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LCRS 2 - HNS Part 2 > Upper airway > Flashcards

Upper airway Flashcards

1
Q

Where does the eustachian tube connect to from the ear?

A

Into the nasopharynx

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2
Q

What sticks into the nasal cavity

A

Turbinate bones

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3
Q

What is conchae. What type of epithelium in the nose

A

Turbinate bone + soft tissue. Covered in respiratory epithelium

ciliated psudeostratified epithelium, interspersed with mucus-secreting goblet cells.

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4
Q

How many conchae

A

3 (sup. mid. inf.)

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5
Q

What are the sup. mid and inf meatuses of the nasal cavty

A

spaces between the protruding conchae

Sup= between superor and middle conchae etc.

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6
Q

Function of conchae

A

Warm and humidify air, help trap pathogens

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7
Q

Learn the bones of the nose

A

Learn

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8
Q

Innervation to the nasal cavtiy

A

Olfactory nerve (I)- olfaction
Trigeminal nerve (V1 for anterior and V2 for posterior region)
Facial nerve- glands (i.e. nasolacrimal glands)
Sympathetic nerves from T1 for vascular smooth muscle

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9
Q

Blood supply of nasal cavity

A

Branches of the internal carotid and the external carotid

INTERNAL: anterior and posterior ethmoidal arteries (branches of opthalmic)… they descend into nasal cavity through cribiform

EXTERNAL: 
Sphenopalatine artery
Greater palatine artery
Superior labial artery
Lateral nasal arteries

they form anastomoses

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10
Q

Venous drainage of nasal cavity

A

Top part drains into the cranial cavity

rain into the pterygoid plexus, facial vein or cavernous sinus.

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11
Q

Innervation of the different sinuses

A

Frontal- V1 (this is located where you touch for cranial nerve V1!)

Ethmoidal air cells (=sinus but like honeycomb)- V1&2

Sphenoid- V1&2

Maxillar- V2 (think this is where you touch to test for cranial nerve V2!)

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12
Q

How do sinuses appear on x-ray

A

Dark

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13
Q

Where do the sinuses drain

A

Into the meatuses between conchae

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14
Q

Where do following sinuses drain into the nasal cavity:
-Frontal
-Ethmoidal
-Sphenoid
-Maxilary
Also nasolacrimal duct & Eustachian tube

A

Frontal & Anterior ethmoidal cells = infundibulum opening of semilunar hiatus of middle meatus (lateral wall) via frontonasal duct
Middle ethmoidal cells = ethmoidal bulla above semilunar hiatus of middle meatus (lateral wall)
Posterior ethmoidal cells = superior meatus (lateral wall)
Sphenoid sinus = spheno-ethmoidal recess of posterior roof of nasal cavity
Maxillary sinus = floor opening of semilunar hiatus of middle meatus (lateral wall)

Nasolacrimal duct = inferior meatus
Eustachian tube = nasopharynx (level of inf concha)

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15
Q

What is the larynx made of

A

cartilage, membrane and muscles

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16
Q

Function of larynx

A

VALVE and sound produceer

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17
Q

Where does the hyoid bone lie

A

Between the mandible and the thyroid cartilage

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18
Q

What membrane lies beneath the thyroid cartilage and cricoid cartilage

A

cricothyoid membrane

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19
Q

T/F the cricoid is larger anteriorly

A

F is it larger posteriorly

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20
Q

How is the tension on the vocal folds controlled

A

By muscle and by the thyroid cartilage rocking on the cricoid cartilage

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21
Q

State a case when the larynx is completely open, completely closed off and partially open

A

Open- breathing
Closed- swallowing
Partially open- to speak (create tension on vocal fold

22
Q

What do the vocal folds attach to

A

Arytenoid cartilage (they can be moved by muscle to open or close the airway)

23
Q

What is the name of the join on which the thyroid cartilage rocks

A

Cricothyroid joint (between the inferior horn of thyroid cartilage and the large posterior part of the cricoid)

24
Q

Where do the arytenoid cartilages lie
What is their shape
What structures connect them with the inner side thyroid cartilage

A

On top of the posterior part of the cricoid cartilage
Pyramidal shape
Vestibular ligaments from anterior sup side of ary
Vocal ligaments from anterior inferior edge of ary

25
Q

Function of the ligaments vs folds in the larynx

A

Ligament- support cartilaginous skeleton

Folds- airway protection and phonation

26
Q

List the extrinsic muscles of the larynx

A

Supra and infra hyoid muscles.

Supra hyoid tend to elevate the larynx while infrahyoid tend to depress it.

Suprahyoid: Mylohyoid, anterior and posterior belly of digastric, geniohyoid and stylohyoid

Infrahyoid: strap muscles: sternohyoid, sternothyroid, thyrohyoid and omohyoid (superior and inferior belly)

27
Q

List the instrinsic muscles of the larynx

A

Cricothyroid
Thyroarytenoid (thyroid - arytenoid cartilage) - sphincter of laryngeal inlet
Posterior cricoarytenoid (ridge of posterior surface of cricoid - arytenoid cartilage) - ext rotate arytenoid cartilages + abduct vocal cords = open rima glottidis
Lateral cricoarytenoid (lateral side of cricoid - arytenoid cartilage) - int rotate ary cartilage + adduct vocal cords
Transverse arytenoid (between arytenoid cartilages) - adduct arytenoid cartilages
Oblique arytenoids (X between arytenoid cartilages) - sphincter of laryngeal inlet

28
Q

Function of cricothyroid muscle and attachment

A

Rocks thyroid cartilage forward stretching vocal cords….
TENSOR of vocal cords
Increase pitch

Attached to anterolateral cricoid and inferior horn of the thyroid

29
Q

Function of thyroarytenoid muscle

A

Rocks thyroid cartilage back allowing vocal cords slack…. RELAXOR of vocal cords
Decrease pitch

Attached to posterior aspect of thyroid cartilage and anterolateral part of arytenoid

30
Q

Function of posterior cricoarytenoid muscle

A

Rotates arytenoid laterally, allows vocal cords to ABDUCT (move apart)

Attaches to posterior part of cricoid and the musclar process of the arytenoid

31
Q

Function of lateral crycoarytenoid muscle

A

Rotates arytenoid medially, allows vocal cord to ADDUCT (move together)

Attaches to arch of cricoid and muscular process of arytenoid

32
Q

Function of transeverse and oblique arytenoid muscles

A

Adduct the vocal cords, closing posterior portion of the rima glottidis… narrows laryngeal inlet

Spans between arytenoids

33
Q

What is the nerve supply of the intrinsic muscles of the larynx

A

All supplied by the recurrent laryngeal nerve (branch of the vagus nerve)

Apart from cricothyroid. muscle (tensor) which is supplied by the external branch of the superior laryngeal nerve (also a branch of the vagus)

34
Q

State the divisions of superior laryngeal nerve

A

So from vagus you have superior and recurrent laryngeal

Superior splits into internal and external laryngeal nerve.

Internal: sensory innervation above the vocal folds

External: Motor innervation to cricothyroid

35
Q

Outline sensory supply to the larynx

A

Above vocal folds: internal laryngeal nerve

Below vocal folds: recurrent larygneal nerve

36
Q

Consequences of lesions to:

  • vagus
  • internal laryngeal
  • external larngeal
  • Recurrent laryngeal
A

Look at diagram

37
Q

When could there be a lesion of the recurrent laryngela nerve

A

During thyroid surgery

Or left bronchial or oesophageal tumour/swollen mediastinal lymph nodes

38
Q

Differentiate course of left and right laryngeal nerve

A

Obvious

39
Q

Outline possible routes of infection into the cranial cavity

A

Infection of teeth of upper jaw can spread to maxillary sinus and cranial cavity

Infection of the middle ear can spread to mastoid air cells and cranial cavity

40
Q

What is the clinical relevance of the sphenoid sinus

A

It must be passed through in a transsphenoidal approach to pituitary surgery (pituitary gland lies right behind it)

41
Q

Differentitate the anatomical positions for emergency cricothyroidotomy vs tracheotomy

A

Cricothyroidotomy done in emergency…. between thyroid (sup.) and cricoid (inf) so through the cricothyroid membrane

Trachemotomy done below both strucutres into the trachea not larynx

42
Q

Outline the course of the superior laryngeal nerve and the recurrent LN

A

Superior travels with superior thyroid artery (1st branch of external carotid)

Recurrent travels with inferior thyroid artery (from thyrocervical trunk of the subclavian artery)

43
Q

Learn anatomy of external ear

A

Concha of aurice

44
Q

State the protective mechanisms of the airway

A

Swallowing
Gag reflex
Coughing
Sneezing

45
Q

Differenitate a cough and a sneeze

A

Cough= when the nasopharynx is closed off (so when the soft palate closes of nasopharynx)

Sneeze= when oropharnx close aas soft palatate depresses gainst the tongue

46
Q

Differentiate the afferents leading to sneeze and cough

A

Sneze - V2

Cough - X

47
Q

Muscles and nerves used to move soft palate in cough and sneeze

A

Sneeze- palatopharyngus and palatoglossus (X)

Cough (levator veli palatini (X), tensor veli palatini (V3) and superior constrictor (X)

ABDUCTION of vocal folds to increase intrathoracic pressure through nose or mouth

48
Q

How can airway be managed

A
  1. Chin lift/ jaw thrust
  2. Oropharyngeal or nasopharyngeal airway
  3. Endotracheal intubation
  4. Cricothyroidotomy
  5. Tracheostomy
49
Q

What is the motor function of facial nerve

A

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

50
Q

Sensory function of facial nerve (smaller)

A

Taste (ant 2/3 tongue), parasympathetic (lacrimal glands, mucous glands of nasal cavity, hard and soft palates, sublingual and submandibular glands) by CHORDA TYMPANI

General sensation from external acoustic meatus and deeper parts of auricle.

51
Q

look at where facial nerves exit the skull base

A

…

52
Q

Which vessels do the nerves supplying the larynx travel with

A

External branch of superior laryngeal: superior thyroid artery

Recurrent laryngeal: woth inferior thyroid artery

LCRS 2 - HNS Part 2 (5 decks)

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