Lecture 19: Airway Anatomy (Exam III, Andy's Cards) Flashcards
The trachea extends from the base of the ________ down to the bifurcation and splitting of the left/right bronchi.
larynx
(25:00)
What is the length of a typical trachea (range)?
By tilting the head back, how much can the trachea elongate?
11 to 13 cm
+2 cm (elongation)
(25:40)
What will happen to the internal diameter of the trachea if there is elongation?
Decreased internal diameter of the trachea.
(26:00)
The width of the trachea is similar to the width of what body part, according to Dr. James Schmidt?
Index Finger
What is the circular structure at the bottom of the larynx attached to the trachea?
Cricoid Cartilage
What cartilages make up the larynx?
How many cartilages make up the larynx?
- Thyroid Cartilage (largest cartilage)
- Epiglottis (large cartilage)
- Cricoid Cartilage (large cartilage)
- Ayrentoids Cartilage (2)
- Cuneiform Cartilage (2)
- Corniculate Cartilage (2)
9 cartilages make up the larynx
How many total airway segments are there in the right lung?
How many total airway segments are there in the left lung?
- 10 air segments on the right lung
- 8 airway segments on the left lung
The picture shows 10 airway segments for the left lung, but some segments are fused together.
What type of muscle sits between the tracheal rings?
Smooth Muscle
What cartilage will prevent food from entering the lungs?
Epiglottis
What is the largest piece of cartilage in the larynx?
Thyroid Cartilage
What cartilage is a continuous ring in the larynx?
Cricoid Cartilage
The vocal cords are attached to what two cartilage?
- Thyroid Cartilage (Thyroid Notch)
- Arytenoid Cartilage
In pediatric patients (<10 yrs), their narrowest upper airway point is going to be the ________.
Cricoid Cartilage
Section III (red) in the picture.
(33:00)
In adult patients, their narrowest upper airway point is going to be the ________.
Level of the Vocal Cards
Section II (green) in the picture.
What is the region of the blue circle called?
Pharynx
What are the regions of the pharynx?
- Nasopharynx
- Oropharynx
- Pharynx (Laryngopharynx)
What are the two components that make up the roof of the mouth?
- Hard palate (bone)
- Soft palate (flesh)
Label A, B, C, and D.
A. Pharyngeal Tonsil
B. Lingual Tonsil
C. Hard Palate
D. Soft Palate
Label A, B, C, and D
A. Hard Palate
B. Soft Palate
C. Uvula
D. Palatine Tonsil
The tongue is a ________ muscle.
Skeletal
What is the region in the green triangle called?
Vallecula
This is where the tip of our Mac Blade goes.
What is the specialized bone that makes up the nose?
Ethmoid Bone
What part of the ethmoid bone serves as an attachment for the meninges of the brain?
Crista galli
Label A, B, C, D, and E.
Where is the best place to insert a nasal airway?
On the floor of the nasal cavity (the palatine process of the maxilla).
You want to avoid the conchae; they are very fragile.
What is another name for concha?
Turbinates
What is the dividing septum between the two sides of the nose?
Vomer
Why are the conchae porous?
To house blood vessels and humidify the inspired air.
How many sets of salivary glands do we have? Name them.
- Parotid Gland
- Submandibular Gland
- Sublingual Gland
What is the largest cranial nerve in your head?
- Trigeminal Nerve (V)
Takes care of sensory innervation for almost the entire face.
What are the three divisions of the Trigeminal Nerve?
- Ophthalmic Branch / V1 (forehead)
- Maxillary Branch/ V2 (front of the face)
- Mandibular Branch/ V3 (lower jaw)
What nerve innervates the movement and taste of the back one-third of the tongue?
- Glossopharyngeal Nerve (IX)
What nerve is responsible for the taste in the front two-thirds of the tongue?
What nerve innervates the movement of the front two-thirds of the tongue?
- Facial Nerve (VII)
- Mandibular Branch (V3) of Trigeminal Nerve
What is the sensory nerve for the larynx?
- Vagus Nerve (X)
What nerve innervates the hard palate?
The greater palatine nerve of the maxillary branch of the trigeminal nerve.
What division of the trigeminal nerve is responsible for our ice cream headache/brain freeze?
Ophthalmic branch (V1) of the Trigeminal Nerve
Need to clarify
How many turbinates are there?
What is another name for turbinates?
Three (also known as meatus or concha)
- Inferior
- Middle
- Superior
Which turbinate does the endotracheal tube pass through during a nasal intubation?
- Inferior turbinate
What area is indicated by 1 on the figure below?
Nasopharynx
What area is indicated by 2 on the figure below?
Oropharynx
What area is indicated by 3 on the figure below?
Pharynx
What structure divides the oropharynx and the pharynx?
- Epiglottis
Loss of pharyngeal muscle tone results in _________ _________.
Airway obstruction
Which laryngeal cartilages are unpaired?
- Thyroid (largest, supports soft tissue)
- Cricoid
- Epiglottis
Which laryngeal cartilages are paired?
- Arytenoid
- Corniculate
- Cuneiform
What muscle extends from behind the ear to sternum?
Sternocleidomastoid Muscle
Where does the SCM muscle attach on the skull?
Mastoid Process
What are the divets between lung lobes called?
Fissures
How many fissures does each lung have?
2 - Right lung
1 - Left lung
Name the right lung fissures and what they separate
Horizontal - upper and middle lobes
Oblique - middle and lower lobes
Place in chest where air or vacuum most likely to happen?
Costodiaphragmatic Recess
Which lung is taller? Why?
Left. Because it sits on central tendon with heart and drops the diaphragm a little on the left
Space between visceral and parietal pleura
Pleural space. Potential space
What spine does the diaphragm attach to?
L spine
What are the leaflets of the diaphragm that attach to the spine called?
Left and right Crus
Rib muscles for inspiration
External intercostals
Rib muscles for expiration
Internal intercostals
Accessory muscles for breathing
Scalene, abdominal, shoulder, pec muscles
What kind of muscle is the tongue and floor of mouth?
Skeletal so does paralyze.
What cerebral structure connects to the cristal galli?
Falx cerebri
Olfactory or smell sensors run through what structure in the nose?
Cribriform plate
What tonsils can we see?
Palatine tonsils
What tonsils can collapse soft palate?
Pharyngeal tonsils (adenoids)
What nerve is responsible for somatic sensation to the epiglottis?
Vagus Nerve X
What nerve is responsible for somatic sensation to the back 1/3 of tongue?
Glossopharyngeal 9
What nerve is responsible for somatic sensation to the anterior 2/3 of tongue?
Mandibular N (branch of the trigeminal nerve V)
What nerve is responsible for taste sensation to the anterior 2/3 of tongue?
Facial Nerve 7 (chorda tympani)
What nerve is responsible for taste sensation to the posterior 1/3 of tongue?
Glossopharyngeal 9
What nerve is responsible for taste sensation to the epiglottis?
Vagus N X
Which blade enters the vallecula?
MAC blade
Which blade sits on top of the structures and lifts up?
Miller blade
What two ways does the epiglottis cover the airway?
- Gets pulled down
- The larynx moves up and covers the airway
How does cricoid pressure prevent aspiration?
Compression closes off esophagus preventing GI contents from going up
How can cricoid pressure be bad?
If the patient is not paralyzed and muscles contract, the intra-abdominal pressure can blow out LES. Lower esophageal sphincter
Which lung tends to have a little more volume? Why?
The right lung has more volume due to the heart being more in the left thoracic cavity.
In the figure below, what structure is indicated by 7?
Middle Lobe
In the figure below, what structure is indicated by 9?
Superior Lobe
In the figure below, what structure is indicated by 6?
Inferior Lobe
During inspiration, the rib cage ______ while the _________ drops.
elevates ; diaphragm
Where does the diaphragm insert at?
Three points:
- Xiphoid process
- Bottom of costal cage
- L-spine vertebral bodies.
What structure is indicated by 3 in the figure below?
Left dome of the diaphgram
What structure is indicated by 6 in the figure below?
Right dome of the diaphgram
When are the scalene muscles often noticed?
What is the purpose of the scalene muscles?
- If someone is using strong inspiratory effort.
- Scalene muscles prevent the diaphragm from pulling the thorax down.
What scalene muscle is noted by 5 in the figure below?
Where does it attach?
- Anterior Scalene
- Attaches to 1st rib and C3-C6
What scalene muscle is noted by 6 in the figure below?
Where does it attach?
- Middle Scalene
- Attaches to 1st rib and C3-C7
What scalene muscle is noted by 7 in the figure below?
Where does it attach?
- Posterior Scalene
- Attaches to 2nd rib and C5-C7
What structure is indicated by 1 in the figure below?
Thyroid cartilage
What structure is indicated by 2 in the figure below?
What is the importance of this structure?
- Cricoid cartilage: connects the thyroid cartilage and the trachea.
What structure is indicated by 3 in the figure below?
Why is this structure important?
- Cricothyroid ligament (This is the location for an emergent cricothyrotomy airway)
What structure is indicated by 1 in the figure below?
What is the significance of this structure?
Hyoid bone: connects the jaw to the voicebox area.
What structure is indicated by 2 in the figure below?
Cricothyroid ligament
What structure is indicated by 1 in the figure below?
Epiglottic cartilage
What piece of anatomy moves down when swallowing?
What moves up to help prevent aspiration?
- Epiglottis
- Vocal folds
A fast vibration of the vocal ligament results in what kind of sound?
- Faster vibration = higher pitch (like a scream)
What are the vocal ligaments controlled by?
Skeletal muscles
What makes a voice deeper?
Vocal Cord length. Men have longer vocal cords due to a farther out laryngeal prominence (adams apple)
The inferior horns of the thyroid cartilage connect what cartilage to it? At what joint?
Cricoid cartilage at the cricothyroid joint
Paired Cartilages
Arytenoid
Cuneiform
Corniculate
Unpaired Cartilages
Epiglottis
Thyroid cartilage
Cricoid cartilage
What muscle connects the thyroid and cricoid cartilages
The cricothyroid muscle
Why is the nose a great place for drug administration?
Heavy blood supply
Direct path to brain
Lack of mucus or inflammation of the lungs causes what?
Friction which is painful (pleurisy)
Which muscle connects to ribs 3,4,5 to the shoulder blade to help stabilize thorax?
Pectoris Minor
Where on the shoulder blade does the chest muscle connect?
The coracoid process
Which structure can swell largely if hit there?
Parotid gland
Which tonsil is at the back of the tongue?
Lingual tonsil
What does the cricothyroid joint allow for?
Allows for the thyroid cartilage to pivot down
On the cricoid cartilage, there are 4 articular facets for connections. What connects to the top 2 and what connects to the bottom 2?
The top 2 articular facets are for the arytenoid cartilage
The bottom 2 articular facets are for the thyroid cartilage
What structures are fused to the arytenoid cartilages?
Corniculate cartilages
Where does the thyroid sit?
On the lamina of the thyroid cartilage
What can break with a gnarly karate chop?
Hyoid bone
What does the curved shape of the turbinates/concha allow for?
Create turbulent air flow to have air hit the mucus and deposit pollutants
What structures can dry out if we don’t have humidification?
Larynx and trachea
