Head And Neck Session 11 Flashcards Preview

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Flashcards in Head And Neck Session 11 Deck (80):
1

What are the cartilaginous components of the larynx?

3 singular: thyroid, cricoid and epiglottic
3 paired: arytenoid, corniculate and cuneiform

2

Which vertebral levels is the larynx located at?

C3-6

3

Which bone is part of the larynx?

Hyoid

4

What are the functions of the larynx?

Respiration, phonation, protection of trachea and bronchial tree during swallowing, cough reflex

5

What covers the anterior aspect of the larynx?

Infrahyoid muscles

6

What is found lateral to the larynx?

Loves of thyroid and major BV of neck

7

What lines the larynx?

Ciliated columnar epithelium

8

Where is the supraglottis?

Inferior surface of epiglottis to vestibular folds

9

What is the alternative name for the vestibular folds?

False vocal cords

10

Where is the vallecula?

Between tongue base and epiglottis

11

Where is the glottis?

From the vocal cords to 1cm inferiorly

12

What is between the supraglottis and glottis?

Transglottic space

13

What is the subglottis?

1cm inferior to the vocal cords to border of cricoid cartilage

14

What does the superior margin of the quadrangular membrane form?

Aryepiglottic fold

15

What are the layers of the vocal cord?

Stratified squamous epithelium, Reinke's space, vocal ligament, vocalis muscle

16

What are the components of the vestibular fold that runs from the thyroid to the arytenoid?

Ventricular ligament and loose mucosa

17

What is the function of Reinke's space?

Allow free vibration of the epithelium

18

What does Reinke's space contain?

Watery, amorphous substance

19

What forms the sub-mucosal fibroelastic membrane of the larynx?

Quadrangular membrane and conus elasticus

20

What forms Adam's apple?

Laryngeal prominence of thyroid cartilage

21

What attaches to the lateral thyroid ligaments?

Thyrohyoid membrane

22

What does the superior horn of the thyroid cartilage articulate with?

Hyoid bone

23

Which nerves pierce the thyrohyoid membrane?

Superior and internal laryngeal nerves

24

What does the inferior horn of the thyroid cartilage articulate with?

Cricoid cartilage

25

What does the rotation and gliding movement of the cricoid at the inferior horn of the thyroid cartilage allow?

Change in vocal fold length

26

What is the cricoarytenoid joint?

Base of arytenoid and superolateral cricoid

27

What movements does the cricoarytenoid joint facilitate?

Slide, tilt and rotate

28

What action does the cricoarytenoid joint have on the vocal folds?

Approximate, tense and relax

29

What shape is the cricoid cartilage?

Signet ring

30

Which ligaments attach to the cricoid cartilage?

Median cricothyroid and cricotracheal

31

What are the two facets on the cricoid cartilage for?

Articulation with arytenoid cartilage and inferior horn of thyroid cartilage

32

Which muscles attach to the muscular process of the arytenoid cartilage?

Posterior and lateral cricoarytenoid muscle

33

What is the articular facet of the arytenoid cartilage for?

Corniculate cartilage

34

What does the apex of the arytenoid cartilage bear?

Corniculate cartilage

35

What does the vocal process of the arytenoid cartilage attach to?

Vocal ligament

36

Which two cartilages are found in the aryepiglottic fold?

Corniculate and cuneiform

37

Which cartilage found in the larynx does not attach to any other cartilages?

Cuneiform

38

What provides arterial supply to the larynx?

Superior and inferior laryngeal arteries

39

What arteries do those supplying the larynx branch from?

Superior and inferior thyroid

40

Which nerve follows the superior laryngeal artery?

Superior laryngeal nerve

41

Which nerve follows the inferior laryngeal artery?

Internal laryngeal nerve

42

Where does the superior laryngeal vein drain?

Into superior thyroid to IJV

43

Where does the inferior laryngeal vein drain?

Inferior thyroid or into venous plexus on trachea to L brachiocephalic vein

44

Describe the lymphatic drainage of the larynx.

Superior to vocal folds: with superior laryngeal artery to superior deep cervical nodes.
Inferior to vocal folds: pretracheal and paratracheal nodes to inferior deep cervical nodes

45

Which are the extrinsic muscles of the larynx?

Suprahyoids, infrahyoids and stylopharyngeus

46

Which are the intrinsic muscles of the larynx?

Cricothyroid, thyroarytenoid, posterior cricoarytenoid, lateral cricoarytenoid, transverse and oblique cricoarytenoids

47

What is the action of cricothyroid?

Stretch and tense vocal cords

48

What is the action of thyroarytenoid?

Relax vocal cords

49

What is the function of posterior cricoarytenoid?

Abduct vocal folds

50

What is the action of lateral cricoarytenoid?

Addict vocal folds

51

What is the common function of transverse and oblique cricoarytenoids?

Adduct arytenoid cartilages

52

Describe the innervation of the intrinsic laryngeal muscles.

All internal laryngeal nerve except cricothyroid that is external laryngeal nerve

53

Which structure of the neck does the superior laryngeal nerve travel in?

Carotid sheath

54

What innervation does the internal laryngeal nerve supply?

Sensory and autonomic to supraglottis

55

What are the two branches of the superior laryngeal nerve?

Internal and external

56

What innervation does the external laryngeal nerve give?

Motor to inferior pharyngeal constrictor and cricothyroid

57

Which branch of the recurrent laryngeal nerve supplies the larynx?

Inferior laryngeal nerve

58

What do the anterior and posterior branches of the inferior pharyngeal nerve give innervation to?

Motor to intrinsic muscles and sensory to infraglottic cavity

59

Which membrane of the larynx is incised in the midline to secure the airway?

Cricothyroid

60

Why is left recurrent laryngeal nerve palsy more common?

Has a longer course

61

What are some causes of recurrent laryngeal nerve palsy?

Idiopathic, thyroid surgery, thyroid carcinoma, oesophageal carcinoma, penetrating wounds, bronchial carcinoma, mediastinal lymph node malignancy, aortic aneurysm

62

What is Semon's law?

Incomplete paralysis affects adductors first therefore affected cords remain abducted

63

What are the S/S of recurrent laryngeal nerve palsy?

Hoarseness/change in quality of voice, bovine cough

64

What is the treatment for recurrent laryngeal nerve palsy?

Teflon injections and voice therapy

65

What type of tumour are virtually all laryngeal carcinomas?

SCCs

66

Which area of the larynx is predominantly affected by carcinoma?

Glottis

67

What is the male and female distribution of laryngeal carcinoma?

Four times more common in men

68

What age range is most commonly affected by laryngeal carcinoma?

3/4 of pts >60 y.o.

69

What are the risk factors for laryngeal carcinoma?

Smoking, occupational exposures, HPV16

70

What are the S/S of laryngeal carcinoma?

Chronic hoarseness, pain, dysphagia, neck lump, persistent cough, earache, weight loss, loss of laryngeal crepitus

71

How is laryngeal carcinoma investigated?

CXR, flexible laryngoscopy, fine-needle aspiration, CT, MRI

72

What treatment is available for laryngeal carcinoma?

Radiotherapy +/- chemotherapy, laryngectomy, palliation

73

How does the prognosis of laryngeal carcinoma vary depending on its location?

Glottis has good prognosis whereas subglottis is poor

74

Why does the carcinoma in the glottis have a good prognosis?

Presents early with hoarseness

75

What are the different procedures used in thyroid surgery?

Thyroid lobectomy, sub-total thyroidectomy, total thyroidectomy

76

Describe sub-total thyroidectomy.

Leave enough gland to retain hormone function to avoid lifelong medication

77

When is total thyroidectomy preferred?

Malignancy

78

What complications are associated with thyroid surgery?

Bleeding --> tracheal compression, RLN --> partial airway obstruction, hypoparathyroidism, thyrotoxicosis storm, SLN

79

Why is superior laryngeal nerve injury generally only noticed by professional singers?

Causes an inability to create high-pitched sound

80

What are the S/S of thyrotoxic storm?

Hyperexia, HR>140 bpm, nausea, jaundice, vomiting, confusion, delirium, seizures