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Neuro Exam II > Larynx - SRS > Flashcards

Larynx - SRS Flashcards

1
Q

What are the functions of the larynx?

A
  1. Respiratory - connects pharynx to trachea
  2. Voice producing (phonation)
  3. Prevent food entering airways
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2
Q

At what vertebral level is the larynx located?

A

CV3-CV6

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3
Q

What are the internal features of the larynx? (9)

A
  1. Laryngeal aditus – superior opening from pharynx
  2. Vestibule – area proximal (above) vestibular folds
  3. Vestibular (false) folds
  4. Rima vestibuli – opening between vestibular folds
  5. Ventricle – between vestibular and vocal folds
  6. True vocal folds
  7. Rima glottidis – opening between true vocal folds
    1. Shape varies depending on position of vocal folds
    2. Variation in the tension and length of the vocal folds, and width of rima produces changes in pitch of the voice.
  8. Glottis – rima glottidis plus vocal folds
  9. Infraglottic cavity - distal (below) true vocal folds
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4
Q

What vertebral level is the cricoid cartilage at?

A

CV6

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5
Q

What is the junction of the larynx and trachea?

A

Cricoid cartilage - CV6

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6
Q

What is the junction of the esophagus and pharynx?

A

cricoid cartilage - CV6

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7
Q

Where is a tracheotomy performed to overcome obstruction of the upper airway?

A
  1. Obstruction of the upper airway can be overcome by puncturing the larynx or trachea.
  2. Incision is made between the cricoid cartilage and the first tracheal cartilages.
  3. Incision can also be made between the cricoid and thyroid cartilages (through the cricothyroid ligament).
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8
Q

What are the laryngeal cartilages?

A
  1. Thyroid
  2. Cricoid
  3. Arytenoid
  4. Epiglottic
  5. Corniculate
  6. Cuneiform
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9
Q

What vertebral level is the thyroid cartilage at?

A

CV4 and CV5

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10
Q

What level is the cricoid cartilage found at?

A

CV6

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11
Q

Where do we find the arytenoid cartilage?

A

Lie perched atop the posterior portion of the cricoid cartilage

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12
Q

What are the important structures of the arytenoid cartilage? (3)

A
  1. Apex – attaches to aryepiglottic fold
  2. Vocal process – attaches to vocal ligament
  3. Muscular process – attaches to posterior and lateral cricoarytenoid muscles
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13
Q

The epiglottic cartilage is a leaf shaped, elastic cartilage situated posterior to the root of the tongue. The broad superior end is free, and the inferior end is attached to the thyroid cartilage.

What is the function of this cartilage?

A

Muscles of the pharynx pull the thyroid cartilage against the epiglottis during swallowing to prevent food from moving into the larynx.

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14
Q

What are the four ligaments of the epiglottic cartilage?

A
  1. Thyroepiglottic ligament
  2. Hyoepiglottic ligament
  3. Aryepiglottic ligament
  4. Glossoepiglottic ligaments (median and lateral)
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15
Q

Where is the corniculate cartilage found?

A

Lies atop the apex of the arytenoid cartilages

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16
Q

Where is the cuneiform cartilage found?

A

In aryepiglottic folds

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17
Q

The larynx has extrinsic and intrinsic ligaments. What are the extrinsic ligaments?

A
  1. Thyrohyoid membrane
  2. Cricotracheal ligament – attaches cricoid to first tracheal cartilage
  3. Hyoepiglottic ligament
  4. Glossoepiglottic ligament
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18
Q

What pierces the thyrohyoid membrane?

A

Internal laryngeal nerve

Superior laryngeal artery

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19
Q

What are the intrinsic ligaments of the larynx?

A
  1. Quadrangular ligament
  2. Cricovocal ligament
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20
Q

The quadrangular ligament attaches anteriorly to the thyroid and epiglottic cartilages, and posteriorly to the arytenoid cartilage.

What ligaments does it form?

When covered with mucosa what do these form?

A
  1. Forms vestibular ligaments; covered with mucosa = vestibular fold
  2. Forms aryepiglottic ligament; covered with mucosa = aryepiglottic fold
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21
Q

The cricivocal (conus elasticus) ligament attaches inferiorly to cricoid cartilage and superiorly to thyroid and arytenoid cartilages. It has three thickened regions,

  1. Median cricothyroid ligament
  2. lateral cricothyroid ligament

and the third one is what?

A

Vocal ligament – extends from internal surface of thyroid lamina to vocal process of arytenoid; covered with mucosa = vocal fold

22
Q

There are two laryngeal folds, what are they?

A
  1. Vocal folds
  2. Vestibular folds
23
Q

What forms the vocal folds?

A

Mucosa overlying the vocal ligament and vocalis muscle.

24
Q

The vocal ligaments are the innermost portion of cricovocal ligament, extending from thyroid cartilage to vocal process of arytenoid cartilage.

What is the function of these ligaments?

A

Change tension/length to control pitch of voice

25
Q

What is the innermost portion of the thyroiaretynoid muscle?

A

Vocalis muscle

26
Q

The vestibular folds are formed from mucosa overlying the vestibular ligament. What does the highly vascularized mucosa overlying the vestibular folds contain?

A

Mucus-secreting glands

27
Q

What are the two joints of the larynx?

A
  1. Cricothyroid joint
  2. Cricoarytenoid joint
28
Q

The cricothyroid joint is an articulation between the cricoid cartilage and inferior horn of thyroid cartilage, what thype of joint is this?

What does it allow?

A
  1. Synovial - mainly gliding movements
  2. Allows thyroid to glide on cricoid in order to change vocal cord length
29
Q

The cricoarytenoid joint is an articulation between the cricoid cartilage and arytenoid cartilage. What joint type is this?

What does this allow?

A
  1. Synovial – mainly gliding and rotational movements (condylar joint)
  2. Allows arytenoid cartilages to rotate, glide toward one another.
30
Q

What muscles are associated with the larynx?

(7)

A
  1. Vocalis
  2. Thyroarytenoid
  3. Lateral cricoarytenoid
  4. Posterior cricoarytenoid
  5. Transverse arytenoids
  6. Oblique arytenoids
  7. Cricothyroid
31
Q

What is the action of the cricothyroid?

A

tilts thyroid forward to elongate and tighten vocal ligament

32
Q

What is the action of the transverse and oblique arytenoids?

A
  1. Adduct arytenoid cartilages
  2. Close laryngeal inlet by approximating the arytenoid cartilages
33
Q

What is the action of the posterior cricoarytenoid?

A

abduct vocal folds (to open rima glottidis)

34
Q

What is the function of the lateral cricoarytenoid?

A

Adduct vocal folds (to close rima glottidis)

35
Q

What is the action of the thyroarytenoid?

A

rotates thyroid cartilage back to shorten and loosen vocal ligament

36
Q

What is the action of the vocalis muscle?

A

Locally controls vocal ligament; produces minute adjustments or vocal ligament tension and length.

37
Q

Describe the innervation of the laryngeal muscles.

A
  1. Cricothyroid - External branch of the superior laryngeal n.
  2. All other muscles - the recurrent laryngeal nerve (Inferior laryngeal nerve)
38
Q

What does the internal laryngeal nerve provide?

A
  1. GVE-P and GVA proximal to true vocal folds (supraglottic region)
  2. SVA to epiglottic region of tongue
39
Q

What does the external laryngeal nerve provide?

A

SVE to cricothyroid m.

40
Q

Describe the cough reflex

A

There is a very strong reflex, mediated by CN X, which functions to prevent foreign objects from entering the airways. When foreign objects (ex: food) enter the larynx, the superior laryngeal nerve is stimulated (GVA) and causes contraction of laryngeal muscles which close the larynx. Vagus nerve will stimulate a cough in order to force air out of the larynx. Injury to the superior laryngeal nn will ablate this protective function due to anesthesia of the laryngeal mucosa. Cough reflex – afferent limb is CN X; efferent limb is CN X.

41
Q

What might result from a lesion to the superior laryngeal nerve?

A
  1. Loss of cough reflex
  2. cricothyroid m. paralysis - leading to a monotonous voice
42
Q

If a foreing object enters the larynx the cough reflex is engaged and the rima glottidis closes tightly. How does the Heimlich maneuver dislodge the foreign object?

A

Raises intrathoracic pressure

43
Q

What nerve is blocked when inserting an endotracheal tube?

Where is the needle inserted?

A
  1. Superior laryngeal nerve
  2. The needle is inserted halfway between the hyoid bone and superior border of the thyroid cartilage. The needle pierces the thyrohyoid membrane and anesthetic agent will bathe the superior laryngeal n.
44
Q

The inferior laryngeal nerve is a continuation of the recurrent laryngeal nerve, what does it provide to the true vocal folds and the larynx muscles?

A
  1. GVE-P and GVA distal to true vocal folds (infraglottic region)
  2. SVE to all muscles of larynx, except cricothyroid
45
Q

Injury to the recurrent laryngeal nerve can occur with neck or thoracic damage or surgery. Recall that the left recurrent laryngeal nerve branches in the thorax (aortic aneurysms, tumors, enlarged lymph nodes in the thorax can compress and damage the recurrent laryngeal nerve).

What can happen as a result of this type of injury?

If it is bilateral?

A

Injury to the nerve will affect the function of the larynx due to the fact that all but one laryngeal muscle are innervated by the recurrent laryngeal nerve. If damage is unilateral, patient will present with hoarseness; if bilateral will present with aphonia.

46
Q

What three arteries supply the larynx?

A
  1. Superior laryngeal
  2. Cricothyroid artery
  3. Inferior laryngeal
47
Q

What does the superior laryngeal artery supply?

A

Supplies larynx above true vocal folds

48
Q

What does the cricothyroid artery supply?

A

Cricothyroid muscle

49
Q

What does the inferior laryngeal artery supply?

A

Supplies the larynx below the true vocal folds

50
Q

The larynx is drained by the

  1. Superior laryngeal vein
  2. Inferior laryngeal vein

Where do these drain to?

A

Superior laryngeal vein → internal jugular vein
Inferior laryngeal vein → left brachiocephalic vein

51
Q

The lymph drainage of the larynx can be divided into proximal and distal regions. Describe the drainage of each region.

A

Proximal (above) true vocal folds → superior deep cervical lymph nodes

Distal (below) true vocal folds → inferior deep cervical lymph nodes

Neuro Exam II (13 decks)

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