Airway Anatomy and Physiology
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Questions and Answers

What is the boundary of the oropharynx superiorly and inferiorly?

  • Superiorly by soft palate, inferiorly by epiglottis (correct)
  • Superiorly by Cricoid cartilage, inferiorly by arytenoid cartilage
  • Superiorly by Hard palate, inferiorly by cricoid cartilage
  • Superiorly by Epiglottis, inferiorly by thyroid cartilage

    • Which of the following nasal sinuses is divided into posterior, middle, and anterior cells and consists of numerous air cells?

  • Frontal sinus
  • Ethmoid sinus (correct)
  • Maxillary sinus
  • Sphenoidal sinus

    • What is the function of the cricothyroid membrane?

  • Attaches the thyroid cartilage to the hyoid bone
  • Provides a site for emergency airway access (correct)
  • Allows for articulation between the cricoid and hyoid cartilages
  • Separates the cricoid cartilage from the thyroid cartilage (correct)

    • What is the only complete cartilaginous ring in the larynx?

    <p>Cricoid cartilage</p> Signup and view all the answers

    Which of the following statements about the soft palate is true?

    <p>It rises when eating or drinking and prevents ingested substances from going to the nose</p> Signup and view all the answers

    Which nerve is responsible for the motor function of all muscles of the larynx except the cricothyroid muscle?

    <p>Recurrent laryngeal nerve (RLN)</p> Signup and view all the answers

    What is the function of the posterior cricoarytenoid muscle?

    <p>Abduction of the vocal cords</p> Signup and view all the answers

    What is the site used for an emergency airway access?

    <p>Below the vocal cords</p> Signup and view all the answers

    What is the result of unilateral RLN injury?

    <p>Paralysis of the ipsilateral vocal cord, which compensates by shifting to the uninjured side</p> Signup and view all the answers

    What is the function of an oral airway (OPA) device?

    <p>To resolve occlusion usually from the tongue or redundant tissue in the pharynx</p> Signup and view all the answers

    Which nerve is responsible for the sensory function above the vocal cords?

    <p>Internal branch of the Superior laryngeal nerve (SLN)</p> Signup and view all the answers

    What is the result of bilateral RLN injury?

    <p>Chronic bilateral RLN injury with gruff speech and increased risk of aspiration</p> Signup and view all the answers

    Which of the following cartilages is NOT paired?

    <p>Epiglottis</p> Signup and view all the answers

    What is the primary function of the arytenoid cartilage movement?

    <p>To allow for tension and relaxation of vocal cords</p> Signup and view all the answers

    What is the response to noxious stimuli that causes vocal cord closure?

    <p>Laryngospasm</p> Signup and view all the answers

    What is the function of the thyroepiglottic ligament?

    <p>To attach the epiglottis to the thyroid cartilage</p> Signup and view all the answers

    What is the afferent limb of the gag reflex?

    <p>Glossopharyngeal nerve</p> Signup and view all the answers

    What is the shape of the thyroid cartilage?

    <p>Shield-shaped</p> Signup and view all the answers

    What is the location of the cuneiform cartilages?

    <p>Along the lateral edge of the arytenoids</p> Signup and view all the answers

    Which of the following cartilages provides support for the aryepiglottic fold?

    <p>Corniculate and cuneiforms</p> Signup and view all the answers

    Which of the following is the location of the vallecula?

    <p>On either side of the hypoepiglottic ligament</p> Signup and view all the answers

    Which of the following cartilages attaches to the tongue at the base of the hyoid bone?

    <p>Epiglottis</p> Signup and view all the answers

    Which of the following cartilages forms the laryngeal prominence?

    <p>Thyroid</p> Signup and view all the answers

    Which of the following statements about the arytenoid cartilage is true?

    <p>It is a paired, flexible, pyramid-shaped cartilage</p> Signup and view all the answers

    Which of the following nasal sinuses is the largest and only present at birth?

    <p>Maxillary sinus</p> Signup and view all the answers

    At which level of the cervical spine is the oropharynx typically found?

    <p>C2-C3</p> Signup and view all the answers

    What is the primary function of the soft palate?

    <p>Preventing ingested substances from going to the nose</p> Signup and view all the answers

    Which of the following structures lies above the sphenoidal sinus in the sella turcica?

    <p>Pituitary gland</p> Signup and view all the answers

    What is the typical drainage point of the maxillary and frontal sinus?

    <p>Middle nasal meatus</p> Signup and view all the answers

    Which muscle is responsible for the abduction of the airway?

    <p>Posterior cricoarytenoid muscle</p> Signup and view all the answers

    Which nerve is responsible for the sensory function below the vocal cords?

    <p>Recurrent laryngeal nerve</p> Signup and view all the answers

    What is the result of acute bilateral RLN injury?

    <p>Unopposed tension and adduction of the vocal cords</p> Signup and view all the answers

    Which muscle is responsible for the closure of the glottis?

    <p>Transverse arytenoid muscle</p> Signup and view all the answers

    What is the efferent response of the gag reflex obtained via?

    <p>Vagus nerve</p> Signup and view all the answers

    What is the location of the cricothyroid membrane?

    <p>Between the thyroid cartilage and the cricoid cartilage</p> Signup and view all the answers

    What is the result of laryngospasm?

    <p>All of the above</p> Signup and view all the answers

    What is the site used for an emergency airway access?

    <p>Cricothyroid membrane</p> Signup and view all the answers

    An OPA opens the larynx

    <p>False</p> Signup and view all the answers

    Laryngospasm may be provoked by airway instrumentation, pain, or visceral stimuli

    <p>True</p> Signup and view all the answers

    During which stage of anesthesia is laryngospasm a concern?

    <p>Stage II Excitement/Delirium</p> Signup and view all the answers

    What are the signs and symptoms of laryngospasm?

    <p>All of the above</p> Signup and view all the answers

    What is the primary treatment for laryngospasm?

    <p>All of the above</p> Signup and view all the answers

    At which point is the airway narrowest in infants and children? (select 2)

    <p>Cricoid cartilage</p> Signup and view all the answers

    At what level is the airway narrowest in adults?

    <p>Vocal cords</p> Signup and view all the answers

    Why is the epiglottis significant in infants?

    <p>It is longer, narrower, and stiffer in infants</p> Signup and view all the answers

    SLN injury is associated with respiratory distress

    <p>False</p> Signup and view all the answers

    Unilateral RLN injury can result in complete paralysis of vocal cords

    <p>False</p> Signup and view all the answers

    What is a potential cause of left recurrent laryngeal nerve (RLN) injury?

    <p>Mitral stenosis</p> Signup and view all the answers

    Is the soft palate capable of stretching and becoming more movable with age or obesity?

    <p>True</p> Signup and view all the answers

    What is true about the hard palate?

    <p>It is immobile and covers the anterior portion of the oral cavity</p> Signup and view all the answers

    What is the correct description of corniculate cartilages?

    <p>Paired conical nodules resting on the arytenoid apex</p> Signup and view all the answers

    What is the function of Arytenoid cartilage movement in relation to vocal cords?

    <p>It allows for the tension and relaxation of vocal cords</p> Signup and view all the answers

    What do the vocal cords attach to anteriorly and posteriorly?

    <p>Thyroid cartilage anteriorly and arytenoid cartilage posteriorly</p> Signup and view all the answers

    What is the correct order of airway structures from pharynx to carina?

    <p>Pharynx → Larynx → Trachea → Carina→ Bronchi</p> Signup and view all the answers

    Trachea is anterior to the esophagus

    <p>True</p> Signup and view all the answers

    What is the correct range of the larynx?

    <p>From the epiglottis to the cricoid cartilage</p> Signup and view all the answers

    The base of which cartilage articulates with and rotates on cricoid cartilage?

    <p>Arytenoid</p> Signup and view all the answers

    What lies behind the tongue and forms the superior part of the anterior wall of the larynx?

    <p>Epiglottis</p> Signup and view all the answers

    Which laryngeal cartilage is located most anterior and cephalad of all others?

    <p>Epiglottis</p> Signup and view all the answers

    What is attached to the internal surface of the thyroid cartilage and projects over the pharynx, allowing the passage of air into the larynx, trachea, and lungs?

    <p>Epiglottis</p> Signup and view all the answers

    What cartilage has an inferior horn with a circular facet that allows it to articulate with the cricoid cartilage?

    <p>Thyroid cartilage</p> Signup and view all the answers

    Which single cartilage lies mostly in the subglottic region?

    <p>Cricoid cartilage</p> Signup and view all the answers

    What provides sensory innervation to the trachea?

    <p>Recurrent laryngeal nerve</p> Signup and view all the answers

    What is the direction of the carina, which is the last tracheal cartilage?

    <p>Downward and backward</p> Signup and view all the answers

    What is the function of extrinsic muscles in relation to the airway?

    <p>Provide gross motor movement to the larynx</p> Signup and view all the answers

    What is the function of the intrinsic muscles in the airway?

    <p>Provide fine motor movement for sound production, phonation, and movement of vocal cords</p> Signup and view all the answers

    What does abduction refer to in the context of airway anatomy?

    <p>Opening of the airway</p> Signup and view all the answers

    What nerve provides innervation to all intrinsic muscles of the airway except the cricothyroid muscle?

    <p>RLN</p> Signup and view all the answers

    All intrinsic muscles play a role in adduction of airway except posterior cricoarytenoid which abducts airway

    <p>True</p> Signup and view all the answers

    What is true about the recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN)?

    <p>Both arise from branches of the vagus nerve</p> Signup and view all the answers

    At what level of the spine does the Superior Laryngeal Nerve (SLN) arise from the vagus nerve?

    <p>C2</p> Signup and view all the answers

    At which point does the Superior Laryngeal Nerve (SLN) divide into internal and external branches?

    <p>Greater horn of hyoid bone</p> Signup and view all the answers

    What muscle does the external branch of the superior laryngeal nerve (SLN) provide motor innervation to?

    <p>Cricothyroid muscle</p> Signup and view all the answers

    What is unique about the recurrent laryngeal nerve (RLN)?

    <p>It is a branch of the vagus nerve that loops around the subclavian artery on the right side and the aortic arch on the left side</p> Signup and view all the answers

    What is triggered by sensory receptors in the glottis and subglottic mucosa, resulting in strong adduction of the vocal cords?

    <p>Gag reflex</p> Signup and view all the answers

    The efferent response of the gag reflex is obtained via which nerve?

    <p>Vagus nerve</p> Signup and view all the answers

    Where does the gag reflex synapse?

    <p>Medulla with nuclei of vagus and spinal accessory nerves</p> Signup and view all the answers

    What is the likely result of damage to the recurrent laryngeal nerve (RLN)?

    <p>Unopposed adduction, causing potential airway problems</p> Signup and view all the answers

    What is the site used to perform a transtracheal block to anesthetize the recurrent laryngeal nerve (RLN)?

    <p>Cricothyroid membrane</p> Signup and view all the answers

    What are the possible causes of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) injury?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Nasal Sinuses

    • Ethmoid sinus: consists of numerous air cells, divided into posterior, middle, and anterior cells
    • Frontal sinus: lies in the frontal bone, drains into the middle nasal meatus
    • Maxillary sinus: largest sinus, present at birth, lies in maxilla on each side, drains into the middle nasal meatus
    • Sphenoidal sinus: contained within sphenoid bone, pituitary gland lies above in sella turcica

    Oropharynx

    • Found at C2-C3 level
    • Bound superiorly by soft palate, inferiorly by epiglottis
    • Where we assess Mallampati classification
    • Hard palate: immobile/stationary, covers anterior portion of oral cavity
    • Soft palate:
      • Covers posterior portion of oral cavity
      • Rises when eating or drinking, preventing ingested substances from going to nose
      • Can stretch and become more movable with age or obesity
    • Blood supply to mouth primarily from branches of the external carotid artery

    Pharynx and Larynx

    • Pharynx and larynx are different structures
    • Larynx begins with the epiglottis and extends to the cricoid cartilage
    • OPA does not open the larynx, resolves occlusion usually from tongue or redundant tissue in pharynx

    Cartilages of the Larynx

    • Paired: arytenoids, corniculates, cuneiforms
    • Arytenoids:
      • Paired, flexible, pyramid-shaped cartilages
      • Base articulates with and rotates on cricoid cartilage
      • Vocal cords attach to arytenoid cartilages posteriorly and thyroid cartilages anteriorly
      • Movement allows for tension and relaxation of vocal cords
    • Corniculate and cuneiforms:
      • Corniculate cartilages are paired conical nodules resting on the arytenoid apex
      • Cuneiform cartilages are paired cartilages that lie along the lateral edge of the arytenoids
      • Both provide support for the aryepiglottic fold
    • Single: epiglottis, thyroid, cricoid (ETC)
    • Epiglottis:
      • Curved leaf structure
      • Located most anterior and cephalad of all laryngeal cartilages
      • Lies behind tongue and forms superior part of the anterior wall of pharynx
      • Attaches to tongue at the base of the hyoid bone and anteriorly by the hypoepiglottic ligament
      • Extends down to the thyroid cartilage, attaching via the thyroepiglottic ligament
    • Thyroid cartilage:
      • Shield-shaped and largest cartilage
      • Forms the laryngeal prominence (Adam’s apple)
      • Attaches to the inferior laryngeal constrictors, sternothyroid, and thyrohyoid muscles
      • Inferior horn of thyroid cartilage has a circular facet that articulates with the cricoid cartilage
      • Attached to the hyoid bone via the thyrohyoid ligament and the cricoid via the cricothyroid membrane
      • Cricothyroid membrane is our emergency airway because it’s beneath the vocal cords
    • Cricoid cartilage:
      • Single hyaline cartilage shaped like a ring
      • Is the only complete cartilaginous ring
      • Attaches to the thyroid cartilage and arytenoids
      • Separated from the thyroid cartilage by the cricothyroid membrane
      • Lies mostly in the subglottic region
    • Trachea:
      • Tubular structure from cricoid cartilage to carina
      • Anterior to esophagus
      • Cricoid cartilage is the only cartilage of trachea that is a complete ring
      • Sensory innervation is from the RLN
      • Carina is downward and backward projection of last tracheal cartilage

    Innervation of the Airway

    • Airway muscles:
      • Extrinsic muscles: outside of the airway, provide gross motor movement to larynx
      • Intrinsic muscles: inside of the airway, provide fine motor movement for sound production, phonation, and movement of vocal cords
      • All intrinsic muscles innervated by RLN except the cricothyroid, which is innervated by SLN
      • Abduction: opening of airway
      • All intrinsic muscles play a role in adduction of airway except posterior cricoarytenoid, which abducts airway
    • Transverse arytenoid and oblique arytenoid close glottis
    • If there is damage to the RLN, there is unopposed adduction, causing potential airway problems

    Cricothyrotomy and Emergency Airway

    • Site used as an emergency airway because it’s below the vocal cords
    • Attaches superior surface of cricoid cartilage to inferior edge of thyroid cartilage
    • Can be identified 1-1.5 fingerbreadths below the laryngeal prominence
    • Site used to perform transtracheal block to anesthetize the RLN

    RLN and SLN Injury

    • Damage causes vocal cord dysfunction
    • Damage secondary to surgery, neoplasms, trauma
    • Unilateral RLN injury:
      • Paralysis of the ipsilateral vocal cord
      • Vocal cords compensate by shifting to the uninjured side
      • Causes hoarseness
    • Left RLN injury can occur from mitral stenosis, dissecting aortic arch aneurysms
    • Bilateral RLN injury affects both vocal cords
      • Chronic bilateral RLN injury – patients compensate but have gruff speech and increased risk of aspiration
      • Acute bilateral RLN injury:
        • Causes unopposed tension and adduction of the vocal cords
        • Stridor → respiratory distress → death
    • SLN injury is not associated with respiratory distress

    Laryngospasm

    • Laryngospasm: response to noxious stimuli causing vocal cords to close
    • Provoked by airway instrumentation/foreign body or vocal cord irritation
    • May also result from pain or visceral stimuli
    • Can cause partial or complete airway obstruction
    • Can cause hypoxia and NPEE (negative pressure pulmonary edema), dysrhythmias, cardiac arrest, and death
    • Concern in stage 2 (delirium/excitement) of general anesthesia
    • Afferent limb and efferent limb???
    • Inspiratory stridor
    • Suprasternal and subclavicular retraction during inspiration
    • Paradoxical appearance of chest wall
    • Treatment:
      • Remove stimulus
      • O2 and PPV
      • Deepen anesthetic
      • Bilateral pressure at laryngospasm notch (Larson’s maneuver)
      • Neuromuscular blocking agent

    Nasal Sinuses

    • Ethmoid sinus: consists of numerous air cells, divided into posterior, middle, and anterior cells
    • Frontal sinus: lies in the frontal bone, drains into the middle nasal meatus
    • Maxillary sinus: largest sinus, present at birth, lies in maxilla on each side, drains into the middle nasal meatus
    • Sphenoidal sinus: contained within sphenoid bone, pituitary gland lies above in sella turcica

    Oropharynx

    • Found at C2-C3 level
    • Bound superiorly by soft palate, inferiorly by epiglottis
    • Where we assess Mallampati classification
    • Hard palate: immobile/stationary, covers anterior portion of oral cavity
    • Soft palate:
      • Covers posterior portion of oral cavity
      • Rises when eating or drinking, preventing ingested substances from going to nose
      • Can stretch and become more movable with age or obesity
    • Blood supply to mouth primarily from branches of the external carotid artery

    Pharynx and Larynx

    • Pharynx and larynx are different structures
    • Larynx begins with the epiglottis and extends to the cricoid cartilage
    • OPA does not open the larynx, resolves occlusion usually from tongue or redundant tissue in pharynx

    Cartilages of the Larynx

    • Paired: arytenoids, corniculates, cuneiforms
    • Arytenoids:
      • Paired, flexible, pyramid-shaped cartilages
      • Base articulates with and rotates on cricoid cartilage
      • Vocal cords attach to arytenoid cartilages posteriorly and thyroid cartilages anteriorly
      • Movement allows for tension and relaxation of vocal cords
    • Corniculate and cuneiforms:
      • Corniculate cartilages are paired conical nodules resting on the arytenoid apex
      • Cuneiform cartilages are paired cartilages that lie along the lateral edge of the arytenoids
      • Both provide support for the aryepiglottic fold
    • Single: epiglottis, thyroid, cricoid (ETC)
    • Epiglottis:
      • Curved leaf structure
      • Located most anterior and cephalad of all laryngeal cartilages
      • Lies behind tongue and forms superior part of the anterior wall of pharynx
      • Attaches to tongue at the base of the hyoid bone and anteriorly by the hypoepiglottic ligament
      • Extends down to the thyroid cartilage, attaching via the thyroepiglottic ligament
    • Thyroid cartilage:
      • Shield-shaped and largest cartilage
      • Forms the laryngeal prominence (Adam’s apple)
      • Attaches to the inferior laryngeal constrictors, sternothyroid, and thyrohyoid muscles
      • Inferior horn of thyroid cartilage has a circular facet that articulates with the cricoid cartilage
      • Attached to the hyoid bone via the thyrohyoid ligament and the cricoid via the cricothyroid membrane
      • Cricothyroid membrane is our emergency airway because it’s beneath the vocal cords
    • Cricoid cartilage:
      • Single hyaline cartilage shaped like a ring
      • Is the only complete cartilaginous ring
      • Attaches to the thyroid cartilage and arytenoids
      • Separated from the thyroid cartilage by the cricothyroid membrane
      • Lies mostly in the subglottic region
    • Trachea:
      • Tubular structure from cricoid cartilage to carina
      • Anterior to esophagus
      • Cricoid cartilage is the only cartilage of trachea that is a complete ring
      • Sensory innervation is from the RLN
      • Carina is downward and backward projection of last tracheal cartilage

    Innervation of the Airway

    • Airway muscles:
      • Extrinsic muscles: outside of the airway, provide gross motor movement to larynx
      • Intrinsic muscles: inside of the airway, provide fine motor movement for sound production, phonation, and movement of vocal cords
      • All intrinsic muscles innervated by RLN except the cricothyroid, which is innervated by SLN
      • Abduction: opening of airway
      • All intrinsic muscles play a role in adduction of airway except posterior cricoarytenoid, which abducts airway
    • Transverse arytenoid and oblique arytenoid close glottis
    • If there is damage to the RLN, there is unopposed adduction, causing potential airway problems

    Cricothyrotomy and Emergency Airway

    • Site used as an emergency airway because it’s below the vocal cords
    • Attaches superior surface of cricoid cartilage to inferior edge of thyroid cartilage
    • Can be identified 1-1.5 fingerbreadths below the laryngeal prominence
    • Site used to perform transtracheal block to anesthetize the RLN

    RLN and SLN Injury

    • Damage causes vocal cord dysfunction
    • Damage secondary to surgery, neoplasms, trauma
    • Unilateral RLN injury:
      • Paralysis of the ipsilateral vocal cord
      • Vocal cords compensate by shifting to the uninjured side
      • Causes hoarseness
    • Left RLN injury can occur from mitral stenosis, dissecting aortic arch aneurysms
    • Bilateral RLN injury affects both vocal cords
      • Chronic bilateral RLN injury – patients compensate but have gruff speech and increased risk of aspiration
      • Acute bilateral RLN injury:
        • Causes unopposed tension and adduction of the vocal cords
        • Stridor → respiratory distress → death
    • SLN injury is not associated with respiratory distress

    Laryngospasm

    • Laryngospasm: response to noxious stimuli causing vocal cords to close
    • Provoked by airway instrumentation/foreign body or vocal cord irritation
    • May also result from pain or visceral stimuli
    • Can cause partial or complete airway obstruction
    • Can cause hypoxia and NPEE (negative pressure pulmonary edema), dysrhythmias, cardiac arrest, and death
    • Concern in stage 2 (delirium/excitement) of general anesthesia
    • Afferent limb and efferent limb???
    • Inspiratory stridor
    • Suprasternal and subclavicular retraction during inspiration
    • Paradoxical appearance of chest wall
    • Treatment:
      • Remove stimulus
      • O2 and PPV
      • Deepen anesthetic
      • Bilateral pressure at laryngospasm notch (Larson’s maneuver)
      • Neuromuscular blocking agent

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    Description

    This quiz covers the anatomy and physiology of the airway, including the nasal sinuses, oropharynx, and related structures. Explore the details of the ethmoid, frontal, maxillary, and sphenoidal sinuses, as well as the oropharynx location and function.

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