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Session 10 Flashcards

1
Q

What are the functions of the larynx

A

Airway protection
Ventilation
Phonation
Cough reflex

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2
Q

Anatomical features of the larynx

A

Suspended from and lies below hyoid bone

Part of the URT

Begins at laryngeal inlet, ends at lower border of cricoid cartilage C6

Continuous as trachea

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3
Q

What are piriform fossae

A

Spaces within laryngopharynx - deep recesses

Where pharyngeal muscles have wrapped around back of opening of larynx

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4
Q

3 subdivisions of larynx

A

Supraglottis, glottis, subglottis

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5
Q

Which cartilages form the structural framework of the larynx

A

Epiglottis, thyroid, cricoid and arytenoid cartilages

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6
Q

Synovial joints between the cartilages allow movement between the

A

Thyroid and cricothyroid (A)

Cricoid-arytenoid (F)

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7
Q

Larynx is suspended from the hyoid bone via the

A

Thyrohyoid membrane

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8
Q

2 other important membranes

A
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9
Q

What does a cricothyroidotomy do

A

Provides emergency access to airway, beneath vocal cords

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10
Q

What are aryepiglottic folds

A
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11
Q

The borders of the membranes create

A
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12
Q

The sides of the epiglottis are connected to the arytenoids by the

A

Aryepiglottic folds

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13
Q

What forms the aditus or entrance of the larynx

A

Epiglottis along with aryepiglottic folds

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14
Q

Describe thyroid cartilage

A

Shield like

2 lateral plates form laryngeal prominence

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15
Q

Describe cricoid cartilage

A

Signet ring shpaed, only complete ring of cartilage throughout respiratory Tract

Attached to trachea inferiorly by the cricotracheal membrane

Arytenoids sit on top, one either side

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16
Q

Space in the middle between the true vocal cords is the

A

Rima glottidis

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17
Q

What are highlighted arrows

A
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18
Q

Positions of regions of larynx

A
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19
Q

Supraglottic compartment is also known as the

A

Vestibule

(Includes false vocal cords)

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20
Q

What type of epithelium lines the larynx

A

Pseudostratified ciliated columnar epithelium

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21
Q

True vocal cords are lined with

A

Stratified squamous

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22
Q

If a patient required incubation, larynx is viewed using

A

Laryngoscope

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23
Q

Insertion of endotracheal ET tube

A

Oral cavity, oropharynx, larynx, through vocal cords

Sits in the upper part of the trachea

Small balloon to keep tube in place, ET tube has lumen to allow for mechanical ventilation and oxygenation

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24
Q

What do these pictures show

A

Vocal cords, abducted in left

Yellow - arytenoid cartilages (moved by intrinsic muscles of larynx and alter size and shape of rima glottidis)

Vocal cords will be abducted before intubation

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25
What is this recess called
valecula
26
Laryngeal anatomy labels
27
2 main actions of intrinsic laryngeal muscles
Alter size and shape of laryngeal inlet Alter tension in and position of true vocal cord
28
How do intrinsic laryngeal muscles alter size and shape of laryngeal inlet
Muscles within aryepiglottic folds contract Narrow laryngeal inlet and flatten position of epiglottis Protecting larynx during swallowing
29
How do instrinsic laryngeal muscles alter tension in and position of true vocal cords
Muscles within larynx alter position of arytenoid cartilages- vary position of cords Vocal cords closed together (adducted) Protecting larynx during swallowing and enables phonation
30
All intrinsic laryngeal muscles are supplied by the
Recurrent laryngeal of vagus CN X Right or left With one exception of the cricothyroid muscle
31
Vocal cords run from
Arytenoid cartilages to inner surface of thyroid cartilage (level of laryngeal prominence)
32
Arytenoid cartilages move to alter position of
Vocal cords- narrowing or widening rima glottidis
33
Majority of muscles that impact vocal cords act to
narrow rima glottidis by adducting vocal cords together Only one abducts (widens) Posterior cricoarytenoid
34
What does this show
Arytenoids move relative to one another on cricoid cartilage Alter position of true vocal cords And size of aperture (rima glottidis)
35
Cricothyroid is supplies by the
External laryngeal nerve, branch of the superior laryngeal nerve (branch of CN X)
36
The internal laryngeal nerve (branch of superior laryngeal nerve) innervates the
Laryngeal mucosa able the vocal cords (supraglottis)
37
Recurrent laryngeal nerve innervates
The vocal cords and ifnraglottis
38
Superior and recurrent laryngeal nerves are accompanied by
Arterial branches from the superior and inferior thyroid arteries Important to avoid vocal cord paralysis in thyroidectomy
39
Features of supra hyoid muscles
Anterior triangle 4 pairs of muscles all superiorly to hyoid bone (e.g. Digastric)
40
Features of infra hyoid muscles
Anterior triangle 4 pairs, inferior to hyoid bone (e.g. omohyoid)
41
Infra hyoid muscles are supplies by
Branches from C1-C3 from cervical plexus
42
Infrahyoid muscles are also called
Strap muscles
43
What has to be retracted when thyroid gland surgery happens
Infrahyoid
44
Suprahyoid muscles purpose
Floor of the mouth Move and stabilise the hyoid bone and therefore larynx along with infrahyoids During swallowing, chewing and speaking
45
Vocal cords when breathing
Abducted (open)
46
Vocal cords when swallowing
Adducted (closed)
47
Phonation vocal cords
Adducted Expired air forced through closely adducted vocal cords VC vibration creates sound waves
48
Coughing vocal cord position
Adduct
49
What determines pitch
tension High pitched= taut Low = less taut Contraction of both cricothyroid muscles = increased tension in vocal cords Muscle located outside of larynx
50
Cardinal symptom of laryngeal disease
Hoarseness of voice
51
Benign causes for a hoarse voice
Infection, inflammation, laryngitis, vocal cord nodules
52
Concerning pathologies causing hoarseness of voice
Nerve damage, tissue damage Complete or partial, unilateral or bilateral Determines effects on phonation and breathing
53
Features of increasing tension in vocal cords for high pitch
Cricothyroid muscles Innervated by external branch of superior laryngeal nerve CN X Closely related to superior thyroid artery Risk of injury in thyroid surgery- causes hoarseness of voice when attempting higher pitched sounds
54
Unilateral complete injury (e.g. Division of the nerve) to the recurrent laryngeal nerve causes
Vocal cord on affected side = immobile Takes up a neutral or paramedical position between abduction and adduction Opposite cord can compensate a bit Some hoarseness and weaker cough, passage of air through glottis minimally affected
55
Presentation if both recurrent laryngeal nerves completely damaged
Both vocal cords assume paramedical position with rima glottidis becoming extremely narrow (not completely closed) Will impair speaking ability and breathing
56
Recurrent laryngeal nerves and injury
Long courses in neck, especially left (loops under arch of aorta before ascending back up in groove between oesophagus and trachea) Susceptible to disease and injury affecting neck and upper chest
57
Left recurrent laryngeal nerve can be affected by
Aortic arch aneurysms
58
Right recurrent laryngeal nerve can be affected by
Right apical lung tumours
59
Features of carcinomas of larynx
Present with voice and/or airway problems Hoarseness of voice often earliest presenting sign of lesions involving the vocal cords
60
Prognosis of laryngeal cancer
Small and involves glottis = favourable prognosis as minimal lymphatic drainage Supra and infra glottis regions drain to neck nodes and paratracheal nodes respectively and have poorer prognosis
61
Larynx during swallowing
Tongue pushes epiglottis posteriorly and aryepiglottic muscles contract, Narrowing laryngeal inlet , Epiglottis position horizontally Hyoid bone elevated and move anteriorly by Suprahyoid muscles, Soft pallets raises Adduction of true vocal cords, closure of rima glottidis
62
Food/fluid is directed over curved upper surface of epiglottis into
Piriform fossa of laryngopharynx Can be a site for foreign bodies to get stuck e.g. fish bone
63
Suprahyoids act to
Elevate and anteriorly displace the larynx Ensures patency of pharynx so food can be safely directed into it and not larynx
64
Sensory and motor nerves supplying larynx
65
External branch of superior laryngeal nerve has a route close to
Superior thyroid artery
66
Recurrent laryngeal nerves pass anteriorly to
Right subclavian SCA
67
What happens in a cough
Explosion of compressed air Inspire and fill lungs with air, vocal cords adduct, expiratory muscles contract, intrathoracic pressure builds, then cords suddenly abducted, explosive outflow of air
68
What Laryngitis
Inflammation of the larynx, often involving true vocal cords
69
How do you diagnosis laryngitis
Clinically from history hoarse/weak voice and sore throat History of URTI
70
Typical causes of laryngitis
Infectious (viral typically), and non-infectious aetiology usually self limiting: fully resolves within 2-3 weeks
71
Features of laryngeal tonsils
Acute trauma or chronic irritation Hoarseness of voice more than 3 weeks requires visualisation of cords +/- biopsy
72
Conditions affecting the larynx
Laryngitis Laryngeal nodules Laryngeal cancer Laryngeal oedema Epiglottis Croup
73
Causes of laryngeal oedema
Allergic reaction or swallowed foreign body (choking)
74
certain conditions causing swelling of the larynx can present an immediate threat to the airway Presentation?
Stridor, raised respiratory rate, distress, hypoxia +/- cyanosis
75
Decreased conscious levels cause
Decreased tone and suppression of reflexes Airway at risk
76
2 forms of airway management
Planned (elective) = surgery emergency = acute/immediate threat to airway or unconscious patient e.g. cardiac arrest
77
What is Ludwig’s Angina
Rare infection of tissues of floor of oral cavity
78
Simple airway manoeuvres
Head tilt chin lift
79
Types of airway adjuncts
Maintain patent upper airway Oropharyngeal airway (Guedel), contraindicated if minimal depression of consciousness (illicit gag reflex) Nasopharyngeal airway
80
Allowing for spontaneous ventilation offers no
Protection of Lower repository tract (from vomit/secretions)
81
Supraglottic airway management
iGel Maintains airway and affords some protection, minimal technical skills requires to insert, often first line in cardiac arrest, not for long-term ventilation e.g. if in ITU
82
Definitive airway = intubation
Endotracheal tube Technical skill = requires use of laryngoscope to visualise vocal cords Secures and protects from secretions/vomit, lower respiratory tract Patient (if not in cardiac arrest) anaesthetised prior to insertion
83
What is this
Nasopharyngeal airway adjunct Maintains patent airway
84
What is this
Oropharyngeal airway adjunct
85
What is this
Endotracheal tube Definitive airway passing through vocal cords
86
What is this
IGEL Supraglottic airway device Sits around laryngeal inlet
87
What is croup
Common respiratory disease in children Barking cough, worse with agitations (stridor may occur) Caused by a virus Single dose of corticosteroid
88
What is Epiglottitis
Inflammation secondary to infection causing swelling of epiglottis and Supraglottic tissues Rare 2-6 year olds Stridor, drooling, difficulty breathing and swallowing, high fever, sore throat, sitting upright, sniffing position, mouth open DO NOT EXAMINE THROAT Intubation or tracheostomy Caused by haemophliius influenza, needs antibiotics

HNN (19 decks)

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