upper airway

Question 1

function of the larynx

Answer 1

to protect the airway from ingestion of food

we use it to make sound, phonation and speech - not its principle function

Question 2

how is the larynx related to Parkinson’s

Answer 2

peoplee who die of parkinsons usually have asparated food and fluid and end up dying of pneumonia

Question 3

summarise the implications of the sinuses (frontal and sphenoidal)

Answer 3

they make the head lighter

also clinically - can become infected

Question 4

can the nasal cavity feed into teh cranial cavity

Answer 4

yes

Question 5

describe the nasal cavity *

Answer 5

at the upper part of the resp tract - they permit airflow into airway

have turbinate bones, conchae are bones and the soft tissue - shelves of bone that project into the nasal cavity and are covered by resp epi. there are 3 pairs proijecting ionto nasal cavity - superior, inferior and middle.

spaces between conchae are meatuses. superior between superior adn middle conchae, middle between middle and inferior, inferior below inferior

Question 6

what is the role of the conchae and meatuses *

Answer 6

warm and hufidify air so that cold air is not hitting lungs

immune func - trap pathogens (problem because nasal cavity drains into the cranial cavity)

drainage route for sinuses

Question 7

idnetify the bones that contribute to the nasal cavity *

Answer 7

image

Question 8

why can you only see the frontal and nasal sinuses in a saggital view *

Answer 8

the other sinuses are more lateral so are not seen in the midline

Question 9

describe the arterial blood supply of the nasal cavity *

Answer 9

from branches of the internal carotid artery and external

very good blood supply

Question 10

describe the innervation of the nasal cavity *

Answer 10

sensory innervation - trigeminal (V1 anterior region, V2 ppsterior region), olfactory (smell to the brain), facial (mucous mem of glands eg lacrimal glands),

sympathetic trunks from T1 (vascular sm)

Question 11

describe the venous drainage of the nasal cavity *

Answer 11

superior parts of nasal cavity drain into the cranial cavity - link for infection

Question 12

describe teh paranasal sinuses *

Answer 12

air filled

line anterior aspect of facial skeleton

function - reduce weight, provide crumple zone to protect brain, help with resonation ie project the voice

warm - so bacteria grow = infection

innervated by branches of the trigeminal nerve

Question 13

identify the paranasal sinsues *

Answer 13

image

Question 14

locate the sinues on an x ray

Answer 14

darker region

ethmoidal air cells rather than sinus - because sinus is single large cavity and ethmoid air cells are like honeycomb

Question 15

illustrate the areas of sinus drainage *

Answer 15

in the meatuses

ethmoidal cells drain onto the ethmoidal bulla in the middle meatus

sphenoidal sinus drains into the spheno-ethmoidal recess

frontal sinus drain through the infundibulum opening of frontal nasal duct

maxillary sinus opens in the floor of the semilunar hiatus

Question 16

where are tears drained

Answer 16

through the nasolacrimal duct into the back of the nassal cavity

Question 17

why does head feel full off cold in the morning

Answer 17

fluid collects there over night because sinuses cant drain in that position

Question 18

describe the larynx *

Answer 18

hollow

composed of cartilage, membrane and muscles

acts as a valve (most important function) and sound producer (structures that stop food going down airway can also vibrate = sound)

Question 19

how do you increase volume of voice

Answer 19

project air over vocal cords at a faster rate

Question 20

innervation of the vocal cords

Answer 20

recurrent laryngeal nerve - because of this nerves location problems with the larynx may indicate problems in the L lung which is near the L recurrent laryngeal - would cause a change in voice (hoarseness and cough)

nerve suseptible too damage by bronchial or oesophageal tumour/swollen mediastinal lymph nodes - and surgery in respnse to this

Question 21

illustrate the laryngeal cartilages from a lateral view, and describe relations between the cricoid cartilage and thyroid cartilage *

Answer 21

small gap between thyroid cartilage and cricoid cartilage

thyroid cartilage rocks back and forwards on the larger posterior section of cricoid around the cricothyroid joint - partly how tension in vocal folds is altered - move anterior attachment and posterior attachment of the vocal folds further apart

Question 22

describe the laryngeal cartilages from a posterior view

describe the arytenoid cartilages *

Answer 22

arytenoid cartilages swivel from side to side - elements of the vocal folds are attached to the anterior of these so when they swivel they open and close the airway

Question 23

describe the anatomy of the vocal folds *

Answer 23

there are ligaments from posterior to anteroir

mucosal tissue draped over whole thing - folds out to form a vestibule, then folds back in over another ligament

Question 24

describe the view of the vocal folds down the endoscope

Answer 24

hole betwene vocal chords is the rima glottidis - seen when airway is open

when phonation is taking place the vocal folds are aducted in order to vibrate

Question 25

illstrate a closed airway \*

Answer 25

image

Question 26

describe the intrinsic muscles of the larynx \*

Answer 26

change the tension in the vocal chords - open and clsoe airway for phonation cricothyroid muscle (from cricoid to thyroid catilage) - when contract thyroid cartilage rocks forwards.this puts tension on vocal chords lateral crico-arytenoid - contract andd spin the arytenoid cartilages inwards bringing the vocal folds closer together (aducting the vocal folds) posterior crico-arytenoid, oblique arytenoid and transverse arytenoid - open up vocal folds and so the airway vocalis muscle - reduces the tension in the folds by bringing the thyroid cartilage to the cricoid thyro-arytenoid muscle - broad flat muscles, act asa sphincter for the vestibule by pushing soft tissues medial, they also narrow the inlet by pulling the arytenoid cartilage forward and epiglottis to the arytenoid cartilages - innervated by the recurrent laryngeal nerve

Question 27

describe the nerve supply of the larynx \*

Answer 27

vagus nerve has 2 branches - superior laryngeal nerve and recurrant laryngeal nerve recurrent laryngeal - longer on the L than R because L loops around the ligamentum arteriosum near lung, R goes around R subclavian artery - travel with the inferior thyroid artey superior laryngeal nerve branches into the internal laryngeal nerve and external laryngeal nerve - they travel with the superior thyroid artery internal - sensation and muscles external - smaller involvement (just rocks the thyroid cartilage)

Question 28

describe the effects of lesions of the vagus nerve \*

Answer 28

lesion before branching = complete paralysis lesion of internal laryngeal = loss of sensation above vocal folds - problem because coughing wont be initiated (loss of protective mech) of external = paralysis of cricothyroid of recurrent = paralysis of all muscles of larynx except cricothyroid, and loss of sensation below the vocal folds

Question 29

consequence of the vagus branches travelling with thyroid arteries

Answer 29

removal of thyroid can be associated with damage of these nerves

Question 30

what are teh rpotectove mechanisms for the airway

Answer 30

swallowing - have to close airway and protect airway gag reflex - stop things going down airway sneezing and coughing - remove things irritating the airway

Question 31

describe the differences between coughing and sneezing

Answer 31

relates to the soft palate if raised to block of nasal cavity - air will come out of mouth = coughing - afferent innervation CN 10, efferent = CN10 and V3 if soft palate closed down = air directed posteriorly to the soft palate into nasal cavity = sneezing - afferent innervation V2, efferent = CN10

Question 32

describe how you can intubate someonw

Answer 32

chin lift/jaw thrust so you can see the airway either via the oropharynx or nasopharynx endotracheal intubation/cicothyroidotomy/tracheostomy

Question 33

locate features of the auditory apparatus

Answer 33

Question 34

what is a possible consequence of an ear infection

Answer 34

infection of the mastoid air cells = damage to mastoid air cells = errode through bone into cranial cavity

Question 35

routes of infection into the cranial cavity

Answer 35

from root of upper teeth into the maxillary sinus from nasal cavity into frontal or sphenoid sinus mastoid air cells to cranial cavity venous drainage

Question 36

describe what the facial nerve innervates

Answer 36

motor - muscles of facial expression, stapedius, digastric (posterior belly), stylohyoid sensory - taste for ant 2/3 tongue, PNS (lacrimal glands, mucous glands of nasal cavity, hard and soft palates, sublingual and submandibular glands) and general sensation from the external acousitic meatus and deeper parts of the auricle

Question 37

where on the brainstem does the facial nerve emerge from

Answer 37

the lateral surface between the pons and the medulla

Question 38

describe the path of the facial nerve through the skull

Answer 38

through internal accoustic meatus to the stylomastoid foramen then through the parotid gland for the muscles of facial expression smaller branch leave throigh teh petrotympanic fissure - join the lingual nerve and carry efferent fibres to submandibular and sublingual, bring back taste from anterior 2/3 tongue

Question 39

what does the pharyngotympanic tube connect

Answer 39

the middle ear and the nasal cavity

Question 40

what is the clinical relevance of the relationship between the sphenoid sinus and the pituitary gland

Answer 40

there is only a thin bone shelf between the sinus and the hypophysial fossa also only a thin shelf between sinus and nasal cavity the pit gland can be surgically approached through nasal cavity, passing through the anteroinferior aspect of the sphenoid bone - into the sphenoid sinus and then through the top of the bone into the hypophyseal fossa

Question 41

describe the external ear

Answer 41

made of the auricle, external and auditory meatus - it collects sound and directs it ot tympanic membrane auricle formed from fibrocartilage skeleton covered by adherent skin - has a lobule without fibrocartilage skeleton inferiorly and a tragus anteriorly that overlaps the opening of the external meatus. the meatus leaves from the concha of the auricle which is the hollow centre of teh auricle. It assists in capturing sound medial 2/3 meatus are in the temporal bone skin lining the external meatus contains ceruminous glands and outer part is hairy innervated by the auriculo-temporal nerve anteriorly and the vagus nerve posteriorly

Question 42

describe the middle ear

Answer 42

irregular air space in the temporal bone tympanic cavity extends posteriorly into base of mastoid process as the tympanic antrum and anteriorly it communicates with the nasopharynx via the pharyngotympanic tube the tympanic cavity is traversed by the chain of ossicles that transmits vibrations to inner ear through the oval window in the medial wall of the middle ear

Question 43

describe the internal ear

Answer 43

lies in the petrous temporal bone medial to middle ear has the cochlea, vestibule and 3 semicircular canals

Question 44

describe the laryngeal surface anatomy

Answer 44

feel laryngeal prominance (thyroid cartilage) - palpate the notch, and the 2 laminae of the thyroid cartilage follow anterior border of the cartilage down until you feel a depression due to cricothyroid membrane then the concave anterior part of cricoid cartilage below this you can feel the first 2 rings of teh trachea the hyoid bone lies above the thyroid cartilage - palpate the body and 2 horns laterally

Question 45

describe how you would explore the external auditory meatus and tympanic membrane using an otoscope

Answer 45

straighten ear by pulling pinna upwards and outwards (in paeds - down and back) hold the otoscope like a pen and use little finger to hold at the cheek of pt to avoid trauma to the inner ear rotate the otoscope

Question 46

list the cartilages of the nose and the function\*

Answer 46

they provide support for the nose, anterior and on each side of the nose lateral processes of the septal cartilage septal cartilage superior margin of the septal cartilage major alar cartilage 3/4 minor alar cartilages

Question 47

describe how the laryngeal cartilages are involved in increasing the intra-thoracic pressure \*

Answer 47

they close the rima glottidis the arytenoid cartilages pull the vocal folds closer together - closing the airway = increase in intrathoracic pressure teh arytenoid cartilages are moved by the lateral cricoarytenoid muscles

Question 48

describe how the laryngeal cartilages are involved in phonation \*

Answer 48

vocal cords adducted, they make sound by rubbing together - arytenoid cartilages swiveled air is forced through the closed rima glottidis - cause vocal chords to rub against each other and produce sound the tension in the vocal chords is adjusted by the vocalis and cricothyroid muscles

Question 49

action of the laryngeal cartilages in the cough sneeze reflex \*

Answer 49

there is sudden abduction of the vocal folds ie becasue the arytenoid ligaments have swiveled in the other direction - releasing intrathoracic pressure = sneezing posterior cricothyroid muscles involved

Question 50

what is the tympanic memrane \*

Answer 50

it separates the external acoustic meatus from the middle ear at an angle sloping medially from top to bottom, anteriorly to posteriorly has a connective tissue core and lined with skin on the outside and mucous membrane on the inside around the periphery is a fibrocartilaginous ring attaching it to the tympanic part of the temporal bone

Question 51

describe the anatomy of the auditory ossicles \*

Answer 51

bones of the middle ear, consisting of the malleus, incus and stapes they form an osseous chain across the middle ear from the tympanic membrane to the oval window of the middle ear malleus - head of malleus is rounded upper part (articulates with the incus), below this is teh constricted head of the malleus, below this are anterior and lateral proesses, below these is the handle of the malleus whhich attaches to the tympanic membrane incus - body articulates with the malleus, long limb travels parallel to handle of malleus but bends and articulaees with stapes. short limb extends posteriorly and is attached by a ligament to upper posterio wall of middle ear stapes - head articulates with the incus, anterior and posterior limb attach to the oval base, the base fits into the oval window on the labyrinth wall of the middle ear

Question 52

describe the anatomy of the external acoustic meatus \*

Answer 52

extends from the concha to the tympanic membrane (1 inch) consits of cartilage and bone - lateral 1/3 from cartilaginous extensions from the auricle, medial 2/3 is a bony tunnel in the temporal bone throughout its length it is covered in skin, some contains hair and modified sweat glands producing cerumen (ear wax) doesnt follow a straight course

Question 53

describe the anatomy of the pharyngotympanic tube \*

Answer 53

connects the middle ear to the nasopharynx equalises pressure on both sides of the membrane opening on the middle ear is on the anterior wall and from here it extends forward, medially and downward to meet the nasopharynx 1/3 nearest middle ear is the bony part - clearly visible on inferior surface of the skull at the junction of the squamous and petrous part of the temporal bone, immediately posterior to the foramen ovale and foramen spinosum cartilaginous part - remaining 2/3

Question 54

what separates the upper and lower airway

Answer 54

the vocal chords

Question 55

how do you stop the tongue blocking the oropharynx \*

Answer 55

head tilt chin lift jaw thrust - doenst move the neck, preferable if spinal chord injury

Question 56

describe the relationship of the paranasal sinuses with the nasal cavity \*

Answer 56

they develop as outgrowths from the nasal cavities and erode into the surrounding bones all the sinues drain into the nasal cavity

Question 57

what are the 4 paranasal air sinuses \*

Answer 57

ethmoidal cells sphenoidal sinus maxillary sinus frontal sinus

Question 58

nerve supply of the frontal sinus \*`

Answer 58

supra-orbital nerve from the opthalmic nerve (V1) which is a division of the trigeminal nerve

Question 59

nerve supply of the ethmoidal cells \*

Answer 59

the anterior and posterior ethmoidal branches of the nasocillary nerve from teh opthalmic nerve V1 the maxillary nerve V2 via orbital branches from the pterygopalatine ganglion

Question 60

what is the nerve supply of the sphenoidal sinus \*

Answer 60

posterior ethmoidal branch of the opthalmic nerve V1 maxillary nerve V2 via orbital branches from the pteryogopalatine ganglion

Question 61

what are the membranes of the larynx and are the intrinsic or extrinsic \*

Answer 61

thyrohyoid membrane - extrinsic hyo-epiglottic ligament - extrinsic cricotracheal ligament - extrinsic fibro-elastic membrane - intrinsic cricothyroid ligament (cricovocal membrane, cricothyroid membrane) - intrinsic quadrangular membrane - intrinsic

Question 62

describe the thyrohyoid membrane \*`

Answer 62

spans between superior margin of thyroid cartilage and teh hyoid bone it is attached to superior margin of thyroid laminae and adjacent anterior margins of the superior horns ascends medial to the greater horns and posterior to body of hhyoid bone to attach to superior margin of these structures posterior borders are thickened to form lateral tyrohyoid ligaments also thickened anterior in the midline forming median thyrohyoid ligament

Question 63

describe the hyo-epiglottic ligament \*`

Answer 63

extend from body of epiglottis anterosuperiorly to body of teh hyoid bone

Question 64

describe the cricotracheal ligament \*`

Answer 64

runs from lower border of the cricoid cartilage to adjacent upper border of first tracheal cartilage

Question 65

describe the fibroelastic membrane of the larynx \*

Answer 65

links together with the laryngeal cartilages and completes architectural framework composed of lower cricothyroid ligament and upper quadrangular membrane

Question 66

describe the cricothyroid ligament \*

Answer 66

attached to arch of cricoid cartilage extends superiorly to end in a free margin which attaches to the thyroid cartilage and the vocal processes of the arytenoid cartilages between these points the free margin is thickened to from the vocal ligament anteriorly te cricothyroid ligament is thickened to form median cricothyroid ligament

Question 67

describe the quadrangular membrane \*

Answer 67

runs between the lateral margin of the epiglottis and anterolateral margin of epiglottis on the same side also attaches to corniculate cartilage has a free upper and lower margin free lower margin thickened to form vestibular ligament under the vestibular fold

Question 68

what are the extrinsic muscles of the larynx \*

Answer 68

the infrahyoid and suprahyoid muscles of the larynx