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AIM - The Brain > Larynx > Flashcards

Larynx Flashcards

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1
Q

larynx functions

A
  • phonation
  • sphincter for respiratory system (regulates air to/from lungs, allows inc in abd pressure via valsalva)
  • acts w/ oral cavity, oral pharynx in process of deglutition
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2
Q

upper boundary of larynx

A

tip of epiglottis, opposite to C3/C4

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3
Q

lower boundary of larynx

A

lower border of cricoid cartilage, opposite to C6

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4
Q

the larynx opens into the ________ above and is continuous w/ the _______ below

A

the larynx opens into the LARYNGEAL PT OF THE PHARYNX above and is continuous w/ the TRACHEA below

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5
Q

3 median (unpaired) cartilages of the larynx

A
  1. epiglottis
  2. thyroid cartilage
  3. cricoid cartilage
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6
Q

3 paired cartilages of the larynx

A
  1. arytenoid
  2. corniculate
  3. cuneiform
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7
Q

thyroid cartilage has 2 laminae that meet at midline and form the ________________, with the ________________ at its rostral margin

A

thyroid cartilage has 2 laminae that meet at midline and form the LARYNGEAL PROMINENCE, with the THYROID NOTCH at its rostral margin

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8
Q

the posterior border of each thyroid cartilage lamina forms _______________

A

the posterior border of each thyroid cartilage lamina forms SUPERIOR AND INFERIOR HORNS

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9
Q

Which m. attach to the oblique lines of the thyroid cartilage?

A

thyrohyoid
sternothyroid
inferior constrictor

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10
Q

Which structures attach to superior border of thyroid cartilage?

A
  • throhyoid membrane

- inferior border to cricothyroid membrane

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11
Q

vertebral level of cricoid cartilage

A

C6, lies below thyroid cartilage

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12
Q

first and only complete tracheal ring

A

cricoid cartilage

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13
Q

articular facets on the cricoid cartilage

A

on lateral surface –> for inferior horn of thyroid cartilage

on upper border for articulation w/ base of arytenoid cartilage

^both synovial joints

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14
Q

arytenoid cartilages

  • location
  • articulations
A
  • back of larynx
    base: articulates w/ upper border cricoid cartilage
    apex: supports corniculate cartilage

vocal process: projects forward, attachment to vocal ligament

muscular process: lateral

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15
Q

rima glottidis

A

space between vocal cords

varies w/ position of vocal folds (depends on position of arytenoids)

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16
Q

epiglottis

A
  • flexible (elastic cartilage)
  • behind root of tongue
  • upper edge is free
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17
Q

hyoepiglottic ligament

A

connects front of epiglottis to body of hyoid bone

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18
Q

thyroepiglottic ligament

A

connects stalk of epiglottis to thyroid cartilage

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19
Q

aryepiglottic folds

A

located at the entrance of the larynx

extend from the lateral borders epiglottis to the arytenoid cartilages

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20
Q

anterior mucosa of epiglottis is reflected onto tongue forming 3 ________ and ________

A

anterior mucosa of epiglottis is reflected onto tongue forming 3 GLOSSOEPIGLOTTIC FOLDS and VALLECULAE

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21
Q

vallecula

A

space between posterior portion of tongue and epiglottis

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22
Q

during swallowing, food passes over posterior portion of tongue through the _______, and down into _________ can be trapped before entering esophagus

A

during swallowing, food passes over posterior portion of tongue through the VALLECULA, and down into PIRIFORM RECESS where it can be trapped before entering esophagus

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23
Q

corniculate cartilages

A
  • small conical nodules
  • sit superior to and articulate w/ apices of arytenoid cartilages and prolong them
  • can be seen as projections into the vocal area
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24
Q

cuneiform cartilages

A
  • small, rod shaped
  • in each aryepiglottic folds –> prod small elevation
  • NO articulations w/ any other cartilage
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25
Q

Which cartilages support the aryeepiglottic fold?

A

corniculate and cuneiform cartilages

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26
Q

arytenoids glide/rotate on the lamina of the _____, changing the angle between _____

A

arytenoids glide/rotate on the lamina of the CRICOID, changing the angle between VOCAL LIGAMENTS

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27
Q

thyrohyoid membrane has openings for which structures

A

internal laryngeal n. (br. of superior laryngeal br. of vagus)

superior laryngeal a.

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28
Q

cricotracheal membrane

A

connects cricoid cartilage to first tracheal ring

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29
Q

quadrangular membrane

A

between epiglottis and arytenoid cartilages

  • lower free edge: vestibular ligament
  • upper free edge: aryepiglottic fold
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30
Q

vestibular ligament lies within the _______ (________)

A

vestibular ligament lies within the VESTIBULAR FOLD (FALSE VOCAL FOLDS)

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31
Q

conus elasticus origin/attachments

A

upper edge: forms vocal ligament

lower edge: attached to upper border of cricoid cartilage

anterior attachment: thyroid cartilage

posterior attachment: arytenoid cartilage

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32
Q

vocal ligament

A

upper free edge of conus elasticus

attached anteriorly to deep surface of thyroid cartilage and posteriorly to vocal process of arytenoid cartilage

pt of the TRUE vocal cords

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33
Q

conus elasticus functions

A
  1. sound production (vibrate)

2. close rima glottidis (stops outflow of air, upward movement of diaphragm, inc abd cavity pressure)

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34
Q

ventricle

A

area between true and false vocal folds

entrance into sinus of the larynx

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35
Q

vestibule

A

inlet above false vocal cords

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36
Q

false vocal cords

A

vestibular folds (overlay vestibular ligaments)

  • little/no pt in voice prod
  • protective role
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37
Q

vocal cords (folds)

A

combo of

  • vocal ligaments
  • thyroarytenoid m.
  • vocals m.
  • mucosa above ^
38
Q

glottis

A

combo of vocal cords AND space between them (rima glottidis)

39
Q

laryngeal inlet

A

faces backward and upward, opens into laryngeal pt of pharynx

bounded…
anteriorly by upper margin of epiglottis

posteriorly and below by arytenoid cartilages

laterally by aryepiglottic folds

40
Q

laryngeal cavity

A

extends from laryngeal inlet to lower border cricoid cartilage

narrow region –> rima vestibuli

narrowest region –> rima glottidis

41
Q

rima vestibuli

A

narrow region of laryngeal cavity between the vestibular (false) folds

42
Q

rima glottidis

A

narrow region of laryngeal cavity between true vocal folds

43
Q

lateral recess between vestibular fold and vocal fold

A

sinus of the larynx

entrance into sinus is the ventricle

44
Q

blind uppermost recess of the sinus of the larynx, extending between vestibular fold and thyroid cartilage

A

saccule of the larynx

45
Q

laryngocele

A

abnormal congenital or acquired air-filled sac communicating w/ the ventricle of the larynx

sx: coughing, hoarseness, neck pain if laryngocele becomes infected, upper airway obstruction

46
Q

extrinsic m. of larynx

elevators of larynx

A

digastric
stylohyoid
mylohyoid
(suprahyoids)

stylopharyngeus
palatopharyngeus
thyrohyoid

47
Q

extrinsic m. of larynx

depressors of larynx

A

sternohyoid m.

48
Q

intrinsic m. of larynx controlling size of laryngeal inlet

A
  • oblique and transverse arytenoids

- aryepiglottic m.

49
Q

oblique and transverse arytenoids

A
  • connect posterior and lateral surfaces of both arytenoid cartilages
  • narrows the laryngeal inlet and ADDUCTS vocal cords
50
Q

aryepiglottic m.

A
  • upper portion of oblique arytenoids
  • extend from arytenoid cartilages to lateral edge of epiglottis
  • draw aryepiglottic folds inward, narrow laryngeal inlet (sphincter of inlet during swallowing)
51
Q

cricothyroid m.

A

inc distance between angle of thyroid cartilage and vocal processes of arytenoid cartilages

–> INC length and TENSION of vocal cords

–> raises pitch of voice

–> external br. superior laryngeal n. of vagus

52
Q

paralysis of cricothryoid m.

A

low-pitched voice

53
Q

thyroarytenoid

A

pulls arytenoid cartilage forward toward thyroid cartilage

–> SHORTENS and RELAXES vocal cords

–> lowers pitch of voice

54
Q

vocalis m.

A

more medial portion of thyroarytenoid m.

directly in contact w/ vocal ligament

fine control of vocal cords (relaxes segments of vocal ligaments, adjusting pitch)

55
Q

thyroepiglottic m.

A

pulls laterally on aryepiglottic fold and epiglottis (widens laryngeal inlet)

represents superior fibers of thyroarytenoid m. (fan out to quadrangular membrane/epiglottis)

56
Q

adductors of vocal cords

A

lateral cricoarytenoid

transverse arytenoid

57
Q

whisperer’s muscle

A

lateral cricoarytenoid action

rotates arytenoids MEDIALLY, leaving a space posterior to them

58
Q

abductor of vocal cords

A

posterior cricoarytenoid

  • pivots arytenoids so that vocal process moves laterally
59
Q

bilateral paralysis of posterior cricoarytenoid

A

adduction of vocal cords

potential suffocation

60
Q

vagus n. –> superior laryngeal n. –> ____ and ____

A

vagus n. –> superior laryngeal n. –> INTERNAL and EXTERNAL LARYNGEAL N.

61
Q

all laryngeal m. innervated by __________ n. EXCEPT which m.?

A

br. of recurrent laryngeal

EXCEPT cricothyroid (external br. superior laryngeal n. of vagus)

62
Q

sensory innervation to mucosa below vocal cords

A

recurrent laryngeal n. (br. of vagus)

63
Q

sensory innervation to mucosa above vocal cords

A

internal laryngeal n. (br of superior laryngeal n. of CN X)

64
Q

How does the recurrent laryngeal n. enter the larynx?

A

passes deep to cricopharynxgeus and inferior constrictor to enter larynx

65
Q

sensation in piriform recess

A

internal laryngeal n.

66
Q

recurrent laryngeal n. becomes _________ when it enters the larynx

A

recurrent laryngeal n. becomes INFERIOR LARYNGEAL N. when it enters the pharynx

67
Q

superior laryngeal n. block

A
  • used to abolish the cough reflex during laryngoscopy and bronchoscopy
  • inject anesthesia thru thyrohyoid membrane between hyoid and thyroid cartilage to anesthetize region superior to the vocal fold.
68
Q

afferent limb of cough reflex

A

internal laryngeal n.

69
Q

efferent limb of cough reflex

A

signals transmitted back from cerebral cortex and medulla via vagus, phrenic and intercostal n. to glottis, intercostal, diaphragm, etc.

70
Q

cough reflex response

A
  • glottis closes under contraction of transverse arytenoid and lateral cricoarytenoid m. by the recurrent laryngeal n.
  • expiration of air under pressure from lungs (via contraction of abd m.)
  • vocal cords relax –> explosive release of air from larynx
71
Q

spasm of laryngeal m.

A

foreign object lodged in vestibule –> laryngeal m. spasm, close rima vestibuli and rima glottidis

–> complete blockage, speechless, may completely seal off larynx/choke person

–> administer HEIMLICH MANEUVER

72
Q

valsava maneuver

A

forceful expiator effort against closed airway used during coughing/sneezing/defecation/childbirth

  1. vestibular and vocal folds abduct widely as lungs inflate during deep inspiration
  2. vestibular and vocal cords are voluntarily adducted at end of inspiration
  3. abd wall m. contract to inc intra-and and sub-glottic pressure
73
Q

injury to superior laryngeal n.

A
  • loss of sensation (internal laryngeal n.) from upper pt of larynx and piriform recess (inactivates cough reflex)
  • paralysis of cricothyroid (external laryngeal n.) –> monotonous voice bc vocal cords can’t be tensed
74
Q

injury to recurrent laryngeal n.

A

bilateral –> inability to abduct, adduct, and relax the vocal cords

  • -> hoarseness, difficulty breathing during forced respiration bc cords cannot be widely abducted)
  • -> STRIDOR (high pitch)

inability to close laryngeal inlet during swallowing
–> ASPIRATION of food into trachea

75
Q

unilateral recurrent laryngeal nerve paralysis

A

pt asked to take a deep breath –> ABducting vocal cords

sx: breathiness, low intensity, low pitch, production of 2 pitches at one time

76
Q

blood supply to upper half larynx

A

superior laryngeal a. (br. of superior thyroid a.)

77
Q

blood supply to lower half larynx

A

inferior laryngeal a. (br. of inferior thyroid a.)

78
Q

lymph drainage ABOVE vocal cords

A

drain into superior deep cervical nodes

–> L or R venous angle

79
Q

lymph drainage BELOW vocal cords

A

drain into pretracheal or paratracheal nodes –> inferior deep cervical nodes

–> L or R venous angle

80
Q

bolus pushed back into orpharynx
(mechanics of swallowing)

m. and n. involved

A

mylohyoid (V3)

81
Q

elevating and tetracting tongue
(mechanics of swallowing)

m. and n. involved

A

styloglossus (XII)

palatoglossus (X)

82
Q

soft palate elevated and tensed
(mechanics of swallowing)

m. and n. involved

A

levator veli palatini (X)

tensor veli palatini (V3)

83
Q

laryngeal inlet closed
(mechanics of swallowing)

m. and n. involved

A

aryepiglottic
oblique arytenoids

recurrent laryngeal n. (CN X)

84
Q 
glottis closed
(mechanics of swallowing)

m. and n. involved

A

transverse, oblique arytenoids, lateral cricoarytenoid

recurrent laryngeal n. (CN X)

85
Q

larynx and larynx elevated
(mechanics of swallowing)

m. and n. involved

A

stylopharyngeus (IX)

salpingopharyngeus and palatopharyngeus (X)

86
Q

laryngitis

A

swollen PINK vocal cords, almost same color as surrounding tissue (normal: white, shiny)

causes: usually viral/bacterial, may have noninfectious causes (xs vocal use, smoking, xs alcohol consumption, laryngeal trauma)
sx: hoarsness, dry, burning throat, coughing, difficulty swallowing

87
Q

laryngeal edema

A

abnormal accumulation of fluid in larynx

causes:
- infections
- retropharyngeal abscesses
- surgery of larynx/neck
- drug rxn

can cause swelling of membranes around larynx, narrowing of glottis (life-threatening)

tx: intubation or emergency cricothyrotomy/tracheostomy

88
Q

laryngeal papillomas

A

benign epithelial tumors caused by infection w/ HPV

sx: hoarsness, proportional to size of papilloma, may lock airway –> difficulty breathing
tx: laser surgery

89
Q

vocal cord polyps

A

small, mostly unilateral, swellings in mucous membranes of vocal cords

via voice abuse, chronic laryngeal allergic rxns, chronic inhalation of irritants

90
Q

vocal cord nodules

A

small, inflammatory or fibrous growth –> develops on vocal cords of people who constantly strain their voices

usually appear in PAIRS

structural resemblance to a CALLUS on hand

voice becomes breathy, hoarse

91
Q

endotracheal intubation

A

flexible plastic tube into trachea to maintain open airway

performed on critically injured, ill, anesthetized pts w/

  • upper airway obstruction
  • respiratory failure
  • loss of consciousness
  • undergoing prolonged surgery under anesthesia
  • have risk of pulmonary aspiration

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