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Anatomy - Head, neck and spine > Upper Airway > Flashcards

Upper Airway Flashcards

1
Q

How is the larynx, trachea and bronchioles held open?

A

By plates/crescents of cartilage (a non-mineralised connective tissue, supporting but flexible)

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2
Q

How are the nasal cavities and pharynx kept open?

A

By attachments to nearby bone

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3
Q

How do the alveoli and bronchioles stay open?

A

They have surfactant that prevents collapse by surface tension

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4
Q

What are the 3 parts of the pharynx and describe them?

A

Nasopharynx – posterior to the nasal cavity, and is the Eustachian tube opening

Oropharynx – posterior to the tongue, consists of lymphoid tissue

Laryngopharynx – after the epiglottis

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5
Q

What is the eustachian tube?

A

A tube that links the nasopharynx to the middle ear

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6
Q

What is the purpose of the larynx?

A

Its not there to produce sound – it is there to protect the airway during the ingestion of food. However, we do use the larynx to make sounds (phonation and speech).

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7
Q

Describe the structure of the nasal cavities?

A
  • Nearly triangular cross-section
  • Has fairly smooth medial and inferior walls
  • Has an elaborate lateral wall in which the respiratory epithelium with hairy mucosa covers three scroll-like plates of bones called the conchae
  • Has a complex and important vascular and nerve supply
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8
Q

What is the importance of the conchae?

A
  • Inspired air passes through these warm, moist plates
  • The air becomes warmed and humidified on the way
  • This protects the lower parts of the respiratory tract from cold shock and drying
  • The nasal lining becomes cooled in this process
  • So, during expiration, the nasal lining cools the expired air
  • It also retrieves water by condensation
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9
Q

During exercise why do we breathe through our mouths and what does this result in?

A
  • During exercise the nasal resistance to flow means nasal airflow isn’t fast enough
  • Open-mouth breathing takes over
  • This causes an increased loss of water and exposure to airborne particles
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10
Q

What is the secondary role of the nasal cavity?

A

Sense of olfaction (smell) – olfactory tract has a specialised epithelium with specialised nerve supply

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11
Q

What are the 3 conchae called?

A

Superior, middle and inferior nasal concha

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12
Q

What is found between the conchae?

A

Meatuses (spaces) – superior, middle and inferior

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13
Q

What do the conchae have to combat pathogens?

A

An immune system

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14
Q

What are the conchae a drainage route for?

A

sinuses

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15
Q

Which nerve is responsible for olfaction?

A

olfactory nerve

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16
Q

Which nerve provides innervation to the glands e.g. lacrimal?

A

facial nerve

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17
Q

Which nerve provides sensation to the anterior and to the posterior region of the nasal cavity?

A

anterior: V1
posterior: V2

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18
Q

Where does blood supply to the nasal cavity come from?

A

From branches of the internal carotid artery and external carotid artery

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19
Q

Describe venous drainage of nasal cavities and clinical relevance of this

A

The superior parts of the nasal cavity drain into the cranial cavity. The nasal cavity has a function to trap pathogens, and this can be drained into the cranial cavity -> infection

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20
Q

What are paranasal air sinuses?

A
  • 4 sets of blind-ended holes of the lateral walls of the nasal cavities
  • Includes frontal, maxillary, sphenoidal and ethmoidal sinuses
  • The air turnover in these is fairly slow and plays little role in heat and water transfer
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21
Q

What are the possible roles of the sinuses?

A
  • Reducing the weight of the facial bones – MAIN FUNCTION
  • Providing a “crumple zone” in facial trauma – protects the brain
  • Acting as resonators for the voice
  • Insulating sensitive structures such as dental roots and eyes from the rapid temperature fluctuations in the nasal cavities
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22
Q

Infection of which sinus is common and why?

A

Infection of the maxillary sinus is common as the opening is high up

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23
Q

What supplies sensory innervation to the paranasal sinuses?

A

Trigeminal

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24
Q

Where do the sinuses drain into the nasal cavity?

A

The meatuses

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25
Q

Why does lacrimation get accompanied by sniffling?

A

When lacrimation occurs, tears are produced and drain into the back of the nasal cavity via the nasolacrimal duct.

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26
Q

How does the sphenoid sinus drain into the nasal cavity?

A

Via the spehno-ethmoidal recess

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27
Q

Where do the middle ethmoid air cell drain?

A

Into the ethmoidal bulla between the middle and inferior conchae

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28
Q

Where do the frontal sinuses and anterior ethmoid cells drain?

A

into the nasal cavity via the frontonasal duct

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29
Q

Where do the posterior ethmoid air cell drain?

A

Into lateral wall of superior meatus

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30
Q

Where does the maxillary sinus drain?

A

At floor of semilunar hiatus

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31
Q

Describe the structure of the larynx

A
  • Cartilaginous structure supported from the roof of the mouth by the hyoid bone
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32
Q

Describe the larynx relative to other structures

A

Superior and posterior to the thyroid gland, superior to the trachea

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33
Q

Is the larynx the same in males and females?

A

No, develops differently

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34
Q

What lines the larynx?

A

A membrane, which forms a complete sheath on the inside of the trachea

35
Q

What is the arytenoid cartilage?

A
  • Attached to vocal ligaments that open and close entry to the larynx. This is crucial – act as a sphincter preventing entry into the lower airways
  • They are open during inspiration and closed during phonation
  • When the vocal folds are partially open, and air is passed through, sound is made – this is the mechanism of vocalisation in the mouth
36
Q

Without the larynx what would the voice be like?

A
  • Without the larynx, voice would be monotonous, low pitch

- The role of the larynx is modulation of sound

37
Q

What is the effect of closing the vocal cords?

A
  • Increases the pressure in the thorax and abdomen

- This can lead to an expulsive force e.g. during sneezing, childbirth + vomiting

38
Q

What is the laryngeal prominence?

A
  • The thyroid cartilage consists of two large plates – they are joined at the laryngeal prominence
  • The medial structure palpated in the midline of the neck
39
Q

What does the laryngeal cartilage consist of (2 main plates)?

A

cricoid and thryoid (epiglottis is also a cartilage)

40
Q

Describe the arrangement of the two cartilages

A
  • There is a small gap between the thyroid and cricoid cartilages
  • The cricoid cartilage is a full ring – it is wider at the back than at the front
41
Q

Describe the movement of the cartilages and how tension in the vocal cords is altered

A
  • The thyroid cartilage above the cricoid cartilage rocks backwards and forwards (assisted by cricothyroid membrane). This is how tension in the vocal folds is altered
  • Moving the distance between the anterior and posterior attachments of the vocal folds further apart allows for alteration of tension in the vocal folds
42
Q

What is inferior to the cricoid cartilage?

A

tracheal ring

43
Q

Where is the hyoid bone located relative to the cartilages?

A

Between the underside of the mandible and the thyroid cartilage

44
Q

How do the arytenoid cartilages move?

A

The arytenoid cartilages on top of the cricoid swivel from side to side (abduction and opening). They are conical, with the large part facing inferiorly.

45
Q

What is the cricothyroid joint?

A

The cricothyroid joint is the joint around which the thyroid cartilage rocks backwards and forwards by the actions of various muscles, to increase/decrease tension on the vocal folds.

46
Q

Describe the articulations of the laryngeal cartilages

A
  • The cricoid cartilage has some facets; there are joints between the arytenoids
  • There is a process on the thyroid cartilage: the facet for cricoid (medial surface of horn)
  • It projects down from the thyroid cartilage and articulates with the cricoid
47
Q

Describe the structure of the vocal cords

A
  • There are many indentations and folds that give the vocal cords their characteristic view
  • There are ligaments slung between the posterior and anterior parts of the vocal cords
48
Q

What is the hole between the vocal cords called?

A

rima glottidis

49
Q

What happens to the rima glottidis when we are inspiring and phonation is occuring?

A

When air is being taken in (inspiration) the rima glottidis is open. When this happens, we can see the trachea.

When phonation is taking place, the rima glottidis is closed (the vocal cords need to be abducted in order to vibrate, as air travels across them).

50
Q

Which muscle are involved in sound production and movement of vocal folds?

A

The intrinsic muscles

51
Q

What happens when the cricothyroid muscles shorten to the thyroid cartilage?

A

The thyroid cartilage rocks forward

52
Q

Which muscles help to abduct and adduct the vocal folds?

A

the transverse and oblique muscles attached to the arytenoids

53
Q

What does the vocalis muscle do?

A

Reduces the tension on the vocal cords, because it brings the thyroid cartilage towards the cricoid. Tension is increased when the thyroid moves away from the cricoid.

54
Q

Which nerves supply the larynx?

A

Vagus supplies entire larynx - branch is the superior laryngeal nerve (internal and external) and the recurrent laryngeal nerve

55
Q

Which nerves provides motor innervation?

A

recurrent laryngeal nerve supplies everything but criothyroid muscle which is supplied by external larygneal nerve

56
Q

Which nerves provide sensory innervation to the larynx?

A
  • Everything above vocal cords: recurrent laryngeal

- Everything below vocal cords: internal laryngeal

57
Q

Describe the pathway of the recurrent laryngeal nerves (L+R) and the importance of this

A
  • The recurrent laryngeal nerve is longer on the left side than on the right side
  • The left laryngeal nerve loops around the junction between the aortic arch and pulmonary trunk
  • This loop occurs around the liagmentum arteriosum
  • The left RLN winds around the ligamentum arteriosum on its way back up to the larynx
  • The vagus nerve continues down to form the oesophageal plexus
  • The right RLN winds around only the right subclavian artery.
  • This is why there is discrepancy of the function of the larynx, more in one side than the other. You are more likely to damage the left RLN.
58
Q

What effects will lesions at different points along the vagus have?

A
  • If the lesion occurs before branching -> complete paralysis of all muscles
  • A lesion of the internal branch of the superior laryngeal nerve will cause loss of sensation above the vocal folds (sensation is critically important – any noxious stimulation of the throat causes reflex coughing)
  • A lesion in the RLN causes paralysis in almost all of the muscles in the larynx, and loss of sensation below the vocal cords
59
Q

Why is the RLN at risk of being damaged during thyroid surgery?

A
  • The superior laryngeal artery branches travel with the thyroid artery (first branch of ext. carotid artery)
  • Removal of the thyroid gland can be associated with damage to the external/internal laryngeal nerves
  • The recurrent laryngeal nerve travels with the inferior thyroid artery
  • So the RLN is vulnerable during thyroid surgery
60
Q

What is the left RLN vulnerable to?

A

Anything going on in the upper part of the pleural cavity, mediastinum and oesophagus

61
Q

What are some protective mechanisms for the airway?

A
  • Swallowing
  • Gag reflex
  • Sneezing
  • Coughing
62
Q

What happens during sneezing? (pathway)

A
  • Afferent: V2
  • Inspiration, intrathoracic pressure increases, glottis closed, abdominal muscles contract
  • Soft palate depressed against tongue (palatopharyngeal and palotglossal innervated by nerve 10) to direct air into the nasal cavity
  • Sudden abduction of vocal cords to release intrathoracic pressure through nose or mouth
63
Q

What happens during coughing? (pathway)

A
  • Afferent: Vagus
  • Inspiration, intrathoracic pressure increases, glottis closed, abdominal muscles contract
  • Soft palate raised against posterior wall of pharynx (closes off nasal cavity)
  • Sudden abduction of vocal cords to release intrathoracic pressure through nose or mouth
64
Q

What determines the difference between a cough and sneeze?

A

The raising or depressing of the soft palate
cough -> up
sneeze -> down

65
Q

What are the different ways of managing the airway (clinical)?

A
  • Chin lift and jaw thrust
  • Oropharyngeal or nasopharyngeal airway intubation
  • Endotracheal intubation
  • Cricothyroidotomy
  • Tracheostomy
66
Q

How many cartilages does the trachea have?

A

20 horseshoe shaped to keep the trachea open

67
Q

What is the anterior and posterior surface of the trachea lined with?

A
  • The anterior surface is lined with epithelium
  • Posterior surface consists of trachealis muscle, which is anterior to oesophageal muscle
  • Trachealis muscle is needed for swallowing
68
Q

What happens to the ears while the aircraft lands?

A

A change in pressure between the cabin and the inner ear.

This pressure needs to be equilibrated.

69
Q

How can infection spread from air cells in the mastoid to the cranial cavity?

A

There are some air cells sitting in the mastoid process. Infections of the mastoid air cells (due to an ear infection, for example) can cause destruction of these cells. These cells can then erode through the bone, into the cranial cavity.

70
Q

How can the upper jaw spread infection to the cranial cavity?

A

The roots of the upper jaw are in the maxillary sinus. Another root of infection is from the upper teeth into the maxillary sinus -> cranial cavity.

71
Q

How can infection spread from the sphenoid sinus?

A

The sphenoid sinus is bordered by the sella turcia (contains the pituitary)

72
Q

Describe the pathway of the facial nerve

A

travels from pons through the facial canal in the temporal bone -> stylomastoid foramen

73
Q

What provides sensory innervation to the external acoustic meatus and deeper parts of the auricle?

A

Facial nerve

74
Q

What is the pahryngotympanic tube and its importance in spreading of infection?

A

AKA Eustachian tube, that links the nasopharynx to the middle ear

75
Q

What are the three parts of the ear?

A

external, middle and inner

76
Q

What is the external ear made of, describe its structure?

A
  • The external ear consists of the auricle and external auditory meatus, which collect sound and direct it towards the tympanic membrane
  • The auricle is formed from a fibrocartilage skeleton, covered by firmly adherent skin.
  • It has a lobule without a fibrocartilage skeleton inferiorly and a tragus anteriorly that overlaps the opening of the external meatus
    • The lateral third of the external auditory meatus is formed from fibrocartilage continuous with that of the auricle and the medial two thirds of the meatus lie within the temporal bone
    • The skin lining the external meatus contains ceruminous glands and the outer part is hairy
77
Q

What innervates the external ear?

A

The auriculo-temporal nerve anteriorly and the vagus nerve posteriorly

78
Q

Describe the structure of the middle ear

A
  • The middle ear is an irregular air space within the temporal bone
  • This tympanic cavity extends posteriorly into the base of the mastoid process as the tympanic antrum
79
Q

Where is the internal ear?

A

Lies in the petrous temporal bone medial to the middle ear

80
Q

What makes up the inner ear?

A

Cochlea, vestibule and three semi-circular canals

81
Q

How is the ear straightened in adults and children before using an otoscope?

A
  • Adults: pull pinna upwards and backwards to straighten the ear
  • Children: pull pinna downwards and backwards
82
Q

How should the otoscope be held?

A

Like a pen, and use the little finger to hold the cheek (prevents trauma to ear)

83
Q

What does the middle ear do?

A
  • Anteriorly, it communicates with the naso-pharynx via the pharyngo-tympanic (Eustachian) tube
  • The tympanic cavity is traversed by the chain of ossicles (maleus, incus and stapes)
  • These transmit the vibrations of the tympanic membrane to the inner ear through the oval window in the medial wall of the middle ear

Anatomy - Head, neck and spine (6 decks)

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