Airway Anatomy Flashcards
exam 2/7
name the mallampati score:
complete visualization of the soft palate
class 1
name the mallampati score:
complete visualization of the uvula
class 2
name the mallampati score:
visualization of only the base of the uvula
class 3
name the mallampati score:
soft palate is NOT visible at all
class 4
name the cormack and lehane grade:
most or full view of the glottic opening
grade 1
name the cormack and lehane grade:
only the posterior portion of the glottic opening can be visualized
grade 2
name the cormack and lehane grade:
only the epiglottis can be visualized, no portion of the glottic opening can be seen
grade 3
name the cormack and lehane grade:
epiglottis can not be seen, only view is of the soft palate
grade 4
at rest, the vocal cords lie in the _____ position with ____
midline position with tone
during respiration, vocal cords _____
abduct (pull apart)
during phonation, vocal cords _____
adduct (pull together)
what structure is The Musculo-membranous cavity
behind the nasal cavities, mouth,
and the larynx that leads to the
esophagus.
pharynx
this structure located in the anterior part of
the neck ANTERIOR TO THE ESOPHAGUS
It lies anterior to the inferior portion of the
pharynx and superior to the trachea.
the larynx
what are the 3 major functions of the larynx?
phonation
respiration
swallowing
the _____ extends from the
laryngeal entrance downwards to the lower
border of the cricoid cartilage where it is
continuous with the trachea
laryngeal cavity
the internal cavity of the larynx may be dividied into 3 parts:
vestibule
ventricle
infraglottic region
the _____ is the portion of the cavity of the larynx above the vocal folds. It
stretches from the free margin of
the epiglottis inferiorly to the lower
margin of the false cords.
the vestibule or the upper compartment
what structure is wide and triangular in shape and contains vestibular folds
the vestibule
the _____ is the space between the vestibular folds and the vocal folds
the ventricle of the larynx
the ____ is the inferior cavity of the larynx that extends from the vocal folds to the inferior border of the cricoid cartilage where it is continuous with the cavity of the trachea
infraglottic cavity
what does the laryngeal skeleton consist of?
the hyoid bone and 9 cartilages
the ____ is U shaped, found at the level of the 3rd cervical vertebra in the adult
and does not articulate with other bony structures
the hyoid bone
what is the hyoid bone made up of?
body
greater cornu (2)
lesser cornu (2)
what is situated just above the thyroid in the anterior wall of the hypopharynx
the hyoid bone
name the unpaired and paired cartilages of the larynx
UNPAIRED:
thyroid, cricoid, epiglottis
PAIRED:
arytenoids (2)
corniculates (2)
cuneiforms (2)
how is the location of the thyroid cartilage described as?
prominent/anterior
what Extends laterally but is not continuous
posterior (does not form a complete ring)
the thyroid cartilage
wht is the other name for the dip of the thyroid cartilage
the superior thyroid notch
the ____ projects anteriorly to from the laryngeal prominence
dip/ superior thyroid notch
the ____ of the dip determines length of the vocal cords and consequent pitch
shape
the cricoid cartilage is an unpaired signet-ring shaped cartilage with:
the narrow band facing anteriorly and the broadened signet portion facing posteriorly
the anterior and lateral borders of the cricoid attach to the ______
cricothyroid muscle
a method of prevewnting regurgitation in an anesthestized patient during endotracheal intubation by applying pressure to the cricoid cartilage
sellick’s maneuver or cricoid pressure
_____ is composed of elastic cartilage (the only one) and separates the Larynx from the Pharynx
the epiglottis
the epiglottis does not ____ and therefore remains felxible throughout life
ossify
The anterior side of the epiglottis is the posterior wall of the pre-epiglottic space
vallecula
____ c o n t a i n s l o o s e a r e o l a r t i s s u e t h a t c o n s i s t s o f a me s h wo r k o f t h i n f i b e r s t h a t i n t e r l a c e i n
all directions, giving the tissue both elasticity and strength
vallecula
the ____ are paired 3 sided pyramidal bodies
arytenoids
lies on the posterior superior margin of the cricoid cartilage
the arytenoids
Small paired, non-functional elastic cartilages on top of arytenoid cartilages
corniculate cartilages
Paired, rod shaped bodies in the
aryepiglottic fold lateral to the
epiglottis.
cuneiform cartilages
The corniculate and cuneiform
cartilages are located within the
______ and provide
support
aryepiglottic folds
Also called the Nasopharyngeal tonsils - in the nasopharynx
pharyngeal tonsil (adenoid)
he tonsil’- in between the anterior & posterior pillars of oropharynx
palatine tonsils
how many tonsils are there?
6
name the mallampati scores for each:
a: 1
B: 2
C: 3
D: 4
name the structures of the glottic opening:
Name the structures of the larynx:
larynx structures:
1: epiglottis
2: hyoid bone
3: thyrohyoid membrane
4: superior cornu of thyroid cartilage
5: cuneiform cartilage (paired)
6: thryoid cartilage lamina
7: corniculate cartilage (paired)
8: arytenoid cartilage (paired)
9: cricothyroid ligament
10: inferior cornu of thyroid cartilage
11: cricoid cartilage
12: trachea
name these structures/ligaments of the larynx
1: hyoid bone
2: lateral thryohyoid ligament
3: superior cornu of thyroid cartilage
4: superior laryngeal nerve and artery
5: oblique line
6: cricothyroid muscle
7: inferior cornu of thyroid cartilage
8: cricothyroid joint
9: trachea
10: cricoid cartilage
11: conus elasticus
12: median cricothyroid ligament
13: thyroid cartilage
14: laryngeal incisure
15: median thyrohyoid ligament
16: thryohyoid membrane
name these extrinsic muscles of the larynx:
1: mastoid process
2: stylohyoid
3: digastric (posterior belly)
4: stylopharyngess
5: thryohyoid
6: oblique line
7:scapula
8: sternum
9: sternothyroid
10: omohyoid
11: sternohyoid
12: genohyoid
13: digastric (anterior belly)
14: styloid process
name these structures of the mouth:
1: hard palate
2: soft palate
3: uvula
4: cheek
5: molars
6: premolars
7: cuspid (canines)
8: incisors
9: oral vestibule
10: inferior labial frenulum
11: gingival
12: opening duct of submandibular gland
13: lingual frenulum
14: tongue
15: palantine tonsil
16: palatopharyngeal arch
17: facues
18: palatoglossal arch
19: gingivae
20: superior labial frenulum
name these structures of the epiglottis:
1: aryepiglottic muscle
2: oblique and transverse arytenoid muscles
3: posterior cricoarytenoid muscle
4: cricothyroid msucle
5L epiglottis
6: thryoepiglottic muscle
7: thryoarytenoid muscle
8: lateral cricoarytenoid muscle
9: hyoid bone
10: cartilago triticca
11: hyothryoid membrane
12: corniculate cartilgage
13:arytenoid
14: posterior crick-arytenoid ligament
15: cricothyroid articulation
name these arytenoid cartilages:
RECAP: name all the cranial nerves and if they are motor or sensory
remember the pneumonics;)
olfactory -sensory
optic-sensory
oculomotor-motor
trochlear- motor
trigeminal-both
abducent- motor
facial- both
vestibulochocler- sensory
glossopharyngeal- both
vagus- both
accesory- motor
hypoglossal0=- motor
name the three branches of the trigeminal nerve:
ophthalmic, maxillar, and mandubular divisions
V1, V2, V3
all the muscles of the pharynx are innvervated by the _____ nerve, except for the stylopharyngeus, which is innervated by the _____ nerve
vagus (CN X)
glossopharyngeal (CN IX)
name the two laryngeal nerves and their branches
superior laryngeal nerve- internal and external branch
recurrent laryngeal nerve- inferior laryngeal branch
of the superior laryngeal nerve, name whether the internal or external branches are motor or sensory
internal branch- sensory
external branch- motor
name these laryngeal nerves:
what nerve pierces the thyrohyoid ligament?
the superior laryngeal nerve (SLN)
what is the principal sensory nerve of the larynx above the vocal cords?
superior laryngeal nerve (internal)
sensory above the cords
what is responsible for inducing the cough reflex when something other than air enters the larynx?
superior laryngeal nerve: internal branch
____ nerve only innervates the cricothyroid muscle and is motor?
superior laryngeal nerve-extrernal branch
the ____ is the only tensor of the vocal cords and helps control vocal pitch
the cricothyroid muscle
what does injury to the external laryngeal nerve (external branch) produce?
paralysis of the cricothryoid muscle
inability of vocal cords to tense causing weakness and huskiness of the voice
the _____ nerve is the continuation of the left and right recurrent laryngeal nerves
the inferior laryngeal nerve
the inferior laryngeal nerve innervates ALL intrinsic muscles of the larynx except:
cricothyroid
the recurrent laryngeal nerves are vulnerable to injury during operations in the neck that include: name a few
thyroidectomy
parathryoidectomy
carotid endarterectomy
cervice spine surgery
cardiac surgeries adn surgeries around aorta
mediastinoscopy
what nerve can be compressed by tumors or other growths anywhere along its path?
the inferior branch of the laryngeal nerve
the inferior branch of the laryngeal nerve can also be injured during endotracheal tube intubation as well as by _______ of the ETT (cuff too high)
misplacement
a transient episode of motor parlysis with little or no sensory or autonomic dysfunction
neuropraxia
injury to the ________ nerve effects the movement of the vocal cords
recurrent laryngeal nerve / inferior branch
what is the most common injury after a subtotal thyroidectomy?
unilateral injury to the recurrent laryngeal nerve
what is characterized by hoarseness and a paralyzed cord that assumes midline position without tone?
unilateral injury to the recurrent laryngeal nerve
name the issues with these cords
what happens when only ONE vocal fold is involved? (3)
breathy (most common sign)
HOARSE
speaker needs to take breaths more often during speech
what can unilateral vocal folds paralysis lead to?
choking, coughin, esp after eating/drinking
water may leak into lungs
a person with no vocal cord paralysis can hold the ““e’ sound for 20 seconds, while someone with one cord paralysis can only hold it for ___ seconds
6-8 seconds
bilateral injury to the recurrent laryngeal nerve results in:
aphonia and paralyzed cords
a TRUE AIRWAY EMERGENCY= intubate stat
defined as a sudden, prolonged, forceful opposition of the vocal cords, and it is believed to be the result of a laryngeal reflex response to noxious stimuli
laryngospams
what are the two nerves involved in laryngospasms?
superior laryngeal nerve and the recurrent laryngeal nerve
the laryngeal reflex arc consists of an AFFERENT limb carried by the stimulated ______ nerve and an EFFERENT limb carried by the ____ nerve
superior laryngeal nerve
recurrent laryngea nerve
name the 3 muscles most involved in laryngospams:
lateral cricoarytenoid muscles
thryoarytnoids muscle
cricothyroid muscles** (primary)
label this diagram:
chest movement but stridorous noise with a mismatch between the patient’s respiratory effort and the small amount of bag movement:
partial laryngospam
chest movement but silent with NO bag movement and NO ventilation
total laryngospams
retractions of trachea or nasal flaring
LOCKED TIGHT no air is moving
name some preoperative risk factors for laryngospasm:
exposure to secondhand smoke
concurrent or recent URI
GERD
mechanical irritants (secretions)
name some intraoperative risk factors for laryngospasm:
excitement phase of inhalation induction
tracheal intubation/extubation during LIGHT anesthesia
upper airway surgical procedures
name some preventative measures for laryngospams:
(sorry theres like 8 so do your best here)
avoid noxious airway/surgical stimulation during LIGHT anesthesia
assure sufficient anesthesia prior to airway instrumentation
topical application of lidocaine to suppress laryngeal sensory nerve activity
IV lidocaine prior to extubation
suction prior to extubation
extubate when fully awake
administer 100% O2 for 3-5 min prior to extubation
name 5 methods of treatment during laryngospams:
administer 100% o2
apply positive pressure to airway
put pressure on the laryngospasm notch
deepen propofol or inhalation agen
give sux IV/IM
what is another name for the laryngospasm notch?
the Larsen’s maneuver
what is a major complication post laryngospam?
negative pressure pulmonary edema
what connets the larynx, hyoid bone, and neighboring anatomic structures?
the extrinsic muscles of the larynx
the primary function is to adjust the position of the trachea during phonation, breathing, and swallowing?
extrinsic muscles of the larynx
name the two extrinsic muscles of the larynx:
the SUPRAhyoids (elevators) and the INFRAhyoids (depressors)
what muscles lifts the larynx during swallowing
moves the epiglottis down to prevent aspiration
the suprahyoid muscle of the larynx
what muscle displaces the larynx down during the inspiratory phase of respiration?
the infrahyoid muscles of the larynx
name the 4 muscles that make up the supra hyoid extrinic muscles:
geniohyoid
mylohyoid
digastric
stylohyoid
name the 3 muscles that make up the infrahyoid extrinsic muscles:
omohyoid
sternohyoid
sternothyroid
label the extrinsic muscles of the larynx:
label this diagram:
what are the 2 major functions of the intrinsic muscles of the larynx?
one set regulates LENGTH (position) and TENSION in the vocal folds
second set opens, closes, and determines size and shape of the glottis
what is it?
the action; contraction affects frequency of vibration of the vocal ligaments resulting in the control of pitch and the fine adjustments required in vocalization
vocalis muscle
it is composed of the fibers of thryoarytenoid muscle closest to the vocal ligaments-
the vocalis
what would be the consequence of damaging the posterior cricoarytenoid muscles?
can’t pull cords apart- risk for instability to breath
what nerve does innervate the cricothyroid muscle?
the superior laryngeal nerve external branch
name 4 common injuries to the vocal cords:
vocal cord paralysis*
contact granuloma
vocal cord hemorrhage
laryngeal cancer
excessive flaccidity of supraglottic larynx, omega shaped epiglottis:
laryngomalacia
fluid filled smooth swelling in the supraglottic larynx:
laryngeal cyst
air filled dilation of saccule in larynx-
laryngocele
laryngeal webbing can be on anterior glottic area - you cannot clearly see the ____ of the vocal cords
length
when the tongue is too large for the mouth it creates marks on the tongue from pressing against the teeth, most likely a difficult airway
crenation
abnormal thickening of cricoid cartilage or fibrous tissue seen below the vocal cords
subglottic stenosis
an abnormal opening between the larynx and the esophagus through which food and liquid can pass through
congenital or injury
laryngeal cleft or laryngotrac heal cleft
this is a tell tale sign of what disease?
Mulberry Molars
Congenital syphilis
what does the cricothyroid muscle do?
tenses and helps control pitch
how much firm pressure do you apply when performing Sellick’s maneuver?
30-40 Newtons,
6-9 pounds OR 3-4kgs
what are the main cranial nerves we care about?
(5 and dime)
Trigeminal and Vagus
When you have procedures of the aorta, left sided chest surgery, invasive procedures, what can be damaged?
vagus nerve- laryngeal nerves AKA airway nerves and reflexes
what are risk factors to laryngospasm?
a. Exposure to secondhand tobacco smoke
b. Concurrent or recent upper respiratory tract infection
c. GERD
d. Mechanical irritants (secretions)
e. Excitement phase of inhalation induction
f. Tracheal intubation/extubation during light anesthesia (Stage II)
g. Upper airway surgical procedures
