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Respiratory Flashcards

1
Q

Dorsal pharyngeal wall supported by which muscle? Innervated by?

A

Stylopharyngeus

Innervated by CN IX (glossopharyngeal); if blocked causes dorsal pharyngeal collapse

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2
Q

Dilation of pharynx on inhalation

A

Geniohyoid & genioglossus pull rostrally & ventrally; sternothyroid & sternohyoid pull caudally –> extension of stylohyoid-ceratohyoid articulation, ventral movement of hyoid bone, & nasopharyngeal dilation

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3
Q

Muscles that dilate external nares?

A

Dilator naris & transversus nasi; innervated by CN 7

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4
Q

Position of soft palate determined by which 4 muscles?

A
  1. Palatinus
  2. Tensor veli palatini
  3. Levator veli palatini
  4. Palatopharyngeus
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5
Q

Dysfxn of which muscle destabilizes the cranial portion of the soft palate?

A

Tensor veli palatini

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6
Q

Innervation of the muscles of the soft palate?

A

Pharyngeal br of Vagus innervates all but tensor veil palatini
T veli palatini - medial branch of mandibular nerve

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7
Q

Dysfxn of which muscle destabilizes the cranial portion of the soft palate?

A

T veli palatini

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8
Q

Blocking pharyngeal branch of Vagus nerve results in what?

A

DDSP

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9
Q

Which muscle stabilizes epiglottis?

A

M. hyoepiglotticus

Originates on basihyoid bone & inserts on base of epiglottis
When contracts – pulls epiglottis ventrad toward base of tongue

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10
Q

Hyoepiglotticus innervated by what nerve?

A 
CN XII (hypoglossal) 
Blocking causes epiglottic retroversion during inhalation in exercising horses
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11
Q

What upper airway dysfxn easier to recreate on treadmill than overground endoscopy in racehorses?

A

Palatal dysfxn & DDSP

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12
Q

After laryngoplasty & ventriculocordectomy peak inspiratory flow & minute ventilation increase how much?

A

Peak inspiratory flow - 30-70%

Minute ventilation - up to 50%

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13
Q

On ultrasound, depth of basihyoid bone was shown to be affected how in horses with DDSP?

A

More shallow in horses w DDSP

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14
Q

US sensitivity & specificity for RLN?

A

Increased muscle echogenicity of cricoarytenoideus lateralis

Sensitivity 90.77%
Specificity – 90%

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15
Q

Key diagnostic feature of 4-BAD?

A

Absence of cricothyroid articulation

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16
Q

6 pairs of sinuses

A

Dorsal, middle, & ventral nasal conchal sinuses
Sphenopalatine sinus
Frontal sinus
Maxillary sinus

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17
Q

Dorsal conchal sinus communicates with which sinus?

A

Frontal sinus; formin conchofrontal sinus

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18
Q

Ventral conchal sinus communicates with which other sinus?

A

Rostral maxillary sinus; over infraorbital canal through conchomaxillary opening

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19
Q

Which sinus is largest?

A

Maxillary

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20
Q

Roots of which maxillary teeth enter the rostral & caudal maxillary sinus?

A

109/209 - rostral

110/210 & 111/211 - caudal

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21
Q

Describe communications of caudal maxillary sinus

A

Caudal max sinus partially divided by infraorbital canal over which it communicates w sphenopalatine sinus
Communicates dorsally w conchofrontal sinus via frontomaxillary opening @ level of osseous lacrimal canal & medial wall of orbit
Communicates w nasal cavity thru nasomaxillary opening into caudal aspect of middle meatus

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22
Q

Describe communications of rostral maxillary sinus?

A

Rostral max sinus divided by infraorbital canal into medial & lateral compartments
Medial compartment communicates w middle nasal meatus via narrow slit (nasomaxillary opening)
Rostral compartment communicates w ventral conchal sinus over infraorbital canal thru conchomaxillary opening

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23
Q

Sphenopalatine sinus communicates with which other sinus?

A

Caudal maxillary sinus

24
Q

Complications of nasal septum removal

A

Formation of excessive granulation tissue of caudal septal stump
Adhesions to nasal conchae
These may result in persistent noise or exercise intolerance
Prognosis for normal fxn guarded

25
Q

Treatment for ethmoid hematoma in fundus of nasal cavity & < 5 cm diameter?

A

Nd:YAG laser or intralesional formalin

Several laser applications & formalin injections typically needed
Laser – best ablated using noncontact technique @ 60W
Formalin – injected into mass endoscopically q3-4 wks (avg 5 injections)

26
Q

Rate of recurrence of ethmoid hematoma after sx?

A

43%

27
Q

Where is site for establishing communication btw rostral maxillary sinus & nasal cavity?

A

Dorsally over infraorbital canal in young horses & ventral to infraorbital canal in older horses

28
Q

Blood supply to soft palate

A

Maxillary artery

Linguofacial trunk

29
Q

Innervation of soft palate

A

Branches of trigeminal, glossopharyngeal, & vagus

30
Q

Intrinsic muscles of soft palate & function?

A 
Palatinus 
Levator veli palatini
Tensor veli palatini
Palatopharyngeus 
Stylopharyngeus

Fxn - contributes to stability of nasopharynx

31
Q

Palatine aponeurosis formed by?

A

Expansion of tendon of tensor veil palatini; attaches to caudal margin hard palate

32
Q

Origin, insertion, function of tensor veli palatini?

A

Muscular process of petrous temporal bone & lateral lamina of auditory tube; passes along lateral wall of nasopharynx to insert w/in soft palate

Elevates SP during swallowing, closes nasopharynx, & facilitates oral ventilation in nonobligate nasal breathers

33
Q

Origin, insertion, function of palatinus muscle?

A

Paired fusiform muscle that originates at caudal aspect of palatine aponeurosis & courses thru middle of SP, just beneath nasal mucosa to ramify in caudal free margin of SP

Shortens SP & depresses it toward tongue (with palatopharyngeus)

34
Q

Origin, insertion, function of palatopharyngeus?

A

Arises from palatine aponeurosis (lateral to palatinus) & from palatine & pterygoid bones; fibers continue caudal on lateral wall of pharynx & partially insert into upper edge of thyroid cartilage; remainder continues dorsad & inserts at median fibrous raphe

Shortens SP & depresses it toward tongue (with palatinus)

35
Q

Origin, insertion, function of tensor veil palatini?

A

Fusiform mm; originates @ muscular process of petrous part of temporal bone, pterygoid bone, & lateral lamina of auditory tube & travels rostroventrad along lateral wall of nasopharynx lateral to levator veli palatini; tendon courses around Hamulus of pterygoid bone & ramifies in palatine aponeurosis

Tenses rostral aspect of SP by using Hamulus as pulley & retracts SP away from dorsal pharyngeal wall expanding nasopharynx & slightly depressing it ventrad during inspiration

36
Q

Origin, insertion, function of rostral stylopharyngeus?

A

Originates from medial surface of rostral end of stylohyoid bone & inserts on pharyngeal raphe

Acts as pharyngeal constrictor; not stimulated during exercise

37
Q

Origin, insertion, function of caudal stylopharyngeus?

A

Originates from medial aspect of caudal third of stylohyoid bone & courses ventrally & rostrally to attach on dorsolateral wall of pharynx

Pharyngeal dilator & is responsible for tension on roof of nasopharynx that helps to resist collapse w inspiratory pressure

38
Q

Caudal stylopharyngeus innervated by?

A

CN IX (glossopharyngeal)

39
Q

Extrinsic musculature of pharynx?

A 
Geniohyoideus
Thyrohyoideus
Genioglossus
Hyoglossus
Styloglossus
Sternohyoideus
Sternothyroideus
Hyoepiglotticus

Fxn –> Contribute to respiratory patency of nasopharynx by indirectly increasing diameter thru change in size of oropharynx or posn of larynx; also increases stability of SP @ exercise

40
Q

Origin, insertion, fun of geniohyoideus?

A

Originates in conjunction w genioglossus on medial surface of mandible near symphysis & inserts on basihyoid bone

Draws hyoid apparatus rostrally & protrudes tongue

41
Q

Origin, insertion, & function of thyrohyoideus?

A

Extends from lateral lamina of thyroid cartilage to caudal aspect of thyrohyoid bone

Enhances SP stability during exercise by moving larynx rostrad so thyroid cartilage rests more dorsal & rostral in relation to basihyoid; resection disrupts stability resulting in DDSP

42
Q

Origin, insertion, function of genioglossus?

A

Originates w/in median plane of tongue; attaches to oral surface of mandible caudal to symphysis

Contraction protracts tongue & pulls basihyoid bone rostrally; activity may be reproduced by tongue tie

43
Q

Origin, insertion, & function of hyoglossus?

A

Located medial to styloglossus, originates on hyoid bones (lingual process & stylohyoid & thyrohyoid bone) & inserts on medial plane of dorsum of tongue

Retracts & depresses base of tongue

44
Q

Origin, insertion, & function of sternohyoideus & sternothyroideus?

A

Originate on sternal manubrium & extend cranially; sternothyroideus inserts on caudal abaxial aspect of thyroid cartilage & sternohyoideus inserts on basihyoid bone & lingual process of hyoid apparatus

Contraction results in caudal traction on hyoid apparatus & larynx

45
Q

Origin, insertion, function of hyoepiglotticus muscle?

A

Attaches to hyoid bone @ base of epiglottis

During contraction pulls epiglottis ventrad toward base of tongue increasing ventral dimension of rima glottidis

46
Q

Geniohyoideus, genioglossus, styloglossus, hypoglossus, & hyoepiglotticus innervated by which nerve?

A

Hypogossal nerve

47
Q

Sternohyoideus & sternothyroideus innervated by what nerves?

A

Branches from 1st & 2nd cervical nerves

48
Q

Pharyngotomy allows access to which portion of soft palate?

A

Caudal 1/3

49
Q

Which muscle can be damaged during pharyngotomy?

A

Hyoepiglotticus or its innervation

50
Q

Treatment options for rostral pharyngeal collapse?

A

Laser thermoplasty - diode laser 20 W, 600 um contact fiber
Thermal palatoplasty
Tension palatoplasty

51
Q

Dysfunction of what muscle results in collapse of roof of nasopharynx?

A

Stylopharyngess caudalis

52
Q

Potential etiologies for DDSP

A

Masses
Epiglottic hypoplasia or deformation - unable to hold SP in sub epiglottic posn
Caudal retraction of tongue - base of tongue may push soft palate dorsad (tongue tie)
Opening of mouth letting air into oropharynx - disturbs stabilizing effect of sub atmospheric pressure on ventral surface SP (drop/fig-8 noseband)
Abnormal pos of larynx & hyoid bone - more ventral basihyoid bone & more caudal pos larynx in DDSP
Dysfxn of pharyngeal branch vague nerve
Dysfxn of thyrohyoideus muscle
Dysfxn of hypoglossal nerve

Causes increased impedance, decreased minute ventilation, & hypoxia

53
Q

3 models used to induce DDSP

A
  1. Blockade of pharyngeal branch of vagus nerve; palatinus & palatopharyngeus mm important in stabilizing sp during rest & exercise; results in feed & water contamination of upper airway
  2. Thyrohyoideus muscle model – actions of these muscles collapsibility of nasopharynx @ exercise supporting beneficial effect of swallowing on palatal instability
  3. Blockade of hypoglossal nerve – stabilizing effect on nasopharynx
54
Q

4 surgical treatment options for DDSP

A
  1. Staphylectomy (partial soft palate resection) - > 0.75 cm resection disturbs seal btw oropharynx; generally for resection of granuloma or cyst or txt of permanent DDSP w tie-forward
  2. Standard myectomy (sternohyoideus & sternothyroideus)
  3. Minimally invasive myectomy (Llewellyn procedure - partial sternothyroidectomy); rapidly performed & easy in field
  4. Laryngeal tie-forward

(Tension & thermal palatoplasty ineffective for DDSP)

55
Q

Tie-forward intends to replace action of which muscle?

A

Thyrohyoideus muscle; by sutures placed btw thyroid cartilage & basihyoid bone

56
Q

3 treatment options for choanal atresia

A

Diode laser resection
Choanal memo & partial nasal septum resection via nasal bone flap
Membrane resected through laryngotomy (young foal)

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