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Upper Airway Anatomy

Organisation of the Body

QuestionAnswer
Upper airway structures Nasal cavity Choanae Nasopharynx Oropharynx Laryngopharynx Oesophagus Larynx Oral cavity Nares Hard palate
Skull structures Sutures - join different bones - coronal and sagittal etc not fused at birth Fontanelle - present in fetal skull where bone is not present - anterior closes at 18 months and posterior closes at 3 months Structure of this can indicate pathology
Bones of facial skeleton Key bones are temporal, maxilla, mandible, sphenoid bone Key join is tempomandibular joint Orbit is formed by lots of bones - means fractures are complicated
Paranasal sinuses Air filled pockets in the skull that develop in childhood Frontal sinuses Ethmoidal cells Maxillary sinuses Inflamed in sinitus Lined with mucosa - can fail to drain
Orbital cellulitis Infection of erythroid cells can spread to orbit Infection of soft tissue of the eye Puts pressure on optic nerve Can cause clots in blood supply to the eye Due to thin layer between sinus and orbit
External nose Most is cartilaginous Bones from nasal bones and maxillary bone Septum can be infected/damaged in drug use
Nasal cavity Rich blood supply to warm and humidify incoming air High surface area due to conchae - 3 fold of bone Meati between these Causes turbulent flow Lacrimal gland drains into this
Temporomandibular joint The condylar process of the mandible articulates with the mandibular fossa of the temporal bone A synovial joint - can be inflamed, arthritic and dislocated
Movement of the jaw Protrusion - lateral pterygoid assisted by medial pterygoid Retraction - posterior fibres of temporalis, deep part of masseter and geniohyoid and digastric Elevation - temporalis, masseter, medial pterygoid Depression - gravity, digastric, geniohyoid
Innervation of muscles of mastication Innervated by mandibular part of the trigeminal nerve - 5th cranial nerve
Adult teeth Central incisors Lateral incisors Canines 1st premolars 2nd premolars 1st molars 2nd molars 3rd molars
Tongue Innervated by hypoglossal nerve Muscles extrinsic to the tongue help move it Powerful muscle
Innervation of the tongue Motor - hypoglossal nerve Sensory to posterior 1/3 - glossopharyngeal nerve Sensory to anterior 2/3 - Lingual nerve and CN VII
Salivary glands Parotid gland Sublingual gland Submandibular gland Stones can form and block glands Parotitis - swelling of paratoid
Pharynx Nasopharynx - choanae to lower border of soft palate - CN V2 and IX Oropharynx - lower border of soft palate to superior border of epiglottis - CN IX Laryngopharynx - Superior border of epiglottis to cricopharyngeal - CN IX and X
Muscles of pharynx Superior, middle and inferior constrictor - overlap to cause peristaltic like movement Circopharyngeus - upper oesophageal sphincter to prevent reflux into lungs
Movement in swallowing Tongue pushes against hard palate - food moves to back of oral cavity Tongue blocks oral cavity, soft palate blocks nasal cavity and epiglottis blocks larynx The UES opens and food moves into oesophagus If this goes wrong food can move into trachea
Larynx Predominantly cartilaginous structure on top of trachea Gap between thyroid and cricoid cartilage is a site of emergency access to the airways Hyoid bone is where cartilage attaches
Innervation of larynx Predominantly vagus nerve via the recurrent laryngeal nerve This is dragged down by mediastinal structures during development so loops back up to the larynx Means abnormalities in mediastinum can affect this
Cartilage of the larynx Arytenoid cartilages attach to vocal cords This can move them apart and alter tension in the cords to allow speech
Control of vocal chords Posterior cricoarytenoid Lateral cricoarytenoid Transverse cricoarytenoid Oblique cricoarytenoid These muscles allow us to speak
Phonation Vocal cords adducted and stridulating as air is forced between them Vestibule open
Forced inspiration - effect on vocal chords Vocal chords abducted and rime glottidis wide open Vestibule open
Airway protection Epiglottis swings down to arytenoids to protect against food etc being aspirated into lower airways Any aspirated bodies are most likely to enter right lobe
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