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MRCS: Head and Neck Anatomy > Session 5: The Airway and its Relations > Flashcards

Session 5: The Airway and its Relations Flashcards

1
Q

What are the roles of the nasal cavities?

What type of epithelium lines the conchae?

A

They are the upper part of respiratory tract with anterior and posterior regions, they warm and humidify air and help to trap pathogens and they contain conchae

Respiratory Epithelium
It increases the surface area for warming and humidifying the inspired air (conchae are also referred to as turbinate bones)

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2
Q

What name is given to the gaps between conchae?

What are the four main paranasal sinuses?

A

Meati (superior, middle, inferior)

Frontal sinus, Ethmoidal air cells, Sphenoid sinus, Maxillary sinus

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3
Q

What is the name of the space superior to the superior concha?

A

Sphenoethmoidal Recess

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4
Q

Which sinus drains into the sphenoethmoidal recess?

A

Sphenoidal Sinus

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5
Q

What action does the epiglottis perform to close off the laryngeal inlet?

A

Retroflexion

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6
Q

What is the role of the pharyngotympanic tube (Eustachian/Auditory tube)?

A

Equalises the pressure on either side of the tympanic membrane by allowing a connection between the middle ear and the nasopharynx

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7
Q

Where are the ethmoidal cells found?

A

Medial to the orbit

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8
Q

What is the clinical relevance of the sphenoid sinus in relation to the pituitary gland?

A

It is penetrated in transphenoidal hypophysectomy

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9
Q

Where do the posterior ethmoidal air cells drain?

A

Lateral wall of the superior meatus

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10
Q

What significant structure is found inferior to the middle nasal concha?

A

Semilunar Hiatus

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11
Q

Where does the sphenoidal sinus drain?

A

Into the sphenoethmoidal recess

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12
Q

What are the three parts of the ethmoidal air cells and where do each of them drain?

A

Anterior, middle and posterior ethmoidal air cells
Posterior – lateral wall of superior meatus
Middle – ethmoidal bulla
Anterior – top of the semilunar hiatus via the frontonasal duct with the drainage of the frontal sinus

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13
Q

Where does the maxillary sinus drain?

A

To the bottom of the semilunar hiatus

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14
Q

Where does the nasolacrimal duct drain and what is its role?

A

To the lateral wall of the inferior meatus

It drains tears from the lacrimal sac to the nasal cavity

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15
Q

State some roles of the paranasal sinuses in the skull.

A

It makes the skull lighter
Acts as a crumple one for the brain
Increases projection of the voice/acts as resonators
Protects sensitive structures from rapid temperature fluctuations

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16
Q

What are the mastoid air cells and describe its connection with the middle ear.

A

They are small sinuses within the mastoid part of the temporal bone
The mastoid air cells communicate with the middle ear via the aditus and the mastoid antrum
This is a possible route for infection of the middle ear

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17
Q

What is the name given to the thin plate of bone that forms the roof of the tympanic cavity?

A

Tegmen tympani

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18
Q

Through which membrane is a cricothyroidotomy performed?

A

Cricothyroid ligament

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19
Q

What important cartilage is found attached to the top of the cricoid cartilage?

A

Arytenoid cartilage - it’s crucial because it’s attached to the vocal ligaments which open and close entry to the larynx so it acts as a sphincter for the lower airways

20
Q

What effect does tilting the thyroid cartilage forwards have on the vocal folds? Which muscles perform this action?

A

Puts tension on the vocal folds - raises pitch of voice
Cricothyroid muscles

(The thyroarytenoid muscle relaxes the vocal folds)

21
Q

What are the two parts of the cricoid cartilage?

A

Lamina and Arch

22
Q

What two things do the cricoid cartilage articulate with?

A

Arytenoid cartilage

Inferior horns of the thyroid cartilage

23
Q

What name is given to the protrusion between the laminae of the thyroid cartilage and what notches are found above and below this point?

A

Laryngeal prominence

Superior and inferior thyroid notch

24
Q

What two bits of cartilage are found on top of the arytenoid cartilage?

A

Corniculate and Cuneiform Cartilage

25
Q

What are the two folds in the mucosa in the laryngeal inlet and how are they arranged?

A 
Vestibular Fold (false vocal fold)  
Vocal Fold (true vocal fold)  
Vestibular folds are lateral to the vocal folds
26
Q

What membranous outpouching is formed between these two folds?

A

Laryngeal ventricle and laryngeal saccule

27
Q

What is the name given to the opening between the vocal folds?

A

Rima glottidis

28
Q

Which muscles are attached only to the arytenoids?

A

Transverse and Oblique Arytenoid muscles

29
Q

Which muscles are involved in abducting and adducting the vocal folds?

A

Posterior cricoarytenoid muscle – abduction

Lateral cricoarytenoid muscle – adduction

30
Q

Which nerve provides sensory and motor control of the larynx?

A

Vagus Nerve

31
Q

What are the different laryngeal branches of the vagus nerve and what do these branches do?

A

Superior Laryngeal Nerve – separates into internal and external laryngeal
Internal Laryngeal – sensory above the vocal folds (lesion causes loss of sensation)
External Laryngeal – motor to cricothyroid muscles (lesion causes paralysis of cricothyroid)
Recurrent Laryngeal – sensory below the vocal folds + motor to all other muscles of the larynx (lesion causes paralysis of all larynx muscles except cricothyroid and loss of sensation below vocal folds)

32
Q

Which arteries do the superior and recurrent laryngeal nerves run alongside?

A

Superior – Superior thyroid artery

Recurrent – Inferior thyroid artery

33
Q

Why is the left recurrent laryngeal nerve more susceptible to damage by bronchial/oesophageal tumours and swollen mediastinal lymph nodes than the right recurrent laryngeal nerve?

A

Because the left recurrent laryngeal nerve branches off the vagus much more inferiorly than the right so it has more of its length that is near the bronchus, oesophagus and mediastinal lymph nodes

34
Q

What are the common changes that occur during sneezing and coughing?

A

Inspiration
Closed glottis and contraction of abdominal muscles
Increase in intrathoracic pressure
Sudden abduction of the vocal folds to release the intrathoracic pressure

35
Q

What is the difference in the oropharyngeal isthmus in coughing compared to sneezing?

A

In coughing, the oropharyngeal isthmus is open When sneezing, it is closed

36
Q

Which afferents take information from laryngeal receptors to trigger the cough reflex?

A

Vagus

37
Q

Which afferents take information from laryngeal receptors to trigger the sneeze reflex?

A

Maxillary branch of the Trigeminal nerve

38
Q

How is the movement of the soft palate different in cough reflexcompared to a sneeze?

A

Cough – soft palate is raised and tensed against the posterior wall of the pharynx
Sneeze – soft palate is depressed against the tongue

39
Q

The soft palate is depressed against the tongue when sneezing to prevent the release of the pressure through the mouth. Which nerve and muscles are involved in this?

A

Vagus – palatoglossus/palatopharyngeus

40
Q

What happens to the vocal folds when sneezing and coughing?

A

They abduct

41
Q

The soft palate is raised and tensed against the posterior wall of the pharynx when coughing. Which muscles are involved in this action and which nerves innervate these muscles?

A

Tensor veli palatini (mandibular of trigeminal (V3))
Levator veli palatini (X)
Superior constrictor (X)

42
Q

Management of airway?

A 
Chin lift/jaw thrust 
Oropharyngeal or nasopharyngeal airway intubation
Endotracheal intubation
Cricothyroidotomy
Tracheostomy
43
Q

What is the blood supply and innervation of the nasal cavities?

A

Innervation:
Olfactory Nerve for olfaction
Trigeminal Nerve V1 for anterior region and V2 for posterior region
Facial Nerve for glands
Sympathetic Nerves for vascular smooth muscle

Blood supply: largely from the branches of the internal and external carotid arteries

44
Q

What is found on the anterior and posterior walls of the trachea

A

Anterior: 20 C-shaped rings of cartilage which keeps the trachea open

Posterior: trachealis muscle which is needed for swallowing

45
Q

What does the sensory/smaller/intermediate facial nerve do?

A

Taste from anterior 2/3 of the tongue
Parasympathetic (to lacrimal glands, mucous glands of nasal cavity, hard and soft palates, sublingual and submandibular glands)
General sensation from external acoustic meatus and deeper parts of the auricle

46
Q

What are the three parts of the ear and what do they contain?

A

External ear:
Consists of the auricle and the external acoustic meatus which collect sound and direct it towards the tympanic membrane
The skin lining the external meatus contains ceruminous glands and the outer part is hairy, and it is innervated by the auriculo-temporal nerve anteriorly and the vagus nerve posteriorly

Middle ear:
Irregular air space within the temporal bone which contains the tympanic cavity - this extends posteriorly into the base of the mastoid process as the tympanic antrum and it communicates anteriorly with the naso-pharynx via the Eustachian/pharyngotympanic tube
The cavity is traversed by ossicles (maleus, incus, stapes) which transmit vibrations of the tympanic membrane to the inner wall through the oval window

Inner ear:
Lies in the petrous temporal bone medial to the inner ear and it comprises of the cochlea, vestibule and three semi-circular canals

47
Q

How is otoscopy performed?

A

Adults: pull pinna upwards and backwards to straighten the ear - this aligns the cartilaginous and bony canal
Children: pull pinna downwards and backwards

Hold otoscope like a pen and use the little finger to hold the cheek - prevents ear trauma

MRCS: Head and Neck Anatomy (6 decks)

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