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Airway Anatomy Flashcards

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1
Q

Components of the upper airway

A

Nose, mouth, pharynx, hypopharynx, larynx

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2
Q

Components of pharynx and location

A

Extends from nose to cricoid cartilage in three components

Nasopharynx, oropharynx, hypopharynx

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3
Q

Nasopharynx

Location and structures

A

Lies anterior to C1
Bound superiorly by base of skull and inferiorly by soft palate
Contains nasal septum, turbinates, and adenoids

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4
Q

What impedes airflow in nasopharynx

A

Tonsillar lymphoid structures

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5
Q

Oropharynx

Location

A

Lies at C2-C3
Bound superiorly by soft palate and inferiorly by epiglottis
Opens into mouth anteriorly through the anterior and posterior tonsillar pillars

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6
Q

What is the major source of oropharyngeal obstruction and why

A

The tongue due to decreased genioglossus muscle tone (CNXII - hypoglossal)

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7
Q

Hypopharynx

Location

A

C5-C6
Lies posterior to larynx and leads to esophagus
Bound by superior border of epiglottis and inferior border of cricoid cartilage (C5-C6)

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8
Q

What is the purpose of the upper esophageal sphincter

A

Lies at lower edge of hypopharynx and acts as a barrier to regurgitation in the conscious patient

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9
Q

Waldeyer’s Tonsillar Ring

A

Lymphoid tissue ring in pharynx that is at high risk for bleeding, especially with nasal intubation

Made up of:

  1. Pharyngeal tonsils (adenoids) - nasopharynx
  2. Tubal tonsils - between pharyngeal and palatine
  3. Palatine tonsils - oropharynx (the ones we think of as tonsils)
  4. Lingual tonsils - base of tongue
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10
Q

Larynx location

A

Epiglottis to lower lever of cricoid cartilage (C5-c6 in adults)
Sits at the junction of the airway and esophagus

Posterior border = mucus membrane which extends between the arytenoid cartilage and laterally by the aryepiglottic folds (aka false cords)

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11
Q

Larynx components and cartilages

A

Cartilagenous skeleton held together by ligaments, muscles, NINE cartilages, and hyoid bone

The nine cartilages are (Three individual and three paired)

  • thyroid
  • cricoid - C6
  • epiglottic
  • corniculate pair
  • aryetnoid pair
  • cuneiform pair
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12
Q

Epiglottis

A

Base of tongue, separates hypopharynx from larynx
On either side of glossepiglotic fold is the vellecula
Protects against aspiration because it covers trachea while swallowing

VASCULAR AREA

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13
Q

Arytenoids

A

Lie posterior and vocal cords attach to these

Pyramidal

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14
Q

Vocal cords attachment points

A 
Anteriorly = thyroid
Posteriorly = arytenoids
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15
Q

Glottic opening

A

The triangular fissure between the cords

The narrowest portion of an adult airway (6-9mm - can be stretched to 12mm)

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16
Q

What is the narrowest part of the pediatric airway

A

Just below the cords at the cricoid ring

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17
Q

What is the largest cartilage of the larynx

A

Thyroid cartilage

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18
Q

Cricoid cartilage location and special fact

A

The only complete tracheal ring

Sits at c6

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19
Q

Thyrohyoid membrane

A

Connects thyroid cartilage to hyoid bone

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20
Q

Where does the internal branch of the SLN penetrate the thyrohyoid membrane

A

And the level of the cornu of the hyoid

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21
Q

Cricothyroid membrane info

  1. Is it vascular?
  2. Where is it?
A

Relatively avascular

Thyroid cartilage is attached to the cricoid cartilage anteriorly by the cricothyroid membrane

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22
Q

Trachea location

A

Begins at C6 at the inferior border of the cricoid cartilage and extends to carina

Bifurcated to right and left main stem bronchus at the level of T5

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23
Q

How long is the trachea

A

10-15 cm in length and is 16-20 rings so long

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24
Q

At what angles do the mainstems bifurcate

Study These Flashcards
A 
Right = 25-30 degree angle
Left = 45 degree angle
25
intrinsic muscles of the larynx job
responsible for opening, closing, and controlling tension of vocal cords
26
extrinsic muscles job
connect larynx with hyoid bone and other structures and serve to move the larynx as a whole (elevating and depressing) during phonation, swallowing, and breathing
27
what does the posterior cricoarytenoid muslce do?
abducts the vocal cords and opens the glottis
28
what does the lateral cricoarytenoid mucle do?
adducts the vocal cords
29
what do the arytenoids (muscle) do?
adducts the vocal cords
30
what does the criocothyroid muscle do?
produces cord tension, closure, and enlongates the vocal cords can result in total and prodound glottic closure aka laryngospasm
31
what does the thyroarytenoid muscle do
shortens and relaxes the vocal cords
32
name the 5 intrinsic muscles of the larynx
``` posterior cricoarytenoid lateral cricoarytenoid arytenoid cricothyroid thryoarytenoid ```
33
which intrinsic muscle of the larynx is responsible for laryngospasm
cricothyroid
34
name the six extrinsic muscles of the larynx
``` sternohyoid sternothyroid thyrohyoid omohyoid stylohyoid mylohyoid ```
35
sternohyoid muscle function
draws hyoid bone inferiorly depresses larynx
36
sternothyroid muscle function
draws thyroid cartilage caudad Depresses larynx
37
thyrohyoid muscle function
draws hyoid bone inferiorly *elevates larynx if hyoid bone is fixed
38
omohyoid muscle function
draws hyoid bone caudad Depresses larynx
39
what is the function of the stylohoid and mylohyoid muscles?
elevate larynx
40
Nose sensory innervation
anterior septum and lateral walls = CNV - trigeminal nerve *specifically the anterior ethmoidal nerve posterior septum = CNV - trigeminal nerve *specifically the nasopalanatine and sphenopalantine nerves
41
sympathetic stimulation of the nose causes
vasoconstriction and shrinkage of nasal tissue
42
parasympathetic stimulation of the nose causes
engorgement of blood vessels and increases likelihood of breathing with airway manipulation seen with general anesthesia!!!
43
what innervates the tonsils, roof of pharynx, and underside of soft palate (sensory)?
glossopharyngeal nerve - CN 9
44
what innervates the anterior 2/3 of tongue (sensory)?
CNV - trigeminal | *specifically the lingual nerve/mandibular division of CNV
45
what innervates the posterior 1/3 of tongue? (sensory)
CN 9 - glossopharyngeal nerve
46
what does CN7 do? aka the facial nerve
- motor - facial expression - sensory - taste to anterior 2/3 of tongue - afferent conduction to oropharynx (small amount) - motor - stylohyoid muscle (pulls hyoid bone up and back which elevates tongue) - salivary glands - PSNS saliva production
47
what does CN12 do? aka hypoglossal nerve
motor - tongue muscles
48
what happens if you damage the hypoglossal nerve
tongue relaxes and can fall back to obstruct airway
49
what does CNX (vagus) nerve do?
innervates airway below epiglottis - SUPERIOR laryngeal nerve * sensory to larynx ABOVE cords (epiglottis to cords) = internal branch * motor = external branch - to cricothyroid muslce - RECURRENT laryngeal nerve * sensory to larynx BELOW cords * motor - all other laryngeal muscles
50
Which nerve provides motor innervation for all muscles of the larynx?
CNX - VAGUS SLN external branch = motor to cricothyroid muscle RLN = motor to all muscles of larynx EXCEPT cricothyroid
51
what is the superior laryngeal nerve responsible for?
INTERNAL *sensory - larynx from epiglottis to cords aka ABOVE CORDS and lower pharynx EXTERNAL *motor - cricothyroid muscle of larynx
52
what is the recurrent laryngeal nerve responsible for?
- SENSORY - larynx BELOW CORDS and upper esophagus | - MOTOR - all muscles of larynx except cricothyroid muscle
53
which nerve is involved in laryngospasm
vagus X
54
what happens when you have injury to superior laryngeal nerve
``` unilateral = minimal effects bilateral = hoarseness, vocal tiring ```
55
what happens when you have injury to the recurrent laryngeal nerve
unilateral = hoarseness bilateral * acute - stridor, respiratory distress from unopposed tension of cricothyroid muscles * chronic - aphonia common after thyroidectomy because this nerve comes down and loops around inominate artery
56
what happens to vagus nerve injury
bilateral vagal denervatiosn produce flaccid, midpositioned cords = APHONIA
57
Superior laryngeal artery supplies
supraglottic laryngeal structures flows from carotid, to superior thyroid artery, to SLA to above
58
inferior laryngeal artery supplies
infraglottic laryngeal structures flows from subclavian to inferior thyroid artery to ILA to above

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