Laryngology Flashcards
What muscle attaches to the vocal process of the larynx?
vocal process: thyroarytenoid
What structure(s) attach to the muscular process?
muscular process: LCA, PCA
Motion of the CA joint and impact on vocal process position?
CA joint - rotation of arytenoids outward leads to elevation and lateral displacement of the vocal process. rotation inwards leads depression and medial displacement.
Motion of the cricothyroid joint and function?
Cricothyroid joint - hinge/visor like movement anteriorly; lengthens VF
Where are the quadrangular membrane and conus elasticus located relative to VF?
quadrangular membrane is superior, runs between epiglottis and false VF
conus elasticus is inferior to that — superior border on conus elasticus is vocal process/vocal ligament; inferior is cricoid cartilage
What is the only abductor of the larynx? What is its effect on the muscular process? The vocal process? Arytenoids?
PCA - muscular process depression and posterior. vocal process elevation and lateral deviation. arytenoids lateral rotation.
The only unpaired muscle of the larynx?
interarytenoid
Innervation of the cricothyroid muscle? Impact on length and tension in vocal cords? How does it accomplish this?
superior laryngeal nerve; increases length and tension in the vocal cords by causing anterior closure of the cricothyroid space
Define: vestibule, ventricle, rima glottidis
vestibule - space in the supraglottis from inlet to the false VF, ventricle - invagination/recess between FVF and TVF; rima glottitidis - space between the TVF
Histology: cell type in the vocal fold/upper vestibule? cell type everywhere else in larynx?
Stratified squamous epithelium; ciliated columnar squamous epithelium everywhere else. NOTE: false vocal folds are pseudostratified.
Layers of the membranous vocal fold?
Epithelium, superficial/middle/deep layers of the superficial lamina propria, vocalis muscle.
General description of the layers of the lamina propria?
Superficial to deep gets progressively denser. hyaluronic acid in superficial layer, cross-linked collagen in deep.
Course of the left RLN? Course of the right RLN?
Left RLN wraps around ligamentum arteriosum, RLN wraps around the subclavian.
Course of a non-recurrent right RLN and associated developmental anomaly?
Non-recurrent right RLN comes off of vagus and directly to TE groove; a/w retroesophageal subclavian.
Associated developmental anomaly in the rare event of a non-recurrent left RLN?
Non-recurrent left RLN a/w situs inversus.
Origin of the superior thyroid artery vs the inferior thyroid artery?
superior thyroid artery comes off of external carotid. inferior thyroid artery comes off of thyrocervical trunk.
Lymphatic drainage of the supraglottis, infraglottis, and glottis?
supraglottis - upper jugular, infraglottis - lower jugular/pretracheal; glottis - no significant lymphatic drainage
Position of the larynx (relative to cervical vetebrae) at birth vs adults? When does this descent occur?
Birth - C2-3, adult - C5, descent occurs around 6-8 years old in both genders; second descent at puberty in men
Branchial cleft embryology of the larynx: a) which arch develops into cricothyroid muscle? which nerve associated? b) which arch develops remainder of laryngeal muscles? which nerve associated?
a) 4th arch; superior laryngeal nerve. b) 6th arch; recurrent laryngeal nerve
Cause/Management of nodules
phonotrauma/“overuse”, voice therapy.
Cause/management of VF polyp
like a mucocele/outpouching of mucosa, treatment is surgery.
Cause/management of granuloma/contact ulcer
often trauma- intubation or phonotrauma, GERD. medical management +PPI unless obstructive, then surgery with high recurrence rate
Contrast cyst vs sulcus vs pseudocyst: a) location b) management
cyst - epithelial lined. surgery but significant risk of persistent voice change. sulcus - deep invagination of the vocal fold w/wo epithelial lining. surgery or injection (with variable results). pseudocyst - submucosal; surgery.
Management of leukoplakia/keratosis: a) possible etiologies b) conservative management options
both are premalignant. a) smoking, GERD, chronic phonotrauma, vitamin deficiencies b) if low suspicion for malignancy can initially watch closely with smoking cessation/PPI/voice therapy -> DL/excision with subsequent serial follow-up
RRP: a) implicated HPV subtypes? b) management? adjunctive options?
a) serotypes 6&11. b) management is surgery. Adjunctive therapies include cidofovir, laser/photodynamic, cryotherapy
VF paralysis: surgical options for unilateral?
injection, medialization +/- arytenoid adduction.
most common cause for bilateral VF paralysis ? surgical options for bilateral?
most common cause for bilateral is THYROIDECTOMY. Surgical options include cordotomy/cordectomy, tracheotomy, arytenoid abduction. Innervation for either.
Laryngeal reinnervation procedure: expected impact on function/outcome?
restore bulk/tone position, does not restore function; does not restore abductor function
Spasmodic dysphonia, adductor vs abductor: a) which one more common? b) what type of words have breaks? c) options for management?
a) adductor more common; b) sixties/puppy for abductor spasmodic dysphonia, eighties/elephant for ADductor spasmodic dysphonia; c) botox injection to TA or lateralization thyroplasty for adductor. medialization thyroplasty for abductor.
Classic X-ray finding for epiglottitis vs croup?
epiglottitis - thumb sign; croup - steeple sign
Histological difference between pemphigus and pemphigoid?
pemphigus = intraepithelial blisters, pemphigoid = subepithelial blisters
Systemic conditions that can affect the larynx based on buzzwords: non-caseating granulomas? what site(s) most commonly affected?
sarcoidosis; supraglottis, especially epiglottis.
Systemic conditions that can affect the larynx based on buzzwords: cricoarytenoid joint fixation? what other conditions can cause this?
RA. Also SLE, TB, Crohn’s, syphilis, gonorrhea.
Systemic conditions that can affect the larynx based on buzzwords: waxy gray or orange lesions on the epiglottis, nonspecific findings on H&E? What kind of stain needed to make the diagnosis?
amyloidosis; congo-red with birefrigence.
Systemic conditions that can affect the larynx based on buzzwords: necrotizing granulomatous subglottic process and capillary thrombosis?
Wegener’s/PGA
Systemic conditions that can affect the larynx based on buzzwords: oral ulcers that progress caudally to involve the larynx with 15% mortality?
pemphigoid
Systemic conditions that can affect the larynx based on buzzwords: relapsing polychondritis - what site of dysfunction in the airway?
tracheal stenosis
How to manage an acute unstable airway in laryngeal fracture? What is the one “exception” to this?
tracheotomy UNLESS complete cricotracheal separation — in which case theoretically attempt fiberoptic but may be extremely difficult and end up with slash trach anyway
How to approach workup for a stable airway in laryngeal fracture?
If stable and no fracture suspected - observe. If stable but scope shows significant hematoma/fracture suspected - CT first, possible OR pending results. If stable but scope shows exposed cartilage/significant mucosal injury -> OR.
Surgical treatment options for supraglottic, glottic, and subglottic stenosis?
Supraglottic - supraglottic laryngectomy most effective, other targeted expansion/stenting high risk for recurrence.
Glottic - can attempt cordotomy/cordectomy, possible trach. Issue is posterior VF usually fixed so need static opening but sacrifices voice.
Subglottic - can try endoscopic interventions but often may need tracheal resection
Laryngeal cleft staging?
type 1 - interarytenoid cleft, does not pass TVF. type 2 - past TVF, into but not through cricoid. type 3 - through cricoid into cervical trachea, not into thoracic inlet. type 4 - into thoracic inlet/thoracic trachea
X-ray findings on inspiration vs expiration for bronchial foreign body?
inspiration - atelectasis. expiration - hyperinflation
