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FEES®: Another Tool For Dysphagia Assessment and Intervention Anatomy Review Idaho State University – Pocatello March 4, 2016 Presenter: John R. Ashford, Ph.D. CCC-SLP Nasal Cavity primer Superior Nasal Concha Middle Meatus Middle Nasal Concha Pharyngeal Tonsil Inferior Nasal Concha Eustachian Tube Superior Meatus Limen Nasi Nasal Vestibule SalpingoPharyngeal Fold Inferior Meatus Thieme Atlas of Anatomy, 2007 “Meatus” = Opening or Passage ©2016.SASwallowingServices,PLLC. “Concha” = Curled Bony Structure 1 Bony Structures Scope Thieme Atlas of Anatomy, 2007 Speculum View Netter, Atlas of Human Anatomy, 2006 ©2016.SASwallowingServices,PLLC. 2 Nasal Cavity Arteries Ophthalmic Artery Sphenopalatine Artery Kiesselbach’s Area Internal Carotid Artery External Carotid Artery Anterior Ethmoidal Artery Lateral Posterior Nasal Arteries External Carotid Artery Thieme Atlas of Anatomy, 2007 Nasal Epithelium (Pseudostratified Ciliated Columnar Epithelium) Mucous Layer Serous Layer Columnar Ciliated Cells Serous Cells Basement Membrane Lamina Propria Goblet Cell Seromucous Gland Submucosa Also known as “Respiratory Epithelium” ©2016.SASwallowingServices,PLLC. 3 Anatomy Through An Endoscope Nasal Vestibule Anterior extent of Inferior Turbinate Nasopharynx Nasal Septum SASS ©2016.SASwallowingServices,PLLC. Floor of Nasal Cavity (Maxilla) 4 Posterior Nasal Cavity Posterior wall of Nasopharynx Velopharyngeal Port Uvula Posterior wall of Oropharynx Velum SASS Pharyngeal Landscape Post Pharynx Wall Upper Esophageal Sphincter Postcricoid Space Piriform Sinus (Left) PS F AE T V F Epiglottis SASS Pharyngeal Channel (Left) Pharyngeoepiglottic Fold Vallecular Space Base of Tongue ©2016.SASwallowingServices,PLLC. 5 Where is the Base of Tongue Exactly? Pharyngoepiglottic Fold Med. Glossoepiglottic Fold SASS Base of Tongue Lt Vallecula “…from the line of the circumvallate papillae to the junction of the base of the epiglottis–valleculae, including the pharyngoepiglottis and glossoepiglottic folds.” (McGraw-Hill Concise Dictionary of Modern Medicine 2002) Larynx Landscape Interarytenoid Space Corniculate Tubercle Posterior Commissure Cuneiform Tubercle Trachea F AE Ventricle of Morgagni Vent Fold T V F Vocal Process Epiglottis SASS Anterior Commissure ©2016.SASwallowingServices,PLLC. Cricoid Cartilage 6