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Oral cavity, pharynx, and esophagus
Terms in this set (21)
Afferent taste pathway
Papillae -> afferent fibers -> lingual nerve -> chorda -> geniculate ganglion -> intermediary nerve -> nucleus solitarius
Foramina of the palate
Greater palatine foramen: Conveys descending palatine branch of V2 to innervate the palate as well as descending palatine artery from maxillary artery. 1cm medial to the 2nd molar.
Accessory palatine foramen: posterior to greater palatine foramen. Conveys lesser descending palatine artery.
Incisural foramen: Lines in midline of anteiror palate and transmits incisural artery to anterior septum.
Palatoglossus, palatopharyngeus, levator veli palatini, and tensor veli palatini muscles
Palatoglossus forms the anterior pillar. Approximates the palate to the tongue and narrows oropharyngeal opening.
Palatopharyngeus forms posterior pillar. Raises larynx and pharynx closing the oropharyngeal aperture.
LVP: Raises soft palate to contact posterior pharyngeal wall.
TVP: Pulls soft palate laterally to give rigidity. Muscles originate on the eustachian tube, so contraction opens the tube.
Phases of the pharyngeal phase of swallowing
All involuntary and should occur very quickly.
Nasopharyngeal closure with palate elevation and contraction of superior constrictor.
Cessation of respiration.
Glottic closure with approximation of true cords, false cords, and arytenoids to epiglottis (in that order).
Bolus preparation and contraction of pharyngeal constrictor muscles.
Laryngeal elevation and pharyngeal shortening.
Epiglottic rotation occurs due to laryngeal elevation.
UES dilation and relaxation of CP muscle. UES and LES open at the same time to create a pressure gradient.
Lower esophageal sphincter
Not a true anatomic structure, but an area of high pressure extending 1-2cm above and below diaphragm.
LES function is controlled by parasympathetic tone and gastrin.
Angle of His is the oblique angle of entry of the esophagus into the stomach. This is absent in infants predisposing them to reflux.
Diaphragm crura create a sling around the hiatus to assist in sphincter function. This effect is lost with hiatal hernia.
Reticular branching pattern of leukoplakia with most common site on the buccal mucosa. Advanced cases termed erosive lichen planus with 10-15% chance of progression to squamous cell carcinoma.
Treatment = topical steroids.
Neoplasm of enamel origin that presents in the 3rd or 4th decade. Most common site is the mandible, usually in the molar region. Slow growing, painless, and surrounded by bone.
Rapidly growing tumor with pain and swelling.
Most common between 10-25yo. Mandible is MC in the H&N.
Tx = CRT. 50% survival.
Non-specific term for tumor like mass of the gingiva. Often a pyogenic granuloma.
Common in pregnancy.
Congenital is rare and resembles a granular cell myoblastoma.
Swelling of the uvula often in association with acute bacterial tonsillitis.
Uvular swelling can also occur with trauma (snoring, burn from food).
Pus forms between the capsule and superior constrictor.
Complications = parapharyngeal abscess (rupture through superior constrictor), venous thrombosis, mediastinitis, brain abscess, airway obstruction, peritonitis, dehydration.
Occur in Killian dehiscence between the inferior constrictor and cricopharyngeus muscle.
Associated with failure of UES opening due to incomplete cricopharyngeal muscle relaxation or failure of active dilation due to inadequate laryngeal elevation.
Tx = CP myotomy (open or endoscopic).
Polymyositis effects on the esophagus
Effects striated muscle. Presents with proximal muscle weakness.
Involves the striated muscle of the hypopharynx and upper esophagus. Peristalsis is weak and poorly coordinated. Esophagus may dilate.
Manometry shows decreased UES pressure and reduced peristaltic waves.
Scleroderma effects on the esophagus
Involves smooth muscle with a marked decrease in LES pressure. Associated with reflux and esophagitis.
40% develop strictures due to reflux.
Upper esophagus may be normal, but with aperistalsis, dilation, and reflux distally.
Aperistalsis, esophageal dilation, and failure of LES relaxation.
Primary is due to idiopathic degeneration of ganglion cells of Auerbach plexus.
Secondary is due to carcinoma, CVA, Chagas, postvagotomy, or DM
LES ring that occurs at the GE junction.
Found in 6-14%, but only 1/3 are symptomatic from it.
Symptoms only occur if the lumen is <13mm in diameter.
Involves only mucosa.
Females of scandanavian descent.
Syndrome is associated with iron deficiency anemia, upper esophageal web, hypothyroidism, glossitis, and gastritis.
Increased risk of postcricoid carcinoma.
Linear tear through all layers of the esophagus due to sudden increased esophageal pressure, usually due to vomiting.
Severe, stabbing epigastric pain. SubQ emphysema, shock.
Initially on imaging, have widened mediastinum. Can then get left pleural effusion or hydropneumothorax.
Tx = thoracotomy and repair.
Most common (85%) is distal TEF with upper esophageal atresia.
Less common are blind upper and lower esophageal pouches without connection to the trachea and true H-type fistula.
Drooling, coughing, abdominal distention, cyanosis.
XR shows marked air filling the stomach and often aspiration on CXR.
Attempts at passing NGT meets obstruction at 9-13cm.
Symptomatic compression of the esophagus by anomalous right subclavian.
Subclavian arises from the descending aorta instead of the innominate. Passes posterior to the esophagus.
Associated with a nonrecurrent right recurrent laryngeal nerve and aneurysm of the aorta and right subclavian artery.
Treatment = ligation and division with anastomosis of distal subclavian to carotid
Alkalis are worse than acids.
Do esophagoscopy within 24 hours. If you find a burned area, do not advance beyond the burn.
Treat with abx and steroids.
Sequence of burns:
0-24 hrs: Dusky cyanotic edematous mucosa.
2-5 days: Gray-white coat of coagulated protein fibroblasts appear.
4-7 days: Slough with demarcation of burn depth. Esophageal wall is weakest from 5-8 days.
8-12 days: Appearance of collagen
6 weeks: Scarring and stricture.
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