AA APEX: AIRWAY ANATOMY Flashcards
Adducts VOCAL Cords muscle of the larynx
Lateral Cricoarytenoids
ABDUCTS VOCAL Cords muscle of the larynx
POSTERIOR Cricoarytenoids
Elongates vocal cords
CRICO(T)HYROID
Shorten Vocal cords
Thyroarytenoids
Intrinsic Muscles that tense and relax vocal cords
Cricothyroid - tenses
(T)hyroa(R)ytenoids_ THEY RELAX
Extrinsic Muscles of the Larynx: ELEVATE the larynx ( Style-GENI-MY-THY-Di- STyloP
Extrinsic=Elevate
Stylohoid Geniohyoid Mylohyoid Thyrohyoid Digastic Stylopharyngeus
Extrinsic Muscles of the Larynx: DEPRESSES the larynx (SOS)
Omohyoid
Sternohyoid
Sternothyroid
Closes posterior commissure of the glottis
interarytenoids
Key players of the Laryngospasm reflex
Cricothyroid muscles
What is the ONLY intrinsic laryngeal muscles that receive motor innervation from EXTERNAL branch of the SLN
CRICOTHYROID muscles
RLN course underneath the
Aortic arc before ascends the trachea towards the larynx
What are causes of left RLN injury>
PDA ligation
Left atrial enlargement secondary to mitral stenosis
Aortic Arch Aneurysm
Thoracic tumor
The Superior Laryngal nerve innervates
underside of the epiglottis
Cricothyroid muscles
4 nerves that should come to mind with innervation of the airway
Trigeminal
Glossopharyngeal
SLN (external or internal)
RLN
The SLN branches off the
Vagus nerve just beyond the jugular foremen at the skull base
Where does the SLN divides into internal and external branches
At the level of they hyoid
The internal branch of the SLN penetrates the thyrohyoid membrane between the
Greater cornu of the hyoid bone
The internal branch of the SLN penetrates the _____while the external branch of the SLN penetrates the ________
Thyrohyoid
Cricothyroid
The recurrent laryngeal nerve branches off the
Vagus nerve inside the thorax
The right RLN loops under the ______while the left RLN loops under the
Subclavian artery
Aortic ARCH
After the right RLN and the Left RLN loop under the vascular structure both nerves ascend the
Tracheoesophageal groove to join the larynx
Which nerve is more likely to be injured and why?
The left RLN due to its location in the thorax.
What are the branches of the trigeminal nerve (CN V)
V1: Ophtalmic (anterior ethmoidal)
V2: Maxillary (sphenopalatine)
V3: Mandibular (lingual
V3 mandibular branch is responsible for sensory innervation of the airway of what part
Anterior 2/3 of tongue
Turbinates and septum are innervated by
V2 (maxillary) sphenopalatine
Nares and Anterior 1/3 of nasal septum innervated by
V1 Opthalmic (anterior ethmoidal)
Soft palate innervated by
Glossopharyngeal (CN IX)
Oropharynx innervated by
Glossopharyngeal (CN IX)
Tonsils innervated by
Glossopharyngeal (CN IX)
Posterior 1/3 of tongue innervated by
Glossopharyngeal (CN IX)
Vallecula innervated by
Glossopharyngeal (CN IX)
Anterior side of the epiglottis
Glossopharyngeal (CN IX)
The true vocal cords are
Ligaments
WHich innervates structure below the vocal cords?
RLN
Tuning fork for the voice
SLN (external branch)
Injury to the trunk of the superior laryngeal nerve or the external branch causes
hoarseness (Because the vocal cords can’t be tense)
RLN injury can be classified as
Unilateral
acute Bilateral
Unilateral injury of RLN results in _______ Does it cause resp distress?
paralysis of the ipsilateral vocal cords abductors. DOES NOT CAUSE RESP DISTRESS
Bilateral injury of RLN results in _______ Does it cause resp distress?
bilateral paralysis of the ipsilateral vocal cords abductors. Danger because the TENSING action of the Cricothyroid muscles act unopposed. RISK FOR STRIDOR and RESP DISTRESS. Requires intubation or a SURGICAL AIRWAY
Procedure that put patient at risk for RLN injury on the left side
PDA ligation
Left atrial enlargement and mitral stenois
AA Aneurysm
Thoracic tumor
Procedure that put patient at risk for RLN injury on either side (R or L)
External pressure on ET tube Extern pressure on LMA Thryroid and parathyroid surgeires Neck stretching Tumor
What are the 3 key airway blocks
Glossopharyngeal
Superior Laryngeal
Transtracheal
To block the SLN, LA is injected where?
just below the border of the GREATER CORNU of the HYOID BONE.
1 ml is injected outside the thyrohyoid membrane
2ml are injected just beneath the thyrohyoid membrane.
In what block in the needle inserted at the base of the palatoglossal arch (anterior tonsillar pillar) ?
Glossopharyngeal block
You are performing a glossopharyngeal block and you aspirate air, what does that mean?
Needle is too deep
You are performing a glossopharyngeal block and you aspirate BLOOD, what does that mean?
Needle should be withdrawn and redirected medially (Carotid artery is very close)
There is a risk of _________with glossopharyngeal block which will be manifested as ______
Intracarotid injection
Seizure
Superior Laryngeal block : where is the anesthetic injected?
Inferior border of the greater cornu of the hyoid bone
You are performing a Superior Laryngeal block and you aspirate air, what does that mean?
Needle is too deep
Transtracheal block, the needle is advance in a_____as it penetrates the _______membrane
Caudal; cricothyroid membrane
During the transtracheal block, after aspiration and before injection what should the patient do? and what does the practitioner do ?
Take a DEEP BREATH ; During that inspiration part of that deep breath, 3-5ml of LA is injected into the tracheal lumen. The PATIENT will cough , SPRAYING THE LA up through the vocal cords
The adult larynx extends from
C3-C6
Larynx consists of
One bone, ligaments and 9 cartilages (3 paired and 3 unpaired.
What is the only bone in the body that does not articulate with another bone?
HYOID
Form the main support of the larynx and attaches to the thyroid cartilage via the THYROHYOID ligament
Hyoid
Anterior ligaments are the
Thyrohyoid membrane
Cricothyroid membrane
Which ligament attaches the larynx to the hyoid bone
Thyrohyoid membrane
Which ligament attaches the cricoid and thyroid cartilages
Cricothyroid membrane
What is puncture during the cricothyroidotomy ?
Cricothyroid membrane
What are the paired cartilages?
Arytenoid
Cuneiform
Corniculate
What can you not see during direct laryngoscopy ?
Arytenoids
What do the corniculate and cuneiform cartilates do?
provide structure to the aryepiglottic folds.
What cartilages shapes like 3-sided pyramids
Arytenoids
2 conditions that may impair movement of the arytenoids,
RA
SLE
Provides a mechanical barrier between pharynx and the laryngeal opening?
Epiglottis
What is the space between the base of the tongue and the anterior side of the epiglottis
Vallecula
Which ligament connects the epiglottis to the thyroid cartilage>
Thyroepiglottic
Provide structure and protection to the larynx
Thyroid cartilage
What is the largest cartilage in the larynx?
Thyroid
Forms Adam’s appled
Thyroid