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H&N > Session 10: Anatomy and Disorders of the Larynx > Flashcards

Session 10: Anatomy and Disorders of the Larynx Flashcards

1
Q

Where can the larynx be found?

A

Between the hyoid bone superiorly and the trachea inferiorly.

(C3/C4-C6)

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2
Q

Functions of the larynx.

A

Airway protection to prevent food, fluid and other foreign objects to enter the airway.

Ventilation

Cough reflex

Production of sound

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3
Q

What are the subdivisions of the larynx?

A

Supraglottis

Glottis

Subglottis

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4
Q

What are the main cartilages found in the larynx?

A

Thyroid cartilage

Arytenoid cartilage

Cricoid cartilage

Epiglottis

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5
Q

What is the thyroid cartilage attached to superiorly?

A

To the hyoid bone via the thyroid membrane.

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6
Q

What is the Thyroid cartilage attached to inferiorly?

A

To the cricoid cartilage via the cricothyroid membrane.

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7
Q

Clinical significance of the cricothyroid membrane.

A

It can be palpated anteriorly and in acute laryngel obstruction leading to being unable to breathe the cricothyroid membrane can be punctured in order to access into the infraglottic area and achieve temporary breathing.

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8
Q

What is found on the inferior margin of the quadrangular membrane?

A

The vestibular ligament.

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9
Q

What is found on the superior margin of the cricothyroid membrane?

A

The vocal ligament

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10
Q

What is the vestibular ligament?

A

A fixed ligament also called the false vocal cords

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11
Q

What is the vocal ligament?

A

A mobile ligament also called the true vocal cords.

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12
Q

Where does the supraglottis extend?

A

From the laryngeal vestibule to the false cords (includes them)

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13
Q

Where does the glottis extend?

A

Narrowest part and more or less only includes the true cords.

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14
Q

Where does the infraglottis/subglottis extend?

A

Below the true cords until trachea.

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15
Q

Purpose of the ventricle between the vestibular and vocal ligaments.

A

Leads laterally and upwards into the saccule and contains mucous glands that keep the true vocal cords moist.

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16
Q

What type of epithelium lines the larynx?

A

Pseudostratified ciliated columnar epithelium.

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17
Q

There is an exception of the larynx that is not lined with pseudostratified ciliated columnar epithelium.

Which and what is it lined with?

A

True vocal cords lined with stratified squamous epithelium.

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18
Q

What is the epiglottis?

A

A leaf-shaped structure made of elastic cartilage that sits on top of the larynx.

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19
Q

Attachments of the epiglottis.

A

To the hyoid and to the back of the thyroid cartilage.

Laterally it is connected to the arytenoids by aryepiglottic folds.

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20
Q

What are the aryepiglottic folds shaped by?

A

The quadrangular membrane joins the sides of the epiglottis to the arytenoids giving the shape.

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21
Q

What does the epiglottis along with the aryepiglottic folds form?

A

The margins of the entrance (aditus) of the larynx.

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22
Q

Explain the shape of the thyroid cartilage.

A

A shield-like structure made of two lateral plates that meet in the midline and form the laryngeal prominence.

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23
Q

Explain the shape of the cricoid cartilage.

A

A signet-ring shaped structure that is the only complete ring of cartilage in the entire resp. tract.

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24
Q

What joints can be found in the larynx?

A

Cricothyroid joint

Cricoarytenoid joint

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25
Q

What is the space in the middle between the vocal cords called?

A

The rima glottidis.

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26
Q

Main functions of the intrinsic laryngeal muscles.

A

Open the glottis in inspiration by opening vocal cords and laryngeal inlet.

Close the laryngeal inlet and vocal cords during swallowing.

Phonation by altering the tone of the vocal cords.

Cough reflex

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27
Q

What is the collective action of the intrinsic muscles of the larynx?

There is one exception.

A

Adduction of the vocal cords.

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28
Q

There is one exception that doesn’t share the adduction of the vocal cords of the intrinsic muscles of the larynx.

Which?

What does it do?

A

Posterior crycoarytenoid.

It abducts the vocal cords and is the only muscle to do so.

In the absence of damage of this muscle the vocal cords would shut and there would be permanent adduction of the vocal cords.

29
Q

What are the intrinsic muscles of the larynx innervated by?

A

The recurrent laryngeal nerve (CN X)

30
Q

There is an exception of a muscle of the intrinsic larynx not innervated by the recurrent laryngeal nerve.

Which muscle?

A

The cricothyroid muscle.

31
Q

Innervation and action of the cricothyroid muscle.

A

Actually found externally and not intrinsically but still called it.

Innervated by the superior laryngeal nerve (CN X)

It tilts the thyroid cartilage forward on the cricoid to increase the tension of the vocal cords.

This is important to reach higher pitch.

32
Q

What can cause weakness of the cricothyroid muscle?

A

Thyroid surgery as the nerve lies in close relation to the superior thyroid artery.

This will lead to hoarseness of voice especially when attempting higher pitched sounds.

33
Q

Vocal cord movements on inspiration and expiration.

A

They abduct

34
Q

Vocal cord movements on phonation.

A

They closely adduct and the expired air is forced through the closely adducted (but not shut) vocal cords.

The vibration of the vocal cords lead to the creation of sound waves.

35
Q

Vocal cord movements in the cough reflex.

A

Vocal cords adduct

The expiratory msucles contract and the intrathoracic pressure builds as the vocal cords are still adducted.

The cords then suddenly abduct and there is an explosive outflow of air.

36
Q

Vocal cords shape in high-pitched sounds.

A

Vocal cords are taut and stretch/elongate

37
Q

Vocal cords shape low-pitched sounds.

A

Vocal cords are less taut and they shorten.

38
Q

Muscle actions during swallowing.

A

Hyoid bone is elevated and move anteriorly by suprahyoid muscles. This leads to the larynx moving up and forward.

The tongue pushes epiglottis posteriorly and aryepiglottic muscles (pulls down the sides of the epiglottis over the laryngeal inlet). This narrows the laryngeal inlet and brings the epiglottis from a vertical to a horizontal position.

The vocal cords also adduct to prevent any entry of foreign objects into trachea.

39
Q

Sensory innervation of the larynx.

A

Internal laryngeal nerve

Recurrent laryngeal nerve

40
Q

What does the internal laryngeal nerve innervate?

A

Sensory innervation to supraglottis and glottis.

41
Q

What does the recurrent laryngeal nerve innervate in larynx?

A

Sensory to the subglottis/infraglottis

Motor to the intrinsic muscles except for cricothyroid (innervated by the external laryngeal nerve)

42
Q

What does the superior laryngeal nerve lie in close relation to?

A

The superior thyroid artery

43
Q

What does the recurrent laryngeal nerve lie in close relationship to?

A

The inferior thyroid artery.

44
Q

Explain the route of the recurrent laryngeal nerve.

A

Arise from the vagus nerve.

Loops around the SCA on the right and the arch of the aorta on the left.

It then ascends in the tracheo-oesophageal groove in close anatomical relationship with the thyroid gland and inferior thryoid arteries.

It the innervates all intrinsic msucles of the larynx and sensory to the infraglottic region.

45
Q

Give causes of injury to the recurrent laryngeal nerve.

A

Lies in close relation to the inferior thyroid artery to surgery to the thyroid gland can lead to damage.

Aortic arch aneurysm as the left RLN loops

Cancer in apex of lung (Pancoast e.g.)

Disease or surgery involving larynx, oesophagus or thyroid.

46
Q

What does a unilateral RLN lesion lead to?

A

Unilateral vocal cord palsy and hoarse voice + ineffective cough.

This is because the affected vocal cord assumes a paramedian position that is between fully abducted and fully adducted.

47
Q

Why might a unilateral palsy of the vocal cords not be very apparent?

A

Because the contralateral vocal cord can compensate in time and cross the midline to meet the vocal cord on affected side.

48
Q

What happens in the case of a bilateral RLN injury?

A

Both the vocal cords will assume a paramedian position. This means that any of the vocal cords can’t compensate.

Hoarseness och voice and ineffective cough ensues as well as airway obstruction. This can be a medial emergency.

49
Q

Give examples of conditions that affects the larynx.

A

Laryngitis

Laryngeal nodules

Laryngeal cacer

Croup

Epiglottitis

Laryngeal oedema

50
Q

What is epiglottis?

A

Inflammation of the epiglottis. It can also affect the soft tissue surrounding the epiglottis so can be termed supraglottitis as well.

51
Q

Usual age of presentation of epiglottitis.

A

Children 2-5 years.

52
Q

Most common pathogen of epiglottitis.

A

Haemophilus influenza B used to be the most common one historically but is no longer the case due to vaccination.

It is now Streptococcus spp.

53
Q

Clinical presentation of epiglottitis.

A

Sore throat

Painful swallowing

Inability to swallow secretions

Hot potato voice

Fever

Tachy cardia

Ear pain

Tripod sign.

54
Q

Clinical presentation of more severe epiglottitis.

A

Dyspnoea

Dysphagia

Dysphonia

Resp distress

Stridor

55
Q

Dx of Epiglottitis.

A

Pharyngitis

Laryngitis

Inhaled foreign body

Croup

Retropharyngeal abscess

Peritonsillar abscess

Tonsillitis

56
Q

Investigation and diagnosis of epiglottitis.

A

Fibre-optic laryngoscopy is gold standard. Needs to be performed in operating theatres prepared for intubation or tracheostomy in event of upper airway obstruction.

Lateral neck X-ray

Throat swabs when airway is secure

CT or MRI scans.

57
Q

Treatment of epiglottitis.

A

Usually conservative with IV or oral antibiotics.

58
Q

Complications of epiglottitis.

A

Abscess formation

Meningitis

Sepsis

Pneumothorax

59
Q

What is Croup?

A

A common childhood illness causing symptoms like harsh barking cough, a hoarse voice and stridor.

Usually due to inflammation of upper resp as a result of viral infection.

60
Q

Pathophysiology of Croup.

A

URTI leads to nasopharyngeal inflammation. Can spread down the larynx and compromise airways.

Vocal cords movements are impaired.

Fibrinous exudation can occur in airways as well to further compromise ventilation.

61
Q

Causative organisms of croup.

A

Parainfluenza virus types I, II, III and IV.

Adenoviruses

Rhinoviruses

Enterviruses

etc…

62
Q

Risk factors of croup.

A

More common in males.

Prevalent in autumn and spring

63
Q

Clinical presentation of croup.

A

Sore throat, fever and cough

Progresses to barking cough and hoarseness. Tend to be worse at night.

Stridor

64
Q

Dx of croup.

A

Epiglottitis

Inhaled foreign body

Peritonsillar abscess

etc…

65
Q

Assessment of severity.

A

Westley clinical scoring system.

66
Q

Investigations of croup.

A

Pulse oximetry

Considering CXR and blood tests but need to assess the distress of the child.

Rapid influenza A

67
Q

Management of croup.

A

Usually conservative with paracetamol or ibuprofen

Fluid

Usually do not give antibiotics unless there are sound clinical reasons to suspect secondary bacterial infection.

Adrenaline

Steroids

68
Q

Complications of croup.

A

Bacterial superinfection like pneumonia

Pulm oedema, pneumothorax, otitis media

Dehydration

H&N (37 decks)

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