Airway Anatomy Flashcards
(142 cards)
1
Q
Upper airway consists of
A
Nasal cavity
Oral cavity
Pharynx
Laryn
2
Q
Nasopharynx and oropharynx separated by
A
the soft palate anteriorly & join posteriorly in the pharynx
3
Q
Oropharynx and laryngopharyx separated by
A
epiglottis anteriorly & join posteriorly
4
Q
Anterior the the laryngopharynx is
A
the larynx
5
Q
posterior to the laryngopharynx is
A
the esophagus
6
Q
Functions of the nose
A
oNasal mucosa warms and humifies inspired air
oProvides almost 2/3 of the resistance to breathing
oPrimary passage for air to enter lungs
oTurbinates (nasal conchae) and the sinuses (surface area) offer humidification and primary filtration
7
Q
Opening of the nose
A
Vestibule
8
Q
Turbinates
A
bones projecting from the lateral wall
As air passes through the nose, it meets these, which cause directional changes in the airflow
Overlie the superior, middle, and inferior meatus which contain the openings to the paranasal sinuses
9
Q
Smallest of the conchae
A
Superior conchae
10
Q
Most commonly injured during intubation
A
Inferior conchae of nose
11
Q
What in the nasal mucosa can be exacerbated by general anesthesia
A
Bleeding- nose is highly vascular and anesthesia vasodilates allowing nasal mucosa to become highly engorged
12
Q
Opening of this is located in the nasopharynx and drains ears into nasopharynx
A
Eustachain tubes
13
Q
Where is the opening of the Eustachian tubes located
A
Nasopharynx
14
Q
Posterior border of nasopharynx is superiorly bound by the base of the skull
A
the base of the skull
15
Q
Posterior to the nasopharynx is
A
body of C1-C2 vertebrae
16
Q
What separates the nasal passages from the mouth
A
Hard palate (anteriorly) and soft palate (posteriorly)
17
Q
Covers posterior third to half of the oral cavity and rises during eating to prevent contents from the mouth going into the nose
A
Soft palate
18
Q
Is the maxilla (hard palate) mobile or stationary
A
Stationary
19
Q
Is the mandible (jawbone) stationary or mobile?
A
Mobile
20
Q
Where are the three frenulums
A
Upper and lower lip and the tongue
21
Q
Pendulous piece of tissue
Extends from the posterior posterior edge of the middle of the soft palate into the oral cavity
If swollen, enlarged, or injured it can be a cause of airway obstruction
A
Uvula
22
Q
Posterior bilateral border between oral cavity and oropharynx
A
Palatoglossal and palatopharyngeal folds/arch
23
Q
Which of the arches in the oral cavity is more anterior?
A
Palatoglossal (part of oral cavity)
24
Q
Which of the arches in the oral cavity is more posterior?
A
Palatopharyngeal arch - part of oropharynx
25
Walnut shaped and resides between the palatoglossal and palatopharyngeal folds
Palantine tonsils
26
Average number of adult teeth
32
27
U-shaped fibromuscular structure
Extends from base of skull to cricoid cartilage
Party of respiratory and alimentary tract
Consists of 3 compartments
Pharynx
28
Where does the pharynx extend from and to?
Starts at base of skull to cricoid cartilage (anteriorly) and level of C6 vertebrae (posteriorly)
29
Functions of the pahrynx
oParticipates in respiration
oSwallowing and protection of larynx during eating
oSpeech
30
What is Waldeyers Ring
Palantine tonsils
Lingual tonsils
Pharyngeal tonsils
31
Tonsillar fossae – reside in the oropharynx between the arches
These are what removed in a tonsillectomy
Palantine tonsils
32
Tonsils that reside at base of tongue
Lingual tonsils
33
Tonsils that reside in the nasopharynx
Pharyngeal tonsils (adenoids)
34
The most common reason for an unanticipated difficult intubation is usually from a
Hypertrophy of lingual tonsils
35
Boundaries of nasopharynx
Anterior to C1
| Bound superiorly by the base of the skull and inferiorly by the soft palate
36
Boundaries of the oropharynx
Lies at the C2 to C3 level and is bound superiorly by the soft palate and inferiorly by the epiglottis
37
Anterolateral walls of the oropharynx
paired tonsillar fossae formed by the palatoglossal and palatopharyngeal folds
38
Epiglottis
functionally separates the oropharynx from the laryngopharynx (or hypopharynx)
39
Hypopharynx (laryngopharynx)
Extends from the tip of the epiglottis to the level of C6
40
Boundaries of the hypopharynx
Lies posteriorly to the larynx and is bound superior border of the epiglottis and the inferior border of the cricoid cartilage at the C5 to C6 level
41
Criopharyngeus muscle
acts as a barrier to regurgitation in the conscious patient
42
Superior boundary of the hypopharynx
Continuous with the oropharynx
43
Inferior border of the hypopharynx
continuous with the esophagus
44
Posterior border of hypopharynx
Bones C4-C6 of vertebrae
45
Lateral walls of hypopharynx
Middle and inferior constrictor muscles
46
Larynx extends from...
vertebrae C3-C6
47
Start of larynx and chief support
| Only bones that does not form a joint with another
Hyoid bone
48
Lies in anterior neck extending from hyoid bone to level of C6 vertebrae
Larynx
49
The thee unpaired cartilages of the larynx
Epiglottis
Thyroid
Cricoid
50
The 3 paired cartilages of the larynx
Arytenoid
Corniculate
Cuneiform
51
Primary function of the larynx
vocalization and artiulation
52
Reflex of the larynx
Cough reflex
53
Narrowest portion of the airway in adults
Rima Glottidis (openign of vocal cords)
54
Narrowest portion of the airway in children under 10
Cricoid cartilage
55
What connects the thyroid cartialge to the hyoid bone?
Thyhyoid membrane
56
Unpaired cartilage of the larynx that is the largest anteriorly but posteriorly it is open
Thyroid cartilage
57
Inferior to thyroid cartilage
| Narrow anteriorly but wider posteriorly and is the only continuous ring of the airway
Cricoid cartilage
58
The cricoid cartilage is connected to the thyroid cartialge by the...
Cricothyroid ligament
59
Emergency airway is placed here
Criocthyroid ligament
60
Where is pressure placed during RSI to prevent aspiration and why
The cricoid ligament because it is the only continuous ring of the airway
61
Leaf-like unpaired cartilage of the larynx
Epiglottis
62
Demarcation of pharynx to larynx
Epiglottis
63
Attaches the epiglottis to the body of the thyroid cartilage anteriorly through the
Thyroepiglottic ligament
64
Serves to prevent aspiration; protects from foreign body entry
Covers glottis (opening of the larynx) during swallowing
Epiglottis
65
Epiglottis is united to tongue by=
median and lateral glossoepiglottic folds
66
The space between the epiglottis and the base of the tongue
Superior valeculla
67
When using what type of blade, tip is placed in the superior valeculla
Curved laryngoscope (MAC)
68
Formed by the space between the inferior edge of the epiglottis and true vocal cords
Inferior valeculla
69
When using what type of blade we go beyond the epiglottis and lift and we end up in the inferior vallecula
straight blade (MILLER)
70
The two nodules in the posterior aryepiglottic folds
Corniculates and cuneiformd
71
Attach the to apices of the arytenoids and sit superior of each arytenoid
Corniculates
72
Of the two nodules seen in posterior ayrepiglottic folds which is more lateral and which is more medial?
```
Cuneiforms = lateral
Corniculates = medial
```
73
Opening between cords
| In adults this is the NARROWEST part of the airway
(Glottis) Rima Glottidis
74
Quadrangular membranes run between lateral sides of epiglottic cartilage and arytenoid cartilages on either side
Aryepiglottic folds - connects epiglottis to arytenoids
75
oFolds of mucous membrane over vestibular ligaments superior to vocal folds
oProtective in function
Ventricular/Vesetibular folds (false cords)
76
Where do vocal cords attach from
From cricoid to the aryteniods
77
Where do foreign object such as fish bones get stuck?
Piriform recess
78
Small depressions on either side of laryngeal inlet
Separated from inlet by aryepiglottic folds
Bounded medially by thyroid cartilage and thyrohyoid membrane
Piriform recess
79
Extends from above the “false cords” to the tip of the epiglottis
Supraepiglottic area (AKA vestibule)
80
Located between the false cords and true cords
Laryngeal ventricles
81
Below the true cords
| Above the beginning of the trachea
Infraglottic region
82
Corresponds to the beginning of the trachea
Cricoid cartialge
83
Most inferior of the nine laryngeal cartilages
Cricoid cartialge
84
What does the Opthalmic division (V1) (anterior ethmoid nerve) of trigeminal nerve innervate
Anterior nose
85
What is V1 of the trigeminal nerve
Opthalmic division (anterior ethmoid nerve)
86
What does Maxillary division (V2) (Sphenopalatine nerve) of trigeminal nerve innervate?
Posterior nose
87
What is V2 of trigeminal nerve?
Maxillary division (sphenopalatine nerve)
88
What does mandibular division (V3) (lingual nerve) of trigeminal nerve innervate?
anterior 2/3 of tongue
89
What is V3 of trigeminal nerve?
Mandibular division (lingual nerve)
90
•Sympathetic innervation from the superior cervical ganglion
| stimulation results in
vasoconstriction and shrinkage of the nasal tissue
91
What nerve provides sensory to the superior and inferior surfaces of the hard and soft palate
Palantine nerve (division of trigeminal nerve)
92
innervates nasal mucosa to provide sense of smell
CN I (olfactory nerve)
93
What nerve innervates the posterior 1/3 of the tongue?
CN IX (glossopharyngeal nerve)
94
What nerves provide the sensation of tase?
Branches of facial nerve (VII) & Glossopharyngeal nerve (IX)
95
What nerve innervates the roof of the pharynx, tonsils, epiglottis, base of the tongue, and the under surface of the soft palate
CN IX (Glossopharyngeal)
96
Afferent sensory pathway that causes gag reflex
CN IX (Glossopharyngeal)
97
Efferent motor pathway that causes gag reflex
CN X (vagus nerve)
98
For a nerve block if you want to block the gag reflex which nerve do you block?
CN IX (glossopharyngeal) afferent sensory
99
Provides sensation to the airway below the epiglottis
Vagus nerve (CN X)
100
Branch of vagus nerve that divides into external and internal nerve
Superior laryngeal nerve
101
Provides motor function to the cricothyroid muscle of the larynx
External (motor) nerve
102
Provides sensory input to the hypopharynx above the vocal cords
Internal (senesoy) nerve
103
Which branch branches off earlier for the SLN?
The internal branch
104
Branches of the vagus nerve that provides sensory innervation to the subglottic area and the trachea (below the cords)
Recurrent laryngeal nerve (RLN)
105
Provides motor function to all the muscles of the larynx except the cricothyroid muscle
Motor branch of RLN
106
What nerve provides motor function to the cricothyroid muscle?
External branch of the SLN
107
What does the R RLN loop around?
Subclavian artery
108
What does the L RLN loop around?
Aorta
109
Nerve injury to unilateral vagus nerve can cause?
Hoarseness
110
Bilateral injury to vagus nerve can cause
Aphonia
111
Unilateral damage to SLN can cause
Minimal effects
112
Bilateral damage to SLN can cause
hoarseness, tiring of voice
113
Unilateral damage to RLN can cause
hoarseness
114
Bilateral acute damage to RLN can cause
stridor and respiratory compromise
115
Chronic damage to bilateral RLN can cause
aphonia
116
Intrinsic muscles of the larynx control
Tension of the vocal cords and the opening and closing of the glottis
117
Function of cricothyroid muscle
Tension and elongation of vocal cords to determine pitch
118
Function of the thyroarytenoids and vocalis muscle
Relaxes vocal cords
119
Function of the lateral crycoarytenoid, transverse & oblique arytenoid muscles
Adduction of vocal ligaments - closure of the cords and glottis
120
Function of the posterior cricoarytenoid muscle
Abduction of vocal ligaments - opening of the cords/glottis
121
Closure of the laryngeal inlet is accomplished by which muscles?
Aryepiglottic & oblique arytenoid muscles
122
Opening of the laryngeal inlet is accompished by what muscle?
Thyroepiglottic muscle
123
Components of a preoperative airway assessment
- Length of upper incisors
- Relation of maxillary and mandibular incisors during normal jaw closure
- Relation of maxillary and mandibular incisors during voluntary protrusion (ULBT)
- Interincisor distance
- Visibility of uvula (mallampati test)
- Shape of palate
- Compliance of mandibular space
- Thyromental distance
- ROM of head of neck
- Length of neck
- Thickness of neck
124
Non-reassuring findings of airway assessment
- Long length of upper incisors
- Prominent “overbite” (maxillary incisors anterior to mandibular incisors)
- Inability to protrude mandibular incisors anterior to maxillary incisors
- Less than 3cm interincisor distance
- No visibility of uvula
- Highly arched or very narrow
- Stiff, indurated, occupied by mass or non resilient mandibular space
- Thyromental distance is less than three ordinary finger-breadths
- Patient cannot touch tip of chin to chest or patient cannot extend neck
- Neck is short and thick
125
Difficult BMV can be due to
MOOANSs
- Mask seal impeded (beards, airway anatomy, NG tubes)
- Obstruction of upper or lower airway
- Obesity of redundant upper airway tissue
- Age (>55)
- No teeth (improper seal)
- Snores or Stiff
126
Difficult laryngoscope and tracheal intubation can be due to
LEMONS
- Look externally
- Evaluate 3-2-2
- Mallampati score (class III and IV)
- Obstruction
- Obesity
- Neck mobility
127
What does 3-3-2 measure?
3: Interincisor gap
3: Length of mandible
2: Distance between the base of the tongue and the top of the larynx
128
Studied the relationship between the success rate of laryngoscopic intubation and the visibility of the posterior oropharyngeal structures
Mallampati Class
129
How to perform Mallampati class
```
oWith patient sitting upright
oNeck extended vs head neutral
oMouth open as much as possible
oTongue protruded
oAvoiding phonation
```
130
What mallampati class is uvula, faucial pillars, soft palate visible
Class I
131
What mallampati class is faucial pillars, soft palate visible, portion of the uvula
Class II
132
What mallampati class is soft and hard palate visible
Class III
133
What mallampati class is the hard palate only visible?
Class IV
134
Cardinal signs of upper airway obstruction
Muffled voice, difficulty swallowing, stridor, thick neck
135
Best position to achieve optimal view during oral laryngoscopy
"Sniffing position" - head extension and neck flexion
136
Reasons an extraglottic device may be hard to place
RODS
- Restricted mouth opening (interincisor)
- Obstruction
- Distrupted or distorted airway
- Stiff lungs or cervical spine
137
Scoring given when doing a direct laryngoscopy and looking at laryngeal inlet
Cormack-Lahane Laryngeal View Scoring
138
Cormack-Lahane Laryngeal View Scoring grade when visualization of the entire glottic opening
Grade I
139
Cormack-Lahane Laryngeal View Scoring with visualizaition of only the posterior aspects of the glottic aperature
Grade 2
140
Cormack-Lahane Laryngeal View Scoring with visualization of the tip of the epiglottis (epiglottis only)
Grade 3
141
Cormack-Lahane Laryngeal View Scoring with visualization of the soft palate only
Grade 4
142
Distance between the mentum and the superior thyroid notch
| Greater than 6cm desired
Thyromental distance
