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ENT > Anatomy- the Larynx > Flashcards

Anatomy- the Larynx Flashcards

1
Q

what are the functions of the larynx

A 
voice box
sphincter of the respiratory tract:
-regulates airflow 
-protection from aspirated objects 
maintains patency of URT
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2
Q

what is the larynx

A

series of cartilages joined by connective tissue and moved by muscles
found between the pharynx and trachea

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3
Q

what fascia is the larynx in

A

pretrachial fascia

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4
Q

what is in the pretracheal fascia

A 
strap muscles 
thyroid gland 
trachea and larynx 
oesophagus and pharynx 
recurrent laryngeal nerves
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5
Q

what is the function of the strap muscles

A

accessory muscles of breathing - also help in swallowing by positioning the hyoid and larynx

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6
Q

muscles from which pharyngeal arch control the movement of the pharynx

A

6th (vagus)

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7
Q

where is the larynx

A

anterior to laryngopharynx
between carotid sheath structures
between C4-6 level

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8
Q

what level is the crichocartilage at

A

C6

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9
Q

what level is the inferior part of mandible and hyoid bone at

A

C3

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10
Q

where is the laryngopharnx

A

area of pharynx from the epiglottis to the oesophagus

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11
Q

what is the adams apple

A

laryngeal prominence of the thyroid cartilage

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12
Q

what parts of pharynx are used in both breathing and eating

A

oro and laryngopharnx

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13
Q

what reduces the chance of aspiration

A

raising the larynx towards the oesophagus
epiglottis
cough reflex

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14
Q

what aids in the closure of the laryngeal inlet

A

epiglottis moves posteriorly

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15
Q

what bones create the nasal septum

A

ethmoid, vomer, cartilage

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16
Q

is a deviated septum common

A

yes

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17
Q

what is the floor of the nasal cavity

A

palate

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18
Q

what is the roof of the nasal cavity

A

anterior cranial fossa

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19
Q

which wall of nasal cavity has the conchae

A

lateral

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20
Q

what makes up the ‘skeleton’ of the larynx

A

cartilages suspended from the hyoid bone

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21
Q

what articulates with the cricoid cartilage

A

inferior horn of the thyroid cartilage

articulates at cricothyroid joint

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22
Q

which cartilage in larynx is a complete ring

A

only the crichoid- all the rest C shaped

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23
Q

where are the arytenoid cartilages

A

articulate with cricoid cartilage at cricoarytenoid joints

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24
Q

what is ‘cricoid pressure’

A

pressing on the cricoid, the lamina of the cricoid compresses the oesophagus pressing it against C6
closes oesophagus but opens airway
prevents regurgitation/aspiration

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25
Q

what are the three holes of the larynx

A

laryngeal vestibule
laryngeal ventricle
infraglottic cavity

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26
Q

what are the true vocal chords

A

true- vocal process of arytenoid cartilage to thyroid cartilage
their movement impacts sound

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27
Q

what are the vocal chords

A

free borders of mucosa covered connective tissue in the larynx

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28
Q

what are the false vocal chords

A

arytenoid cartilage to epiglottis

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29
Q

what is the conus elasticus

A

ligament between cricoid and vocal ligament (directs air towards the vocal chords)

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30
Q

how many pairs of vocal chords do 1ou have

A

1 true and 1 false

false are above true vocal chords

31
Q

where is the quadrangular membrane

A

between vestibular ligament and epiglottis

32
Q

where is a laryngoscope placed

A

into the vallecula (space between epiglottis and tongue)

33
Q

what is the rima glottidis

A

space between the true vocal chords

34
Q

what is the aryepiglottic fold

A

superior border of quadrangular membrane

35
Q

what causes movement of the vocal chords

A

intrinsic muscles of the larynx
all skeletal
all innervated by CN X

36
Q

what is the result of vocal chord movement

A

tension increases pitch
relaxation decreases pitch
adduction makes voice quieter
abduction makes voice louder

37
Q

what are the tensors of the vocal chords and how do they work

A

cricothyroid muscles
tenses the vocal ligament increasing pitch (high voice)
‘nods’ thyroid cartilage

38
Q

what are the attachments of the cricothyroid muscles

A

anterolateral cricoid cartilage to inferior horn of thyroid cartilage

39
Q

what are the relaxors of the vocal chords and how do they work

A 
thyroarytenoid muscles (a.k.a vocalis muscle)
relaxes vocal ligament decreasing pitch (low voice)
40
Q

what are the attachments of the thyroarytenoid muscles

A

posterior thyroid to anterior arytenoid cartilage

41
Q

what are the adductors of the vocal chords

A

lateral crico-arytenoid muscles
arytenoid muscles

make voice quieter

42
Q

what are the attachments of the lateral crico-arytenoid muscles

A

muscular process of the arytenoid to anterior cricoid cartilage

43
Q

how does the lateral cricoarytenoid muscles work

A

brings vocal ligaments together (uses cricoarytenoid joint at a pivot)

44
Q

how does the arytenoid muscels work

A

brings vocal ligaments together, closes rima glottidis

45
Q

what are the attachments of the arytenoid muscles

A

one arytenoid cartilage to another cricoid cartilage (has an oblique and transverse band)

46
Q

what are the abductors of the vocal chords and how do they work

A

posterior crico-arytenoid muscles
abducts vocal chords
making voice louder by opening rima glottidis

47
Q

what are the attachments of the posterior crico-arytenoid muscles

A

posterior cricoid cartilage to the musclular process of arytenoid cartilage
uses cricoarytenoid joint as a pivot

48
Q

what shape is the rima glottis in normal resting respiration

A

open

laryngeal muscles relaxed

49
Q

what shape is the rima glottis in forced respiration

A

opened wider than resting

posterior crico-arytenoids contract

50
Q

what shape is the rima glottis in phonation

A 
adducted 
arytenoid contract (with help from lateral crico-arytenoid)
51
Q

what shape is the rima glottis in whispering

A

open at cricoarytenoid joints

lateral crico-arytenoids contract)

52
Q

what is supraglottis

A

upper part of larynx inc epiglottis

53
Q

where do supraglottis tumour spread

A

drain to superior deep cervical lymph nodes

54
Q

what are the features of glottic tumours

A

present on cords
95% stay on the cords
present woth voice changes/ airway obstruction

55
Q

where do sub glottic tumours spread

A

paratracheal nodes

present with voice/ airway obstruction

56
Q

describe the expiration needed to speak

A

controlled expiration
contraction of anterolateral abdominal wall and inspiratory intercostal muscles
helps build pressure in resp tree inferior to larynx (subglottal pressure)

57
Q

describe phonation

A

once subglottal pressure threshold is reached then air crosses vocal chords causes vibration (inferior to superior rippling)

58
Q

what is resonance

A

laryngeal buzz is amplified by the pharynx, oral and nasal cavities
(funnel shaped pathway from larynx to mouth)

59
Q

how do you articulate oral sounds

A

Soft palate tenses (CN V3) and elevates (CN X) to close off entrance into nasopharynx
Directs stream of air through oral cavity
Sound interrupted by the tongue (CN XII) and the teeth/lips (CN VII) to produce most vowels and consonants in English language

60
Q

how do you articulate nasal sounds

A

Soft palate tenses (CN V3) and descends (CN X) to close off entrance into oropharynx
Directs stream of air through nasal cavities
Produces one of three sounds: “m”, “n” or “ing” depending on position of tongue (CN XII), teeth and lips (CN VII).

61
Q

what is a post laryngectomy

A

removal of the larynx

62
Q

how can you speak without a larynx

A

tracheo-oesophageal puncture
oesophageal speech (belching)
electolarynx

63
Q

what innervates the intrinsic muscles of the larynx

A

all inferior laryngeal nerve except the cricothyroid which is external laryngeal nerve

64
Q

what is the origin of the inferior laryngeal nerve

A

vagus
(gives off superior laryngeal nerve)
gives off left recurrent laryngeal nerve
this becomes inferior laryngeal nerve at the level of the cricothyroid joint

65
Q

what is the origin of the external layrngeal nerve

A

branches off the superior laryngeal nerve (comes from vagus)

66
Q

what supplies the sensory to the mucosa above the vocal chords

A

internal laryngeal nerve

67
Q

what supplies the mucosa below the folds

A

inferior laryngeal nerve

mucosa above vocal folds= internal, mucosa below= inferior

68
Q

what is berry’s ligament

A

the suspensory ligament of the thyroid gland

69
Q

nerves from where supply sensory and motor supply to the palate, pharynx and larynx

70
Q

how do you clinically test the vagus in the pharynx

A

ask patient to swallow small sip of water
watch larynx move up and down
splutter may suggest an abnormal swallow and/ or cough

71
Q

how do you clinically test the vagus in the larynx

A

listen to the patients voice
hoarse? intrinsic muscles may not be working well

ask patient to cough- normal and powerful?

72
Q

where does the recurrent layrngeal nerve branch of the vagus

A

mediastinum- loops under arotic arch

73
Q

what foramen does the vagus go through

A

the jugular foramen

74
Q

how does the vagus descend in the neck

A

in the carotid sheath

ENT (27 decks)

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