Airway innervation/anatomy (Exam 1)

Question 1

Vocal cord effect

Posterior CricoArytenoid

Answer 1

aBducts

Please come apart

Question 2

Vocal cord effect

Lateral CricoArytenoid

Answer 2

ADDucts

Lets close airway

Question 3

Vocal cord effect

ThyroaRytenoid

Answer 3

Relaxes vocal cords (shortens)

They Relax

Question 4

Vocal cord effects

CricoThyroid

Answer 4

Tense cords (elongates)

Cords tense

Question 5

Superior laryngeal n. (SLN) innervates the ____ muscles

Answer 5

cricothyroid

Question 6

Muscles that depress the Larynx

Answer 6

O: Omohyoid
S: Sternohyoid
S: Sternothyroid

Question 7

Muscles that elevate the larynx

Answer 7

• Digastric (anterior belly)
• Mylohyoid
• Stylohyoid
• Digastric (posterior belly)
• Thyrohyoid

Do My Silly Dick Trick

Question 8

Risk factors for recurrent laryngeal nerve damage

Answer 8

• External pressure from ETT or LMA
• Thyroid / parathyroid surgery
• Neck stretching, neoplasm

Question 9

what are the three cranial nerves that innervate the airway

Answer 9

CN5 : Trigeminal
CN9: Glossopharyngeal
X: Vagus

Question 10

Name the 3 branches of the trigeminal nerves and their associated airway innervation

Answer 10

V1: Opthalmic (anterior ethmoidal) -> nares and anterior 1/3 of nasal septum
V2: Maxillary (sphenopalentine) -> turbinates and septum
V3: Mandibular (lingual) -> anterior 2/3 of tongue

Question 11

Which branch of CN5 (trigeminal) provides motor innervation to the tongue

Answer 11

NONE bitch

Question 12

Big picture: CN9 (glossopharyngeal) provides sensory innervation to what two structures

Answer 12

Oropharynx and anterior side of the epiglottis

SENSORY

Question 13

List of everything innervated by CN IX (Glossopharyngeal)

Answer 13

• Soft palate
• Oropharynx
• Tonsils
• Posterior 1/3 of tongue
• Vallecula
• Anterior side of epiglottis

Question 14

Which laterality of recurrent laryngeal nerve is at higher risk for damage?

Answer 14

Left recurrent laryngeal nerve

Question 15

CNX (Vagus) innervates what structure

Answer 15

Larynx

Question 16

What does CNX divide into? What are the branches?

Answer 16

• Superior laryngeal nerve
  (internal and external branches)
• Recurrent laryngeal nerve

Question 17

Glossopharyngeal nerve supports what motor function

Answer 17

phonation
swallowing (ayoooo)

Question 18

What sensory function does the external branch of the Superior laryngeal nerve provide?

Answer 18

NONE

Question 19

What motor function does the external branch of the SLN provide?

Answer 19

CricoThyroid (tense vocal cords)

Cords Tense

Question 20

What sensory function does the interior branch of the SLN provide?

Answer 20

Posterior side of the epiglottis

Vocal cords are ligaments and are NOT innervated

Question 21

What motor function does the internal branch of the SLN provide?

Answer 21

NONE hoe

Question 22

What cranial nerve provides motor function for mastication

Answer 22

Trigeminal nerve (CN V) specifically –>branch V3 Mandibular (lingual)

Question 23

Where does the SLN divide into the 2 branches?

Answer 23

Hyoid

Question 24

where does the superior laryngeal nerve branch off the CN X ?

Answer 24

Just beyond the jugular foramen at the base of the skull

Question 25

The reccurent laryngeal nerves branch off the vagus nerve in the ___

Answer 25

Thorax

Question 26

The right recurrent laryngeal nerve loops under what structure?

Answer 26

Subclavian artery

Question 27

The left recurrent laryngeal nerve loops under what structure?

Answer 27

Aortic arch

Question 28

The right and left recurrent laryngeal nerves ascend through what structure to join the larynx?

Answer 28

tracheoesophogeal groove

Question 29

Specific causes of injury for the left recurrent laryngeal nerve

Answer 29

PDA ligation Left atrial enlargement Ao Arch aneurysm Thoracic tumor

Question 30

# What laryngeal nerve is injured? uni or bi? A patient presents with hoarseness, a "wavy" vocal cord on fiberoptic bronch, and impaired voice quality. Respiratory status is **stable**

Answer 30

Superior laryngeal nerve ## Footnote Cricothyroid is the "tuning fork" of the voice. Voice quality might be effected

Question 31

# What laryngeal nerve is injured? uni or bi? A patient who underwent a subtotal thyroidectomy is extubated after surgery. Patients respiratory status is stable but they have hoarseness.

Answer 31

Recurrent laryngeal nerve ## Footnote affected cord is drawn midline during inspiration

Question 32

# What laryngeal nerve is injured? uni or bi? Patient is extubated following a total thyroidectomy. In PACU they develop severe respiratory distress and stridor.

Answer 32

bilateral recurrent laryngeal nerve damage

Question 33

What is the treatment for bilateral recurrent laryngeal nerve injury?

Answer 33

Emergent intubation or surgical airway

Question 34

Which landmark is identified for a SLN block?

Answer 34

Greater cornu of hyoid bone

Question 35

How do you fully/adequately block the superior laryngeal nerve?

Answer 35

* 1 ml LA injected outside the thyrohyoid membrane below the border of the greater cornu of hyoid bone * 2 ml injected just beneath the thyrohyoid membrane