Session 5: The Airway and its Relations A

Question 1

What type of epithelium lines the conchae? Why is this type of epithelium beneficial? Is this type of epithelium present throughout the airway?

Answer 1

Respiratory Epithelium: ciliated, pseudostratified columnar epithelium with goblet cells. It increases the surface area for warming and humidifying the inspired air (conchae are also referred to as turbinate bones).

Most of the respiratory pathways is lined by this type of epithelium (including pharynx, which has respiratory epithelium + stratified squamous epithelium). However, bronchioles have ciliated simple cuboidal epithelium

Question 2

What name is given to the gaps between conchae?

Answer 2

Meati (superior, middle, inferior)

Question 3

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

Answer 3

Sphenoethmoidal Recess- this is an area above the superior conchae and it has an opening which enters the sphenoidal sinus

Question 4

Which sinus drains into the sphenoethmoidal recess?

Answer 4

Sphenoidal Sinus

Question 5

What is the word used to describe the action does the epiglottis perform to close off the laryngeal inlet?

Answer 5

Retroflexion

Question 6

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

Answer 6

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

Question 7

Where are the ethmoidal cells found?

Answer 7

Medial to the orbit

Question 8

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

Answer 8

It is penetrated in transphenoidal hypophysectomy

Question 9

Where do the posterior ethmoidal air cells drain?

Answer 9

Lateral wall of the superior meatus

Question 10

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

Answer 10

Semilunar Hiatus : crescent-shaped groove in the lateral wall of the nasal cavity just inferior to the ethmoidal bulla

semilunar shaped, hiatus=fissure ethmoidal bulla: Bulging of inner wall of the ethmoidal labyrinth in middle meatus of nose, it is the largest and most consistent ethmoidal air cell

Question 11

Where does the sphenoidal sinus drain?

Answer 11

Into the sphenoethmoidal recess. this is an area above the superior conchae and it has an opening which enters the sphenoidal sinus

Question 12

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

Answer 12

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.

Frontonasal duct drains both the FRONTAL sinus and the anterior ethmoidal air cells slide 10

Question 13

Where does the maxillary sinus drain?

Answer 13

To the bottom of the semilunar hiatus

Question 14

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

Answer 14

To the lateral wall of the inferior meatus It drains tears from the lacrimal sac to the nasal cavity

Question 15

State some roles of the sinuses in the skull.

Answer 15

It makes the skull lighter

Acts as a crumple one for the brain

Increases projection of the voice

Mucous production into the nasal cavity!

Question 16

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

Answer 16

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

aditus= opening

ad= to

antrum= a natural cavity in bone

Question 17

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

Answer 17

Tegmen tympani

tegmen= cover/roof

Question 18

Through which membrane is a cricothyroidotomy performed?

Answer 18

Cricothyroid ligament

Question 19

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

Answer 19

Arytenoid cartilage (attached to the cricoid but behind the thyroid cartilage) see pics

Question 20

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

Answer 20

Cricothyroid muscles can tense and tilt the thyroid cartilage forwards. This puts tension on the vocal folds and allows higher pitched voices to be produced.

try doing do re mi fa so

Question 21

What are the two parts of the cricoid cartilage?

Answer 21

Lamina (the main body part of the cricoid, located POSTERIOR to the arch.) and Arch (ring part of the cricoid). The arch is the thin ring bit and the lamina is the thick board at the back

Question 22

What two things do the cricoid cartilage articulate with?

Answer 22

Arytenoid cartilage

Inferior horns of the thyroid cartilage

if u look at a diagram, the cricoid cartilage has facets for arytenoid cartilage and facets for thyroid cartilage

Question 23

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

Answer 23

Laryngeal prominence

Superior and inferior thyroid notch are found above and below the laryngeal prominence (NOT THE SAME AS SUPRASTERNAL NOTCH/JUGULAR NOTCH)

Question 24

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

Answer 24

Corniculate (small horn) and Cuneiform (means wedge shaped) Cartilage

Question 25

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

Answer 25

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

Question 26

What membranous outpouching is formed between these two folds?

Answer 26

Laryngeal ventricle. Laryngeal saccule is the top outpouching of the laryngeal ventricle

Question 27

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

Answer 27

Rima glottidis (gap between the vocal folds)

Question 28

Which muscles are attached only to the arytenoids?

Answer 28

Transverse and Oblique Arytenoid muscles Oblique is continuous with aryepiglottic muscle but they are sometimes refereed as seprate muscles

Question 29

Which muscles are involved in abducting (move away from midline) and adducting (towards midline) the vocal folds?

Answer 29

Posterior cricoarytenoid muscle – abduction Lateral cricoarytenoid muscle – adduction

Question 30

Which nerve provides sensory and motor control of the larynx?

Answer 30

Vagus Nerve - L and R recurrent laryngeal nerves MOTOR supply to all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. (see next card)

Question 31

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

Answer 31

1. Superior Laryngeal Nerve – separates into internal and external laryngeal: Internal Laryngeal – sensory above the vocal folds External Laryngeal – motor to cricothyroid muscles 2. Recurrent Laryngeal – sensory below the vocal folds + motor to all other muscles of the larynx

Question 32

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

Answer 32

Superior – Superior thyroid artery Recurrent – Inferior thyroid artery

Question 33

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?

Answer 33

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

Question 34

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

Answer 34

1. Inspiration 2. Closed glottis (same as rima glottidis) and contraction of abdominal muscles leading to increase in intrathoracic pressure 3. Sudden abduction of the vocal folds to release the intrathoracic pressure

Question 35

What is the difference in the oropharyngeal isthmus in coughing compared to sneezing? The oropharyngeal isthmus is basically the hole that leads to the 'entry' into oropharynx. Isthmus=passageway

Answer 35

In coughing, the oropharyngeal isthmus is open When sneezing, it is closed See the middle parts of the diagram below

Question 36

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

Answer 36

Vagus

Question 37

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

Answer 37

Maxillary branch of the Trigeminal nerve (during a sneeze, it is normally caused by irritation in nasal cavity (irritation of nasal mucosa). Nasal cavity is innervated by V2

Question 38

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

Answer 38

Cough – soft palate is raised and tensed against the posterior wall of the pharynx, this allows air to come out from the mouth Sneeze – soft palate is depressed (raised DOWN) against the tongue, this forces air to leave via nose

Question 39

The soft palate is depressed (which is what its normally like) against the tongue when sneezing to prevent the release of the pressure through the mouth. Which nerve and muscles are involved in this?

Answer 39

Vagus – palatoglossus and palatopharyngeus muscles Palatoglossus is involved in pulling the posterior tongue upwards (only muscle of tongue not innervated by hypoglossal nerve CNXII) palatopharyngeus is involved mainly in swallowing, it elevates the larynx and pharynx NOTE these are NOT the same as palatoglossal and palatopharyngeal arches

Question 40

What happens to the vocal folds when sneezing and coughing?

Answer 40

They abduct (away from midline ie open)

Question 41

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?

Answer 41

Tensor veli palatini (mandibular of trigeminal (V3)) Levator veli palatini (X) Superior pharyngeal constrictor (X) Tensor and levator veli palatini both contract to elevate soft palate such that food does not enter nasopharynx Superior pharyngeal constrictor's main function normally is to contract to push food down towards esophagus. For coughing, its contraction acts as a sphincter which blocks the air and stops it from leaving via the nasal pathway

Question 42

What is the vallecula?

Answer 42

Behind the root of the tongue between the epiglottis and the tongue– they serve as spit traps, saliva is temporarily held in the valleculae to prevent initiation of the swallowing reflex

Question 43

3 parts of the ear?

Answer 43

outer, middle, inner