Session 5: The Airway and its Relations

Question 1

What type of epithelium lines the conchae?

Answer 1

Respiratory Epithelium It increases the surface area for warming and humidifying the inspired air (conchae are also referred to as turbinate bones)

Question 2

What name is given to the gaps between conchae?

Answer 2

Meati (superior, middle, inferior)

Question 3

What is the name of the space superior to the superior concha?

Answer 3

Sphenoethmoidal Recess

Question 4

Which sinus drains into the sphenoethmoidal recess?

Answer 4

Sphenoidal Sinus

Question 5

What action does the epiglottis perform to close off the laryngeal inlet?

Answer 5

Retroflexion

Question 6

What is the role of the pharyngotympanic tube (Eustachian tube)?

Answer 6

Equalises the pressure on either side of the tympanic membrane by allowing a connection between the middle ear and the nasopharynx

Question 7

Where are the ethmoidal cells found?

Answer 7

Sinuses just medial to the orbit- ethmoidal sinuses

Question 8

What is the clinical relevance of the sphenoid sinus in relation to the pituitary gland?

Answer 8

It is penetrated in transphenoidal hypophysectomy

Question 9

What significant structure is found inferior to the middle nasal concha?

Answer 9

Semilunar Hiatus

Question 10

Where does the sphenoidal sinus drain?

Answer 10

Into the sphenoethmoidal recess

Question 11

What are the three parts of the ethmoidal air cells and where do each of them drain?

Answer 11

Anterior, middle and posterior ethmoidal air cells Posterior – lateral wall of superior meatus Middle – ethmoidal bulla Anterior – top of the semilunar hiatus via the frontonasal duct with the drainage of the frontal sinus

Question 12

Where does the maxillary sinus drain?

Answer 12

To the bottom of the semilunar hiatus

Question 13

Where does the nasolacrimal duct drain and what is its role?

Answer 13

To the lateral wall of the inferior meatus It drains tears from the lacrimal sac to the nasal cavity

Question 14

State some roles of the sinuses in the skull.

Answer 14

It makes the skull lighter Acts as a crumple one for the brain Increases projection of the voice

Question 15

What is the name given to the thin plate of bone that forms the roof of the tympanic cavity?

Answer 15

Tegmen tympani

Question 16

Through which membrane is a cricothyroidotomy performed?

Answer 16

Cricothyroid ligament

Question 17

What important cartilage is found attached to the top of the cricoid cartilage?

Answer 17

Arytenoid cartilage

Question 18

What effect does tilting the thyroid cartilage forwards have on the vocal folds? Which muscles perform this action?

Answer 18

Puts tension on the vocal folds Cricothyroid muscles

Question 19

What are the two parts of the cricoid cartilage?

Answer 19

Lamina and Arch

Question 20

What two things do the cricoid cartilage articulate with?

Answer 20

Arytenoid cartilage Inferior horns of the thyroid cartilage

Question 21

What name is given to the protrusion between the laminae of the thyroid cartilage and what notches are found above and below this point?

Answer 21

Laryngeal prominence Superior and inferior thyroid notch

Question 22

What two bits of cartilage are found on top of the arytenoid cartilage?

Answer 22

Corniculate and Cuneiform Cartilage

Question 23

What are the two folds in the mucosa in the laryngeal inlet and how are they arranged?

Answer 23

Vestibular Fold (false vocal fold) Vocal Fold (true vocal fold) Vestibular folds are lateral to the vocal folds

Question 24

What membranous outpouching is formed between these two folds?

Answer 24

Laryngeal ventricle and laryngeal saccule

Question 25

Which muscles are attached only to the arytenoids?

Answer 25

Transverse and Oblique Arytenoid muscles

Question 26

Which muscles are involved in abducting and adducting the vocal folds?

Answer 26

Posterior cricoarytenoid muscle – abduction Lateral cricoarytenoid muscle – adduction

Question 27

Which nerve provides sensory and motor control of the larynx?

Answer 27

Vagus Nerve

Question 28

What are the different laryngeal branches of the vagus nerve and what do these branches do?

Answer 28

Superior Laryngeal Nerve – separates into internal and external laryngeal Internal Laryngeal – sensory above the vocal folds External Laryngeal – motor to cricothyroid muscles Recurrent Laryngeal – sensory below the vocal folds + motor to all other muscles of the larynx

Question 29

Which arteries do the superior and recurrent laryngeal nerves run alongside?

Answer 29

Superior – Superior thyroid artery Recurrent – Inferior thyroid artery

Question 30

Why is the left recurrent laryngeal nerve more susceptible to damage by bronchial/oesophageal tumours and swollen mediastinal lymph nodes than the right recurrent laryngeal nerve?

Answer 30

Because the left recurrent laryngeal nerve branches off the vagus much more inferiorly than the right so it has more of its length that is near the bronchus, oesophagus and mediastinal lymph nodes

Question 31

What are the common changes that occur during sneezing and coughing?

Answer 31

Inspiration Closed glottis and contraction of abdominal muscles Increase in intrathoracic pressure Sudden abduction of the vocal folds to release the intrathoracic pressure

Question 32

What is the difference in the oropharyngeal isthmus in coughingcompared to sneezing?

Answer 32

In coughing, the oropharyngeal isthmus is open When sneezing, it is closed

Question 33

Which afferents take information from laryngeal receptors to trigger the cough reflex?

Answer 33

Vagus

Question 34

Which afferents take information from laryngeal receptors totrigger the sneeze reflex?

Answer 34

Maxillary branch of the Trigeminal nerve

Question 35

How is the movement of the soft palate different in cough reflexcompared to a sneeze?

Answer 35

Cough – soft palate is raised and tensed against the posterior wall of the pharynx Sneeze – soft palate is depressed against the tongue

Question 36

The soft palate is depressed against the tongue when sneezing toprevent the release of the pressure through the mouth. Which nerve and muscles are involved in this?

Answer 36

Vagus – palatoglossus/palatopharyngeus

Question 37

What happens to the vocal folds when sneezing and coughing?

Answer 37

They abduct

Question 38

The soft palate is raised and tensed against the posterior wall of the pharynx when coughing. Which muscles are involved in this action and which nerves innervate these muscles?

Answer 38

Tensor veli palatini (mandibular of trigeminal (V3)) Levator veli palatini (X) Superior constrictor (X)