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Principles > Airway Anatomy > Flashcards

Airway Anatomy Flashcards

1
Q

Upper airway consists of

A

Nasal cavity
Oral cavity
Pharynx
Laryn

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2
Q

Nasopharynx and oropharynx separated by

A

the soft palate anteriorly & join posteriorly in the pharynx

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3
Q

Oropharynx and laryngopharyx separated by

A

epiglottis anteriorly & join posteriorly

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4
Q

Anterior the the laryngopharynx is

A

the larynx

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5
Q

posterior to the laryngopharynx is

A

the esophagus

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6
Q

Functions of the nose

A

oNasal mucosa warms and humifies inspired air
oProvides almost 2/3 of the resistance to breathing
oPrimary passage for air to enter lungs
oTurbinates (nasal conchae) and the sinuses (surface area) offer humidification and primary filtration

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7
Q

Opening of the nose

A

Vestibule

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8
Q

Turbinates

A

bones projecting from the lateral wall

As air passes through the nose, it meets these, which cause directional changes in the airflow

Overlie the superior, middle, and inferior meatus which contain the openings to the paranasal sinuses

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9
Q

Smallest of the conchae

A

Superior conchae

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10
Q

Most commonly injured during intubation

A

Inferior conchae of nose

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11
Q

What in the nasal mucosa can be exacerbated by general anesthesia

A

Bleeding- nose is highly vascular and anesthesia vasodilates allowing nasal mucosa to become highly engorged

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12
Q

Opening of this is located in the nasopharynx and drains ears into nasopharynx

A

Eustachain tubes

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13
Q

Where is the opening of the Eustachian tubes located

A

Nasopharynx

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14
Q

Posterior border of nasopharynx is superiorly bound by the base of the skull

A

the base of the skull

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15
Q

Posterior to the nasopharynx is

A

body of C1-C2 vertebrae

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16
Q

What separates the nasal passages from the mouth

A

Hard palate (anteriorly) and soft palate (posteriorly)

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17
Q

Covers posterior third to half of the oral cavity and rises during eating to prevent contents from the mouth going into the nose

A

Soft palate

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18
Q

Is the maxilla (hard palate) mobile or stationary

A

Stationary

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19
Q

Is the mandible (jawbone) stationary or mobile?

A

Mobile

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20
Q

Where are the three frenulums

A

Upper and lower lip and the tongue

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21
Q

Pendulous piece of tissue

Extends from the posterior posterior edge of the middle of the soft palate into the oral cavity

If swollen, enlarged, or injured it can be a cause of airway obstruction

A

Uvula

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22
Q

Posterior bilateral border between oral cavity and oropharynx

A

Palatoglossal and palatopharyngeal folds/arch

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23
Q

Which of the arches in the oral cavity is more anterior?

A

Palatoglossal (part of oral cavity)

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24
Q

Which of the arches in the oral cavity is more posterior?

A

Palatopharyngeal arch - part of oropharynx

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25
Q

Walnut shaped and resides between the palatoglossal and palatopharyngeal folds

A

Palantine tonsils

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26
Q

Average number of adult teeth

A

32

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27
Q

U-shaped fibromuscular structure

Extends from base of skull to cricoid cartilage

Party of respiratory and alimentary tract

Consists of 3 compartments

A

Pharynx

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28
Q

Where does the pharynx extend from and to?

A

Starts at base of skull to cricoid cartilage (anteriorly) and level of C6 vertebrae (posteriorly)

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29
Q

Functions of the pahrynx

A

oParticipates in respiration
oSwallowing and protection of larynx during eating
oSpeech

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30
Q

What is Waldeyers Ring

A

Palantine tonsils
Lingual tonsils
Pharyngeal tonsils

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31
Q

Tonsillar fossae – reside in the oropharynx between the arches

These are what removed in a tonsillectomy

A

Palantine tonsils

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32
Q

Tonsils that reside at base of tongue

A

Lingual tonsils

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33
Q

Tonsils that reside in the nasopharynx

A

Pharyngeal tonsils (adenoids)

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34
Q

The most common reason for an unanticipated difficult intubation is usually from a

A

Hypertrophy of lingual tonsils

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35
Q

Boundaries of nasopharynx

A

Anterior to C1

Bound superiorly by the base of the skull and inferiorly by the soft palate

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36
Q

Boundaries of the oropharynx

A

Lies at the C2 to C3 level and is bound superiorly by the soft palate and inferiorly by the epiglottis

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37
Q

Anterolateral walls of the oropharynx

A

paired tonsillar fossae formed by the palatoglossal and palatopharyngeal folds

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38
Q

Epiglottis

A

functionally separates the oropharynx from the laryngopharynx (or hypopharynx)

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39
Q

Hypopharynx (laryngopharynx)

A

 Extends from the tip of the epiglottis to the level of C6

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40
Q

Boundaries of the hypopharynx

A

 Lies posteriorly to the larynx and is bound superior border of the epiglottis and the inferior border of the cricoid cartilage at the C5 to C6 level

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41
Q

Criopharyngeus muscle

A

acts as a barrier to regurgitation in the conscious patient

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42
Q

Superior boundary of the hypopharynx

A

Continuous with the oropharynx

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43
Q

Inferior border of the hypopharynx

A

continuous with the esophagus

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44
Q

Posterior border of hypopharynx

A

Bones C4-C6 of vertebrae

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45
Q

Lateral walls of hypopharynx

A

Middle and inferior constrictor muscles

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46
Q

Larynx extends from…

A

vertebrae C3-C6

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47
Q

Start of larynx and chief support

Only bones that does not form a joint with another

A

Hyoid bone

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48
Q

Lies in anterior neck extending from hyoid bone to level of C6 vertebrae

A

Larynx

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49
Q

The thee unpaired cartilages of the larynx

A

Epiglottis
Thyroid
Cricoid

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50
Q

The 3 paired cartilages of the larynx

A

Arytenoid
Corniculate
Cuneiform

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51
Q

Primary function of the larynx

A

vocalization and artiulation

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52
Q

Reflex of the larynx

A

Cough reflex

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53
Q

Narrowest portion of the airway in adults

A

Rima Glottidis (openign of vocal cords)

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54
Q

Narrowest portion of the airway in children under 10

A

Cricoid cartilage

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55
Q

What connects the thyroid cartialge to the hyoid bone?

A

Thyhyoid membrane

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56
Q

Unpaired cartilage of the larynx that is the largest anteriorly but posteriorly it is open

A

Thyroid cartilage

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57
Q

Inferior to thyroid cartilage

Narrow anteriorly but wider posteriorly and is the only continuous ring of the airway

A

Cricoid cartilage

58
Q

The cricoid cartilage is connected to the thyroid cartialge by the…

A

Cricothyroid ligament

59
Q

Emergency airway is placed here

A

Criocthyroid ligament

60
Q

Where is pressure placed during RSI to prevent aspiration and why

A

The cricoid ligament because it is the only continuous ring of the airway

61
Q

Leaf-like unpaired cartilage of the larynx

A

Epiglottis

62
Q

Demarcation of pharynx to larynx

A

Epiglottis

63
Q

Attaches the epiglottis to the body of the thyroid cartilage anteriorly through the

A

Thyroepiglottic ligament

64
Q

Serves to prevent aspiration; protects from foreign body entry

Covers glottis (opening of the larynx) during swallowing

A

Epiglottis

65
Q

Epiglottis is united to tongue by=

A

median and lateral glossoepiglottic folds

66
Q

The space between the epiglottis and the base of the tongue

A

Superior valeculla

67
Q

When using what type of blade, tip is placed in the superior valeculla

A

Curved laryngoscope (MAC)

68
Q

Formed by the space between the inferior edge of the epiglottis and true vocal cords

A

Inferior valeculla

69
Q

When using what type of blade we go beyond the epiglottis and lift and we end up in the inferior vallecula

A

straight blade (MILLER)

70
Q

The two nodules in the posterior aryepiglottic folds

A

Corniculates and cuneiformd

71
Q

Attach the to apices of the arytenoids and sit superior of each arytenoid

A

Corniculates

72
Q

Of the two nodules seen in posterior ayrepiglottic folds which is more lateral and which is more medial?

A 
Cuneiforms = lateral
Corniculates = medial
73
Q

Opening between cords

In adults this is the NARROWEST part of the airway

A

(Glottis) Rima Glottidis

74
Q

Quadrangular membranes run between lateral sides of epiglottic cartilage and arytenoid cartilages on either side

A

Aryepiglottic folds - connects epiglottis to arytenoids

75
Q

oFolds of mucous membrane over vestibular ligaments superior to vocal folds
oProtective in function

A

Ventricular/Vesetibular folds (false cords)

76
Q

Where do vocal cords attach from

A

From cricoid to the aryteniods

77
Q

Where do foreign object such as fish bones get stuck?

A

Piriform recess

78
Q

Small depressions on either side of laryngeal inlet
Separated from inlet by aryepiglottic folds
Bounded medially by thyroid cartilage and thyrohyoid membrane

A

Piriform recess

79
Q

Extends from above the “false cords” to the tip of the epiglottis

A

Supraepiglottic area (AKA vestibule)

80
Q

Located between the false cords and true cords

A

Laryngeal ventricles

81
Q

Below the true cords

Above the beginning of the trachea

A

Infraglottic region

82
Q

Corresponds to the beginning of the trachea

A

Cricoid cartialge

83
Q

Most inferior of the nine laryngeal cartilages

A

Cricoid cartialge

84
Q

What does the Opthalmic division (V1) (anterior ethmoid nerve) of trigeminal nerve innervate

A

Anterior nose

85
Q

What is V1 of the trigeminal nerve

A

Opthalmic division (anterior ethmoid nerve)

86
Q

What does Maxillary division (V2) (Sphenopalatine nerve) of trigeminal nerve innervate?

A

Posterior nose

87
Q

What is V2 of trigeminal nerve?

A

Maxillary division (sphenopalatine nerve)

88
Q

What does mandibular division (V3) (lingual nerve) of trigeminal nerve innervate?

A

anterior 2/3 of tongue

89
Q

What is V3 of trigeminal nerve?

A

Mandibular division (lingual nerve)

90
Q

•Sympathetic innervation from the superior cervical ganglion

stimulation results in

A

vasoconstriction and shrinkage of the nasal tissue

91
Q

What nerve provides sensory to the superior and inferior surfaces of the hard and soft palate

A

Palantine nerve (division of trigeminal nerve)

92
Q

innervates nasal mucosa to provide sense of smell

A

CN I (olfactory nerve)

93
Q

What nerve innervates the posterior 1/3 of the tongue?

A

CN IX (glossopharyngeal nerve)

94
Q

What nerves provide the sensation of tase?

A

Branches of facial nerve (VII) & Glossopharyngeal nerve (IX)

95
Q

What nerve innervates the roof of the pharynx, tonsils, epiglottis, base of the tongue, and the under surface of the soft palate

A

CN IX (Glossopharyngeal)

96
Q

Afferent sensory pathway that causes gag reflex

A

CN IX (Glossopharyngeal)

97
Q

Efferent motor pathway that causes gag reflex

A

CN X (vagus nerve)

98
Q

For a nerve block if you want to block the gag reflex which nerve do you block?

A

CN IX (glossopharyngeal) afferent sensory

99
Q

Provides sensation to the airway below the epiglottis

A

Vagus nerve (CN X)

100
Q

Branch of vagus nerve that divides into external and internal nerve

A

Superior laryngeal nerve

101
Q

Provides motor function to the cricothyroid muscle of the larynx

A

External (motor) nerve

102
Q

Provides sensory input to the hypopharynx above the vocal cords

A

Internal (senesoy) nerve

103
Q

Which branch branches off earlier for the SLN?

A

The internal branch

104
Q

Branches of the vagus nerve that provides sensory innervation to the subglottic area and the trachea (below the cords)

A

Recurrent laryngeal nerve (RLN)

105
Q

Provides motor function to all the muscles of the larynx except the cricothyroid muscle

A

Motor branch of RLN

106
Q

What nerve provides motor function to the cricothyroid muscle?

A

External branch of the SLN

107
Q

What does the R RLN loop around?

A

Subclavian artery

108
Q

What does the L RLN loop around?

A

Aorta

109
Q

Nerve injury to unilateral vagus nerve can cause?

A

Hoarseness

110
Q

Bilateral injury to vagus nerve can cause

A

Aphonia

111
Q

Unilateral damage to SLN can cause

A

Minimal effects

112
Q

Bilateral damage to SLN can cause

A

hoarseness, tiring of voice

113
Q

Unilateral damage to RLN can cause

A

hoarseness

114
Q

Bilateral acute damage to RLN can cause

A

stridor and respiratory compromise

115
Q

Chronic damage to bilateral RLN can cause

A

aphonia

116
Q

Intrinsic muscles of the larynx control

A

Tension of the vocal cords and the opening and closing of the glottis

117
Q

Function of cricothyroid muscle

A

Tension and elongation of vocal cords to determine pitch

118
Q

Function of the thyroarytenoids and vocalis muscle

A

Relaxes vocal cords

119
Q

Function of the lateral crycoarytenoid, transverse & oblique arytenoid muscles

A

Adduction of vocal ligaments - closure of the cords and glottis

120
Q

Function of the posterior cricoarytenoid muscle

A

Abduction of vocal ligaments - opening of the cords/glottis

121
Q

Closure of the laryngeal inlet is accomplished by which muscles?

A

Aryepiglottic & oblique arytenoid muscles

122
Q

Opening of the laryngeal inlet is accompished by what muscle?

A

Thyroepiglottic muscle

123
Q

Components of a preoperative airway assessment

A
  • Length of upper incisors
  • Relation of maxillary and mandibular incisors during normal jaw closure
  • Relation of maxillary and mandibular incisors during voluntary protrusion (ULBT)
  • Interincisor distance
  • Visibility of uvula (mallampati test)
  • Shape of palate
  • Compliance of mandibular space
  • Thyromental distance
  • ROM of head of neck
  • Length of neck
  • Thickness of neck
124
Q

Non-reassuring findings of airway assessment

A
  • Long length of upper incisors
  • Prominent “overbite” (maxillary incisors anterior to mandibular incisors)
  • Inability to protrude mandibular incisors anterior to maxillary incisors
  • Less than 3cm interincisor distance
  • No visibility of uvula
  • Highly arched or very narrow
  • Stiff, indurated, occupied by mass or non resilient mandibular space
  • Thyromental distance is less than three ordinary finger-breadths
  • Patient cannot touch tip of chin to chest or patient cannot extend neck
  • Neck is short and thick
125
Q

Difficult BMV can be due to

A

MOOANSs

  • Mask seal impeded (beards, airway anatomy, NG tubes)
  • Obstruction of upper or lower airway
  • Obesity of redundant upper airway tissue
  • Age (>55)
  • No teeth (improper seal)
  • Snores or Stiff
126
Q

Difficult laryngoscope and tracheal intubation can be due to

A

LEMONS

  • Look externally
  • Evaluate 3-2-2
  • Mallampati score (class III and IV)
  • Obstruction
  • Obesity
  • Neck mobility
127
Q

What does 3-3-2 measure?

A

3: Interincisor gap
3: Length of mandible
2: Distance between the base of the tongue and the top of the larynx

128
Q

Studied the relationship between the success rate of laryngoscopic intubation and the visibility of the posterior oropharyngeal structures

A

Mallampati Class

129
Q

How to perform Mallampati class

A 
oWith patient sitting upright
oNeck extended vs head neutral
oMouth open as much as possible
oTongue protruded
oAvoiding phonation
130
Q

What mallampati class is uvula, faucial pillars, soft palate visible

A

Class I

131
Q

What mallampati class is faucial pillars, soft palate visible, portion of the uvula

A

Class II

132
Q

What mallampati class is soft and hard palate visible

A

Class III

133
Q

What mallampati class is the hard palate only visible?

A

Class IV

134
Q

Cardinal signs of upper airway obstruction

A

Muffled voice, difficulty swallowing, stridor, thick neck

135
Q

Best position to achieve optimal view during oral laryngoscopy

A

“Sniffing position” - head extension and neck flexion

136
Q

Reasons an extraglottic device may be hard to place

A

RODS

  • Restricted mouth opening (interincisor)
  • Obstruction
  • Distrupted or distorted airway
  • Stiff lungs or cervical spine
137
Q

Scoring given when doing a direct laryngoscopy and looking at laryngeal inlet

A

Cormack-Lahane Laryngeal View Scoring

138
Q

Cormack-Lahane Laryngeal View Scoring grade when visualization of the entire glottic opening

A

Grade I

139
Q

Cormack-Lahane Laryngeal View Scoring with visualizaition of only the posterior aspects of the glottic aperature

A

Grade 2

140
Q

Cormack-Lahane Laryngeal View Scoring with visualization of the tip of the epiglottis (epiglottis only)

A

Grade 3

141
Q

Cormack-Lahane Laryngeal View Scoring with visualization of the soft palate only

A

Grade 4

142
Q

Distance between the mentum and the superior thyroid notch

Greater than 6cm desired

A

Thyromental distance

Principles (4 decks)

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