OSTEOLOGY OF THE SKULL

1. Appropriate anatomical terminology to describe how anatomical

regions or landmarks are related.

Superior – Looking down through the skull / above

Inferior – Looking up through the soles of the feet / below
Anterior – Looking towards the stomach
Posterior – Looking towards the spine
Lateral – Toward the side (e.g. ears)
Medial – Toward the middle / midline
Proximal – Nearer to the point of origin
Distal – Farther from the point of origin
Saggital - left and right
Coronal - front and back - anterior posterior Transverse - superior and inferior

Terms related to movement:

Flexion: The action of bending
Extension: the action of straightening
Abduction: movement away from central axis of the body
Adduction: movement toward central axis of the body
Pronation: turn palm downwards
Supination: turn palm upwards

2. Major bones of the skull and face

Encase brain, protect sensory organs, serve as attachment sites (muscles of head and neck)
8 Cranial bones: Frontal; 2 Parietal; 2 Temporal; Occipital; Sphenoid; Ethmoid
14 Facial bones: 2 Nasal; 2 Maxillae; 2 Zygomatic; Mandible; 2 Lacrimal; 2
Palatine; 2 Inferior 1 Nasal Conchae; 1 Vomer

Sutures: points at which bones of the skull articulate with each other
- Coronal: sep frontal and parietal bones
- Sagittal : sep L and R hemisphere
- Squamosal: sep parietal and temporal
- Lambdoid: sep parietal and occipital

Foramina: Openings for nerves/blood vessels

- Foramen magnum: for spinal cord
- Intraorbital foramen: either side of nose
- Mandibular foramina (paired)
- Mental foramina ( paired) on chin
- Incisive maxilla /palatine foramina: maxilla
Processes: projections
- Maxilla: Alveolar, frontal, palatine and zygomatic (maxilla)
- Mandible: Alveolar, condylar, coronoid
- Temporal: Mastoid, Styloid, zygomatic
Ethmoid bone
Extends into the cranial, nasal, and orbital
spaces. The crista galli protrudes into the
cranial space, and the perpendicular plate
projects down to make up the superior
nasal septum. The cribriform plates
separate the nasal and cranial cavities and
provide the conduit for the olfactory nerves
as they enter the cranial space. The lateral
orbital plates articulate with the frontal
bone, lacrimal bone, and maxilla to form
the medial orbit.

Sphenoid bone
The sphenoid bone is a significant contributor to the cranial structure. It consists of a corpus and three
pairs of processes:
- The greater wings
- The lesser wings
- Pterygoid processes

The greater wing comprises a portion of the anterolateral skull

and articulates with the frontal and temporal bones. A hamulus
projects from each medial lamina, and the tendon of the tensor
veli palatini passes around the hamulus on its course to the
velum.

Frontal bone
The frontal bone makes up the bony forehead, anterior cranial case, and supraorbital region. The frontal
bone articulates with the zygomatic bones via the zygomatic processes and with the nasal bones via the
nasal portion. The supraorbital margin provides the superior surface of the eye socket.
Parietal Bones
The paired parietal bones overlie the parietal lobes of the cerebrum and form the middle portion of the
braincase. United in the middle by a sagittal suture, running from the frontal bone to the occipital bone.
The lateral margin of the parietal bone is marked by the squamosal suture, forming a union between
parietal and temporal bones.

Occipital bone
The unpaired occipital bone overlies the occipital lobe of the brain and makes up the posterior
braincase. It articulates with the temporal, parietal, and sphenoid bones. The occipital bone forms the
base of the skull, wrapping beneath the brain. The foramen magnum provides the opening for the spinal
cord.

Temporal Bone
Contains the organs of hearing and balance, internal carotid, internal jugular and facial nerve. And TMJ
The temporal bone is separated from the occipital bone by the occipitomastoid suture.
EAM = External auditory meatus. IAM= Internal auditory meatus.
Divided into four portions:
- the squamous: thinnest, origin of the zygomatic process. Beneath the zygomatic
process is the mandibular fossa, with which the condyloid process of the mandible
articulates to form the temporomandibular joint.
- The tympanic: EAC origin of the styloid process, which protrudes beneath the EAM and
medial to the mastoid process.
- The mastoid: Makes up the posterior part of the temporal bone, the mastoid process
arises from this portion. (thickest part)
- The petrous portion. (hardest part) Houses the organs of hearing

The Mandible
Unpaired bone that makes up the lower jaw of the face. It
begins as a paired bone but fuses at the midline by the child’s
first birthday. The mental foramen is the hole through which
the mental potion of the trigeminal (V) cranial nerve passes.
The condylar and coronoid processes are separated by the
mandibular notch.
The head of the condylar process articulates with the skull, permitting the rotation of the mandible.
Teeth are found within small dental alveoli on the upper surface of the alveolar part of the mandible.
The mandibular foramen is the conduit for the inferior alveolar portion of the trigeminal (V) nerve,
which provides sensory innervation for the teeth and gums.
The mandible is very important for articulation and allows the teeth, tongue and lips to be in the correct
positions for clear speech.
Changes in the mandible with age: By 12 years of age the angle is nearly a right angle and the condyle is
higher than the coronoid process. With age and the loss of teeth the mandible becomes much thinner.
Ramus height, mandibular body height, and mandibular body length
decreases significantly with age for both genders, whereas the
mandibular angle increases significantly for both genders with increasing

age.

Maxillae
The paired maxillae, (fused to form maxilla) are the bones making up the
upper jaw. They constitute the majority of the hard palate. They also
assist in formation of the orbits (eye sockets), nasal cavity, maxillary
sinus and lodge the upper teeth (alveolar process). The infraorbital
foramen is the conduit for the infraorbital portion of the maxillary part
of the trigeminal (V) nerve, which provides sensory innervation of the
lower eyelid, upper lip, and nasal alae. The two palatine processes of
the maxilla articulate at the intermaxillary suture, when a cleft of the
hard palate occurs, it is on this suture. During embryonic development
there is a small premaxilla at the front of the palate, but in humans this becomes covered by the
palatine processes of the maxilla. This is important in the development of cleft lip.
The palatine process makes up three fourths of the hard palate, with the other one fourth being the
horizontal plate of the palatine bone.

Major landmarks of the hard and soft palates:

Hard and soft palates; ( HP - ¾ SF - ¼ )

The anterior part of the hard palate is the palatine process (¾)
and the posterior part of the hard palate is from the horizontal
plates of the palatine bones( ¼).
The palatine processes articulate in the midline - intermaxillary
suture / median palatine suture
The maxilla on either side of the suture extend laterally to form the alveolar process (houses the teeth)
The posterior nasal spine of the palatine bone articulates with the vomer bone at the back of the nasal
septum of the nasal cavity.
Soft palate - fibromuscular shelf attached to the back of the HP

Temporomandibular joint:
- Sliding hinge joint
- Condylar process and temporal bone , joints are covered with
cartilage
- There is a shock absorbing disk ( articular disk) that separates
the bones.
- It is a flexible and elastic cartilage - acts as a cushion. It lacks
blood supply and nerves in the center - therefore no pain is
felt under normal conditions
- If the disc is displaced - TMJ disorders - the adjacent tissue
(which is vascularized and innervated) becomes the joint, and
this is what causes pain and inflammation.
- Damage can occur due to - bruxism (clenching/grinding of
teeth), disc erosion, arthritic damage to cartilage and impact

Vomer
The vomer is an unpaired, midline bone making up the
inferior and posterior nasal septum, the dividing plate
between the two nasal cavities.
Zygomatic Bone
The zygomatic bone makes up the prominent structures we identify as cheek bones; they articulate with
the maxillae, frontal bone, and temporal bone, as well as with the sphenoid bone and make up the
lateral orbit.
Hyoid Bone:
- Lies free and suspended in muscle - very mobile ( U shaped )
- Floor of the mouth and tongue- attached above
- Larynx is below
- Behind is the epiglottis and pharynx
- Has a curved body, greater horn and lesser horn
The hyoid forms the union between the tongue and the laryngeal structure. This unpaired small bone
articulates loosely with the superior cornu of the thyroid cartilage and has the distinction of being the
only bone of the body that is not attached to another bone.

MUSCLES OF FACIAL EXPRESSION : convey emotion, important for

articulation.
Muscle properties: electrical excitability, contractibility, elasticity and
extensibility.
Muscles of the face
The muscles of the face are subcutaneous: they generally attach to the skull surface and insert
into the dermis (connective tissue under the skin) and so can cause wrinkles and dimples.
All supplied by CN VII (facial nerve)
- Orbicularis oris
Elevators
o Risorius
o Levator labii superioris
o Levator labii superioris
alaeque nasi
o Zygomaticus minor
o Levator anguli oris
o Zygomaticus major
Depressors
o Depressor labii
inferioris
o Depressor anguli oris
o Mentalis
o Platysma
- Buccinator
- Orbicularis oculi
- Frontalis
Elevators / Depressors

- Most of the facial muscles are

positioned around the mouth, given the high degree of mandibular movement.
- Muscles provide lip protrusion, closure, retraction, elevation and depression
- The orbicularis oris is the sphincter (closure) mechanism around the mouth, it forms the bulk of
the lips.
- At rest the lips are in contact, the outer surface of the lips is covered with skin and the inner
surface is a mucous membrane with stratified squamous epithelium. The mucous membrane of
the lips is richly invested with vascular supply.

Buccinator: The buccinator muscle is large and underlies the cheek. It is one of the first muscles that
humans learn to control (sucking). Important to controlling the size of the opening of the mouth. Critical
for mastication, smiling, speaking

Platysma: Originates in the skin dermis, so can see muscle striations fairly easily when it is contracted. It
is a large flat superficial muscle which originates from the lower jaw and extends into the neck
Muscles of orbicularis oris

- Sphincter mechanism around the

mouth - forms bulks of the lips
- Fibers are attached to the upper and
lower jaw near the midline away
from the alveolar margin.
- Insertion point for many muscles -
therefore produces a variety of
facial gestures
- Circular muscle
- The bulk of the orbicularis oris is
made of fibers from the buccinator
which converge toward the modiolus.
- At the modiolus these fibers form a chiasma; the upper and lower fibers go straight to their
respective lips the middle fibers decussate such that the lower fibers go to the upper lip and the
upper fibers go to the lower lip.
- Contraction of the orbicularis oris muscle causes a narrowing of the mouth, the lips becoming
pursed into a circle.
 - The orbicularis oris is innervated by the mandibular marginal and lower buccal branches of the
VII facial nerve.
- The dilator (opening) mechanism consists of the remainder of the facial muscles that fan
outwards (spokes of a wheel) - produce a wide variety of facial expressions.
- The dilators are - levator labii superioris, zygomaticus major, zygomaticus minor, risorius,
depressor anguli oris, labii inferioris, orbicularis oris

Facial expressions

Elevators - happy exp

● Zygomaticus major, - contraction elevates and retracts the corner of the mouth in an upward
and lateral direction, for smiling ( along with Risorius - pull the mouth laterally)
● zygomaticus minor (medially located) : adjacent to zy major, draws the lip upwards - broad
smile with teeth
● Risorius - fake smile when contracted, retracts corner of the mouth - pulls lip laterally.
Originates from the posterior region of the face along the fascia of the masseter muscle.
Innervated by the buccal branch of the VII facial nerve.
● Levator labii superioris: lifts the upper lip along with nose
● Levator anguli oris - lifts corner of the mouth
● levator labii superioris alaeque nasi: lifts the upper lip and opens the nostril
● levator labii superioris, zygomaticus minor and levator labii superioris alaeque nasi - contract
and elevate the nose

Depressors - sad exp

● Depressor labii inferioris pulls the lips down and out - moves laterally (along with buccinator) -
imp for kissing and trumpet playing
● Depressor anguli oris depresses the corner of the mouth , frown (most superficial)
● Mentalis elevates and wrinkles the chin, pulls
the lower lip out - pouting displeased exp /
chin dimpling
● Platysma depresses the mandible (“yikes”
and :( expression) - creases skin of the face
MUSCLES OF MASTICATION
1. Four muscles of mastication and how they are innervated.
Mandibular elevators:
- Masseter
- Temporalis
- Medial pterygoid

Muscle of protrusion:

- Lateral pterygoid

Depressors of the mandible:

- Digastric
- Mylohyoid
- Geniohyoid
- Platysma

All muscles of mastication insert onto the mandible, which is the only bone to move in the
mastication process. Innervated by: CN V (Trigeminal nerve - mandibular branch)

2. How the muscles work on different parts of the mandible

Temporalis:
- Originates from the temporal fossa, forms a tendon which attaches to the coronoid
process of the mandible.
- Elevates the mandible and retracts it back if protruded. (closes the mount and pulls the
jaw posteriorly)
Masseter:
- A strong quadrangular muscle which connects the zygomatic arch and the mandible,
(lateral surface of the ramus).
- It elevates the mandible with secondary functions in mandibular protraction (extending)

The pterygoid muscles differ from the temporalis and masseter as they are located on the medial
surface of the mandible.

Medial pterygoid: (internal pterygoid)

- Originates from the medial side of the lateral pterygoid plate and inserts into the
mandibular ramus.
- Elevates the mandible, acts in conjunction with the masseter.
Lateral pterygoid: (external pterygoid)
- Originates from the lateral pterygoid plate and greater wing of the sphenoid bone.
- It opens and protrudes the mandible and acts to grind the molars.

Mandibular depressors:
 Digastric:
- Dual bellied. The anterior and
posterior bellies converge at the
hyoid bone and their paired
contraction elevates the hyoid.
- The posterior belly originates on
the mastoid process of the
temporal bone. Connective tissue
sling.
- It allatches to the inferior surface
of the mandible, projects
downwards and backwards
Mylohyoid:
- Originates on the underside of the mandible and courses to the corpus hyoid. Fanlike
muscle that forms the floor of the oral cavity.
- Pulls the hyoid bone upwards and forwards ( raises floor of the mouth)

Geniohyoid: Superior to the mylohyoid originating on the inner mandible.

Stylohyoid: Originates on the prominent styloid process of the temporal bone, crosses the path
of the posterior belly of the digastric, inserts into the corpus of hyoid.

Platysma: paired flat superficial

muscle in the neck, directly
connected to the skin

TONGUE
- Oral portion (⅔ - within oral cavity) and pharyngeal portion (⅓ - base of tongue in pharynx)
- Imp for mastication and deglutition (swallowing - more the pharyngeal part)
- Main tastes: sweet, sour, bitter, salty and umami ( monosodium glutamate) - all tastes are
sensed all over the tongue ( bitter is mainly on posterior )
Major landmarks - tongue

- Central/ median sulcus – divides

the tongue into left and right
sides. (median fibrous septum),
serves as a point of origin for the
intrinsic muscles of the tongue.
- Circumvallate papillae – mark
the junction with the posterior
pharyngeal surface. (major site
of taste buds)
- Lingual tonsils – on the
pharyngeal surface beneath the
mucous membrane, lymphoid
tissue, defence against infections
- Foramen caecum – the centre of
the grove of the terminal sulcus; it is remnant from the development of the thyroid gland, which
descends down into the neck in the embryo.

Muscles of the tongue

INTRINSIC: All originate/attach within tongue (no extra

glossal attachment) - finer control of tongue muscles
 - Superior longitudinal: attach to midline septum , shortens tongue and curls apex and sides of
tongue
- Inferior longitudinal: separated by genioglossus (superior and inferior are along the length of
the tongue) - shortens tongue and uncurls apex and turns it downwards
- Transverse muscles: Narrow and elongates the tongue, originates from the median fibrous
septum( it divides tongue longitudinally)
- Vertical muscles: Broaden / flatten tongue. (produce a midline grove for swallowing)

EXTRINSIC: All have an extra glossal attachment but their fibers

contribute to the composition of the tongue. - move the tongue
into the general region desired
- Genioglossus: Prime mover of the tongue, comprises most
of its deeper bulk. Protrudes tongue and depresses centre of
tongue
- Hyoglossus: pulls the sides of the tongue down (depresses)
- Styloglossus: draws the tongue back and up (elevates and
retract tongue)
- Palatoglossus: elevates the back of the tongue and
depresses the soft palate.

Innervation of the tongue muscles

All intrinsic muscles: are innervated by CNXII
(Hypoglossal nerve) - Superior longitudinal,
inferior longitudinal, transverse and vertical

Extrinsic muscles: Genio-, hyo-, stylo-glossus

innervated by CN XII (hypoglossal nerve)

Palatoglossus innervated by CNX (Vagus nerve)

Papillae of tongue
The mucous membrane of the tongue is comprised of stratified squamous epithelium, and
contains several types of papillae:
Filiform: ‘fur’ of the tongue, they make a non-slip surface for moving the bolus of food, many
over the surface. Dominant papillary formation of the tongue. Include taste sensors and also
mechanoreceptors to provide a fine tactile sensory ability to the tongue, permitting fine
discrimination of the bolus characteristics.
Fungiform: discrete pink spots, characteristic shape, that are more numerous on the anterior
2/3 of tongue and sides of the tongue, bearing taste buds.
Foliate: either side of the tongue, in approx. middle, series of clefts along lateral margins
(salivary glands)
(Circum)vallate: posterior surface at junction of oral/pharyngeal cavities, large raised domes
(salivary glands) large V-shaped formation of circles seen in the posterior dorsum of the tongue.

Taste: Mediated by means of four cranial nerves: VII facial nerve mediates the sense of taste
from the anterior two thirds of the tongue, IX glossopharyngeal nerve transmits information
from the posterior one third of the tongue. Taste receptors of the palate are innervated by the
VII facial nerve. Taste receptors of the epiglottis and esophagus are innervated by the X vagus
nerve. Trigeminal nerve (V) is responsible for the mediation of chemesthetic sense.

Epithelial surface:
The oral cavity is lined by stratified squamous
epithelium which does not have keratin

Pseudostratifies columnar ciliated epithelial cells:

The trachea and lower airways are covered in
pseudostratified columnar ciliated epithelial cells
commonly called respiratory epithelium.
ORAL CAVITY AND PHARYNX

Speech is a result of several systems interacting

and functioning in harmony
Respiratory [controlled exhalation], Phonatory:
[voice production], Resonatory [modify voice
signal] and Arculatory [produce speech sounds]

Landmarks
- oral
cavity &
pharynx.
Pharynx -
common
chamber for
resp and
digestive
tracts. Extends from skill base to the esophagus. Has three
divisions

Nasopharynx; Extends from the base of the skull (sphenoid and occipital bones) to the level of the soft
palate. Anteriorly it is continuous with the nasal cavity through the choanae (nasal choanae are paired
openings that connect the nasal cavity with the nasopharynx). The nasopharynx has the opening to the
Eustachian tube.

TONSILS
- Waldeyer’s ring; Tonsils are a collection of lymphoid tissue. The tonsillar tissues of the nasopharynx
and oropharynx from a ring of lymphoid tissue that surrounds the entrances into the pharynx
from the nose and mouth.
o Pharyngeal tonsil (adenoid), lies in the posterior wall and
the roof of the nasopharynx.
o Tubal tonsils (paired), is found around the opening of the
eustachian tube. (nasopharynx ?)
o Palatine tonsils (paired), lies in the triangular recess
between the two pillars - 2 folds of mucous membrane.
[anterior pillar: palatoglossus muscle. Posterior pillar:
palatopharyngeal muscle] (oropharynx)
o Lingual tonsil, located under the mucous membrane of the
posterior third of the tongue. (oropharynx)

Oropharynx; Mid portion of the pharynx. It extends from the soft palate to the valleculate (small
mucosa-lined depression) at the back of the tongue. Continuous with the mouth through the
oropharyngeal isthmus formed by the palatoglossal muscles on each side
(Fauces: A gorge or narrow passage) The lateral wall of the oropharynx has two-fold mucous membrane,
the palatoglossal and palatopharyngeal membranes, created by the muscles of the same name.
Hypopharynx; Extends from the floor of the vallecula to the inferior border of the cricoid cartilage. It is
continuous with the larynx through the laryngeal vestibule, which is formed by the epiglottis and the
aryepiglottic folds.
o Paired pyriform sinuses/fossae; cavities that food can be caught in.
o Post-cricoid region
o Posterior pharyngeal wall

Hard and soft palate

The hard palate constitutes three quarters of the palate, it is made up of the palatine process of the maxilla
(¾ )(anterior) and the horizontal plate of the palatine bones (¼ ).
The soft palate (velum) is a fibro-muscular mesh attached to the paired palatine bones, it seals the oral/
nasal cavities (¼ of the palate)

Muscles Soft palate

3 Paired Muscles:

Tensor veli palatini;

- Arises from the base of the skull and inserts into the palate
- Forms a tendon that passes around the hook of the hamulus on the medial pterygoid plate of the
sphenoid bone.
- Then fans out and joins the muscle from the other side to make the fascial framework of the soft
palate (palatine aponeurosis [aponeurosis: flat sheet or ribbon of tendon like material that anchors a
muscle or connect it with the mart of the muscle that moves]). Fascia- sheet of connective tissue
- It tenses the soft palate for other muscles to act
upon it.
- Open the eustachian tube.(during swallow)

Levator veli palatini;

 - Arises from the temporal bone and the cartilage of the eustachian tube and attaches to the upper
surface of the palatine aponeurosis where it meets the muscle from the other side.
- Forms the main muscle part of the soft palate.
- Raises the soft palate to help seal the nasal cavity ( swallowing and speech)

Musculus uvulae:
- Paired midline muscle extending between the tensor aponeurosis anteriorly and the base of the
uvula posteriorly along the nasal aspect of the velum.
- Shortens and broadens the uvula, which changes the contour of the posterior part of the soft
palate. ( to allow the soft palate to adapt to close the oral cavity from nasal c during swallowing)

Muscles of the pharynx

Muscles of the pharynx consist of the
circular fibers of the constrictor muscles that
surround the longitudinally running fibers of the
stylopharyngeus, salpingopharyngeus and
palatopharyngeus muscles.

Stylopharyngeus: elevates the larynx and pharynx

during swallowing as well as dilating the pharynx.

Palatopharyngeus : pulls the pharynx up and closes it

when bolus passes ( seals nasal cavity)
Salpingopharyngeus: raises the larynx and pharynx. Open the pharyngeal orifice of the eustachian tube

Pharyngeal constrictor muscles (inferior, middle and superior): sequential contraction propels the food
downwards into the esophagus

- Inferior constrictor; 2 parts

o Thyropharyngeus encloses the superior and middle
constrictors as its fibers curve around to the
midline raphe.
o Cricopharyngeus; No midline raphe. Acts as a
sphincter at the lower end of the pharynx and is
continuous with the esophagus. It is closed except
when it opens for swallowing. This closure helps
prevent air from being sucked into the esophagus
and stomach.
- The superior and middle constrictors overlap and are
overlapped by the thyropharyngeus. Below this level the
posterior wall is the single sheet of the thyropharyngeus.
This single sheet is a weaker spot and is known as the
Dehiscence of Killian

Nasal Cavity
- The nose extends from the nostrils to the nasopharynx and is divided
by a midline septum.
- Functions of the nose: Moistens / humidifies air. Warms air. Filters
inspired air. Contains the
olfactory epithelium for the
sense of smell. Sneezing expels
irritant material through the
nose.
- Nasal septum is made of
cartilage anteriorly and bone
posteriorly.
- The floor of the nose is the hard
palate.
- Lateral wall, The walls of the nose have three conchae, or turbinate bones. The largest is the
inferior turbinate.
- The mucosa on these can swell and black the nose instantly in an allergic reaction and also with a
viral upper respiratory infection.
Paranasal sinuses:
There are 4 - ethmoid, frontal, maxillary and sphenoid
Functions uncertain: Lighten the facial bones, alter the resonance of the voice, help to insulate the face by
warming the incoming air. May be protective in head injury.

Salivary glands;
Parotid gland; The duct pierces the buccinator to enter the oral cavity,
and opens at the level of the second upper molar tooth.
Produces thin, serous saliva which helps lubricate the food bolus to pass
through the pharynx.

Submandibular gland; The gland lies behind the free margin of the
mylohyoid muscle, between the muscle and the medial surface of the
mandible.
The duct comes forward and opens into the oral cavity adjacent to the
lingual frenulum. Produces both thick secretions (mucus) and thin
serous secretions, helps lubricate the bolus of food. Lubricates mouth

Sublingual salivary gland; ON the oral cavity side of the mylohyoid

and can be seen as a ridge on the floor of the mouth. They open through
multiple ducts into the submandibular ducts and oral cavity. Produces
mucus, which is thick and protein rich, helps encapsulate the food particles.
Salivary secretion is entirely under neural control. Parasympathetic stimulation;thin saliva in large
volumes. Sympathetic stimulation; small volumes of thick secretions. (dry mouth when stressed.)
Simple (unconditioned) salivary reflexes; Occur when the chemoreceptors and pressure receptors in the
mouth detect food.
Acquires (conditioned) salivary reflexes; Secretion can be increased by the thought or smell of food.
Learned response based on previous experience.

Dentition
Teeth are for chewing; they are also important for several speech
sounds. They are within the alveolar ridges of both the maxilla and the
mandible.
o Incisors; central and lateral, for cutting
o Cuspids; canine, one on each side, single point for tearing food.
o Bicuspids; premolars, two on each side, also for cutting
o Molars; three on each side, large teeth with occlusal surfaces
designed to grind foodl the muscles of mastication are powerful and
able to produce considerable force.
Infants develop deciduous (shedding) teeth. Usually this begins
between 6 and 9 months
Occlusion is bringing the teeth together for contact grinding.
Malocclusion results from abnormal positions of the teeth or abnormal positions of the jaws.
RESPIRATION

Function of the respiratory system

- Pulmonary ventilation; getting air in and out of the lungs
- Gas exchange; supply oxygen to aerobic tissues in the body and remove carbon dioxide as a waste
product
- Transport of respiratory gases; movement of blood (thus gases) from the lungs to the cell and tissues.
o Internal; gas exchange between the capillaries and the tissues (oxygen unloading and CO 2
loading)
o External; gas exchange between the lungs and blood (oxygen loading and CO 2 loading)
- Main source of energy for speech, drives vocal fold vibration
- During Speech: 10% inspiration, 90% expiration. Normal breathing: 40:60

Anatomical features of the respiratory system.

Inspiration: contraction of diaphragm (external intercostals)

Expiration: relaxation of diaphragm (contraction of internal intercostals and abdominal muscles)

Inspiration: (active process)

External intercostals:
- more superficial layer that lifts the rib cage and increases thoracic volume to allow inspiration.
- Found between ribs with fibers running
downward / inward towards sternum.
- They pull ribs together, raising ribs
during inspiration.
o Contraction elevates ribs
o 25% of air entering lungs during
normal quiet breathing
o Accessory muscles for deep,
forceful inhalation.

Diaphragm;
- The most important muscle for inhalation.
- Flattens, lowering dome when contracted.
- Responsible for 75% of air entering lungs during normal quiet breathing.
 - Connects to ribs at side and spine at the back.

Expiration: (passive process)

Internal intercostals:
- deeper layer that aids in forced expiration.
- Between ribs. Run at right angles to external intercostals/ Action is to depress rib cage during
expiration.
Internal oblique abdominis
External oblique abdominis
Rectus abdominis

Abdominal wall:
- The abdominal wall is
composed of 4 paired
muscles (Internal and
external obliques,
transversus abdominis and
rectus abdominis), their
fasciae (fibrous connective
tissue) and their aponeuroses
(layers of tendon).
- Fascicles (bundles) of these
muscles run at right and

oblique angles to one another,

giving the abdominal wall added
strength.
- Additionally, they are involved with
lateral flexion and rotation of the
trunk. They help to promote
urination, defaecation, childbirth,
vomiting, coughing and screaming.

- When the thorax expands, parietal and

visceral pleurae adhere tightly due to
subatmospheric pressure and surface
tension, and are pulled along with
expanding thorax. (parietal outer
pleura, visceral inner pleasure)
- As lung volume increases, the alveolar pressure drops. (Pressure of air inside the lung alveoli)

Physiology of respiration

INSPIRATION EXPIRATION

Inspiratory muscles contract. Diaphragm Diaphragm and external intercostals relaxes - chest
descends / flattens , chest cavity expands cavity deflates

Muscles: external intercostals and diaphragm Internal intercostals and abdominal muscles
(internal and external oblique abdominis, rectus
abdominis and internal intercostals)

Intrathoracic/ pulmonary volume increase Intrathoracic/ pulmonary volume decreases

Intrathoracic/ pulmonary pressure decreases Intrathoracic/ pulmonary pressure increases

Air flows from outside (high pressure) to the Air flows outs of the lungs (high pressure) to the
lungs (low pressure) until intrapulmonary outside (low pressure) till the intrapulmonary
pressure is equal to atmospheric pressure pressure is 0

Inspiration: When you inhale, the diaphragm and external intercostal muscles contract and expand the
chest cavity. This expansion increases the intrathoracic volume and lowers the intrathoracic pressure
(Boyles law). Air then moves into the lungs (from high pressure to low pressure) this inflates the lungs.

Expiration: When you exhale, the diaphragm and external intercostal muscles relax and the chest cavity
gets smaller. The decrease in volume increases the pressure above the outside air pressure. Air from the
lungs then flows out of the airways to the outside air (high pressure to low pressure).

Boyles Law: Gas at a constant temp. Increase in V = decrease in P. Decrease in V = Increase in P. pV=k
(Boyle’s Law; P=F/A)

Tracheobronchial tree: Passage of air

- through the nose and mouth right down to the level of the alveoli.

Tracheobronchial (TB) tree.

● Lungs:
- Left : superior lobe, inferior lobe,
separated by the oblique fissure.
(smaller, heart)
- Right: Superior lobe, middle lobe,
inferior lobe,
 separated by the horizontal fissure (M & S) and the oblique fissure (I and S/M)

On a scan of the lungs these are seen: Vasculature, Gradual decrease in the size of vessels as they branch
peripherally, No opaque sections

Pleural coverings;
o Double layered serosa
o Parietal pleura, lines the thoracic wall
o Pulmonary or visceral pleura, covers
the lung surface
o Pleural cavity is the ‘space’ (not really
a space) between the two layers,
pleural fluid fills the cavity.
Pleurae produces surfactant that reduces the
surface tension of the alveolar lining layer, the
continuous lining provides an airtight seal,
permitting the lungs to follow the movement
of the thorax and maintaining a negative
pressure. They improve the efficiency of respiration, allows the surfaces to glide over one another.

Components of the Respiratory System:

Conducting zone : Conduits for air to reach site of gas exchange
o Nasal cavity; Warm and moisten inhaled air
o Pharynx; Connects the nasal cavity and mouth to the larynx and
oesophagus
o Larynx
o Trachea; Has cartilaginous rings
o Bronchi;
Primary Bronchus (right 20-30)(left 45-55),
secondary/lobar bronchus: R -3 , L -2
tertiary or segmental bronchi.
As bronchi branch out and become smaller, cartilage rings are
replaced with plates.
o Bronchioles; Branch from segmental bronchi, smooth muscle
replaces cartilaginous plates. <1 mm diameter,
o Terminal bronchioles; Last branch of bronchial tree before gas
exchange areas. <0.5 mm.
14L/28R generations of branching airways to form tracheobronchial tree.
Respiratory zone : Site of gas exchange
o Respiratory Bronchioles; Microscopic branches of terminal bronchioles, have pouches that
support gas exchange.
o Alveolar ducts; further subdivisions which give rise to alveoli
 o Alveoli; Thin, cup-shaped out-pouching’s of epithelial cells. 480 million.
Small, thin walled, inflatable sacs at the end of bronchioles.
Surrounded by jacket of pulmonary capillaries.
Provide thin barrier and enormous surface area for gas exchange by diffusion.

Epithelial lining of the TB tree, Trachea to terminal bronchioles (conductive): Ciliated pseudo stratified
columnar epithelium. Primary role in air delivery and protection.
Respiratory bronchioles 🡪 alveolar ducts 🡪 alveoli. Non ciliated cuboidal epithelium. Simple squamous
cells. Very flat thin layer as primary role in gas exchange.
Gas exchange: Diffusion via thin respiratory membrane. Moist environment, lowers surface tension, O2
and CO2 can diffuse into/out of blood

Blood Supply:
Pulmonary circulation:
Pulmonary arteries from the right side of the heart supply blood to the lungs ~ 5L/min
- Carry deoxygenated blood from heart to lungs.
- Pulmonary arteries branch profusely along with the bronchi, Pulmonary capillary networks surround
alveoli.
Pulmonary veins form post alveoli to carry oxygenated blood back to the heart.
Bronchial circulation:
Bronchial arteries come from the aorta and enter the lung at the hilus
provide oxygenated blood to the lungs themselves ~50 ml/min
Bronchial veins drain the bronchi but most moves into the pulmonary circulation

Neural Control of Breathing

Voluntary component 🡪 controlled by motor cortex via projections which innervate the relevant spinal
motor neurons.
Involuntary component 🡪 controlled by respiratory centers in the pons and medulla.
These respiratory centers are a collection of neurons located bilaterally in the brainstem:
o Dorsal respiratory group (DRG) and the ventral respiratory group (VRG) in the medulla.
(respiratory pacemakers)
DRG is located in the dorso-medial region of the medulla, involved in the generation of respiratory
rhythm and primarily involved in inspiration. Sends efferent impulses to the diaphragm and inspiratory
intercostal muscles. Received afferent impulses from peripheral chemoreceptors in the carotid and aortic
bodies and from several different types of lung receptors.
VRG contains both expiratory and inspiratory neurons. Almost inactive during quiet / restful breathing,
becomes active when increased ventilatory
effort is required.
o Pneumotaxic centre and the
apneustic centre in the pons
(pontine respiratory centre)
Don’t generate rhythm but modify
inspiratory depth and rate established by
medullary centres (VRG and DRG)
Apneustic center facilitates inspiration and
prolongs inspiration during increased oxygen
requirements.
Pneumotaxic centre cuts off inspiration to
ensure inspiration does not continue too long.

Clinical problems that arise as a result of respiratory system dysfunction.

- Brainstem lesions, vagus nerve (CN X) dysfunction, anaesthetic drugs, barbiturates, can depress
the activity of the respiratory pacemaker cells, causing apnea.
Pulmonary function is assessed using spirometry.
- COPD (chronic obstructive pulmonary disease): progressive, leading cause is smoking. cause
coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness,
and other symptoms. Long term exposure to lung irritants also contribute to COPD
- Obstructive emphysema –deterioration of alveolar & respiratory bronchiolar walls. Large
spaces form as a result and less air flows in/out. Primary purpose of gas exchange is lost
- Chronic bronchitis – excessive mucus secretion
- Asthma (chronic inflammation): chronic inflammatory disease of the airways characterized by
variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. • Symptoms
include wheezing, coughing, chest tightness, and shortness of breath.
- Cystic Fibrosis: Inherited disease of the mucus glands that affects many body systems. The
disorder's most common signs and symptoms include progressive damage to the respiratory
system and chronic digestive system problems. Body produces mucus - which is thick and
obstructs the airway - leading to prob with breathing and bacterial infections in lungs
 - Ageing: vital capacity decreases, residual volume and dead space increase, Ability to remove
mucus from respiratory passageways decreases , Gas exchange across respiratory membrane is
reduced

LARYNX
Functions: deglutition (swallowing), respiration (breathing), phonation (voice production), cough
reflex
Location: between trachea and pharynx /

Cartilages of the larynx

3 unpaired: thyroid, epiglottis and cricoid
3 paired: arytenoid, corniculate, cuneiform

Thyroid cartilage; unpaired

- Largest laryngeal cartilage. Forms most of
the anterior portion of the larynx.
- Two quadrilateral plates, thyroid laminae,
fused together at the front and diverge widely.
- Most anterior portion is Adam's apple.
(laryngeal prominence)
- Back edges extend upwards into two long
horns and downwards into two short horns
- Upper horns (superior cornua) couple to the
hyoid bone
- Lower horns (inferior cornua) articulates with
joints to the cricoid cartilage. (straddle cricoid cartilage like legs.)

Cricoid - unpaired
- Ring shapes structure above the trachea.
- Thick back plate ( posterior quadrate lamina)
- Anterior arch forms the front of cricoid structure.
- 4 facets. (2 (inferior and lateral)for thyroid cartilage, inferior
horns.
2 (superiorly located) for arytenoid cartilages.

Epiglottis - unpaired
- Single cartilage positioned behind the hyoid bone and root of
the tongue (looks like a shoe horn)
- Front and back surfaces referred to lingual (anterior) and laryngeal
(posterior) surface
 - Laryngeal surface folds over the larynx
- Lingual surfaces attaches to the hyoid bone
- Petiolus ( thin end) attaches to the thyroid cartilage

Arytenoid - paired
2 Arytenoid cartilages.
Located atop the posterior quadrate lamina of the cricoid cartilage.
Pyramidal in shape, although the superior process or apex of the pyramid is the corniculate
cartilage.

Corniculate : paired
Often fused to the arytenoid cartilage superiorly
Elastic cone shaped

Cuneiform
- 2 elongated fibrous pieces of cartilage which supports
the VF by providing rigidity

Posterior view: ( order of cartilages) : Epiglottis,

thyroid cartilage, corniculate cartilages,
arytenoid cartilages, cricoid cartilage
Joints of the larynx
- Only functionally mobile part of larynx, 2
pairs

Cricothyroid joint

- Between the cricoid and the thyroid.

- Encapsulated by membranes that secrete
synovial fluid (kubricant).
- When the cricoid and thyroid move toward
one another in front, the arytenoid cartilage
moves farther away from the thyroid cartilage,
this tenses the vocal folds.
- Allows thyroid cartilage to rock down in front
and glide forward slightly.
- This joint provides the major adjustment for change in vocal pitch.

(VF tense as the distance between the thyroid and arytenoid cartilages increase when the cricothyroid
joint moves . VF extend from the vocal process of the arytenoid cartilage (posteriorly) to the internal
medial surface of the thyroid cartilage (anteriorly)

Cricoarytenoid joint
- Joins the cricoid and arytenoid cartilages. Synovial membrane lubricates joint.
- Movement of the joint is influenced by 2 ligaments
- Anterior cricoarytenoid ligament; limits the degree to which the arytenoid cartilage can be moved
back.
- Posterior cricoarytenoid ligament extends upward
and toward the side. Limits the degree to which the
arytenoid cartilage can be moved forward.

Provides for rocking of arytenoid cartilages and

limited sliding movement.
As arytenoid cartilages rock on the cricoid cartilage
their vocal processes move
● Upward and outward (Abduction - VF open) -
posterior cricoarytenoid
● downward and inward. (adduction - VF close) -
lateral cricoarytenoid
Muscles of the larynx.

EXTRINSIC:
- move the larynx as a whole
- connect laryngeal carilages to other structures of the head and neck
infrahyoid and suprahyoid muscles that move the larynx. Stylopharyngeus muscle is also involved.

INTRINSIC:
- move internal parts of the larynx
- Alter position, shape and tension of VF

Adductors of the vocal cord: (close)

- Lateral cricoarytenoid
- Interarytenoid (transverse and oblique arytenoids)
Abductors of the vocal cord: (open) : Posterior cricoarytenoid
Tensor of the vocal cord: Cricothyroid muscle ; increases the tension of the vocal folds - lengthens VF
and increases pitch
Relaxer of the vocal cord: Thyroarytenoid muscle - - paired (vocalis is medial portion); Shortening of
the vocal folds.
Vocalis: medial portion of the thyroarytenoid. It underlies and provides the bulk of the VF. it is involved
in control of shortening and lengthening the VF
 Vocal
Folds
-
2

true and 2 false VF

- Housed within the larynx
- VF extend from the vocal process of the arytenoid cartilage (posteriorly) to the internal medial
surface of the thyroid cartilage (anteriorly
- VF made up of 5 layers in which are grouped into 3 distinct functional layers.
● Covering / mucosa: Loose structure that is key to vocal fold vibration
during sound production, composed of:
- Epithelium
- Basement membrane
- Superficial lamina propria
● Vocal ligament: The vocal ligament is composed of:
- Intermediate lamina propria
- Deep lamina propria (contains strong collagen fibers)
● Body: Composed of the thyroarytenoid muscle. This muscle helps close
the glottis and regulate tension of vocal fold during speaking and
singing. The medial portion of this muscle is called ‘vocalis muscle’.

Vocal fold vibratory cycle has phases that include an orderly sequence of
opening and closing the top and bottom of the vocal folds, letting short puffs
of air through at high speed. Changes in air pressure generates rapid vibration, producing sound
(voice)

Vocal folds vibrate when excited by aerodynamic

phenomena. Air pressure from the lungs controls
the open phase. The passing air column creates a
trailing ‘Bernoulli effect’ which controls the close
phase.
(Bernoulli effect: For a fluid, when there is an
increase in velocity, this is matched with a
decrease in pressure)
The nose, pharynx and mouth amplify and modify
sound, allowing it to take on the distinctive
qualities of voice.
Abduct: To move away from the midline of the
body and thus to open or pull apart.
Adduct: To bring toward the midline, and thus to close or bring together.
Pitch is controlled by the varying length of vocal folds. (longer vocal fold=lower pitch)
The folds are attached to the thyroid cartilage anteriorly and to the arytenoid cartilages posteriorly,
which ride on the cricoid cartilage, at the rear so their length is largely controlled by moving the
thyroid and cricoid cartilages relative to each other.
External laryngeal muscles must also be strongly involved in pitch raising.
110Hz = lower pitch, men
180-220 Hz = medium pitch, women
300 Hz = high pitch, children
Higher voice: increase in frequency of
vocal fold vibration
Louder voice”: increase in amplitude of
vocal fold vibration

VF Vibrations: bernoulli + venturi

 Innervation and vascularisation of the
larynx.

Vagus nerve (CN X)

Reccurrent laryngeal nerve branch innervates all intrinsic muscles of the larynx thyroarytenoid,
transverse and oblique arytenoid,
posterior and lateral cricoarytenoid,
vocalis ( except the cricothyroid )
( below level of VF)

External branch of the superior

laryngeal nerve supplies the
cricothyroid muscle. (

Superior Laryngeal Artery;

Supplies internal laryngeal
structures.
 Inferior Laryngeal Artery; supplies surrounding laryngeal structures

Superior Laryngeal Vein joins the superior thyroid vein which drains into the internal jugular
vein

Inferior Laryngeal Vein joins the inferior thyroid vein which drains into the innominate vein

IMP: The circuitous path of the left RLN throughout the chest is one reason why any type of
open‐chest surgery places patients at risk for a recurrent laryngeal nerve injury, which would
result in vocal fold paresis or paralysis

SWALLOWING: Mechanics and Neurology

The process of passing a substance from the mouth to the stomach. Fulfills two vital biological
functions
1. Delivering nutrition and hydration
2. Airway protection

Dysphagia is any disruption to this process

• Deglutition = swallowing
• Mastication = Chewing
• Bolus = the thing being swallowed (food, drink, saliva, medication)

Swallowing occurs across three anatomical areas

· Oral cavity (ORAL PHASE) : Preparatory stage, Oral transit/propulsion
· Pharynx (PHARYNGEAL PHASE)
· Oesophagus (OESOPHAGEAL PHASE)

Phases of swallowing
● Volitional
- Pre-oral phase
- Oral phase
o Oral preparatory
o Oral transit/propulsion
● Reflexive
- Pharyngeal phase
- Oesophageal phase

Pre- Oral Phase:

- It involves the interaction of motor, cognitive, psychological and sesnory factors
associated with eating and drinking
- Awareness of food (sensory acknowledgment)
- Pre-performed emotional relationship - excites the taste and olfactory nerve (can be
positive or negative)
- Salivation: mouth preparing to receive a bolus
- Postures,use of cutlery, how we bring food to our mouth

Oral Preparatory Phase

- The bolus is prepared to be swallowed.
- It includes
● Sucking (infants)
 ● Masticating solid foods (mixing food with saliva to form moist, cohesive bolus of
suitable size and consistency).
Movements of the jaw and tongue pump air into the nasal cavity through the
pharynx, delivering the food’s aroma to chemoreceptors in the nose.
● Collecting fluid bolus on tongue ready to be transported to pharynx

Preparation of food bolus (steps)

1. Mouth opens to accept bolus- Isthmus between oral cavity and pharynx remains open
2. Tongue forms a trough to receive and trap the bolus between it and the palate
3. Fork/spoon is retracted from the mouth. Tongue and lips act to strip any residue off
fork/spoon
4. Once moist and cohesive bolus is formed, it is collected on the dorsal surface of the
tongue
5. Bolus is masticated until appropriate size and consistency
6. Mouth closes so no anterior leakage

Mastication
• Involves:
o Rotary lateral movement of the mandible and tongue (creates a synchronous
alternated motion of the L and R muscles of mastication - grinding motion)
o Tongue positioning material onto the teeth
• Buccal musculature provides tension and prevents food entering the lateral sulcus /
buccal cavity
• Tactile and proprioceptive sensory feedback provide information on the size and position
of the bolus within the oral cavity

Preparation of liquid bolus (steps)

1. Mouth opens to accept bolus (sipping from a cup or straw). Posterior portion of the
tongue is raised to seal the oral cavity, and the soft palate is pulled down and forward,
so the bolus does not spill into the pharynx.
2. Tongue forms a trough to receive and trap the bolus between it and the palate
3. Mouth closes so no anterior leakage
4. Once you are ready to swallow, the bolus is collected on the dorsal surface of the
tongue
5. May swill fluid around the mouth
Oral Phase – Transit/propulsion phase
Transfer of the bolus from the oral cavity to the pharynx (steps)
1. Bolus is prepared and collected on the tongue. Decision is made to swallow.
2. The tip and sides of the tongue contract against the hard palate to progressively
squeeze the entrapped bolus
3. The posterior part of the tongue forms a chute that allows bolus to pass into the
pharynx
4. Tongue elevation progresses sequentially more posteriorly – moves bolus in wave like
motion
5. Respiration reflexively inhibited (approximately 1 second) ( exhale - swallow- exhale)

Preparation and transfer stages are both under voluntary control

How do you know when the bolus is ready to be swallowed?

● Tongue contains muscle spindles (sensory receptors within the body of muscles which
detect changes in muscle length) which keep track of bolus position relative to tongue
position
● Tongue epithelium contains sensory receptor cells for taste ( high receptive field
density)
● Two types of sensation:
- General (pressure, touch, temperature, vibration)
- Special (taste)

Type of sensation Anterior 2/3 of tongue Posterior 1/3 of tongue

General: Pressure, touch, CN V: Trigeminal Nerve CN IX: Glossopharyngeal

temperature and vibration Nerve

Special: Taste CN VII: Facial Nerve

What happens when I eat things of multiple consistencies, or if I want to talk while eating?
Dual consistencies:
• Posterior tongue will lower to allow fluid to pass into the pharynx as you continue to chew the
solid part
• Fluid can pool in the pyriform sinuses OR you can swallow, while continuing to chew the
solids
Talking while eating:
• Food can be pocketed in the buccal cavity while airway is open for speech
• Sensory receptors in the oral cavity let you know where the bolus is

Transition from the oral phase to the pharyngeal phase

• Soft palate lifts to close off the nasopharynx from the oropharynx
– What would you see if this seal was not formed?
• Pharyngeal constrictors contract to shorten pharynx
• Posterior part of the tongue moves forwards to enlarge oropharyngeal chamber

Pharyngeal phase
- the passing of the bolus through the pharynx to the oesophagus
- Begins when the bolus enters the pharynx – the swallowing process becomes REFLEXIVE
at this point
- The timing, efficiency and effectiveness of the pharyngeal phase is dependent on the
consistency and size of the bolus
- Involves complex interaction of the tongue, velum, pharyngeal muscles, and larynx

Pharyngeal trigger
• A swallow is triggered by sensory stimulation (sensory feedback sent to the brainstem which
initiates the pharyngeal phase) to the oropharyngeal region
• Swallow trigger sets off a series of events:
– Velar elevation: raising /contraction/ retraction of the soft palate to posterior
pharyngeal wall
– Laryngeal vestibule closure
– Pharyngeal constriction and elevation: pharynx shortens and narrows - pulls the bolus
downwards
– Upper esophageal sphincter opening: bolus is sucked in because of the pressure
change between pharynx and oesophagus

Oral sensation influences the pharyngeal phase of the swallow:

● Small bolus -> late, reduced pharyngeal response (may observe multiple swallows on
your assessment)
● Large bolus -> early, robust pharyngeal response
● Airway protection mechanisms are modified when bolus sizes vary, likely due to oral
sensory information that helps plan swallowing movements
The trigger zone
o Normal for the bolus to fill the valleculae and pyriform sinuses before the swallow is
triggered
o Swallow trigger tends to occur later as we age

Laryngeal vestibule closure (Airway protection)

A number of processes occur to achieve closure of the laryngeal vestibule (period of apnoea):
1. Hyolaryngeal excursion (larynx moves superiorly and anteriorly)
– Mouth must be closed (jaw stable) – acts an anchor point for the hyoid
2. Epiglottic deflection ( to cover laryngeal opening)
3. Arytenoid adduction (forward movement) Closure of true and false vocal folds, and
aryepiglottic folds (aryepiglottic fold “bunching”)

Penetration and aspiration

When any of these processes are impaired, there may be penetration and/or aspiration of the
airway
● PENETRATION = material enters the laryngeal vestibule and stays above the level of the
vocal folds
● ASPIRATION = material enters the laryngeal vestibule and travels below the level of the
vocal folds

Epiglottic deflection
Directs the bolus around the airway. Achieved by:
1. Posterior lingual propulsion of the bolus – pushes the epiglottis into the horizontal plane
2. Hyolaryngeal excursion
3. Pharyngeal contraction also assists to invert the epiglottis into a position near the
arytenoids

Oesophageal phase
· Begins once bolus has passed the cricopharyngeal (upper oesophageal) sphincter
· UOS / UES opening:
o Dependent on upward and outward movement of the larynx
o Lasts about 0.32 – 0.5 seconds
· Bolus the moves through the oesophagus (takes between 8 and 20 seconds), driven by a
peristaltic wave of contraction and passes through LOS / LES into the stomach
Swallowing is complex
• It requires bilateral input from cortical areas, subcortical areas and lower motor neurons
• The pre-oral and oral phases of the swallow is under volitional control
• The pharyngeal phase of the swallow is reflexive (performed without conscious thought and
in response to a stimuli)
• Afferent
- Carries impulses towards to CNS
- Sensory nerves of the PNS
• Efferent
- Carriers nerve impulses away from the CNS
- Motor neurons
Afferent and efferent pathways are opposite direction of neural activity

Cortical brain regions involved in swallowing

Primary somatosensory cortex Regulates and executes movements by

controlling and providing feedback to the
brainstem through the corticobulbar tract that
directly connects the swallow relevant areas in
the primary motor cortex with the brainstem

Primary motor cortex Has direct connections with the motor division
of the cranial nerves via the corticobulbar
tracts

Parieto-temporal cortices (supramarginal Role in swallowing unclear – likely involved in

and angular gyri) sensory-motor integration of afferent, sensory
signals from swallowing musculature and
structures to the cortex and efferent, motor
signals from the cortex to swallowing
musculature and structures

Insular cortex Involved in multiple functions that are directly

or indirectly related to swallowing, such as
taste, touch, somatosensory and motor
 information, language and emotions

Corticobulbar tract
• Messages from the primary motor cortex are received by the cranial nuclei in the brainstem
via corticobulbar motor fibres
• Pyramidal tract
• Upper motor neurons (UMNs):
– Arise from motor cells in precentral cortex
– Synapse at brainstem (medullary pyramids) with motor cranial nerve nuclei (lower
motor neurons; LMNs, which innervate muscles)
• Corticobulbar tract innervates cranial motor nuclei bilaterally (with the exception of lower
facial nuclei CVII and CNXII which are innervated unilaterally)

Lower motor neurons

• Arise from CN nuclei
• Synapse at peripheral muscle

Reflexes
• Involuntary and almost instantaneous
• Occur in response to a stimuli (e.g. bolus entering the pharynx) – Afferent
• REFLEX ARC = a neural pathway that controls a reflex
• Sensory neurones do not pass directly to the brain but synapse at the spinal cord
• Allows for faster reflex actions to occur by activating motor neurons without delay of
routing signal through brain
• Brain still receives sensory input while reflex is occurring

Central pattern generator (CPG)

• CPGs are biological neural circuits which produce rhythmic outputs in the absence of rhythmic
input
• Source of tightly-coupled patterns of neural activity that drive rhythmic motions (Marder,
2001)
• For swallowing, the CPG is located in the pons and medulla oblongata which contains several
motor nuclei and two main groups of interneurons:
Nucleus Tractus Solitarius (NTS) - dorsal
Nucleus Ambiguous (NA) – ventral
Nucleus Tractus Solitarius (NTS)
• Primary sensory nucleus for swallowing
• Located in the dorsal medulla
• Receives direct sensory input from the facial (VII), glossopharyngeal (IX) and vagus (X)
nerves
• Receives indirect sensory input from trigeminal nucleus in the pons, as well as cortical
information from optic and olfactory areas
• Responsible for spatio-temporal organisation of the swallowing motor sequence – sets up the
sequential pattern of neuronal activation that is then transmitted to the nuclei of the PNS

Sensory nuclei

Nucleus ambiguus (NA)

• Motor nucleus for the glossopharyngeal (IX), vagus (X) and spinal accessory (XI) nerves
• Located in ventral medulla
• Directs motor output to the hypoglossal (XII), facial (VII) and trigeminal (V) motor nuclei
• Direct stimulation of the NA does not evoke pharyngeal swallowing – need link with NTS

Motor nuclei
Cough reflex
• Cough = defensive respiratory event in response to stimulus of the airway that begins with
brief inspiration followed by expiration against a closed glottis
• Cough may be triggered in the upper and/or lower respiratory system
• Has afferent and efferent components
• Cough receptors are located in the pharynx, larynx, trachea and lungs
• When the laryngeal vestibule is triggered, impulses travel via the internal laryngeal nerve
(superior laryngeal nerve of CN X) to the medulla – AFFERENT PATHWAY
– Sensory innervation to the subglottis is via the recurrent laryngeal nerve
• Signals then transmitted back from the cortex and medulla to the glottis (via the RLN) and
expiratory muscles – EFFERENT PATHWAY

NEUROSCIENCE - CN
Has 2 divisions
- Central nervous system: brain and spinal cord
- Peripheral nervous system: Further divided into
● Somatic nervous system (voluntary control): cranial (12) and spinal nerves(31)
and associated nerves
● Autonomic/ visceral nervous system: involuntary control
- Parasympathetic - rest and relax - decrease in heart rate
- sympathetic - fight or flight - increase in heart rate and breathing
Peripheral nerves go between the CNS and other parts of the body
- Two types of cells
● Neurons: Transmit information in the form of nerve impulses (NI - electrical and
chemical signal)
● Glial cells: Surround and support neurons
- Myelin is made by:
● Oligodendroglia in CNS
● Schwann cells in PNS
 ● It helps in the transmission of electrical impulses
- A neuron is made up of
● cell body (soma)
● Organelles: plasma membrane, mitochondria, rough endoplasmic reticulum,
smooth endoplasmic reticulum, nucleus, free ribosomes, lysosomes etc
● dendrites (short processes from the cell body ) - grey matter
● Axon (nerve fibre) - single long process covered in myelin sheath - white matter
● Bilipid plasma membrane- a double layer of lipoprotein molecules studded with
globular proteins -
● Neurons are polarized and maintain a negative resting potential
● Na-K pumps keep the concentration of Sodium high outside the cell and
concentration of Potassium high inside the cell -
● Neuron communication
- Electrical communication: highly specialized membranes for transmission
of nerve impulses (action potentials).
- Chemical communication: synapses for cell cell communication
● Types of neurons
- Sensory (afferent)– carry sensory information from the periphery to the
CNS
- Motor (efferent)– excitation causes movement: muscles contract, glands
secrete
- Interneurons– lie within the CNS and process information (majority)
● Morphology of neurons
- Multipolar: huge dendritic tree - motor neurons
- Bipolar: sensory neurons

Types of motor neurons

● Lower motor neurons (in PNS):

- connect the brainstem and spinal cord to
muscle fibers
- bringing the nerve impulses from the
upper motor neurons out to the muscles.
- LMN axon terminates on an effector
(muscle).
- Their axons extend into the PNS
● Upper motor neurons (CNS)
- originate in the motor region of the
cerebral cortex or the brainstem
- carry motor information down to the final
common pathway, that is, any motor
neurons that are not directly responsible
for stimulating the target muscle.
Hierarchical order of complexity of CNS
● Neurons - simplest
● Reflexes (eg: pain)
● Ganglia/Nuclei ( ganglia - PNS, nuclei- CNS)
● Nerves/Tracts (Nerves - PNS, Tracts - CNS)
● Brainstem structures - pons medulla and midbrain
● Diencephalon: thalamus, hypothalamus, interbrain
● Cerebellum -
● Cerebrum - complex

CRANIAL NERVES

Np CN Name Sensory/Motor

I Olfactory S

II Optic S

III Oculomotor M

IV Trochlear M

V Abducens B

VI Trigeminal M

VII Facial B

VIII Vestibulocochlear S

IX Glossopharyngeal B

X Vagus B

XI Accessory M

XIl Hypoglossal M
(USE THE CN DOC)

NEUROANATOMY

Major brain diseases and disorders: CVA, neoplasm

(tumors), demyelination(Multiple sclerosis) ,
degeneration(ALS), motor disorders, deficiency disorders,
bacterial and viral infections (meningitis) epilepsy and psy
disorders
Neurological exams:
- Motor( reflexes, gait, CN exam)
- Sensory (CN - smell, vision, sensation, hearing, balance)
- Higher order functions (lang, cognition, nonverbal)

Cerebral Cortex: outermost layer of the cerebrum which is 1-5 mm thick layer of neurons
- Arranged in 6 well characterized horizontal layers (laminae) of cells
- Layer V - internal pyramidal layer ( CST and CBT tracts reside here). Has huge
dendritic tree

Brodmann Areas :
52 areas that are anatomically similar in L and R hemisphere but functionally different
- FRONTAL
● Area 4: Primary Motor Cortex / strip (pre-central gyrus, anterior to central
fissure) : initiation of voluntary movement
Lesion: apraxia, paresis
● Areas 6 & 8: pre‐motor region (anterior to precentral gyrus) aka: supplementary
motor area or SMA
Axons from motor strip and SMA give rise to the CST and CBT tracts (tracts of voluntary
movement which occurs on side of the body opposite to area of the cortex giving the command
- contralateral innervation)
● Area 44 & 45: Broca's Area (inferior frontal gyrus). Contains motor programs for
speech (larynx, lips, facial muscles) , speech production and motor planning.
This area is adjacent/anterior to the motor strip areas responsible for motor
movements for speech mechanism of tongue, lips, larynx and eyebrows
Damage to Brocas area - diff in articulating words and language production
(execution aphasia)

- PARIETAL: Primary reception area for the senses

● Areas 1,2,3: (post‐central gyrus)– Primary sensory cortex. It is the sensory
counterpart to the motor strip. Proprioception, pain and temperature
● Areas 5,7: (posterior to postcentral gyrus)– Somatosensory association cortex
● Area 39: angular gyrus (close to the visual cortex) Main area for reading and
writing interpretation (visual processing of lang). Damage to this area can result
in a person seeing letters but not understanding - reading deficit
Works alongside Wernicke's area to attach meaning to the visual input

- OCCIPITAL :Site of visual input to the cerebrum (most posterior region of the brain)
● Area 17: Calcarine cortex– Primary visual cortex . damage: visual agnosia
● Areas 18,19: pericalcarine cortical area– Visual association cortex
 - TEMPORAL: primary site of auditory perception
● Areas 41,42: Heschl’s gyrus– Primary auditory cortex: all auditory
information projected here - reception and perception. Damage can cause b/l
deafness
● Area 22: Wernicke’s area– Posterior to Heschl’s gyrus
Key roles in comprehension of written and spoken language
Damage to this area (dominant hemisphere) results in disturbances in spoken
language

Arcuate fasciculus is a white matter tract connecting Broca's area (44 45) and Wernickes (22)
in the dominant hemisphere of the brain

PYRAMIDAL SYSTEM :
- Controls all voluntary movement
- its a efferent descending pathway
- Cell bodies are located in the gray matter of the cerebral cortex but synpase on the LMN
(CST) and spinal nerves (CBT)
- COmpromises of
● CST : movement of the limbs and trunk
● CBT: b/l innervation (except lower part of the face)
- It is a 2 motor neuron system consisting of
● UMN: (in the primary motor cortex) axon extends all the way down from the
cortex to the spinal cord and brainstem. They resides in the precentral gyrus of
the frontal lobe ( motor strip)
 ● LMN:(anterior horn of the spinal
cord) : extends from the spinal cord
(brainstem) to the skeletal muscles
- effector muscles

CORTICOSPINAL TRACT :
- cerebral cortex connects to the spinal
motor neurons and thereby controls the
movement of the torso, upper and lower
limbs
- Pathway : From the motor cortex to lower
motor neurons in the ventral horn of the
spinal cord

- Function: The major function of this

pathway is fine voluntary motor control of the limbs. The pathway also controls voluntary
body posture adjustments.

- CST Pathway: CST axons descend from the cortex, they course through the internal
capsule, the midbrain, and the ventral pons before they reach the ventral surface of the
medulla at the pyramids. They travel ipsilaterally in the pyramids until they reach the
caudal end of the pyramids
- Pyramids are two elongated swellings on the ventral aspect of the medulla, IMP: the
fibers haven't crossed over that the site of the pyramids. The cell bodies of the CST
axons within the pyramids lie within the ipsilateral cerebral cortex
- The majority of CST axons (80%- 90%) decussate at the caudal pole of the pyramids
in the brainstem. and descend contralaterally into the lateral corticospinal tract in the
spinal cord (after pyramidal decussation).
- Lateral CST: (after point of deccastion): controls arms and legs ( cells or origin lie in the
contralateral cerebral cortex) - contralateral
- Anterior CST: Controls trunk and torso ( does not cross over) - contralateral and
ipsilateral

CORTICOBULBAR TRACT:
- control muscles of the face, head and neck
- Composed of UMN of the cranial nerves
- CBT terminates on the motor neurons within the brainstem nuclei
- Axons which form the CBT exit at the appropriate brainstem levels, to synapse with their
lower motor neurons in the cranial nerve nuclei
- Pathway: From the motor cortex to several nuclei in the Pons and medulla oblongata
- Function: Involved in control of facial and jaw musculature, swallowing and tongue
movements.
DAMAGE TO TRACTS
- UMN damage (cerebral cortex to lower end of spinal cord): spastic paralysis and
hypertonia(monoplegia or hemiplegia) on one side of body. This happens as the
inhibitory function is damaged
- UMN don't innervate muscles directly therefore lesions in the UMN do not lead to
atrophy of muscle (CBT AND CST tract neurons)
- LMN damage: flaccid paralysis - decreased tone, strength and reflexes in affected area
- loss of muscle tone. When these neurons die there is atrophy of the muscle

Damage to CST results in a motor deficit - hemiplegia ( same side paralysis) or hemiparesis
(weakness)
- CST damage occurs
● Rostral/ above the pyramidal decussation : results in contralateral motor deficits,
( ie lesion in L CST in internal capsule results in hemiplegia deficits R side of
body)
● Caudal /below the decussation : result in ipsilateral deficits ( ie lesion in RH
results in deficits R side of body) (Lesion in the L lateral CST (below decussation)
results in L hemiplegia )

UMN and LMN

- UMN axons synapse on LMN neurons in
the anterior horn of the spinal cord
- Axons of LMN then exit the spinal cord via
the ventral (anterior) root
- Ventral root then joins the dorsal (posterior)
root to form the spinal nerve, which finally
innervates the skeletal muscle
- LMN neurons connect the brainstem and
spinal cord to muscle fibres, bringing the
nerve impulses from the upper motor
neurons out to the muscles.
- Axon terminates on a muscle

UMN and LMN relationship

- Lesions of CST (UMN) don't destroy motor
neurons that directly innervate muscles (LMN) -
therefore, no death or atrophy of muscle
- LMN (ventral horn of the spinal cord) that directly
innervate muscle - when these neurons die there
is atrophy of the muscle

Clinical examples of damage:

 - Stroke:
● Ischemic : blood supply to the brain is blocked by a thrombosis ( 80%)
● Hemorrhagic: blood vessel ruptures (20%) - aneurysm
- Multiple sclerosis : demyelination of the CNS motor neurons
- TBI - external trauma
- Cerebral palsy

APHASIA
• Broca’s aphasia: expressive aphasia (cant
make the motor plan for speech)
• Wernicke’s aphasia: receptive aphasia (cant
understand)
• Global aphasia
• Conduction Aphasia:: damage to arcuate
fasciculus, can understand written and spoken
language, but difficulty repeating words
• Alexia: • cannot read, but can write
• Word Deafness: corpus callosum affected,
deaf to meaning of heard words

GESCHWIND- WERNICKES : Theory of language

- Listening to a spoken word (blue)

- To read a written word (green)
- To speak a word ( yellow)
- To spell a spoken word (red)
 EXTRAPYRAMIDAL SYSTEM :
- finer more complex and complicated
movements
- Contains the descending spinal tracts
concerned with motor function
- Part of the motor system, required for the
smooth coordination of motor function and
initiation/planning of movement patterns
(but no direct initiation of movements).
- It has multiple point of feedback to adjust
and fine tune movements
- Involves: basal ganglia, small brainstem
nuclei and cerebellum

Basal ganglia (AKA subcortical nuclei)

- Includes caudate, putamen, globus pallidus, subthalamic
nucleus, and substantia nigra
- Striatum = caudate + putamen
- BG is involved in refining the initiation and planning of
movements of muscles and can inhibit unwanted
movement (eg: tennis serve).
- Pyramidal system does the primary initiation of the
movement and then BG supports and coordinates the
various muscles involved to carry out complex ongoing
movement
- It provides feedback to cortex (primary feature of BG)
- Plays an important role in inhibition of unwanted
movements
- Disorders of BG - movement disorders
● Parkinson’s disease: damage to striatum and substantia nigra (midbrain).
Tremors are hallmark, but also akinesia (inability to initiate voluntary movements)
Bradykinesia = slowness of initiation of voluntary movement, usually with
progressive reduction of speed to perform an ongoing motor task (eg. finger tap
on table)
● Huntington’s disease: damage to caudate nucleus and putamen
Chorea (tics) is inability to control limb movement
Dyskinesia: excessive and involuntary limb movements
Cerebellum
- It is involved in monitoring, smoothing modulating and terminating voluntary
movements
- Location: posterior and inferior region of the brain (posterior cranial fossa),
- functionally and anatomically divided into three lobes: anterior lobe, posterior lobe,
flocculonodular lobe
- target neurons in the spinal cord involved in reflexes, locomotion, complex
movements, and postural control
- Coordinates muscle activity, smooths movements and balance fine tunes motor
activity
- Involved in balance and modulation of voluntary movements in terms of trajectory, speed
and force of the moment (eg. Neurological test)
- Many connections to the vestibular system
- Cerebellar tracts are uncrossed : injuries on one side cause diff on the same side of
body (Spinocerebellar, Vestibulospinal, Corticopontocerebellar and
Dentatorubrothalamic )
- Impairments to the cerebellum result in ataxias (loss of full control of body movements)
● Friedrich’s ataxia is a common ataxia seen in SPP. It is a neurodegenerative
disease
- Tumors can also grow in the cerebellum - result in loss of postural control and reduced
coordination of movement. Changes to gait, unsteady and wide

Pyramidal v/s Extrapyramidal

- pyramidal pathways (corticospinal and corticobulbar tracts) innervate motor neurons of
the spinal cord and brainstem
- extrapyramidal system centres around the modulation and regulation (indirect
control) of anterior (ventral) horn cells

CEREBROVASCULAR SYSTEM
- Brain consumes 20% of oxygen transported
- maintains constant circulation, to meet high metabolic requirements of nervous tissue
- Short interruption to supply (seconds) will initiate cellular changes in neurons. Longer
deprivation can have devastating consequences
- Cerebral arteries (cerebrum)
● Anterior cerebral artery - supplies frontal lobe, longitudinal fissure(inside)
● Middle CA: portion of frontal, parietal and temporal lobe (majority of brain). Major
site of ischemic strokes - speech lang and auditory areas affected of dominant
hemisphere is affected
● Posterior CA: occipital lobe and inferior part of temporal lobe and other deep
structures
- Cerebellar arteries (cerebllum)
 - Vascular supply to brain from aorta
● Carotid division: anterior and middle CA
● Vertebral division : Posterior CA and cerebellar arteries
- Vascular lesions
● Obstruction of blood supply is critical
● Ischemic stroke: foreign body within blood vessels (thrombus), can create an
obstruction to blood flow (thrombosis) or becomes an embolus when released
into bloodstream
● haemorrhagic stroke: Aneurysm ballooning of blood vessel (rupture). Aneursyms
are leading cause of hemorrhagic strokes

Neurodiagnostic techniques:
- MRI: Magnetic resonance imaging
● Uses magnetic field and radio waves to create images of the brain
● Magnetic field aligns the water molecules in body
● Radio waves cause aligned particles to produce faint signals
● Signals are used to create cross‐sectional images: like slices in a loaf of bread
● Structural MRI : Provides information on anatomical structure of brain
(diagnostic). There are two kinds
- Standard: major structures
- Tractography: examines the integrity of neural tracts (pathways)- white
matter
● Functional (e.g., FMRI): Provides information on brain activity - used in research
and tracks blood flow to the brain while a function is being performed ( singing)
and records grey matter activation of the brain
- Electroencephalography (EEG)
- Evoked response potentials (ERP)
- CT scans
- PET scans
- Sonography

HEARING
- Essential part of verbal communication
- Impairment to hearing restricts effective communication by affecting the transmission
and/or perception of sound

Auditory system
- Peripheral auditory system (OE, ME , IE) and central auditory pathway
- It has a
● Conductive mechanism : OE and ME
● Sensorineural mechanism : IE + central auditory pathway
 OE ME IE Central Aud P

Anatomy inna + EAC Tympanic membrane + cochlea and auditory nerve

ossicles + Eustachian semicircular
tube canals

Physiology Air vibrations Mechanical vibrations Mechanical Electrochemical

of TM Hydrodynamic
Electrochemical

Role Protection Impedance matching Filtering Information

Amplification Pressure equalization Transduction processing
Localisation Selective stimulation

Temporal Bone : contains organ of hearing and balance, internal carotid vein, internal jugular
being, facial nerve and TMJ
- Squamous: (thinnest part)
- Mastoid (thickest): contains air pockets
- Tympanic : EAC
- Petrous (hardest part) - houses IE, cochclea and
vestibular organ is embedded in it

OUTER EAR:
pinna and external auditory canal
- Pinna
● Comprised of elastic cartilage (support/flexible)
● Covered in skin - keratinised squamous epithelium
● Muscles (vestigial in humans), (sound localisation in animals)
● Pinna convolutions: individual differences have no known function, but act as
complex resonators for high freq sounds
● Tragus of the pinna protects EAM from foreign objects
- EAC
● Protection, amplification and localization of sounds
● It is a curved canal - 2 curves , 2 parts
- Outer 1/3rd: Cartilaginous part runs medially, upwards and posteriorly
(from lateral to medial)
Contains sebaceous (oil, lubricant) and cerumen (wax, antimicrobial)
glands and hair (protection)
It stops particles from entering the canal
- Inner 2/3rd: Bony part runs medially downward and anterior (from lateral
to medial)
No wax glands - wax can blocks the vibrations
It is in the tympanic part of petrous bone
 ● Canal acts like a tunnel: it resonates and amplifies sounds between 2.5‐5 kHz
(within speech range) - selective amplification

- Physiology of OE: localisation and amplification

1. Protection from forign objects
2. Amplification of sounds within speech range
3. Locaisation
- Horizontal plane
● ITD: interaural timing difference: time diff it takes for a sound to enter one ear
and then the other ( it is more in low frequencies)
● ILD (IID): interaural loudness/intensity difference: the loss of intensity from one
ear to the next ( occurs more in high freq as they have shorter waves)
● Brain uses ITD and ILD to localize sound
- Vertical plane (0 to 90degree) : selective amplification of high frequencies. PInna cues
are important. It changes spectral characteristics of a sounds

MIDDLE EAR:
- It is bound by the TM (laterally) and IE (medial;ly)
- Air‐filled cavity
- Contains
● three ossicles: malleus, incus and stapes (connect tympanic membrane to the
oval window )
● Eustachian tube
● Tympanic membrane
- ME functions to transform sound from air to fluid medium.

● Tympanic membrane
- Adult: tympanic membrane makes oblique angle with canal ; Neonates:TM
almost horizontal
- Dimensions : Vertical: 9-10 mm , Area: 70-80 mm2 , Average vibrating surface:
55 mm2
- Two parts :
Pars tensa: 4 layers vibrating surface of TM , attached to long handle of malleus -
(function; to vibrate
Pars flaccida: 2 layers (lacks the radial and circular fiber layers present in the pars
tensa)- thinner (function: equalize pressure)

● ME Ossicles: 3 smallest and hardest bones in the body

- 2 important muscles are attached to the ossicles: •
● Stapedius : facial nerve innervation (attached to stapes)
● Tensor tympani : trigeminal innervation ( attached to TM)
 - Importance of ME
● Sound propagates through air, but cochlea is fluid
filled and the Impedance of cochlear fluids is much
greater than that of air (impedance mismatch)
● ME overcomes this by acting as a mechanical
transformer ( ME impedance matching)
- Area ratio: TM:OW (ow- oval window) = 55:3.2
When there is a larger area (tm) lower pressure is applied for
the same force that acts on a smaller area (OW) at higher
pressure
The pressure increase from TM to OW is around 17
times. This pressure contributes to overcoming the
difference in impedance
- Lever action : due to diff in lengths of malleus and
long process of incus (1.3 : 1)
Uses principle F1 * D1 (tympanum) = F2 * D2
(stapes footplate)

● Eustachian tube
- Connects middle ear with nasopharynx
- Acts to equalize air pressure in the middle ear with
atmospheric pressure on the other side of the tympanic
membrane
- Equalization required for efficient sound transmission to the
cochlea
- Middle Ear Cleft: A 2 cm3 irregularly shaped, air‐filled cavity
in the bone, divided into 3 main spaces
1. Tympanic cavity
2. Mastoid antrum ( surround by mastoid air cells)
3. Eustachian tube
- ET in infants more horizontal, shorter , less cartilage stiffness, muscles less efficient

ET Function:
- 1/3 bony and 2/3 cartilaginous: cartilaginous part is functionally closed at rest, and opens
with swallowing, yawning (equalizing the pressure)
- Tensor veli palatini (innervated by the trigeminal nerve) main muscle responsible for
opening of tube
- Functions
● Ventilation: Pressure equilibrium (e.g. at altitude)
● Clearance: drainage of secretions due to elevation above pharynx
● Protection: prevention of reflux (when vomiting)
ME REFLEXES
- Tensor tympani:
● innervated by the trigeminal nerve (cranial nerve V)
● Contraction of the muscle pulls the malleus in the antero‐medial direction
(‘inward’).
● Attenuates chewing sounds : so its not passed to cochlea
- Stapedius: (afferent)
● innervated by the facial nerve (cranial nerve VII)
● Contraction of the muscle pulls the stapes posteriorly (‘sideways’)- away from
cochlea
● Reduces low loud frequency middle ear gain - reduces vibration passed to
cochlea

Acoustic reflexes:
- Mainly involves stapedius (in
humans) – unilateral stimulation
results in bilateral contraction
- Activated by loud sounds (> ~ 80 dB
SPL) - no protection against loud
sounds like gunshots. Tensor
tympani does not contract
- Activated prior to vocalization (soft
or loud); tensor tympani also
contracts (cf. birds)
- Contraction results in increased
stiffness, thus increases impedance
most for low frequencies
- Attenuates low frequency inputs by
15‐20 dB SPL (or more)
- Offers some protection against loud sounds, but not transient loud sounds (not firearms)

INNER EAR
● 2 parts :
- Cochlea: the organ of hearing
- Vestibular system: organs of motion and gravity - balance
● Mechanical energy is converted into electrical energy by the movement of hair cells
(stereocilia) - both movement and balance
● Cochlear innervation : 8th CN

Cochlea : snail shape

- Consists of Organ of corti (organ for hearing)
- It has three compartments
 ● Scala media ―filled with a endolymph fluid
Scala vestibuli —filled with perilymph fluid
Scala tympani —filled with perilymph fluid

Membranous labyrinth (internal) Bony/ osseous labyrinth (external)

Scala media ( contains hair cells) Scala vestibuli and Scala tympani - helicotrema
point where both join

Endolymph - from the endolymphatic sac Perilymph : via the cochlear aqueduct from CSF
via the endolymphatic duct of brain - extracellular fluid

K >> Na Na >> K
This different composition of cochlear fluids is essential for driving potentials with the aud
system to convert mechanical signal into electrical signal (cochlear battery)

- Membranes of the cochlea

● Reissner's membrane: separates scala
media (E) from scala vestibuli (P)
● Basilar membrane: organ of corti sits on
top of this membrane. It separated
scale media (E) from scala tympani (P)
● Tectorial membrane: sits on top of the
hair cells and keeps the OHC
embedded into the membrane when the
OoC vibrates ( between organ of corti
and scala media)

Note: Stapes footplate fused to oval window of

cochlea. The round window vibrates in the opposite
direction of the OW (if OW vib IN then RW vibrates OUT) - this is needed to create a travelling
wave inside the cochlea
This traveling waves travel and peaks at diff frequencies : high fre ( base of cochlea) and low
freq (apex of cochlea)

BASILAR MEMBRANE MECHANICAL PROPERTIES (BM)

- BM is displaced by variable sound frequencies
- Organ of coti sits on top of it
- Mechanical properties of the BM contribute to the variable resonance
1. Variable width: narrow at the base and wider at the apex of cochlea
 2. Variable tensile properties: it it very tight at
the base and looser/floppier at the apex
3. Variable weight/ OHC length / flexibility :
the base is very light while the apex is much
heavier. The OHC are shorter in the base
than apex which contributes to the weight at
the apex

Therefore
- Base (high freq) : very tight, lighter in weight,
narrower at base
- Apex (low freq) : looser/floppier, heavier in weight
and wider at apex

BM is tonotopically organized - stimulated at regions of maximal displacement

- It separates incoming acoustic waves based on the frequency of
sounds
- High freq - stimulate cochlear at the base and low freq - at the apex

IHC - transducers OHC- motors

1 row of IHC 3 rows of OHC

Pear shaped Conical structure

IHC are the same length in the base SHorter (lighter) in the base and longer (heavier) in the
and apex apex

Prestin: motor protein in the lateral parts of the OHC

SHEARING FORCE OF BM /: to open the channels

- The basilar membrane displacement has effect on HC
- Anatomically the tectorial membrane is more medial and the
BM is more lateral
- Offset attachment points of the 2 membranes (they are not
aligned) results in a shearing force
 - 2nd pic: HC are bent outwards as the shearing force is outwards. BM is displaced
upwards
- 3rd pic: when the BM is displaced downwards the shearing force is towards the middle
of the cochlear and the hair cells are bent inwards
- If they BM and tectorial membrane were aligned (i.e were not offset) the hair cells would
vibrate upwards and downwards - this would not open any channels for ions

Hair cells are graded receptors

- As HC are stretched laterally channels opens and there is entry of ions into the cell
(depolarises cells) - more firing of nerves
- As the HC are deflected medially the channels close, less ions enter - cell is
hyperpolarized - less firing of nerve
Tip links: tiny channels which open (lateral deflection) and ions enter (increases action potential
freq in the associated sensory neuron). Located on the tips of the stereocilia.

IHC are the transducers - IMP

- ICH - mechanoelectrical transducers
- Mechanical vibration is converted into electrical energy by the inner hair cells:
- They give the brain information about the frequency and amplitude/loudness of sounds

OHC - motors
- Provide the system with sensitivity
- They are the amplifiers of the signal
- They contract at the region of maximal displacement to cause additional input

Cochlear amplifier: amplifies sound - improves clarity of hearing

The input from the IHC is sent to the Primary auditory cortex via the
auditory pathway

AUDITORY CORTEX (Area 41 and 42)

- Central auditory pathway terminates in the primary auditory cortex
- Receives input from crossed and uncrossed fibers from both ears
- Retains cochlear tonotopic representation (image)
- Essential for speech perception (nb. adjacent to Wernicke’s area,
for language comprehension)
- Major input is from opposite ear, but still receives input from
ipsilateral ear
- Cortex is plastic and subject to change with experience. (use it or
lose it)
- The cortex reorganizes itself (if a particular freq is lost - freq on either side have more
neurons picking up these freq)
CENTRAL AUDITORY PATHWAY:
afferent ascending pathway
Cochlear - intensity, frequency and timing of
sounds
- Tonotopic organization through the
pathway ( inferior colliculus, primary aud
cortex)

Major divisions of the CAP

- Brainstem: Superior olivary complex
and cochlear nucleus - here there is
emergence of parallel pathways and
binaural processing
- Midbrain: inferiors colliculus and lateral
lemniscus - reintegration of the auditory
image
- Forebrain: medial geniculate nucleus and auditory cortex - integration with other
modalities ( consciousness)

ABR origins of the wave - Auditory brainstem responses

● I and II : 8th CN ( I - distal II - proximal)
● III: cochlear nucleus
● IV: soc
● V : inferior colliculus (or it lateral lemniscus)
● VI - VII: inferior colliculus

Auditory cortical evoked potentials (ACEP) - objective measure

- Can measure electrical activity in response to incoming signals to the cortex

Cochlear implant: electrode array with tonotopic organization of frequencies

TYPES OF HEARING LOSS

Conductive HL
- Affects OE and ME damage (ossicles) - peripheral/ conductive system damaged
- sound doesnt reach cochlear
 - Treatment: hearing aids
- Caused by :
● Wax
● Eardrum perforations
● Otitis media ( ME infections)
● Deformities ( collapse of EAC/ microtia/anotia)
● Otosclerosis (fusion) / disarticulation of ossicles ( no movement = no
vibration)

Sensorineural hearing loss

- Damage to hair cells or neurons of cochlea (due to loud noise, ageing, genetics,
antibiotics)
- Prevents sound from entering into central auditory system
- Hair cells don't regenerate

Central hearing loss

- Central aud pathway lesion from pons to auditory cortex
- Does not result in complete HL in the opposite ear
- b/l cortical ablation involving Brodmann area 41 and 42 results in profound loss of
auditory discrimination and speech perceptive funtions

Emerging therapies for hearing loss

- improve efficacy of cochlear implants
- Maintain density and integrity of the auditory nerve
- Gene therapy
- Stem cell therapy

Muscles summary sheet;

Face

Muscle Risorius

Origin Posterior region of the face along the fascia of the masseter

Course Forward
 Insertion Orbicularis oris at the corners of the mouth

Innervation Buccal branch of the VII Facial Nerve

Function Retracts lips at the corners

Muscle Buccinator

Origin Pterygomandibular ligament

Course Forward

Insertion Orbicularis oris at the corners of the mouth

Innervation Buccal branch of the VII Facial Nerve

Function Moves food into the grinding surfaces of the molars; constricts oropharynx

Muscle Levator labii superioris

Origin Frontal process of maxilla

Course Down and into the upper lip

Insertion Mid-lateral region of the upper lip

Innervation Buccal branches of the VII Facial nerve

Function Elevates the upper lip

Muscle Levator labii superioris alaequae nasi

Origin Frontal process of maxilla

Course Vertically along the lateral margin of the nose

Insertion Mid-lateral region of the upper lip

Innervation Buccal branches of the VII facial nerve

Function Elevates the upper lip

Muscle Levator anguli oris

Origin Canine fossa of maxilla

Course Down

Insertion Corners of upper and lower lips

Innervation Superior buccal branches of VII facial nerve

Function Draws corner of mouth up and medially

Muscle Zygomatic major

Origin Lateral to the zygomatic minor on zygomatic bone

Course Obliquely down

Insertion Corner of the orbicularis oris

Innervation Buccal branches of the VII fracial nerve

Function Elevates and retracts the angle of the mouth

Muscle Zygomatic minor

Origin Facial surface of the zygomatic bone

Course Downward

Insertion Mid-lateral region of the upper lip

Innervation Buccal branches of the VII Facial nerve

Function Elevates the upper lip

Muscle Depressor labii inferioris

Origin Mandible at the oblique line

Course Up and into the lower lip

Insertion Lower lip

Innervation Mandibular marginal branch of the VII facial nerve

Function Dilates the orifice by pulling the lips don and out

Muscle Depressor anguli oris

Origin Lateral margins of the mandible on the oblique line

Course Fanlike upward

Insertion Orbicularis oris and upper lip corner

Innervation Mandibular branch of the VII facial nerve

Function Depresses corners of mouth and helps compress the upper lip against the lower lip

Muscle Mentalis

Origin Region of the incisive fossa of mandible

Course Down

Insertion Skin of the chin below

Innervation Mandibular marginal branch of the VII Facial nerve

Function Elevates and wrinkles the chin and pulls lower lip out

Muscle Platysma

Origin Fascia overlaying pectoralis major and deltoid

Course Up

Insertion Corner of the mouth, region below symphysis menti, lower margin of mandible. And skin
near masseter

Innervation Cervical branch of the VII facial nerve

 Function Depresses the mandible.

Tongue
Intrinsic tongue muscles:

Muscle Superior longitudinal

Origin Fibrous submucous layer near the epiglottis, the hyoid, and the median fibrous septum

Course Fans forward and outward

Insertion Lateral margins of the tongue and region of apex

Innervation XII hypoglossal nerve

Function Elevates, assists in retraction, or deviates the tip of the tongue

Muscle Inferior longitudinal

Origin Root of the tongue and corpus hyoid

Course Forward

Insertion Apex of the tongue

Innervation XII hypoglossal nerve

Function Pulls tip of the tongue downward, assists in retraction, and deviates the tongue
 Muscle Transverse muscles of the tongue

Origin Median fibrous septum

Course Laterally

Insertion Side of the tongue in the submucous tissue

Innervation XII hypoglossal nerve

Function Provides a mechanism for narrowing the tongue

Muscle Vertical muscles of the tongue

Origin Base of the tongue

Course Vertically

Insertion Membranous cover

Innervation XII hypoglossal nerve

Function Pulls the tongue down into the floor of the mouth

Extrinsic tongue muscles:

Muscle Genioglossus

Origin Inner mandibular surface at the symphysis

Course Fans up, back, and forward

Insertion Tip and dorsum of tongue and corpus hyoid

Innervation XII hypoglossal nerve

Function Anterior fibres retract the tongue; posterior fibres protrude the tongue; together, anterior
and posterior fibres depress the tongue.

Muscle Hyoglossus

Origin Length of greater cornu and lateral body of hyoid

Course Upward

Insertion Sides of the tongue between styloglossus and inferior longitudinal muscles

Innervation XII hypoglossal nerve

Function Pulls sides of the tongue down

Muscle Styloglossus

Origin Anterolateral margin of styloid process

Course Forward and down

Insertion Inferior sides of the tongue

Innervation XII hypoglossal nerve

Function Draws the tongue back and up

Muscle Chondroglossus
Origin Lesser cornu hyoid

Course Up

Insertion Interdigitates with intrinsic muscles of the tongue medial to the point of insertion of
hyoglossus

Innervation XII hypoglossal nerve

Function Depresses the tongue

Muscle Palatoglossus

Origin Anterolateral palatal aponeurosis

Course Down

Insertion Sides of posterior tongue

Innervation Pharyngeal plexus from the XI accessory and X vagus nerves

Function Elevates the tongue or depresses the soft palate

Muscles of mastication:

Muscle Masseter

Origin Zygomatic arch

Course Down

Insertion Ramus of the mandible and coronoid process

Innervation Anterior trunk of mandibular nerve arising from the V trigeminal nerve
Function Elevates the mandible

Muscle Temporalis

Origin Temporal fossa or temporal and parietal bones

Course Converging downward and forward through the zygomatic arch

Insertion Coronoid process and ramus

Innervation Temporal branches arising from the mandibular nerve of V trigeminal

Function Elevates the mandible and draws it back if protruded

Muscle Medial pterygoid

Origin Medial pterygoid plate and fossa

Course Down and back

Insertion Mandibular ramus

Innervation Mandibular division of the V trigeminal nerve

Function Elevates the mandible

Muscle Lateral pterygoid

Origin Lateral pterygoid plate and the greater wing of sphenoid

Course Back

Insertion Pterygoid fovea of the mandible

Innervation Mandibular branch of the V trigeminal nerve

Function Protrudes the mandible

Muscle Digastricus anterior

Origin Inner surface of the mandible at digastricus fossa, near the symphysis

Course Medially and down

Insertion Intermediate tendon to juncture of hyoid corpus and greater cornu

Innervation Mandibular branch of V trigeminal nerve via the mylohyoid ranch of the inferior alveolar
nerve

Function Pulls the hyoid forward; depresses the mandible if in conjunction with digastricus
posterior.

Muscle Digastricus posterior

Origin Mastoid process of temporal bone

Course Medially and down

Insertion Intermediate tendon to juncture of hyoid corpus and greater cornu

Innervation Digastric branch of the VII facial nerve

Function Pulls the hyoid back; depresses mandible if in conjunction with anterior digastricus

Muscle Mylohyoid

Origin Mylohyoid line, inner mandible

Course Back and down

Insertion Median fibrous raphe and inferiorly to hyoid

Innervation Alveolar nerve, arising from the V trigeminal nerve, mandibular branch

Function Depresses the mandible

Muscle Geniohyoid

Origin Mental spines of the mandible

Course Medially

Insertion Corpus hyoid

Innervation XII hypoglossal nerve and spinal C1 neve

Function Depresses the mandible.

Muscles of the Velum

Muscle Levator veli palatini

Origin Apex of petrous portion of temporal bone and medial wall of the auditory tube cartilage

Course Down and forward

Insertion Palatal aponeurosis of the soft palate, lateral to musculus uvulae

Innervation Pharyngeal plexus from the XI accessory and X vagus nerves

Function Elevates and retracts the posterior velum

Muscle Musculus uvulae

Origin Posterior nasal spines of the palatine bones and palatal aponeurosis

Course Runs the length of the soft palate

Insertion Mucous membrane cover of the velum

Innervation Pharyngeal plexus of XI accessory and X vagus nerves

Function Shortens the soft palate.

Muscle Tensor veli palatini

Origin Scaphoid fossa of sphenoid, sphenoid spine, and lateral auditory tube wall

Course Course down, terminates in tendon that passes around pterygoid hamulus, then is
directed medially

Insertion Palatal aponeurosis

Innervation Mandibular nerve of V trigeminal

Function Dilates the auditory tube

Muscle Palatoglossus

Origin Anterolateral palatal aponeurosis

Course Down

Insertion Sides of posterior tongue

Innervation Pharyngeal plexus from the XI accessory nerve and X vagus nerve

Function Elevates the tongue or depresses the soft palate.

Muscle Palatopharyngeus

Origin Anterior hard palate and midline of the soft palate

Course Laterally and down

Insertion Posterior margin of the thyroid cartilage

Innervation Pharyngeal plexus from XI accessory nerve and pharyngeal branch of X vagus nerve

Function Narrows the pharynx; lowers the soft palate

Muscles of the pharynx

Muscle Superior pharyngeal constrictor

Origin Pterygomandibular raphe

Course Posteriorly

Insertion Median raphe of pharyngeal aponeurosis

Innervation X vagus, pharyngeal branch and IX glossopharyngeal nerve, pharyngeal branch

Function Pulls pharyngeal wall forward; constricts pharyngeal diameter.

Muscle Middle pharyngeal constrictor

Origin Horns of the hyoid and stylohyoid ligament

Course Up and Back

Insertion Median pharyngeal raphe

Innervation X vagus, pharyngeal branch and IX glossopharyngeal nerve, pharyngeal branch

Function Narrows diameter of the pharynx

Muscle Cricopharyngeus muscle

Origin Cricoid cartilage

Course Back

Insertion Orifice of the esophagus

Innervation X vagus, pharyngeal branch and IX glossopharyngeal nerve, pharyngeal branch

Function Constricts superior orifice of esophagus

Muscle Inferior pharyngeal constrictor

Origin Oblique line of thyroid lamina

Course Up and back

Insertion Median pharyngeal raphe

Innervation X vagus nerve, pharyngeal branch and IX glossopharyngeal nerve, pharyngeal branch

Function Reduces the diameter of the lower pharynx

Muscle Salpingopharyngeus

Origin Lower margin of the auditory tube

Course Down

Insertion Converges with the palatopharyngeus muscle

Innervation X vagus and XI spinal accessory nerve via the pharyngeal plexus

Function Elevates the lateral pharyngeal wall

Muscle Stylopharyngeus

Origin Styloid process

 Course Down

Insertion Into pharyngeal constrictors and posterior thyroid cartilage

Innervation Muscular branch of IX glossopharyngeal nerve

Function Elevates and opens the pharynx.

Muscles of the larynx

Intrinsic muscles of the larynx

Muscle Lateral cricoarytenoid

Origin Superior-lateral surface of the cricoid cartilage

Course Up and back

Insertion Muscular process of the arytenoids

Innervation X Vagus, recurrent laryngeal nerve

Function Adducts vocal folds, increases medial compression

Muscle Transverse arytenoid

Origin Lateral margin of posterior arytenoids

Course Laterally

Insertion Lateral margin of posterior surface, opposite arytenoids

Innervation X vagus, recurrent laryngeal nerve

Function Adducts vocal folds

Muscle Oblique arytenoids

Origin Posterior base of the muscular processes

Course Obliquely up

Insertion Apex of the opposite arytenoids

Innervation X vagus, recurrent laryngeal nerve

Function Pulls the apex medially.

Muscle Posterior cricoarytenoid

Origin Posterior cricoid lamina

Course Superiorly

Insertion Posterior aspect of the arytenoids

Innervation X vagus, recurrent laryngeal nerve

Function Rocks arytenoid cartilage laterally; abducts vocal folds

Muscle Cricothyroid

Origin Cricoid cartilage

Course Upwards

Insertion Thyroid lamina

Innervation X vagus, external branch of superior laryngeal nerve

Function Depresses thyroid relative to cricoid; tenses vocal folds

Muscle Thyrovocalis (medial thyroarytenoid)

Origin Inner surface, thyroid cartilage near notch

Course Back

Insertion Lateral surface of the arytenoid vocal process

Innervation X vagus, recurrent laryngeal nerve

Function Tenses vocal folds.

Muscle Thyromuscularis (lateral thyroarytenoid)

Origin Inner surface of thyroid cartilage near the notch

Course Back

Insertion Base and muscular process of arytenoid cartilage

Innervation X vagus, recurrent laryngeal nerve

Function Relaxes vocal folds

MCT

MCT1: Skull,s Ms of face, mastication and tongue

1. For the muscles of mastication, which of the following statements is TRUE?

-The temporalis muscle depresses the mandible
2. For the anatomy of the tongue, which of the following statements are TRUE?
There are four extrinsic muscles of the tongue which include the styloglossus, hyoglossus,
genioglossus and palatoglossus
The base of the tongue is located posteriorly in the oropharynx
3. For the mandible bone, which of the following are TRUE?
There are mental and mandibular foramina for the passage of nerves and blood vessels
Mandibular movement is facilitated via a specialised joint known as the temporomandibular
joint (TMJ)
4. Which of the following is FALSE regarding the anatomy of the maxilla?
The maxillae are fused and together comprise the posterior 3/4 of the hard palate
5. Which of the following is TRUE regarding the anatomy of the maxilla?
The maxilla contains both infraorbital and incisive foramen
The maxilla houses the upper teeth in the alveolar process
The maxilla is a paired facial bone
6. On the anatomy of the sphenoid bone, which of the following are TRUE?
The sphenoid bone contains the medial and lateral pterygoid plates
The sphenoid bone contains anatomical regions termed the greater and lesser wings
7. Which of the following are INCORRECT regarding the temporomandibular joint:
The temporomandibular joint contains an articular disc which is vascularised
The temporomandibular joints connect the mandible to the skull via the coronoid processes
8. Which of the following are CORRECT regarding the temporomandibular joint:
The temporomandibular joint functions via two key mechanisms: a rotational component
and a sliding component
The temporomandibular joint connects the mandible to the skull via the condylar processes

9. For the muscles of facial expression, which of the following are TRUE?

The orbicularis oris provides the sphincter mechanism around the mouth
The buccinator muscle fibres converge toward the modiolus

10. For the muscles of the face and facial expression, which muscle is primarily responsible
for pressing the cheeks against the teeth? Buccinator

11. Consider giving your close friend a big, warm smile. Which of the following TWO paired
muscles would likely be involved in producing a broad smile?
Risorius
Zygomaticus Major

12. Movement of the orbicularis oris depends upon the various actions of a number of
muscular elevators and depressors which radiate away from the orifice in different
directions. Which of the following are depressors of the orbicularis oris?

Depressor anguli oris

Mentalis

13. For the hard palate, which of the following is TRUE?

Three-quarters of the hard palate is derived from the palatine processes of the maxillae

14. For osteology of the skull, which of the following TWO statements are TRUE?

Only two of the human cranial bones are paired

The temporal bone contains a zygomatic process

15. Regarding the muscles of mastication, which of the following statements is INCORRECT?
The temporalis muscle is a mandibular depressor
16. Regarding the muscles of mastication, which of the following statements is CORRECT?
The temporalis muscle is a mandibular elevator
The masseter muscle is a mandibular elevator
The mylohyoid muscle is a mandibular depressor

17. On the anatomy of the tongue, which of the following statements are TRUE?

The tip or apex is an anatomical landmark on the anterior part of the tongue
18. Which of the following muscles are considered to be primary muscles of mastication?

Masseter muscles

Lateral pterygoid muscles

19. Regarding the orbicularis oris, which of the following statements are CORRECT:
The deepest fibres of the orbicularis oris are derived from the incisive and mental slips
Some of the muscle fibres of the buccinator decussate at an anatomical region termed the
modiolus
20. The movement of the tongue is governed by both intrinsic and extrinsic muscles. Which
of the following muscles ARE NOT considered to be extrinsic muscle of the tongue:
Pharyngoglossus
Myloglossus
21. The movement of the tongue is governed by both intrinsic and extrinsic muscles. Which
of the following muscles ARE considered to be extrinsic muscle of the tongue:
Styloglossus
Genioglossus
22. Which of the following is CORRECT regarding the mucosal epithelium lining the oral
cavity:
The oral cavity is lined with stratified squamous epithelium

23. Which of the following are characteristic anatomical features of the tongue:

Median sulcus

Lingual tonsils

Circumvallate and foliate papillae

Foramen caecum

24. The bones of the human cranium articulate with one another via sutures. Which of the
following is CORRECT regarding the sutures of the human cranium?
The sagittal suture separates the left and right parietal bones
MCT2: Pharynx, respiration and larynx
1. On the tracheobronchial tree, which of the following are false
- The visceral pleura lines the surface of the thoracic wall
- The right lung has two lobes, whereas the left lung has three lobes
2. On the tracheobronchial tree, which of the following are TRUE
- The visceral pleura covers the surface of the lungs
- The left lung has two lobes, whereas the right lung has three
3. Which of the following opens the eustachian tube when contracted
- Tensor veli palatini
4. On the major muscles of respiration, which of the following are false
- The major muscles of inspiration are the diaphragm and the internal intercostal
muscles
- The major muscles of expiration are the diaphragm and the external intercostal
muscles
5. On the major muscles of respiration, which of the following are TRUE
- Boyle’s law describes the relationship between pressure and volume of an ideal
gas, in a closed system
- For speech-related function of the respiratory system, approximately 10% is
devoted to inhalation whilst 90% is used for expiration
6. In reference to the innervation of the larynx, which of the following are true:
- The recurrent laryngeal nerve innervates the thyroarytenoid, oblique and
transverse arytenoids
- The cricothyroid muscle is innervated by the superior laryngeal nerve
7. In reference to the innervation of the larynx, which of the following are FALSE
- The right recurrent laryngeal nerve takes a more circuitous path around the aortic
arch in the chest cavity
- The external branch of the superior laryngeal nerve innervates the
cricoarytenoid muscle
8. Which of the following statements are correct regarding the application of Boyle's law to
the physiological mechanisms of inspiration and expiration
- As the diaphragm relaxes, lung volume decreases and intrapulmonary pressure
increases
- As the diaphragm contracts, lung volume increases and intrapulmonary
pressure decreases
9. Which of the following statements are incorrect regarding the application of Boyle's law
to the physiological mechanisms of inspiration and expiration
- As the diaphragm relaxes, lung volume increases and intrapulmonary pressure
decreases
- As the diaphragm contracts, lung volume decreases and intrapulmonary
pressure increases
10. Regarding the anatomical layers of the vocal folds, which of the following statements are
false
- The deeper layers of the vocal folds contain high levels of elastin for flexibility
 - The most superficial layers of the vocal folds contain high levels of collagen for
flexibility
11. Regarding the anatomical layers of the vocal folds, which of the following statements are
TRUE
- The scarcity of vasculature in the superficial layers of the vocal folds results in
their characteristic white appearance
- The bulk or body of the vocal folds comes from the vocalis muscle (part of the
thyroarytenoid muscle
12. The paired spaces formed by the glossoepiglottic folds at the base of the tongue are
called the
- Valleculae
13. On the diseases of the respiratory system, which of the following is FALSE
- Long-term exposure to lung irritants such as air pollution, chemical fumes, or
dust, is the leading cause of COPD
14. On the diseases of the respiratory system, which of the following is TRUE
- Asthma is a common chronic inflammatory disease of the airways characterised
by wheezing, coughing, chest tightness and shortness of breath.
- Some of the common symptoms of COPD are coughing that produces large
amounts of mucus, wheezing, shortness of breath, and chest tightness
- In people with cystic fibrosis, the body produces mucus that is abnormally thick
and sticky , increasing airway resistance.
15. Imagine the larynx as viewed from a posterior aspect. Select from the list below, the
correct order of the laryngeal cartilages from most superior to most inferior:
- Epiglottis, thyroid cartilage, corniculate cartilages, arytenoid cartilages, cricoid
cartilage
16. The nasopharynx extends from the skull base to the level of the:
- Soft palate
17. In reference to the pharyngeal constrictor muscles, which statement is FALSE
- The salpingopharyngeus arises at the eustachian tube cartilage and blends into
the upper pharyngeal constrictor
18. In reference to the pharyngeal constrictor muscles, which statement is TRUE\
- The upper, middle and inferior pharyngeal constrictor muscles curve around to
the midline raphe on the posterior aspect of the pharynx
- The superior pharyngeal constrictor muscle arises from the pterygomandibular
raphe
- The cricopharyngeus is also known as the upper oesophageal sphincter
19. For the neural control of breathing, which of the following is FALSE?
- The apneustic and pneumotaxic centres are situated in the medulla
20. For the neural control of breathing, which of the following is TRUE
- The apneustic centre facilitates and prolongs inspiration during increased oxygen
requirements
- The dorsal and ventral respiratory groups are located in the medulla and
comprise the “rhythmic centre” for breathing
 - The respiratory centres for breathing are located bilaterally in the brainstem
21. On the muscles of the larynx, which of the following are false?
- Contraction of the cricothyroid muscle shortens the vocal cords
- The vocalis muscle comprises the most lateral portion of the thyroarytenoid
muscle
22. Which of the following tonsils are located most inferiorly in the pharynx
- LIngual tonsils
23. The primary function of the levator veli palatini muscle is t
- Raise the soft palate
24. The parotid gland produces:
- Thin, serous secretions which helps to lubricate the bolus
25. On the mucosal wave, which of the following are true?
- The anatomy of the larynx is a natural venturi, which facilitates rapid opening and
closing of the vocal folds (mucosal wave) as a result of pressure changes which
occur as air from the lungs is forced through the venturi with increased velocity
(Bernoulli principle)
- Normal phonation relies, amongst other things, on adduction of the vocal folds
26. Adduction of the vocal folds occurs with the contraction of which muscles
- The lateral cricoarytenoids, transverse interarytenoid and oblique arytenoids
27. On the thyroid cartilage, which of the following is false?
- The superior cornu articulate with the arytenoid cartilages
28. The superior cornu articulate with the arytenoid cartilages
- Lengthening of the vocal ligament
- Increase in vocal pitch

MCT3: Neuroscience, CN and Swallowing

Which of the following is not true in relation to the cough reflex?

Sensory innervation to the subglottis is via the superior laryngeal nerve

Which of the following is true in relation to the cough reflex?

Cough receptors are located in the pharynx, larynx, trachea and lungs
The cough reflex has afferent and efferent components
The reflex involves a brief inspiration followed by expiration against a closed glottis
For the central nervous system, which ONE of the following is false?
There are three paired lobes comprising the cerebrum: frontal, parietal, and temporal lobes
For the central nervous system, which of the following are true?
The human cerebrum has 4 major fissures: central, lateral, longitudinal and parieto-occipital
The human cerebrum has a corrugated surface containing sulci and gyri
The frontal and parietal lobes are separated by the central fissure (or central sulcus)
The trigemimal nerve in a mixed nerve containing sensory and motor
components. Which of the following statements regarding the CN V nerve are
true?
CN V sensory branches are responsible for sensation for most of the face, including pain and
touch
CN V efferent fibres innervate the muscles of mastication

Which of the following statements is incorrect with regard to the cranial nerves?

CNX innervates all of the intrinsic muscles of the larynx, with the exception of the cricothyroid

Which of the following statements are correct with regard to the cranial nerves?

CNIX carries motor fibres to the stylopharyngeus muscle

CNV carries motor information to the muscles of mastication via the V3 mandibular branch

The facial nerve carries taste sensation from the anterior two-thirds of the tongue

Which of the following occur as a result of the triggering of the pharyngeal phase
of the swallow:

Retraction and elevation of the velum

Closure of the vocal folds

Opening of the upper oesophageal sphincter

In relation to the hypoglossal nerve, which of the following statements is false?

CN XII innervates the intrinsic and extrinsic muscles of the tongue except the styloglossus

In relation to the hypoglossal nerve, which of the following statements are true?

A unilateral lesion to CN XII will causes the tongue to deviate toward the side of the lesion

The hypoglossal nerve is an efferent nerve with its nucleus in the medulla

CNXII innervates the genioglossus muscle

Which nucleus receives direct sensory input from the facial (VII),
glossopharyngeal (IX) and vagus (X) nerves?
Nucleus Tractus Solitarius

Regarding CNV, which of the following is false?

It mediates sensation from the head, jaw, face, some of the sinuses and tactile and taste
sensation from the posterior two thirds of the tongue

Regarding CNV, which of the following are true?

The efferent portion of CNV innervates the muscles of mastication

CNV is a large mixed nerve originating in the pons

CNV provides motor innervation to the muscles that control the mandible, the tensor veli palatini
muscle of the velum, and the tensor tympani muscle of the middle ear

Which of the following phases of swallowing are volitional:

Oral phase

On the accessory nerve (CNXI), which of the following is true?

It innervates the trapezius and sternocleidomastoid muscles of the neck

The cranial nerves contain sensory, motor or both sensory and motor nerve
fibres. Which of the following statements is FALSE regarding the cranial nerves?

CN V, VIII, IX and X are mixed nerves with sensory and motor components

The cranial nerves contain sensory, motor or both sensory and motor nerve
fibres. Which of the following statements are TRUE regarding the cranial nerves?

CN V, VII, IX and X are mixed nerves with sensory and motor components

CN I, II and VIII are purely sensory nerves

CN III, IV, VI, XI and XII are purely motor nerves

The innervation of the muscles of facial expression is unusual, because the upper
and lower face are differentially innervated. Which of the following statements
regarding facial innervation is incorrect?
The upper face receives innervation only from the contralateral facial motor cortex

The lower face receives innervation only from the ipsilateral facial motor cortex

The innervation of the muscles of facial expression is unusual, because the upper
and lower face are differentially innervated. Which of the following statements
regarding facial innervation is correct?

The lower face receives innervation only from the contralateral facial motor cortex

The upper face receives motor innervation originating from the left and the right facial motor cortex

Regarding CNIII, which ONE of the following is correct?

CN III mediates movements of the eyeball and constriction and dilation of the pupil

Which cranial nerve is responsible for general and special sensation to the
posterior third of the tongue:

CN IX

In relation to upper and lower motor neurons, which of the following statements
are true?

The lower motor neurons extend axons into the peripheral nervous system

The upper motor neurons originate in the central nervous system

The lower motor neurons extend efferent axons which innervate muscles and/or glands

Which set of muscles propel the bolus through the pharynx during the
pharyngeal stage of the swallow:

Pharyngeal constrictors

On the Vagus nerve (CNX), which of the following statements are true?

The recurrent branch innervates all intrinsic laryngeal musculature except the cricothyroid
muscle
Damage to the pharyngeal branch of the vagus nerve results in deficits in swallowing and a
potential loss of the gag reflex

Regarding the vestibulocochlear nerve, which of the following are correct?

CN VIII contains sensory afferent fibres which are responsible for relaying sound and balance
information to the brain

CN VIII travels into the brainstem alongside CNVII via the internal auditory (or acoustic) meatus

Regarding CN VII, which of the following are false?

CNVII innervates all of the muscles of mastication including those in the cheeks, and lips, as well as
the stapedius muscle of the middle ear

The facial nerve comprises five major branches: temporal, zygomatic, buccal, maxillary, cervical

Regarding CN VII, which of the following are true?

The facial nerve is a mixed nerve which communicates with CN V, VIII, IX and X

The portion of CN VII that innervates the lower part of the face receives contralateral innervation
from the facial motor cortex

A neuron is a specialised cell which forms an integral part of the nervous system.
Which of the following statements correctly describes the characteristics of
neurons?

Neurons are polarised cells which actively maintain a negative resting potential

Neurons communicate with a combination of chemical and electrical signals

Neurons may be myelinated with glial cells including Schwann cells in the PNS and
oligodendrocytes in the CNS
MCT4: Neuroanatomy and Hearing
There are three fluid-filled compartments in the mammalian cochlea, the scala media,
the scala vestibuli and the scala tympani. Which of the following statements are correct
relating to these compartments?
- The basilar membrane separates the scala media from the scala tympani
- Reissner's membrane separates the scala media from the scala vestibuli
Which of the following statements are correct regarding the fluid-filled spaces of the
inner ear?
- The scala tympani contains perilymph, which has a similar composition to cerebrospinal fluid
- The scala media contains endolymph, which has a high potassium concentration and is
positively charged
The majority of cerebrovascular incidents are due to stroke. Which of the following
statements are false regarding stroke?
- The majority of cerebrovascular accidents due to stroke, are caused by hemorrhagic stroke
The majority of cerebrovascular incidents are due to stroke. Which of the following
statements are true regarding stroke?
- An aneurysm is one of the primary causes of hemorrhagic stroke
- In an ischemic stoke, blood supply is occulded from flowing to a particular area (or areas) of
the brain
- The majority of cerebrovascular accidents due to stroke, are caused by ischemic stroke
On upper and lower motor neurons, which of the following are true?
- Corticospinal tract neurons are referred to as upper motor neurons. They reside within the
CNS and they do not innervate muscles directly
- Damage to upper motor neurons typically results in spastic paralysis and increased muscle
tone
Which of the following correctly identifies the two major functions of the eustachian tube:
- Pressure equalisation, clearance of secretions
On Brodmann areas 44/45 and 22, which of the following are false?
- Broca's aphasia is also known as receptive aphasia
- Individuals affected by Broca’s aphasia have difficulty comprehending spoken language, but
can speak clearly without difficulty
On Brodmann areas 44/45 and 22, which of the following are true?
- Broca’s and Wernicke’s areas are interconnected by the long neuronal white matter fibre
tract known as the arcuate fasciculus
- Individuals affected by Broca’s aphasia have difficulty speaking, but can comprehend spoken
language
The major functions of the outer ear are:
- Protection, amplification, localisation
There are a number of Brodmann areas relevant to speech and language perception
and production in the brain, including: the motor strip, Broca's and Wernicke's areas (in
the dominant hemisphere), the auditory cortex, visual cortex, and angular gyrus. Which
of the following list of Brodmann areas correctly includes all of the key areas noted in
the preceding sentence?
- BA4, BA22, BA41/42, BA44/45, BA17, BA39
Regarding the hair cells of the inner ear, which of the following statements are false?
- There are three rows of outer hair cells, which are located more medially in the organ of Corti
- There is one row of inner hair cells which are located more laterally in the organ of Corti
Regarding the hair cells of the inner ear, which of the following statements are true?
- There is one row of inner hair cells which is located more medially in the organ of Corti
- There are three rows of outer hair cells which are located more laterally in the organ of Corti
On vascularisation of the brain, which of the following is true?
- The cerebrum is supplied by three major arteries, the anterior, middle and posterior cerebral
arteries
There are a number of neurodiagnostic techniques used in the clinic and research to
examine the structure and function of the brain. Which of the following statements are
true regarding neurodiagnostic techniques?
- Additional neurodiagnostic techniques include, EEG, CT scans and PET scans
- Fibre tractography is a type of structural MRI used for investigating the white matter fibre
tracts of the brain
- Structural MRI provides information on the anatomical structure of the brain
- Functional MRI provides information on brain activity, measured by increased blood flow to
specific regions
On the corticospinal tract, which of the following are false?
- At the most rostral pole of the pyramids the corticospinal axons decussate
- The cell bodies of the corticospinal neurons project from layer V of the cerebral cortex in
Brodman Area 3 (BA3)
On the corticospinal tract, which of the following are true?
- The cells of origin of the lateral corticospinal tract lie in the contralateral cerebral cortex
- As corticospinal axons descend from the cortex, they course through the internal capsule,
the midbrain, the ventral pons and then to the ventral surface of the medulla
Which part of the temporal bone is the hardest and contains the cochlea?
- Petrous
On the corticobulbar tract, which of the following is correct:
- The corticobulbar tract differs from the corticospinal tract because the upper motor neurons
of the corticobulbar tract terminates in the brainstem/midbrain to activate cranial nerve nuclei
Select which of the following statements are true for the sensory hair cells of the
cochlea:
- The primary role of the outer hair cells of the cochlea, is in sound amplification and fine
frequency tuning
- The primary role of the inner hair cells of the cochlea, is in mechanoelectrical transduction
The sensory receptor cells for hearing (the hair cells) are located on the upper surface
of which membrane?
- Basilar membrane
In relation to upper and lower motor neuron lesions, which of the following are true?
- Damage to the lower motor neurons characteristically results in flaccid paralysis
- Damage to the upper motor neurons characteristically results in spastic paralysis
Regarding the pyramidal motor system, which of the following statements are true?
- The cell bodies of the anterior corticospinal tract axons reside in the ipsilateral motor cortex
(BA4)
- The cell bodies of corticospinal axons within the pyramids (ie before decussation) originate
from the ipsilateral motor cortex (BA4)
The major function of the middle ear is:
- Impedance matching, via the area ratio and lever principal
The variable resonance of the basilar membrane is due to several anatomical features.
Which one of the following is not one of these key features?
- Differences in the length of the inner hair cells from base to apex
The variable resonance of the basilar membrane is due to several anatomical features.
Which of the following are one of these key features?
- Changes in the shape and weight of the organ of Corti from base to apex
- Variable flexibility of the basilar membrane, due to differences in its tensile properties from
base to apex
- Differences in the length of the outer hair cells from base to apex