The piriform fossa (pyriform recess) of the laryngopharynx has clinical significance because foreign bodies can lodge here. Which nerve is vulnerable to injury from sharp objects lodged in the piriform fossa?

• A External branch of the superior laryngeal nerve, supplying the cricothyroid muscle
• B Glossopharyngeal nerve at the posterior tonsillar pillar
• C Hypoglossal nerve deep to the hyoglossus muscle
• D Internal branch of the superior laryngeal nerve, lying beneath the mucosa of the piriform fossa ✓

Explanation

The internal branch of the superior laryngeal nerve (providing sensory innervation to the laryngeal mucosa above the vocal cord) pierces the thyrohyoid membrane and lies immediately beneath the mucosa of the lateral wall of the piriform fossa. Foreign bodies lodged in the piriform fossa can injure or anesthetize this nerve. This anatomical relationship is also exploited clinically — topical anesthesia to the piriform fossa anesthetizes the supraglottic larynx for awake intubation. The external branch of the SLN supplies only the cricothyroid muscle (pitch control) and is not related to the piriform fossa.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.