Airway (APEX)

Question 1

Laryngeal muscles are classified as __ or ___.

Answer 1

intrinsic or extrinsic

Question 2

Function of intrinsic muscles

Answer 2

participate in phonation and control the vocal cords (tension and position)

Question 3

Function of extrinsic muscles

Answer 3

support the larynx inside the neck and assist with swallowing

Question 4

The vocal cords are ___.

Answer 4

ligaments

they are not innervated

Question 5

Where do the vocal cords attach to?

Answer 5

the vocal cords attach to the thyroid anteriorly and the arytenoids posteriorly

Question 6

How do we remember muscle innervation?

Answer 6

Think “SCAR”

Superior laryngeal nerve = Cricothyroid muscles

All other muscles = Recurrent laryngeal nerve

Question 7

What muscles tense the vocal cords?

Answer 7

Cricothyroid

“Cords Tense”

Question 8

Which muscles relax the vocal cords?

Answer 8

Thyroarytenoid

“They relax”

Question 9

What muscles ABDUCT the vocal cords?

Answer 9

Posterior Cricoarytenoid

“Please Come Apart”

Question 10

What muscles ADDUCT the vocal cords?

Answer 10

Lateral Cricoarytenoid

“Let’s Close Airway”

Question 11

What does ythe superior laryngeal nerve innervate?

Answer 11

The cricothyroid muscle and the underside of the epiglottis

Question 12

Which branch of the SNL (superior laryngeal nerve) is a sensory nerve?

Answer 12

the internal branch

(it innervates the posterior side of the epiglottis to the top side of the vocal folds. It does not have motor function).

Question 13

Which branch of the SNL (superior laryngeal nerve) is a motor nerve?

Answer 13

the external branch

(it innervates the cricothyroid muscle. It does not have sensory function)

Question 14

What are risk factors of RLN (recurrent laryngeal nerve) injury?

Answer 14

External pressure from the ETT or LMA, thyroid or parathyroid surgery, neck stretching, or neoplasm

Question 15

Bilateral injury to the recurrent laryngeal nerve is AKA ___. It presents similarly to ____.

Answer 15

AKA = bilateral paralysis of vocal cord abductors

Presents similarly to laryngospasm

Question 16

What 3 cranial nerves innervate the upper airway?

Answer 16

Vagus

Glossopharyngeal

Trigeminal

Question 17

What do we know about the trigeminal nerve

Answer 17

• Cranial nerve 5
• The primary nerve that provides sensory innervation to the face and head. It divides into 3 branches:
  
  • V1- Opthalamic (anterior ethmoidal). Nares and anterior third of the nasal septum
  • V2- Maxillary (sphenopalatine). Nasal turbinates and septum
  • V3 Mandibular (lingual). Anterior 2/3rds of the tongue.
• Branches V1 and V2 have no motor function
• Branch V3 has motor function of mastication, NOT tongue movement.

Question 18

What do we know about the glossopharyngeal nerve?

Answer 18

• Cranial nerve 9
• gives sensory innervation to the oropharynx and to the anterior side of the epiglottis
• the glossopharyngeal nerve is the afferent limb of the gag reflex. If the patient gags during fiberoptic intubation, then this nerve was not adequately anesthetized
• Provides Sensory function of the soft palate, oropharynx, tonsils, posterior third of the tongue, vallecula, & anterior side of the epiglottis
• Provides motor function of swallowing and phonation

Question 19

What do we know about the vagus nerve?

Answer 19

• Cranial nerve 10
• Innervates the larynx. Divided into the SNL and RLN.