Anatomy Upper Airway & Larynx
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Transcript of Anatomy Upper Airway & Larynx
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Part 2A Part 2A Normal AnatomyNormal AnatomyUpper airway and LarynxUpper airway and Larynx
Prepared ByPrepared ByBronchoscopy Bronchoscopy InternationalInternational
Contact us at Contact us at [email protected]@bronchoscopy.org
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The Upper AirwayThe Upper Airway The upper airway starts :The upper airway starts :
At the nostrils, extends At the nostrils, extends through the nasal conchae through the nasal conchae to the nasopharynx, over to the nasopharynx, over the uvula to the the uvula to the hypopharynx and larynx,hypopharynx and larynx,
or,or, At the lips, extends through At the lips, extends through
the oral cavity, over the the oral cavity, over the tongue and below the hard tongue and below the hard and soft palates, to the and soft palates, to the hypopharynx and larynx.hypopharynx and larynx.
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Upper Airway: From Pharynx to Upper Airway: From Pharynx to LarynxLarynx
Uvula
Epiglottis
Larynx
Midline guidance: “The uvula points to the epiglottis, the epiglottis leads into the
larynx”.
Lingual Tonsil
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The LarynxThe Larynx• The larynx is a 5-7 cm The larynx is a 5-7 cm
long structure. long structure. • Its upper boundary Its upper boundary
starts at the tip of the starts at the tip of the epiglottis, opposite the epiglottis, opposite the 3rd to 4th, cervical 3rd to 4th, cervical vertebra.vertebra.
• Its lower end is at the Its lower end is at the lower border of the lower border of the cricoid cartilage.cricoid cartilage.• This lies opposite the This lies opposite the
6th cervical vertebra. 6th cervical vertebra. www.phon.ox.ac.uk
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The LarynxThe Larynx
Superior surface anatomy: Superior surface anatomy:
Major Landmarks IMajor Landmarks I
Base of Tongue
http://www.nyee.edu/top#top
Superior Surface ofEpiglottis
Posterior Wall ofHypopharynx(Leading toEsophagus)Lateral
GlossoepiglotticFolds
MedianGlossoepiglottic
FoldVallecula
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The Cricoid The Cricoid cartilagecartilage
Cricoid Cartilage
Cricothyroid membrane
Thyroid glandThyroid
cartilageCricoid cartilage
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Time Out! … Why is it so Time Out! … Why is it so important to recognize the surface important to recognize the surface
anatomy?anatomy? As a bronchoscopist, we are responsible to report As a bronchoscopist, we are responsible to report
any nasal, oral, pharyngeal or laryngeal pathology any nasal, oral, pharyngeal or laryngeal pathology that we observe en-route to the lungs.that we observe en-route to the lungs.
We only know that we are correctly positioned and We only know that we are correctly positioned and in the midline, when we know in the midline, when we know exactly where we areexactly where we are..
During a difficult intubation, either with a During a difficult intubation, either with a bronchoscope or a rigid laryngoscope, knowledge of bronchoscope or a rigid laryngoscope, knowledge of surface anatomy ensures timely intubation and surface anatomy ensures timely intubation and saves a life.saves a life.
In a variety of conditions, such as GERD, changes in In a variety of conditions, such as GERD, changes in laryngeal anatomy and structures, are the best laryngeal anatomy and structures, are the best clues to pulmonary pathology.clues to pulmonary pathology.Shall we continue?Shall we continue?
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The LarynxThe LarynxSuperior surface anatomy: Superior surface anatomy:
Major Landmarks - IIMajor Landmarks - II
Ventricle
PyriformSinus
Laryngeal Surface ofEpiglottis
Posterior Wall ofHypopharynx(Leading toEsophagus)
http://www.nyee.edu/top#top
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The LarynxThe Larynx
Superior surface anatomy: Superior surface anatomy:
Major Landmarks - IIIMajor Landmarks - III
Vallecula
PyriformSinus
Epiglottis
http://www.nyee.edu/top#top
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The LarynxThe LarynxSuperior surface anatomy: Superior surface anatomy:
Major Landmarks - IVMajor Landmarks - IV
http://www.nyee.edu/top#top
AryepiglotticFold
Posterior Commissure
Anterior Commissure
Ventricle
TrueVocalCords
FalseVocalCords
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The LarynxThe LarynxSuperior surface anatomy: Superior surface anatomy:
Major Landmarks - VMajor Landmarks - V
AryepiglotticFold
Posterior Wall Of Hypopharynx
CorniculateTubercle onArytenoidCartilage
CuneiformTubercle
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The LarynxThe LarynxSuperior surface anatomy: Superior surface anatomy:
Major Landmarks - VIMajor Landmarks - VI
Arytenoid Cartilage
TrueVocal Cords
FalseVocalCords
Ventricle
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The LarynxThe LarynxSuperior surface anatomy: Superior surface anatomy:
Major Landmarks Major Landmarks to look for - VIIto look for - VII
Cartilaginous
Rings ofTrachea
TrueVocal Cords
Vocal Cord Sulcus (onTrue Vocal
Cords)
CricoidRing
FalseVocalCords
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This is the..This is the..
A.A. The epiglottisThe epiglottisB.B. The ventricleThe ventricleC.C. The arytenoid The arytenoid
cartilagecartilageD.D. The true vocal cordThe true vocal cordE.E. The false vocal cordThe false vocal cord
Click for correct answer: B
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The Larynx: AnatomyThe Larynx: Anatomy The structural rigidity of the The structural rigidity of the
larynx is provided by the three larynx is provided by the three median cartilages:median cartilages: The epiglottisThe epiglottis Thyroid cartilageThyroid cartilage Cricoid cartilageCricoid cartilage ,,
along with the hyoid bone.along with the hyoid bone.
The thyrohyoid membrane The thyrohyoid membrane forms a C-shaped barrier forms a C-shaped barrier around the anterior and lateral around the anterior and lateral walls of the supraglottis, and walls of the supraglottis, and inferiorly becomes confluent inferiorly becomes confluent with the connective tissue in with the connective tissue in the perichondrium of the the perichondrium of the tracheal cartilaginous rings.tracheal cartilaginous rings. www.throat-cancer-symptoms.com/
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The Larynx: AnatomyThe Larynx: Anatomy The six smaller cartilages of The six smaller cartilages of
the larynx ( 3 pairs) are the larynx ( 3 pairs) are functionally involved with the functionally involved with the movements of the vocal cords. movements of the vocal cords. These are: These are: The arytenoidsThe arytenoids The corniculatesThe corniculates The cuneiformsThe cuneiforms
The The arytenoidarytenoid cartilages are cartilages are pyramid-shaped and articulate pyramid-shaped and articulate with the superior margin of with the superior margin of the cricoid lamina. On their the cricoid lamina. On their summit, are the summit, are the corniculatecorniculate cartilages; on their anterior cartilages; on their anterior aspect, the aspect, the cuneiformcuneiform cartilagescartilages www.polychondritis.com
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The Larynx: AnatomyThe Larynx: Anatomy The The vocal ligamentsvocal ligaments, are , are
attached posteriorly to the attached posteriorly to the apex of the arytenoids and apex of the arytenoids and corniculates. The cuneiforms corniculates. The cuneiforms extend laterally, between the extend laterally, between the layers of the vocal cords, from layers of the vocal cords, from the anterior aspect of the the anterior aspect of the arytenocorniculate complex.arytenocorniculate complex.
The The epiglottisepiglottis is attached to is attached to the base of the tongue by a the base of the tongue by a median and two lateral median and two lateral glossoepiglottic folds.glossoepiglottic folds.
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The Larynx: Critical StructuresThe Larynx: Critical Structures The Larynx neighbors The Larynx neighbors
major critical structures:major critical structures:
Carotid arteries and Carotid arteries and jugular veins, and the jugular veins, and the vagus nervevagus nerve
Superior and inferior Superior and inferior thyroid arteriesthyroid arteries
Superior and recurrent Superior and recurrent laryngeal nerveslaryngeal nerves
www.yoursurgery.com
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The Larynx: Topical The Larynx: Topical AnesthesiaAnesthesia
Bilateral nasal Bilateral nasal administration of administration of anesthetic provides anesthetic provides partial posterior partial posterior pharyngeal anesthesia pharyngeal anesthesia by affecting the by affecting the Sphenopalatine nerve Sphenopalatine nerve fibers, thus diminishing fibers, thus diminishing the gag reflex.the gag reflex.
Ask patient to inhale deeply through nostril
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The Larynx: Topical The Larynx: Topical AnesthesiaAnesthesia
Topical anesthetic Topical anesthetic usually affects the usually affects the superior laryngeal superior laryngeal nerve and blocks nerve and blocks sensory innervation sensory innervation to the base of the to the base of the tongue epiglottis, tongue epiglottis, pyriform fossa, and pyriform fossa, and valleculae. valleculae.
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The Larynx: Topical The Larynx: Topical AnesthesiaAnesthesia
The topical instillation The topical instillation of Lidocaine with theof Lidocaine with the““Spray as you go” Spray as you go” method numbs the method numbs the submucosal plexus of submucosal plexus of the larynx, derived the larynx, derived from the external and from the external and internal branches of internal branches of the superior laryngeal the superior laryngeal nerve.nerve.
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Laryngeal function: Airway Laryngeal function: Airway ProtectionProtection
Open Closed
The glottis: open for inspiration and closed for The glottis: open for inspiration and closed for swallowingswallowing
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Laryngeal function: PhonationLaryngeal function: Phonation
Adducted: Talking Abducted: Breathing
The vocal cords: Adducted for phonation; The vocal cords: Adducted for phonation; abducted for inspirationabducted for inspiration
www.voice.northwestern.edu
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Laryngeal function: PhonationLaryngeal function: Phonation
The vocal cords open and close while talking
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Which of the following defends against Which of the following defends against aspiration?aspiration?
A.A. The epiglottisThe epiglottisB.B. The false cordsThe false cordsC.C. The true cordsThe true cordsD.D. The ventricleThe ventricleE.E. All of the aboveAll of the above
Click for correct answer: E
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