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Head N Neck > Lecture 16 - Applied Anatomy Of The Larynx > Flashcards

Lecture 16 - Applied Anatomy Of The Larynx Flashcards

1
Q

What are the functions of the larynx?

A

Ventilation
Airway protection (main function)
Cough reflex
Phonation (production of sound)

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2
Q

Go the last slide and label image 1:

A

1 = nasopharynx
2 = oropharynx
3 = soft palate
4 = Laryngopharynx
5 = trachea

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3
Q

Where does the larynx begin?

Where does the larynx end?

A

Start = where laryngeal inlet communicates with Laryngopharynx

Ends = at C6 vertebral level at cricoid cartilage

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4
Q

What are the piriform fossa?

A

The point in pharynx where food particles can get stuck preventing it from entering the trachea

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5
Q

What bone is the larynx suspended from?

A

Hyoid Bone

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6
Q

What is the membrane between the hyoid bone that attaches to the thyroid cartilage?

A

Thyrohyoid membrane

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7
Q

What is the cartilage that attaches inferiorly to the thyroid cartilage?

A

Cricoid cartilage

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8
Q

What si the name of the name of the membrane connecting the thyroid cartilage to the cricoid cartilage?

A

Cricothyroid cartilage

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9
Q

What is the name of the membrane joining the cricoid cartilage to the trachea?

A

Cricotracheal membrane

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10
Q

What is the order of structures from the hyoid bone inferiorly?

A

Hyoid bone
Thyrohoid membrane
Thyroid cartilage
Cricothyroid membrane
Cricoid cartilage
Cricotracheal membrane

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11
Q

What special cartilages sit superiorly on the cricoid cartilage?

A

Arytenoid cartilages

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12
Q

How can you palpate/determine where the Cricothyroid membrane is?

A

Palpate the Adam’s apple (laryngeal prominence of the Thyroid cartilage)
Its the soft and squishy area immediately inferior to it

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13
Q

Why may you need to rapidly identify the Cricothyroid membrane?

A

For front of neck access for a Cricothyroidotomy

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14
Q

What is a cricothryoidotomy?

A

Where a hole is made in the Cricothyroid membrane for emergency access to the airways underneath the vocal cords

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15
Q

What cartilage does the epiglottis connect to?

A

Throid cartilage

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16
Q

What i the joint called between the cricoid cartilage and the arytenoid cartilage called?

A

Cricoid-arytenoid cartilage

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17
Q

What is the synovial joint which allows the thyroid cartilage to tilt forwards?

A

Thyroid-Cricothyroid joint

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18
Q

What structure does the true vocal cord run from and to?

A

Runs from arytenoid cartilage to the inner surface of the thyroid cartilage

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19
Q

What is the laryngeal inlet?

A

The start of the larynx

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20
Q

What forms the margins of the laryngeal inlet?

A

The 2 aryepiglottic folds either side and the upper edge of the epiglottis

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21
Q

What structures does the quadrangular membrane form?

A

Aryepiglottic fold

False vocal cord/vestibular fold

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22
Q

What border of the quadrangular ligament forms the aryepiglottic fold?

A

Upper border

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23
Q

What border of the quadrangular ligament forms the vestibular ligament/false vocal cord?

A

Lower border

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24
Q

The upper border of what membrane forms the true vocal cord?

What cartilage does this have an edge running deep to?

A

Cricothyroid membrane

Thyroid cartilage

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25
Q

What type of eof membrane lines the larynx?

A

Mucous membrane

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26
Q

What are the 3 named regions of the larynx?

A

Supraglottis
Glottis
Infraglottis

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27
Q

What is the Supraglottis of the larynx?

A

Most superior section
From epiglottis to the false vocal cords/vestibular ligament

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28
Q

What is the glottis of the larynx?

A

The narrowest part
Where the true vocal cords can be found

Between false cords and 1cm below true cords

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29
Q

What is the Infraglottis of the larynx?

A

Below the glottis to lower boundary of the cricoid cartilage

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30
Q

Go to the last slide and label image 2:
(Larynx)

A

1 = Supraglottis
2 = glottis
3 = Infraglottis
4 = false cords/vestibular ligament
5 = true vocal cords
6 = epiglottis

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31
Q

What type of epithelium lines most of hte larynx?

A

Pseudostratified Ciliated columnar epithelium
(Respiratory epithelium)

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32
Q

Which part of the larynx is NOT line by Pseudostratified Ciliated columnar epithelium?

A

True vocal cords

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33
Q

What cells line the true vocal cords?

Why?

A

Stratified squamous epithelium

Exposed to lots of abrasive forces from the air

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34
Q

How can we visualise the larynx?

A

Flexible nasendoscopy

Endotracheal tube during intubation

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35
Q

What is the name of the depression anterior to the epiglottis in the larynx?

A

Valecula

36
Q

What is the name of the depressions/fossae towards the posterior wall of the Laryngopharynx?

A

Piriform fossae

37
Q

Go to the last slide and label image 3:

A

1 = valecula
2 =aryepiglottic folds
3 = false vocal cords/vestibular folds
4 = true vocal cords
5 = arytenoid cartilage location
6 = Piriform fossae
7 = Rima glottidis

38
Q

What is the rima glottidis?

A

The opening between the true vocal cords

39
Q

How can you determine anatomical position from the rima glottidis?

A

The point of the rima glottidis points anterior

40
Q

Broadly what can we do to the larynx to prevent food entering the trachea during swallowing?

A

Alter shape and position of larynx in swallowing

41
Q

What are the 2 main functions of the intrinsic laryngeal muscles?

A

Alter size and shape of laryngeal inlet

Alter tension and position of the true vocal cords

42
Q

What do the intrinsic laryngeal muscles act on to vary the position of the true vocal cords to control pitch of voice/tension in cords?

A

Arytenoid cartilages

43
Q

Where are the intrinsic laryngeal muscles which contract narrowing the laryngeal inlet and flattening the epiglottis?

A

Aryepiglottic folds

44
Q

What nerves supply the majority of the intrinsic laryngeal muscles?

What cranial nerve is this a branch of?

A

Recurrent laryngeal nerves

Branch from the Vagus Nerve (X)

45
Q

During swallowing, how does the larynx act to protect the airways from food and fluid?

A

Epiglottis flattens
Aryepiglottic folds contract narrowing laryngeal inlet
Food caught in the piriform fossae

46
Q

What bone moving is important in protecting the airways in swallowing?

A

Hyoid Bone

47
Q

What muscles move the hyoid bone during swallowing?

What muscle stabilises the hyoid bone?

A

Suprahyoid muscles

Infrahyoids

48
Q

How do the suprahyoid muscels move the hyoid bone?

A

Move antero-superiorly

49
Q

How does movement of the hyoid bone Antero-superiorly by the suprahyoid muscles help protect the airway from food and fluid?

A

Hyoid moves the larynx up and off the pharynx this directs any food/fluid collected in the piriform fossa into the open pharynx

50
Q

The movement of what cartilage opens and closes the true vocal cords/rima glottidis?

A

Arytenoid cartilage

51
Q

What action would a person be doing if their true vocal cords were firmly adducted and the laryngeal inlet narrowed?

A

Swallowing
(Protecting the trachea)

52
Q

What action would a person be doing if their true vocal cords were abducted and the laryngeal inlet open?

A

Breathing/ventilating

53
Q

What is the position of the true vocal cords during phonation/speech?

How does this produce speech?

A

They are closely adducted but expired air can be forced through

Vocal cords vibrate along their length setting up vibrations int he air

54
Q

What happens to the vocal cords in the cough reflex?

A

Inspired and fill lungs with air
Vocal cords ADduct
Expiraotry muscles contract
Intra thoracic pressure increases
Vocal cords then suddenly ABduct allowing explosive outflow of air

55
Q

What muscles control the pitch of the voice/tension in the Vocal cords?

A

Cricothyroid muscles

56
Q

How do the Cricothyroid muscels control pitch of the voice?

A

Controls the tilt of the thyroid cartilage on the cricoid cartilage controlling how taut it is

Vocal cords taut = high pitch
Vocal cords less taut = low pitch

57
Q

What nerve innervates the Cricothyroid muscles therefore controlling pitch?

What is this a branch of?

A

External branch of superior laryngeal nerve

Branch of the Vagus nerve (X)

58
Q

What artery is the external branch of teh superior laryngeal nerve associated with?

A

Superior thyroid artery

59
Q

What can happen if the external branch of the superior laryngeal nerve is damaged in a thyroid surgery?

A

Hoarseness of voice when trying for higher pitched sounds

60
Q

What are the 2 main nerves branching from the vagus nerve supplying the larynx?

A

Superior laryngeal nerve
Recurrent laryngeal nerve

61
Q

What are the 2 branches from the superior laryngeal nerve?

A

Internal branch
External branch

62
Q

What is the function of the internal branch of the superior laryngeal nerev?

A

Sensation to Supraglottis and glottis (+true vocal cords)

63
Q

What is the function of the external branch of the superior laryngeal nerve?

A

Motor function to Cricothyroid muscles (control pitch of voice)

64
Q

What is the function of the recurrent laryngeal nerve?

A

Motor function to intrinsic laryngeal muscles (moving vocal cords)

Sensory to Infraglottis

65
Q

What is the route of the left recurrent laryngeal nerve?

A

Branches from the left vagus nerve and loops under the arch of aorta to where it then ascends upwards to the larynx

66
Q

What is the route of the right recurrent laryngeal nerve?

A

Branches from right vagus nerve
It then loops under the right subclavian artery to where it then ascends up to the larynx

67
Q

What type of surgery puts the external laryngeal nerve at risk?

A

Thyroid surgery since it runs closely with the superior thyroid artery

68
Q

What does injury to the recurrent laryngeal nerve cause?

A

Vocal cord palsy (needed to move the true vocal cords)

69
Q

How does a unilateral recurrent laryngeal nerve. Injury present?

A

Hoarse voice
Weak/ineffective cough

Cant fully abduct or Adduction cords

70
Q

If the right recurrent laryngeal nerve is damaged what would the position of the right vocal cord be?

A

Halfway between adducted and abducted
(PARAMEDIAN position)

71
Q

Why is a bilateral recurrent laryngeal nerve injury life threatening?

A

Both vocal cords assume resign gparamedian position so rima glottis NARROW
Significant airway obstruction

Need emergency surgical airway access below Vocal cords
Cricothryoidotomy

72
Q

What is laryngitis?

A

Inflammation of larynx often involving vocal cords

73
Q

Why do you often lose your voice with laryngitis?

A

Cant create a full seal of the vocal cords due to the inflammation

74
Q

How dangerous is epiglottis?

A

Very dangerous since significant risk to airway

75
Q

What causes laryngeal oedema?

A

Allergic reaction or swallowed foreign body

76
Q

What is a laryngeal nodule?

A

Benign lump in larynx

77
Q

What type of tumour are laryngeal cancers normally?

A

Squamous cell carcinoma on vocal cord

78
Q

What is Croup?

A

Viral infection of subglottic region and laryngeal mucosa causing inflammation oedema

79
Q

Who does croup usually affect?

A

Young children/infants

80
Q

What is epiglottitis?

A

Inflammation/infection of the supraglottis

81
Q

What are the 3 most likely causative pathogens for epiglottitis?

A

Haemophilus influenzae B
Streptococcus pneumoniae
Moraxella catarrhalis

82
Q

Go to the last slide and label the larynx:
(4)

A

1 = epiglottis
2 = laryngeal inlet
3 = false vocal cord
4 = true vocal cord
5 = infraglottis/subglottic region
6 = trachea
7 = aryepiglottic fold
8 = hyoid bone
9 = thyroid cartilage
10 = cricoid cartilage
11= lateral lobe of thyroid gland

83
Q

What is the afferent and efferent limb of the gag reflex?

A

Afferent = Glossopharyngeal

Efferent = vagus

84
Q

What structure does the left recurrent laryngeal nerve runn close to?

A

Superior thyroid artery

85
Q

What symptoms occur if the external branch of superior laryngeal nerve is injured and why?

A

Hoarseness with high pitch

Innervates the cricothyroid muscles which control tone of vocal cords (angle of thyroid cartilage on cricoid cartilage)

86
Q

What are a couple causes of voice hoarseness?

A

Laryngeal cancers
Pancoast tumours

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