H&N: Nose & Larynx Flashcards
Which bones in the facial skeleton are more susceptible to fracture?
- Nasal bone due to prominence
- Zygomatic bone
- Mandible
How the pituitary gland be accessed?
Through the nasal cavity through the sphenoid
What is a septal hematoma?
- Cartilaginous part of the septum takes blood supply from the overlying perichondrium
- Trauma to nose can lead to buckling of the septum and shearing of blood vessels
- Blood accumulates between the perichondrium and cartilage
- This leads to less blood supply to cartilage
What is the effect of untreated septal haematoma?
- Avascular necrosis of cartilaginous septum
- Saddling of nasal dorsum
- Can develop infection in the collecting haematoma
- Septal abscess formation further increases likelihood of avascular necrosis of septum
What are nasal polyps?
- Swelling of nasal mucosa
- Usually bilateral
- Pale or yellow in appliance/fleshy and reddened
What are the symptoms of nasal polyps?
- Blocked nose and watery rhinorrhoea
- Post nasal drip
- Decreased smell and reduced taste
- Unilateral polyp +/- blood tinged secretion may suggest tumour
What is rhinitis?
-Inflammation of the nasal mucosal lining
What are symptoms of rhinitis?
- Nasal congestion
- Rhinorrhoea
- Sneezing
- Nasal irritation
- Post nasal drip
What are common causes of rhinitis?
- Acute infective rhinitis (common cold)
- Allergic rhinitis
What is epistaxis?
Nose bleed
-Mucosa and blood vessels easily injured
Which branches does the arterial supply to the nasal cavity arise from?
- Ophthalmic artery
- Maxillary artery
What is formed in the anterior septum?
Arterial anastomoses (Kiesselbach's area) -Most common source of bleeding in epistaxis
What is the relevance of the venous drainage from the nasal cavity?
- Pterygoid venous plexus
- Cavernous sinus
- Facial vein
This means infection can spread intracranially
What arteries supply blood to nasal cavity?
- Anterior ethmoidal
- Posterior ethmoidal
- Sphenopalatine artery
Which type of epistaxis is potentially more serious?
- Bleeding from the sphenopalatine artery
- Potentially more serious and difficult to treat
What are paranasal sinuses?
- Air filled extensions of nasal cavity which are lined by respiratory mucosa
- Helps to humidify and warm inspired air
- Drain into the nasal cavity via mall channels called Ostia into the meatus
What is acute sinusitis?
-Acute inflammation of lining of sinus. Commonly infective and often secondary to viral infection of nasal cavity
What are symptoms of acute sinusitis?
- Non resolving cold or flu like illness
- Pyrexia
- Blocked nose and rhinorrhoea (yellow/green discharge)
- Headache/facial pain
What is the pathophysiology of acute sinusitis?
- Primary infection leads to reduced ciliary function, oedema of nasal mucosa and sinus Ostia and increased nasal secretions
- Drainage from sinus is obstructed
- Stagnant secretion within the sinus become ideal breading ground for bacteria (secondary infection)
- Caused by dental infections and respiratory infections.
How can the cricothyroid membrane be used in an emergency?
-Emergency access to provide patent airway for the patient
What forms the vocal and vestibular ligament?
- Quadrangular membrane forms the vestibular ligament
- Upper free border of cricothyroid ligament-thickened edge forming the vocal ligament
What is found between the vestibular and vocal folds?
Ventricle which leads laterally and upwards into the saccule. Contains mucus glands that keep vocal folds moist
What is the epithelium lining of the larynx?
Pseudo-stratified ciliated columnar epithelium
-Stratified squamous epithelium on the true vocal cord lining
What is the purpose of the laryngeal muscles?
- Closing of the larynx during swallowing to protect the respiratory tract
- Act to open larynx and allow movement of air during inspiration and expiration
- Control movement of vocal cords in phonation and in cough reflex
Which intrinsic muscle isn’t supplied by the recurrent laryngeal nerve of the vagus?
-Cricothyroid muscle which is supplied by external branch of superior laryngeal nerve
What is the position of the vocal cords in deep breathing?
-Widely abducted
What is the position of the vocal cords during phonation?
-Adducted
What leads to hoarseness of voice especially when attempting high pitched sounds?
- Injury to the external branch of superior laryngeal nerve
- Closely related to the superior thyroid artery
What does the recurrent laryngeal nerve supply?
- Sensory to subglottic
- Motor to the intrinsic muscles (except cricothryoid)
What does the superior laryngeal nerve supply?
- Internal branch provides sensory to the supraglottic
- External branch supplies motor to the Cricothyroid
What is the path of the recurrent laryngeal nerve?
- Arises distally
- Loops under the right Subclavian artery on the right
- Loops under the arch of aorta on the left
- Ascends the tracheo-oesophaageal groove
- Close relationship with inferior thyroid arteries supplying thyroid gland
What are the causes of vocal cord palsies?
- Thyroid Surgery causes damage to the nerve due to reaction with he inferior thyroid artery
- Aortic arch aneurysm (LRLN)
- Cancer involving the apex of the lung (RRLN)
- Disease or surgery involving larynx, oesophagus or thyroid
What is the effect of unilateral lesion of the RLN?
- Paralysed vocal cord assumes a paramedian position between fully abducted and fully adducted
- Unilateral palsies may lead to hoarseness of voice and sometimes ineffective cough
- Often the contralateral sides compensates in time
What is the effect of bilateral lesion of the RLN?
- Both vocal cords paralysed and in paramedic position
- Narrow glottis
- Significant airway obstruction. Needs an emergency surgical airway
What are the signs of bilateral vocal cord palsies?
- Cyanosis
- Hypoxia
- Distress
- Raised respiratory rate
- Stridal breathing
- Often more acute and dangerous
What are other conditions affecting the larynx?
- Laryngitis
- Laryngeal nodules
- Laryngeal cancer
- Croup
- Epiglottittis
- Laryngeal oedema
What does the nasal septum consists off?
- Perpendicular plate
- Ethmoid bone
- Septal cartilage
- Vomer
What are the four major paranasal sinuses?
- Maxillary
- Frontal
- Ethmoidal
- Sphenoid
Maxillary narve supply
Which sinus is most prone to infection and why?
-Maxillary sinus and because of the location of its opening high on the wall of the nasal cavity.
What is the purpose of the turbinates?
Increase surface area in order to warm, humidify and slow down air
Where does the olfactory nerve run in the nasal cavity?
Upper part of the nose
What does the larynx consist of?
-Series of cartilages and bone held together by membranes, ligaments and muscles
Where is the larynx found?
- Hyoid bone superiorly
- Trachea below
What are the regions of the larynx?
- Supraglottis
- Glottis
- Subglottis
What joins the hyoid bone and thyroid cartilage?
-Thyrohyoid membrane
What joins the cricoid cartilage and thyroid cartilage?
-Cricothyroid membrane
What forms the structural framework of the larynx?
- Epiglottis
- Thyroid
- Cricoid
- Arytenoid cartilages (paired)
What connects the epiglottis and arytenoid cartilages?
Aryepiglottic folds
What are the structural features fo the cartilages of the larynx?
- Thryoid is shield like and has a laryngeal prominence.
- Cricoid cartilage is signet-ring shaped. It is the only complete ring of cartilage in the respiratory tract
- Arytenoid sits on top of the cricoid cartilage posteriorly one on each side
What are the two folds of mucosa lining the interior of the larynx?
- Vestibular fold (false vocal cords)
- True vocal cord containing vocal ligament.
What is the space found between the true vocal cords?
-Rima glottis
Which is the only intrinsic muscle that abducts the vocal cords to allow breathing?
-Posterior Cricoarytenoid
