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N928 - Basics of Anesthesia > Airway Anatomy > Flashcards

Airway Anatomy Flashcards

1
Q

components of upper airway

A
  • nose
  • mouth
  • pharynx
  • hypopharynx
  • larynx
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2
Q

components of lower airway

A
  • trachea
  • bronchi
  • bronchioles
  • terminal bronchioles
  • respiratory bronchioles
  • alveoli
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3
Q

two openings of human airway

A

nose and mouth; separated anteriorly but join posteriorly by the pharynx

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4
Q

nose

A
  • one of the openings to the human airway
  • leads to the nasopharynx
  • warms/humidifies inspired gases
  • primary pathway for normal breathing unless obstruction (secretions, tumor, polyps, etc)
  • nasal breathing resistance almost 2x that of mouth breathing
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5
Q

mouth

A
  • leads to oropharynx

- mouth breathing used with HIGH flow rates (like in exercise)

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6
Q

pharynx

A
  • u-shaped fibromuscular structure

- extends from posterior aspect of the nose to the level of the cricoid cartilage

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7
Q

three components of the pharynx

A
  • nasopharynx
  • oropharynx
  • hypopharynx
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8
Q

nasopharynx

A

-lies anterior to C1
-bound superiorly by base of skull and inferiorly by soft palate
-contains nasal septum, turbinates, and adenoids
tonsillar lymphoid structures impede airflow here

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9
Q

oropharynx

A

-lies at the level of C2-C3
-bound superiorly by soft palate and inferiorly by epiglottis
-opens into the mouth anteriorly through the anterior and posterior tonsillar pillars
tongue is a major source of oropharyngeal obstructions due to decreased genioglossus muscle tone (like what happens when you give you anesthetic agents)

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10
Q

hypopharynx

A
  • lies posterior to the larynx and leads to the esophagus
  • bound by superior border of epiglottis and inferior border of cricoid cartilage at C5-C6
  • upper esophageal sphincter lies at lower edge of hypopharynx and acts as a barrier to regurg in conscious patient
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11
Q

Waldeyer’s Tonsillar Ring

A

lymphoid tissue ring in the pharynx that is extremely vascular so at a high risk for bleeding, especially with nasal intubation

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12
Q

Waldeyer’s Tonsillar ring components

A
  • pharyngeal tonsils (aka adenoids) located in nasopharynx
  • palatine tonsils (aka tonsils) located in oropharynx
  • lingual tonsils located at base of tongue
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13
Q

tubal tonsils

A
  • located bilaterally posterior to eustachian tubes at opening of nasopharynx
  • develop from accumulation of lymphoid tissue
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14
Q

larynx

A
  • C3-C6 level in adults
  • C2-C4 in infants and children
  • descents to C4-C5 by age 5
  • organ on phonation and a valve to protect the lower airways
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15
Q

larynx location

A
  • extends from epiglottis to lower level of cricoid cartilage and sits at junction of the airway and the esophagus
  • attached anteriorly by the epiglottis, posteriorly by mucous membrane which extends between arytenoid cartilage and laterally by the aryepiglottic folds (aka false cords)
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16
Q

structure of layrnx

A
  • cartilaginous skeleton held together by ligaments, muscles, cartilages, and one bone (hyoid)
  • house vocal cords, which extend in an anterior posterior plane from thyroid to arytenoid cartilages
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17
Q

nine cartilages of larynx

A
  • epiglottic
  • thyroid
  • cricoid
  • arytenoid (2)
  • cuneiform (2) (lateral)
  • corniculate (2) (middle)
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18
Q

epiglottis

A
  • sits at base of tongue
  • separates hypopharynx from larynx and hangs over laryngeal opening
  • fibrous cartilage with mucous membrane covering that reflects up to the pharyngeal surface of the tongue and makes the glossoepiglottic fold
  • on either side of this fold is the valleculae
  • protects against aspiration by covering glottis when swallowing
  • broad/leaf shaped
  • VASCULAR area (bleeding risk)
  • can be traumatized and swell
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19
Q

arytenoids

A
  • paired cartilages
  • pyramidal
  • posterior
  • cords attach to them
  • most commonly seen paired cartilages on laryngoscopy
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20
Q

vestibular folds

A
  • aka false cords

- narrow bands of fibrous tissue on each side of the larynx that are found first inside the laryngeal cavity opening

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21
Q

vocal cords

A

-pale, white, ligamentous structures that attach to the thyroid anteriorly and the arytenoids posteriorly

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22
Q

glottic opening

A
  • triangular fissure between the vocal cords
  • narrowest portion of an adult airway
  • avg width of 6-9 mm (can be stretched to 12 mm)
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23
Q

thyroid cartilage

A
  • “adam’s apple”
  • anterior neck/thyroid notch
  • largest cartilage of the larynx
  • vocal cords attached anteriorly
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24
Q

cricoid cartilage

A
  • only complete ring cartilage (tracheal rings are NOT complete rings of cartilage)
  • sits at C6
  • narrowest part of the airway in a child (may have trouble passing tube beyond the cords)
  • site for Sellick’s maneuver - compresses esophagus between cricoid cartilage and cervical spine to prevent aspiration
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25
Q

thyrohyoid membrane

A
  • connects thyroid cartilage with the hyoid bone

- internal branch of SLN (superior laryngeal nerve) penetrates the membrane at the level of the cornu of the hyoid

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26
Q

cricothyroid membrane

A
  • relatively avascular (why it is an ideal location for LA injection during awake intubation)
  • translaryngeal injection
  • emergency airway site
  • thyroid cartilage is attached to the cricoid cartilage anteriorly by the cricothyroid membrane
27
Q

trachea

A
  • begins at C6 at inferior border of the cricoid cartilage and extends to carina
  • approximately 10-15 cm in length
  • cricoid - only complete cartilagenous ring of the trachea
  • remainder of trachea composed of 16-20 incomplete rings anteriorly
  • bifurcates to R and L mainstem bronchi at level of T5
28
Q

R bronchus angle

A

25-30 degrees

29
Q

L bronchus angle

A

45 degrees

30
Q

pediatric airway

A
  • larynx positioned higher in neck
  • tongue larger relative to mouth size
  • epiglottis larger, stiffer, angled more posteriorly
  • head and occiput larger relative to body size
  • short neck
  • narrow nares
  • cricoid ring is narrowest region (as opposed to glottic opening)
31
Q

role of airway muscles

A

adduct, abduct, regulate tension, or physically move the larynx

32
Q

what do the intrinsic muscles do?

A

open, close and control tension of the vocal cords

33
Q

what do the extrinsic muscles do?

A

connect larynx with the hyoid bone and other structures and serve to move the larynx as a whole (elevating and depressing) during phonation, swallowing, and breathing

34
Q

what are the intrinsic muscles?

A
  • posterior cricoarytenoid
  • lateral cricoarytenoid
  • arytenoids
  • cricothyroid
  • thyroarytenoid
35
Q

action of posterior cricoarytenoid

A

abducts (opens) the vocal cords an opens the glottis

36
Q

action of lateral cricoarytenoid

A

adducts (closes) the vocal cords

37
Q

action of arytenoids

A

adducts (closes) the vocal cords

38
Q

action of cricothyroid

A
  • produces cord tension, closure, and elongates vocal cords

- can result in total and profound glottic closure called laryngospasm

39
Q

action of thyroarytenoid

A

shortens and relaxes the vocal cords

40
Q

what are the extrinsic muscles?

A
  • sternohyoid
  • sternothyroid
  • thyrohyoid
  • omohyoid
  • stylohyoid
  • mylohyoid
41
Q

action of sternohyoid

A

draws hyoid bone inferiorly

42
Q

action of sternothyroid

A

draw thyroid cartilage caudad

43
Q

action of thyrohyoid

A

draws hyoid bone inferiorly

44
Q

action of omohyoid

A

draws hyoid bone caudad

45
Q

action of stylohyoid

A

elevates larynx

46
Q

action of mylohyoid

A

elevates larynx

47
Q

what innervates anterior septum and lateral walls of nose?

A
  • opthalmic division of trigeminal nerve (CN V)

- specifically anterior ethmoidal nerve

48
Q

what innervates posterior septum of nose?

A
  • maxillary division of trigeminal nerve (CN V)

- specifically nasopalatine nerves and sphenopalatine ganglion

49
Q

SNS stimulation of nose results in…

A

vasoconstriction and shrinkage of nasal tissues

50
Q

PSNS stimulation of nose results in…

A

engorgement of blood vessels and increases likelihood of bleeding with airway manipulation (aka what we see in anesthesia)

51
Q

what innervates tonsils, roof of pharynx, and underside of soft palate?

A

glossopharyngeal nerve (CN IX)

52
Q

what innervates anterior 2/3 of tongue?

A

lingual nerve (mandibular division of trigeminal nerve CN V)

53
Q

what innervates posterior 1/3 of tongue?

A

glossopharyngeal nerve (CN IX)

54
Q

Facial Nerve CN VII

A
  • supplies muscles of facial expression
  • taste to anterior 2/3 tongue
  • small amount of afferent conduction to oropharynx
  • motor control of stylohyoid laryngeal muscle
  • salivary glands (PSNS stim increases saliva production)
55
Q

Hypoglossal Nerve (CN XII)

A
  • provides motor innervation to most muscles of the tongue

- damage to this nerve can relax the tongue, causing it to fall back and obstruct the airway

56
Q

Vagus Nerve (CN X)

A
  • innervates airway below epiglottis
  • separates into superior laryngeal nerve (SLN) and recurrent laryngeal nerve (RLN)
  • these two branches provide innervation for all muscles of the larynx
57
Q

superior laryngeal nerve (SLN)

A
  • 2 branches
  • internal branch (SENSORY SIS) - provides sensation to larynx from epiglottis to vocal folds (sensation ABOVE vocal cords); sensory specifically to lower pharynx, underside of epiglottis, and larynx above the cords
  • external branch (MOTOR SEM)- a motor nerve; motor innervation to cricothyroid muscle (so involved in laryngospasm)
58
Q

recurrent laryngeal nerve (RLN)

A

SENSORY - provides sensation to larynx BELOW vocal cords
MOTOR
-on R, leaves vagus at level of subclavian artery and loops up
-on L, leaves vagus at level of the aortic arch and loops up
-runs in the groove alongside the trachea
-innervates all muscles of the larynx EXCEPT for cricothyroid muscle (innervated by SLN)

59
Q

SLN damage

A
  • unilateral = minimal effects

- bilateral = hoarseness, vocal tiring

60
Q

RLN damage

A
  • unilateral = hoarseness
  • bilateral acute = stridor, respiratory distress from unopposed tension of the circothyroid muscle
  • bilateral chronic = aphonia
61
Q

vagus nerve injury

A
  • affects SLN and RLN

- bilateral vagal denervations produces flaccid, midpositioned cords, resulting in aphonia

62
Q

superior laryngeal artery (SLA)

A
  • blood supply to supraglottic laryngeal structures

- carotid –> superior thyroid artery –> SLA

63
Q

inferior laryngeal artery (ILA)

A
  • blood supply to infraglottic laryngeal structures

- subclavian –> inferior thyroid artery –> ILA

64
Q

venous drainage

A

superior/inferior thyroid veins to SVC

N928 - Basics of Anesthesia (17 decks)

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