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CONCISE HNS > Session 5: The Airway and its Relations > Flashcards

Session 5: The Airway and its Relations Flashcards

1
Q

What type of epithelium lines the conchae?

A

Respiratory Epithelium
Increases SA for warming + humidifying inspired air + traps pathogens
(conchae AKA turbinate bones)

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2
Q

What name is given to the gaps between conchae?

A

Meati (superior, middle, inferior)

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3
Q

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

A

Sphenoethmoidal Recess

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4
Q

Which sinus drains into the sphenoethmoidal recess?

A

Sphenoidal Sinus

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5
Q

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

A

Retroflexion

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6
Q

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

A

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

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7
Q

Where are the ethmoidal cells found?

A

Medial to the orbit

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8
Q

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

A

It is penetrated in transphenoidal hypophysectomy

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9
Q

What significant structure is found inferior to the middle nasal concha? Which sinus drains to the bottom of this structure?

A

Semilunar Hiatus

Maxillary sinus

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10
Q

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

A

Anterior, middle + posterior
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

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11
Q

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

A

To the lateral wall of the inferior meatus

It drains tears from the lacrimal sac to the nasal cavity

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12
Q

State 3 roles of the sinuses in the skull.

A

Make the skull lighter
Provide crumple zone for the brain
Increase projection of the voice

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13
Q

What are the mastoid air cells and describe its connection with the middle ear.

A

Small sinuses within the mastoid part of the temporal bone
Mastoid air cells communicate with the middle ear via the aditus ad antrum + the mastoid antrum
= a possible route for infection of the middle ear

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14
Q

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

A

Tegmen tympani

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15
Q

Through which membrane is a cricothyroidotomy performed?

A

Cricothyroid ligament

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16
Q

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

A 
Arytenoid cartilage
Signet ring (broad posteriorly, thinner anteriorly)
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17
Q

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

A

Puts tension on the vocal folds

Cricothyroid muscles

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18
Q

What are the two parts of the cricoid cartilage?

A

Lamina

Arch

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19
Q

What two things do the cricoid cartilage articulate with?

A

Arytenoid cartilage

Inferior horns of the thyroid cartilage

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20
Q

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

A

Laryngeal prominence

Superior + inferior thyroid notch

21
Q

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

A

Corniculate + Cuneiform Cartilage

22
Q

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

A 
Vestibular Fold (false vocal fold)  
Vocal Fold (true vocal fold)  
Vestibular folds are lateral to the vocal folds
23
Q

What membranous outpouching is formed between the vestibular and vocal folds?

A

Laryngeal ventricle and laryngeal saccule

24
Q

What is the name given to the opening between the vocal folds?

A

Rima glottidis

25
Q

Which muscles are attached only to the arytenoids?

A

Transverse + Oblique Arytenoid muscles

26
Q

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

A

Posterior cricoarytenoid muscle: abduction

Lateral cricoarytenoid muscle: adduction

27
Q

Which nerve provides sensory and motor control of the larynx?

A

Vagus Nerve

28
Q

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

A

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

29
Q

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

A

Superior: Superior thyroid artery
Recurrent: Inferior thyroid artery

30
Q

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?

A

Left branches off the vagus much more inferiorly than the right so has more of its length that is near the bronchus, oesophagus + mediastinal lymph nodes

31
Q

What are the 4 common changes that occur during sneezing and coughing?

A

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

32
Q

What is the difference in the oropharyngeal isthmus in coughing compared to sneezing?

A

In coughing, the oropharyngeal isthmus is open

When sneezing, it is closed

33
Q

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

A

Vagus

34
Q

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

A

Maxillary branch of the Trigeminal nerve

35
Q

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

A

Cough: soft palate is raised + tensed against the posterior wall of the pharynx
Sneeze: soft palate is depressed against the tongue

36
Q

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

A

Vagus – palatoglossus/ palatopharyngeus

37
Q

What happens to the vocal folds when sneezing and coughing?

A

They abduct

38
Q

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?

A

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

39
Q

What and where is the vallecula?

A

Behind the root of the tongue between the folds in the throat
Serve as spit traps, saliva is temporarily held in the valleculae to prevent initiation of the swallowing reflex

40
Q

What is the principle function of the larynx?

A

Protect airways from ingested food (valve)

Phonation

41
Q

Describe innervation of the upper airways

A

Olfactory nerve- Olfaction
Trigeminal nerve: V1 (anterior region), V2 (posterior region)
Facial nerve- glands
Sympathetic nerves (from T1): vascular smooth muscle

42
Q

Describe the structure of the larynx

A

Hollow

Composed of cartilages, membrane + muscles

43
Q

What would a lesion in the vagus nerve, internal laryngeal, external laryngeal and recurrent laryngeal cause?

A

Vagus: Complete paralysis
Internal: Loss of sensation above vocal folds
External: Paralysis of cricothyroid
Recurrent: Paralysis of all muscles of larynx except cricothyroid + loss of sensation below vocal folds

44
Q

What procedure may be associated with damage to the superior and recurrent laryngeal nerves?

A

Thyroidectomy

45
Q

Name 4 protective mechanisms for the airway

A

Swallowing
Gag reflex
Sneezing
Coughing

46
Q

What does the facial nerve provide motor innervation too?

A

Muscles of facial expression, stapedius, digastric (posterior belly), stylohyoid

47
Q

What does the facial nerve provide sensory innervation too?

A

Taste (ant. 2/3 of tongue)
Parasympathetic (lacrimal glands, mucous glands of nasal cavity, hard + soft palates, sublingual + submandibular glands)
General sensation from external acoustic meatus + deeper parts of auricle

48
Q

What is found superior to mastoid air cells? What is the significance of this?

A

Middle cranial fossa

Infections can erode the bone into the cranial cavity to cause intracranial infection

CONCISE HNS (3 decks)

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