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Sensory systems > Lecture 12.2 Larynx > Flashcards

Lecture 12.2 Larynx Flashcards

1
Q

What are the main differences between larynx structure between adults who sit upright and babies who breastfeed lying down

A
  1. In babies the epiglottis is huge and goes up to the nasopharynx.
    In adults, it only comes up to the bottom of oropharynx, smaller.
  2. When suckling the epiglottis doesn’t move and it blocks the oropharynx.
    In adults the epiglottis moves up and down when swallowing to block the superior opening to the larynx
  3. Milk flows either side of the epiglottis to the piriform recess. Adults food goes directly to eosophagus
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2
Q

What are the 6 cartilages that make up the framework of the larynx- top to bottom

Label these on the diagram

A
  1. Epiglottis
  2. Thyroid cartilage: (where the larynx sits inside)
  3. Arytenoid cartilage (small triangle connected to cricoid and vocal cords)
  4. Cricoid cartilage: ring- narrower in the ant aspect

(+ corniculate and cuneiform)

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3
Q

What are the Extrinsic ligaments/fibroelastic membranes that make up the larynx and their attachments

A

Extrinsic

  1. Thyrohyoid membrane
    - hyoid bone to the thyroid cartilage
  2. Hyo-epiglottic ligament
    - hyoid bone to epiglottis
  3. Cricotracheal ligament:
    - lower border of cricoid cartilage to 1st tracheal cartilage
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4
Q

What is the vocal fold vs vestibular fold - what ligaments are they associated with, where do they attach

A

Vocal fold is the true vocal cord - a thickening of the upper part of the cricothyroid ligament, running between the vocal process of arytenoid cartilage and the thyroid cartilage

The vestibular fold is the thickening of the inferior aspect of the quadrangular membrane aka false vocal cord. It attaches from epiglottis to arytenoid but it is more lateral than true vc.

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5
Q

What are the 7 intrinsic muscles of the larynx and what is their job and innervation exceptions

A
  1. Cricothyroid -sits on the outer aspect of larynx so innervated by External laryngeal nerve

Muscles inside the Larynx: All innervated by Recurrent laryngeal nerve

  1. Lateral cricoarytenoid
  2. Transverse arytenoid
  3. Oblique arytenoid
  4. Thyro-arytenoid
  5. Vocalis
  6. Posterior cricoarytenoid

All of them act to close the larynx for phonation EXCEPT Posterior cricoarytenoid which opens the larynx by rotating the arytenoid cartilage out for breathing.

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6
Q

What are the boundaries of the piriform recess in adults and why is it clinically important

A

Within the thyroid cartilage (lateral boundary), on either side of the laryngeal inlet bound medially by the aryepiglottic fold

Important because it is the place for food/foreign bodies get trapped. Need to be examined because it could go inside the larynx, or to the arterial structures

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7
Q

What is the rima glottidus, rima vestibuli. What are their opening (+ positions of the vestibule and true vocal cords) when larynx is

  • Forced closure for straining
  • Phonation
A

Rima glottidus is entry to the trachea between the true vocal cords

Rima vestibuli is the space between the 2 vestibular folds

  1. Forced closure: rima glottidus, rima vestibuli and lower part of vestibule is completely closed - vocal cords adducted
  2. Phonation
    Vocal cords are adducted to force air through- rima glottidus closed. Vestibule + rima vestibuli open
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8
Q

What are the actions that happen to the larynx and its rima glottidus, rima vestibuli, vestibule, larynx etc during swallowing to stop food going into respiratory tract

A
  1. Rima glottidis, rima vestibuli and vestibule are closed
  2. laryngeal inlet is narrowed by Larynx moves up and forward.
  3. This causes the epiglottis to swing downward to arytenoids
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9
Q

What are the 3 divisions of the larynx from top to bottom

A
  1. Vestibule
  2. Middle part (very thin and between folds
  3. Infraglottic space (below vocal folds)
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10
Q

What is the consequence of laryngitis in the vocal cord

A

The inflammation of the tissue can lead to suffocation and death

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11
Q

What is the arterial supply to the larynx

A
  1. Superior laryngeal artery (from sup thyroid)

2. Inferior laryngeal artery (from inf thyroid)

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12
Q

What is the venous drainage of the larynx - 3 gen

A
  1. Superior laryngeal vein –> superior thyroid vein–> int. Jugular
  2. Inferior laryngeal vein–> inferior thyroid vein –> left brachiocephalic
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13
Q

What is the lymphatic drainage of the larynx

A

Above vocal fold: deep cervical nodes associated with bifurcation of common carotid

Below the vocal folds: deep nodes associated with upper trachea

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14
Q

What is the sensory and motor innervation of the larynx above and below the vocal cords

( branches of vagus )

A

Above VC
1. Superior laryngeal nerve–>

a) external laryngeal: motor to cricothyroid
b) internal laryngeal: sensory to laryngeal cavity

Below VC
1. Recurrent laryngeal nerve: motor to rest of intrinsic muscles + sensory innervation

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15
Q

In what two procedures can the recurrent laryngeal nerve be damaged and what is the consequence of uni or bilateral damage

A

Thyroidectomy (in the tracheosophageal groove, Tracheostomy

  1. Unilaterally: patient gets a hoarse voice
  2. Bilaterally: can hardly breath
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16
Q

Where is a surgical/needle Cricothyroidotomy done, what are the possible complications

(this is preparatory for tracheostomy just until patient is stabilised)

A

In the gap between inferior thyroid notch and cricoid cartilage in the midline of an extended neck.

  1. Surgical: transverse incision made down to and through the cricothyroid membrane.
  2. Needle is just temporising measure
  3. Structures at risk - branch of superior thyroid artery running over cricothyroid, injury to trachea, oesophagus
17
Q

What are the steps for doing a Tracheostomy and what are the possible complications

(formal airway management)

A
  1. Horizontal incision made midway between suprasternal/jugular notch and cricoid cartilage (in emergency this can be vertical midline incision)
  2. Skin, platysma, superficial veins are divided together with investing layer of deep fascia
  3. Strap muscles are retracted laterally to expose thyroid isthmus
  4. Thyroid isthmus with its overlying Pretracheal fascia is divided and oversewn
  5. The 2nd and 3rd tracheal rings are incised.
18
Q

What are the things that have to be avoided damage in a tracheostomy

A

Incising the first tracheal ring

  • Injuring recurrent laryngeal nerves,
  • carotid sheath
  • inferior thyroid veins

Prevent by sticking to the midline

19
Q

What are the Intrinsic ligaments/fibroelastic membranes that make up the larynx and their attachments

A

Intrinsic

  1. Cricothyroid membrane
    - cricoid cartilage to thyroid cartilage
  2. Quadrangular membrane
    - lateral margin of epiglottis to anterolateral surface of arytenoid cartilage on same side

Sensory systems (19 decks)

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