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Upper Airway Antho
| Question | Answer |
|---|---|
| Describe the linings of the sinuses. | They are lined with respiratory mucosa, and continuos with the nasal cavity |
| How do you surgically reach the pituitary gland? | thru the nasal cavity → sphenoid sinus → bone separating sphenoid sinus from pituitary gland |
| Which are the largest paranasal sinuses? | Maxillary |
| Does fluid collecting in the maxillary sinuses drain upward or downward to the lateral wall of the nasal cavity? | Upward to the big hole in the hiatus semilunaris |
| What are the borders of the nasal cavity? | Orbits and maxillary sinuses |
| What special mucosa is the roof of the nasal cavity covered with? | Olfactory mucosa |
| Which nerve is at the roof of the nasal cavity? What kind fo nerve is it? | CNI, olfactory, special sensory nerve |
| Describe the path of CNI. | Sensory nerve endings in olfactory mucosa → cribriform plate of ethmoid bone→ synapse on olfactory bulb in anterior cranial fossa→ olfactory tract → brain |
| Describe the structure of the floor of the nasal cavity. | Hard palate (bone), soft palate (skel muscle flap) |
| Describe the lateral wall of the nasal cavity. | 3 turbinates (conchae), superior, middle, inferior; meatuses (channels) below each concha/turbinate |
| Where do the middle ethmoid air cells drain? | Through ethmoid bulla in the middle meatus |
| Where is the hiatus semilunaris located? å | Located beneath the ethmoid bulla in the middle meatus |
| List the sinuses that drain here (hiatus semilunaris). | Frontal and anterior ethmoids drain through frontonasal duct (bony canal) and maxillary sinuses drain through large hole |
| List the sinuses that DO NOT drain to the middle meatus and where they drain. | Posterior ethmoid (superior meatus), Sphenoid sinus (sphenoethmoid recess on posterior roof of nasal cavity) |
| What is the cavity continuous with the oropharynx and posterior to the larynx? | Hypopharynx (laryngopharynx) |
| What does the posterior wall of the pharynx rest on? | Upper cervical vertebral bodies |
| Opening at the anterior wall of the nasopharynx? | Choanae |
| Posterior wall of nasopharynx attaches to? | Skull base, C1/2 |
| Inferior passage of the nasopharynx to the oropharynx is called? | Pharyngeal isthmus |
| Describe swallowing in context of the nasopharynx. | Skel muscle of soft palate contracts, blocking pharyngeal isthmus. Prevents H2O/food going to nasopharynx → airway (no aspiration) |
| Where is the pharyngeal recess and what is in it? | Posterior to the torus tubarius, pharyngeal tonsil |
| Where does the pharyngotympanic tube lead from where and what is its fn? | Lateral wall of nasopharynx → tympanic cavity of middle ear w/in the petrous part of temporal bone, fn – equalize pressure |
| What is the wall of the pharyngotympanic tube formed by? | cartilage at beginning (torus tubarius) → bony canal as it approaches tympanic cavity |
| What is the main fn of these (cartilaginous rings)? How many? What kind are they? | prevent airway collapse when no air in trachea, 20, hyaline |
| What are the rings connected by? Where? | Trachealis muscle, posteriorly |
| What kind of muscle and what innervates the trachealis muscle? | Smooth muscle, ANS |
| What are the borders of the trachea? | C6→T4/5; inferior border of the cricoid → sternal angle (carina) **varies based on respiratory stage |
| What are the dense fibrous connective sheets that separate the neck into compartments? | 1. Investing fascia 2. Carotid sheaths 3. Pretracheal fascia 4. Prevertebral fascia |
| Describe the investing fascia. | immed beneath skin, surrounds all neck |
| Describe the carotid sheaths. | 2 NV collumns; Anterior neck; common carotid artery/internal jugular/CNX |
| Describe the Pretracheal fascia. | visceral collumn; anterior neck; larynx (C3-6)/trachea(C6-T4/5)/Esophagus(C6→)/Thyroid gland |
| Describe the prevertebral fascia. | Posterior neck; c-spine/associated musculoskeletal tissues/cervical sympathetic chain |
| Name passageway from the oropharynx to the larynx. | Laryngeal inlet |
| What are the 3 large unpaired cartilages in the larynx? | Thyroid, cricoid, epiglottis |
| Describe the thyroid cartilage. | 2 laminae meet midline forming the laryngeal prominence (adam’s apple) |
| Describe the articulations of the thyroid cartilage. | 2 superior horns → articulate with hyoid bone, 2 inferior horns → articulate with cricoid cartilage |
| What veterbral level is the thyroid cartilage at? | C4/5 |
| Describe the cricoid cartilage. | Ring of cartilage just inferior to the thyroid cartilage |
| Is the cricoid cartilage larger anteriorly or posteriorly? | Posteriorly |
| Describe the articulations of the cricoid. | Articulate with inferior horns of the thyroid cartilage and the arytenoid cartilages |
| What veterbral level is the cricoid? | C6 |
| Describe the structure of the epiglottis. | Leaf-shaped elastic cartilage |
| Where does the epiglottis attach? | Posterior wall of thyroid cartilage |
| What are the two processes of the arytenoid cartilages? | Vocal and muscular |
| What does the base of the arytenoid cartilage articulate with? | Cricoid |
| What are the corniculate cartilages? | 2 small conical cartilages whose bases articulate with apices of the arytenoid cartilages |
| What is the small “u-shaped” bone in the upper anterior neck called? | Hyoid bone |
| What are the attachments of the hyoid bone? | Superior: oral cavity floor, inferior: larynx, posterior: pharynx |
| What structures does the thyrohyoid membrane anchor? | Thyroid cartilage to hyoid bone |
| What structures does the cricothyroid ligament anchor? | Thyroid to the cricoid cartilage |
| What structures does the cricotracheal ligament anchor? | Cricoid to upper border of the first tracheal cartilage |
| What travels through the thyrohyoid membrane hole? | Superior laryngeal artery and internal laryngeal nerve (from superior laryngeal nerve branch) |
| What are the extrinsic ligaments of the larynx and what is their fn? | Thyrohyoid/cricothyroid/cricotracheal, fn in anchoring thyroid and cricoid to surrounding structures |
| Where is the intrinsic ligament of the larynx and what is its fn? | deep to the mucosa, fn to support the mucosal lining |
| What is the most prominent fold when looking down the larynx? | Vocal fold |
| Describe the 2 spaces in the internal larynx. | Supraglottic (above vocal folds), infraglottic (vocal folds and below) |
| What are the two folds in the supraglottic space? | Aryepiglottic (forms part of the laryngeal inlet, skel muscle help close it) and Vestibular folds (false vocal cords, distal end of supraglottic space) |
| Opening btwn vestibular folds is called? | Rima vestibuli |
| Where is the ventricle of the larynx? | indentation btwn vestibular folds in the supraglottic space and vocal folds of the infraglottic space |
| Where do the vocal cords attach? | vocal process of the arytenoid cartilage |
| Vocal folds extend from ______ to ______? | Anterior edge of arytenoid cartilage to the posterior surface of the thyroid cartilage |
| Opening btwn vocal folds is called? | Rima glottidis (leads to trachea and lower airway) |
| What are the fn and the kind of muscle of the extrinsic muscles of the larynx? | Adjust position of larynx in anterior neck during swalowing, skeletal muscle |
| How does the laryngeal inlet close? | Skeletal muscle in the aryepiglottic folds contract to close the diameter |
| Which muscles close the rima glottidis (brings the vocal cords together)? | Transverse and oblique arytenoid muscles (on posterior surface of the 2 arytenoid cartilages → pulls them closer together) and Lateral cricoarytenoid finishes the closing by rotating the muscular processes of the arytenoid cartilages inward. |
| Which muscles open the rima glottidis? | Posterior crocoarytenoid (only muscle in the larynx that widens the rima glottidis, for force expiration and inspiration) |
| High pitch? | Cricothyroid muscle (tilts thyroid cartilage anteriorly, lengthens and increases tension of vocal cords) |
| Low pitch? | Thyroarytenoid muscles (along the length of the vocal folds, pull the arytenoid closer to thyroid, shorten/decr tension) |
| Fine tune? | Vocalis muscle (medial edge of thryoarytenoid muscle) |
| Whisper? | Rima glottidis partially open and air pushes under vocal folds |
| How to create sound (not pitch)? | Lateral cricoartenoid muscles work with transverse and oblique arytenoid muscles to close the rima glottidis, forced expiration pushes air under closed vocal folds → vibration |
| All sympathetic innervation to the head originates where? | T1-4 lateral horn grey matter preganglionic cell bodies. Come up to superior cervical ganglion → synapse → wrap internal carotid artery → head |
| All sympathetic fibers to head are pre or post ganglionic? | Postganglionic |
| What are the 3 roots of the pterygopalatine ganglion? | CNVII (Greater petrosal), deep petrosal, CNV2 (maxillary) |
| What kind of ganglion is the pterygopalatine ganglion? | Parasympathetic (although sympathetic and somatic sensory fibers course through it) |
| What are the four branches of the pterygopalatine? | Paranasal, nasal, nasopharynx, palate |
| What nerve fibers do the 4 branches of the pterygopalatine ganglion have? | parasympathetic postganglionic, sympathetic postgang, somatic sensory |
| Describe the trigeminal nerves. | CNV, 3 main branches, (V1: ophthalmic, V2: maxillary, V3: mandibular), each branch courses a different opening in middle cranial fossa to their targets |
| Describe CNV1. | Ophthalmic, transverses superior orbital fissure, somatic sensory |
| Describe CNV2. | Maxillary, transverses foramen rotundum to enter middle cranial fossa, somatic sensory → 4 branches of pterygopalatine |
| Describe CNV3. | Mandibular, transverses foramen ovale, somatic sensory and motor |
| Where is the trigeminal ganglion located? | Rests on ridge of petrous part of temporal bone |
| Describe the path of CNVII (facial nerve) to Greater Petrosal. | CNVII transverses internal acoustic meatus in posterior cranial fossa and enters petrous part of the temporal bone where it divides in 3 (GP → parasymp) → middle cranial fossa |
| Where is the pterygopalatine ganglion located? | Pterygopalatine fossa |
| Describe the pathway of the nasal branches. | Sphenopalatine foramen at posterior of each cavity → lateral and septal wall branches |
| Describe CNX parasympathetic innervation in upper airway. | Parasymp pregang fibers (no synapse in head) synapse in ganglia scattered along mucosa at larynx and trachea (glands) |
| Describe CNX visceral sensory innervation in upper airway. | Cell bodies in 2 ganglion: superior and inferior ganglion. Receptors are in mucosal lining of larynx and trachea |
| Describe CNX somatic motor innervation. | Fibers innervating internal laryngeal muscles. |
| Vagus travels thru _______ to innervate internal laryngeal muscles. | Jugular foramen. |
| Vagus nerve gives off _______ then _______ to innervate larynx. | Superior laryngeal nerve then Recurrent laryngeal nerve |
| Superior laryngeal nerve divides into: | Internal and external laryngeal nerve |
| Internal laryngeal nerve is what type and innervates what? | Visceral sensory and parasymp nerve → thru thyrohyoid membrane hole (with superior laryngeal artery) to innervate mucosa of supraglottic space |
| External laryngeal nerve is what type and innervates what? | Somatic motor. Innervates cricothyroid muscle of larynx |
| Recurrent laryngeal nerve is what type and innervates what? | Visceral sensory, parasymp, and somatic motor. Innervates mucosa of infraglottic space, all intrinsic muscles of larynx except cricothyroid, and trachea |
| Common carotid divides into internal and external at what vertebral level? | ~C4 |
| Describe the blood supply to nasal cavities. | Maxillary artery → sphenopalatine artery → lateral and septal branches; ophthalmic artery → anterior and posterior ethmoid arteries |
| Describe the blood supply to paranasal sinuses. | Maxillary artery: Maxillary and Sphenoid sinuses; Ethmoid artery: Ethmoid and frontal sinuses |
| Describe the blood supply to larynx. | Superior laryngeal artery from superior thyroid artery from external carotid, enters thru hole in thyrohyoid membrane (w/nerve). Supplies supraglottic. Inferior Laryngeal artery, from inferior thyroid artery from subclavian artery. Supplies infraglottic. |
| Describe the blood supply to trachea. | Subclavian of the neck. |
| Internal carotid gives off? | Ophthalmic artery |
| External carotid gives off? | Maxillary artery and superior thyroid |
Created by:
THerzogA
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