of the thyroid cartilage, deep to cricothyroid ligament *posteriorly, its upper margins are attached to vocal processes of the arytenoid cartilages d. vocal ligaments *upper thickened edges of the conus elasticus *anterior attachment to thyroid cartilage is fixed but its posterior attachment to vocal process of the arytenoid is moveable *epithelial coverings over the vocal ligament form the vocal folds/true vocal cords --Joints of the Larynx a. cricothyroid joint: synovial joints on both sides b/w cricoid and inferior horns of the thyroid cartilages --Interior of the Larynx a. inlet/aditus/entrance of the larynx *piriform recesses of pharynx are lateral to laryngeal inlet b. vestibule: extends from inlet to vestibular folds *vestibular/ventricular folds (aka false vocal cords): extend from thyroid cartilage anteriorly to arytenoid cartilages posterior (above vocal process) *rima vestibuli: space /w the vestibular folds c. ventricle: on each side extends from vestibular folds to vocal folds *saccule: upward extension of the ventricle *laryngocele: enlarged saccule d. glottis: consists of vocal fold and space b/w (rima glottidis) *vocal fold/true voal cords: below the ventricles, contain vocal ligament, vocal processes of the arytenoid cartilages, and vocalis m. *rima glottidis: narrowest part of the larnygeal cavity, its shape and size are altered by movement of the arytenoid cartilages e. subglottic/infraglottic cavity *extends from rima glottidis --Sensory Inn. of Larynx a. internal laryngeal branch of superior laryngeal n: supplies mucous mem. as far down as vocal folds b. recurrent laryngeal n: supples mucous mem. below the vocal fold --Extrinsic Muscles of the Larynx --Intrinsic muscles of the Larynx a. cricothyroid m. *O: external surface of the arch of cricoid cartilage *Act: act on cricothyroid joints to tilt the lamina of the cricoid cartilage backward and slide the thyroid cartilage slightly forward thus lengthening, tensing, and adducting the vocal fold *Inn: external laryngeal branch of the superior laryngeal n. b. lateral cricoarytenoid m. *Inn: recurrent n. *Act: adductor of vocal fold c. thyroarytenoid m. *Inn: recurrent n. *Act: adductor of vocal fold d. vocalis m. *Inn: recurrent n. *Act: adductor of vocal fold e. arytenoideus m. *Inn: recurrent n. *Act: adductor of vocal fold f. posterior cricoarytenoid m. *Inn: recurrent n. *only abductor of the vocal folds --Blood Supply of the Larynx a. superior laryngeal branch of superior thyroid a (branch from external carotid a.) b. inferior laryngeal branch of the inferior thyroid a (branch from thyrocervical trunk off of subclavian a)