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Upper Airway Antho

QuestionAnswer
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