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Head, neck and introduction to neuroanatomy > Session 10 > Flashcards

Session 10 Flashcards

1
Q

What are the functions of the larynx?

A
  • Airway protection
  • Ventilation
  • Key role in cough reflex (rapidly expels anything inadvertently entering airway)
  • Role in production of sound
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2
Q

Outline the location of the larynx in the body

A
  • Suspended from hyoid bone
  • Lies below hyoid bone
  • Begins at laryngeal inlet
  • Ends at lower border of cricoid cartilage (C6)
  • Continues as trachea
  • Sits in front of pharynx
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3
Q

Which system is the larynx a part of?

A
  • Upper respiratory system
  • Transmits air in and out of lower respiratory tract
    DO NOT CONFUSE WITH PHARYNX (part of GI system)
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4
Q

What facilitates communication between the larynx, oropharynx and laryngopharynx?

A
  • Laryngeal inlet
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5
Q

What is a piriform fossa?

A
  • Recesses
  • Part of laryngopharynx
  • Formed because pharynx hugs around the back of the larynx
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6
Q

Outline the framework of the larynx

A
  • Consists of series of cartilages and connective tissue membranes
  • Epiglottis (leaf-like cartilage)
  • Arytenoid cartilages - pyramid-shaped, sit on top of cricoid cartilage, swivel to allow action of vocal cords
  • Cricoid cartilage (only complete ring-shaped cartilage)
  • Thyroid cartilage
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7
Q

Where are connective tissue membranes found in the pharynx?

A
  • Quadrangular sheet between arytenoid cartilage and epiglottis
  • Sheet of connective tissue between hyoid bone and thyroid cartilage
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8
Q

What is the relationship between the epiglottis and the thyroid cartilage?

A
  • Epiglottis connected by its stalk to inner surface of thyroid cartilage
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9
Q

What joints are found in the larynx?

A
  • Synovial joints
  • Thyroid-cricoid
  • Cricoid-arytenoid
  • Allows opening and closing of parts of larynx
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10
Q

What suspends the larynx from the hyoid bone?

A
  • Thyrohyoid membrane
  • Whenever hyoid bone moves, larynx also moves
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11
Q

Which cartilages and membranes of the pharynx are palpable?

A
  • Hyoid bone
  • Laryngeal prominence
  • Cricothyroid membrane
  • Cricoid cartilage
  • 1st tracheal ring
  • Isthmus and lobes of thyroid gland
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12
Q

What is a cricothyroidotomy?

A
  • Provides emergency access to airway beneath vocal cords
  • Done when patient cannot be intubated or ventilated
  • Temporary device inserted into airway via cricothyroid membrane
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13
Q

What makes up the laryngeal inlet?

A
  • Aryepiglottic folds x2 (upper free edges of quadrangular membrane)
  • Upper edge of epiglottis
  • Form oval-shaped opening of larynx
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14
Q

What creates the aryepiglottic fold?

A
  • Free upper border of quadrangular membrane
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15
Q

What creates the false vocal cord?

A
  • Free lower border of quadrangular membrane = vestibular ligament
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16
Q

What creates the true vocal cord?

A
  • Free upper border of cricothyroid membrane = vocal ligament
  • Inserts into internal surface of thyroid
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17
Q

What lines the larynx?

A
  • Mucous membrane
  • Internal anatomy is shaped by folds formed by various ligaments/membranes
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18
Q

What are the 3 regions of the larynx?

A
  • Supraglottis - epiglottis up to and including false cords
  • Glottis - narrowest part and includes true vocal cords until about 1 cm below
  • Infraglottis - below true vocal cords to inferior boundary of cricoid
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19
Q

What type of epithelium lines the larynx?

A
  • Pseudostratified ciliated columnar epithelium
  • Except true vocal cords, which are lined with stratified squamous epithelium (protects against abrasive forces of air)
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20
Q

What is flexible nasoendoscopy?

A
  • Insert flexible endoscope via nasal cavity and pharynx to then visualise larynx
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21
Q

What should be seen on a laryngoscopic view?

A
  • Need to see vocal cord to ensure tube does not go through pharynx and oesophagus
  • Tip of laryngoscope is inserted in vallecula (space between back of tongue and epiglottis)
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22
Q

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

A
  1. Alter size and shape of laryngeal inlet:
    - muscles within aryepiglottic folds can contract
    - narrow laryngeal inlet
    - flatten position of epiglottis
    - protects larynx during swallowing
  2. Alter tension in and position of true vocal cords
    - muscles within larynx alter position of arytenoid cartilages
    - vary position of vocal cords
    - adduction of vocal cords protects larynx during swallowing
    - enables phonation
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23
Q

What nerve supplies the intrinsic laryngeal muscles?

A
  • Recurrent laryngeal nerve of vagus nerve
  • Except for cricothyroid muscle
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24
Q

When do we need to alter the size and shape of laryngeal inlet?

A
  • Direct food away from laryngeal inlet and into piriform fossae
  • When swallowing
  • Epiglottis is flattened
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25
Where are the vocal cords located?
- Run from arytenoid cartilages to inner surface of thyroid cartilage at level of laryngeal prominence
26
How is the position of the arytenoid cartilages altered?
- Arytenoid cartilages move to alter position of vocal cords - Widens and narrows rima glottidis - Majority of muscles narrow rima glottidis by adducting vocal cords together - Only one muscle abducts vocal cords to widen rima glottidis
27
What is the position of the vocal cords when breathing?
- Abducted - Laryngeal inlet open
28
What is the position of the vocal cords when swallowing?
- Adducted - Laryngeal inlet also narrowed by muscles in aryepiglottic folds
29
What is the position of the vocal cords during phonation?
- Closely adducted but with a slight gap between them - Expired air forced through closely adducted vocal cords - Vibration of vocal cords creates sound waves
30
What is the position of the vocal cords during a cough?
- Vocal cords adduct and create a tight seal so no air escapes - Pressure builds until vocal cords snap open - Air is expelled
31
How do the vocal cords change pitch?
- High-pitched sounds = vocal cords taut - Low-pitched sounds = vocal cords less taut - Contraction of both cricothyroid muscles increases tension in vocal cords - Muscle located outside of larynx
32
What is the action of the cricothyroid muscle?
- Tilts thyroid cartilage forward on cricoid - Increases tension in vocal cords - Allows higher pitches to be reached
33
Which nerve innervates the cricothyroid muscles?
- External branch of superior laryngeal nerve (branch of CN X) - Closely related to superior thyroid artery - Risk of injury in thyroid surgery - Causes hoarseness of voice when attempting higher pitched sounds
34
What happens to the epiglottis during swallowing?
- Tongue pushes epiglottis posteriorly - Aryepiglottic muscles contract - Laryngeal inlet narrows - Epiglottis positioned horizontally
35
Where is food directed towards on swallowing?
- Directed over curved upper surface of epiglottis into piriform fossae of laryngopharynx
36
What happens to the hyoid bone during swallowing?
- Hyoid bone elevated and moved anteriorly - By suprahyoid muscles - Larynx moves and forward (away from pharynx, makes it more open for receiving food)
37
What happens to the vocal cords during swallowing?
- True vocal cords are adducted - Closure of rima glottidis
38
What are the sensory and motor nerves that supply the larynx?
- Sensory only to supraglottis and glottis = internal branch of superior laryngeal nerve - Motor only to cricothyroid muscle = external branch of superior laryngeal nerve - Recurrent laryngeal nerve supplies motor to intrinsic muscles and sensory to infraglottis
39
Which artery does the superior laryngeal nerve run to?
- Superior thyroid artery
40
Outline the route of the right and left recurrent laryngeal nerves
- Innervates all intrinsic muscles of larynx - Passes anteriorly to and then loops under right subclavian artery and arch of aorta on left - Ascends in tracheo-oesophageal (behind lobes of thyroid gland)
41
Which nerve is at risk of damage during thyroid surgery?
- Right and left recurrent laryngeal nerves - Close anatomical relationship with thyroid gland and inferior thyroid arteries - Results in paralysis of muscles moving a true vocal cord
42
What can cause injury to the recurrent laryngeal nerve?
- Disease or surgery involving larynx, oesophagus or thyroid - Aortic arch aneurysm (left RLN) - Cancer involving apex of lung (right RLN)
43
What does a unilateral RLN lesion lead to?
- Unilateral true vocal cord palsy - Hoarse voice - Ineffective cough - No significant impairment to airflow during breathing
44
What happens to a vocal cord affected by a RLN injury?
- Affected VC assumes a resting paramedian position - Paramedian = between fully abducted and fully adducted
45
Why are bilateral RLN injuries so dangerous?
- Both vocal cords assume a resting paramedian position - Bilateral RLN lesions are rare - Narrow rima glottis significantly - Significant airway obstruction - Emergency surgical airway needed
46
What is laryngitis?
- Inflammation of larynx often involving true vocal cords - Can have infectious cause or non-infectious - E.g. due to repetitive strain on voice
47
How is laryngitis diagnosed?
- Diagnosed clinically from history - Hoarse/weak voice and sore throat (oedema affects pliability vocal cords and increases their bulk) - History of URTI - Infectious and non-infectious aetiology - Usually self-limiting: fully resolves in 2-3 weeks
48
Outline laryngeal nodules
- Benign growth on vocal cords - Acute trauma or chronic irritation - Hoarseness of voice (>3 weeks) - Requires visualisation of cords +/- biopsy
49
What is laryngeal oedema?
- Due to allergic reaction or swallowed foreign body - Acute presentation
50
What is epiglottitis?
- Rare (more common in children) - Potentially airway threatening - Inflammation secondary to infection (usually Haemophilus Influenza type B) - Cellulitis of epiglottis and surrounding tissues - Child will be sitting forward in sniffing position, drooling, with stridor - Don't upset the child, don't place anything in the mouth
51
What is croup?
- Acute laryngotracheobronchitis - Barking cough - Inspiratory stridor - Classically caused by parainfluenza - Can be managed at home with steroids (reduce inflammation) - If stridor present at rest, give adrenaline/budesonide nebulisers and admit
52
How do patients with a compromised upper airway present?
- Stridor - Raised respiratory rate - Distress - Hypoxia - May or may not have cyanosis
53
How is the airway maintained?
- Actions and general tone in muscles of upper pharynx/larynx/tongue - Protective reflexes e.g. gag, cough, swallow - Complex neural pathways and reflexes involved to keep airway patent and safe
54
What happens to the airway when a person is unconscious?
- Decreased muscle tone - Suppression of reflexes - Airway at risk - Tissues can relax and fall back onto upper airway resulting in occlusion
55
When do we need to manage a person's airways?
- Can be planned e.g. in preparation for surgery involving general anaesthetic - Can be emergency as there is an acute/immediate threat to airway e.g. laryngeal oedema/unconscious patient
56
What simple manoeuvres can be done to manage the airways?
- Head tilt - Chin lift
57
When are airway adjuncts used?
- If patient is breathing spontaneously - Can be oropharyngeal airway (Guedel) though this is contraindicated if minimal depression of consciousness (illicits gag reflex) - Or nasopharyngeal airway
58
What are the pros and cons of airway adjuncts?
- Allow for spontaneous ventilation - But offer no protection of lower respiratory tract from vomit/secretions
59
What are the pros and cons of supraglottic airways?
- E.g. iGel - Maintains airway and affords some protection - Minimal technical skills required to insert - Often first line in cardiac arrest - Not for long-term ventilation e.g. if in ITU
60
How is a definitive airway inserted?
- Endotracheal tube (oral cavity, oropharynx, pharynx, trachea) - Technical skill - Requires use of laryngoscope to visualize vocal cords - Secures and protects lower respiratory tracts from secretions/vomit - Patient anaesthetised prior to insertion

Head, neck and introduction to neuroanatomy (11 decks)

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