Components

of the UPPER

Airway

Nose

Mouth

Pharynx

Hypopharynx

Larynx

Components of

LOWER

Airway

Trachea

Bronchi

Bronchioles

Terminal Bronchioles

Respiratory Bronchioles

Alveoli

Pharynx

(location/compartments)

Extends from posterior aspect of nose to the level of the cricoid cartilage (C1-C6)

3 compartments:

Nasopharynx, Oropharynx,

Hypopharynx

Nasopharynx

(location/anatomy)

Anterior to C1

contains nasal septum, turbinates, and adenoids

Oropharynx

(location)

Lies at C2-C3

Anterior opening through the anterior and posterior tonsillar pillars

Hypopharynx

also called laryngopharynx

Lies posterior to the larynx and leads to esophagus

Superior border- epiglottis and inferior border=cricoid cartilage (C5-C6)

Upper Esophageal Sphincter

(location/function)

Lies at lower edge of hypopharynx

Acts as a barrier to regurgitation in the conscious patient

Waldeyer's Tonsillar

Ring

made up of pharyngeal tonsils (adenoids), palatine tonsils and lingual tonsils.

High risk for bleeding

Larynx:

List function and

location( adult vs child)

Located at C3-C6 in adults

C2-C4 in infants/children and descends to C4-C5 by age 5

Serves as organ of phonation and valve to protect lower airways

Nine Cartilages of Larynx

(list whether single or paired)

Thyroid (single)

Cricoid (single)

Epiglottic (single)

Corniculate (paired)

Arytenoid (paired)

Cuneiform (paired)

Epiglottis

(description and location)

sits at base of tongue and seperates hypopharynx from the larynx

Broad leaf shaped cartilage that protects against aspiration by covering glottis during swallowing

Arytenoids

Paired laryngeal cartilages

Pyramidal

posterior

cords attach to them

Most commonly seen paired cartilages on laryngoscopy

Vestibular Folds

False vocal cords

narrow bands of fibrous tissue on each side of the larynx

Triangular fissure  between the vocal cords

Narrowest area of ADULT airway

(avg width 6-9 mm,

can be stretched to 12 mm)

Complete ring, sits at C6

site for Sellick's maneuver (Cricoid pressure)

Narrowest part of airway in CHILD

How much pressure should be applied during Sellick's Maneuver

(cricoid pressure)?

6-8 lbs in an asleep patient

Start with 2-4 lbs and increase as pt is going to sleep

Thyroid Cartilage

Attaches thyroid cartilage to the cricoid cartilage anteriorly

Relatively AVASCULAR

Emergency airway

Begins at C6 at inferior border of cricoid cartilage and extends to carina,

Approximately 10-15 cm in length

Bifurcates to right & left mainsten bronchus at T5

Larynx positioned higher in neck

Tongue larger relative to mouth size

Epiglottis larger, stiffer and more posterior

Head and occiput larger relative to body size

Short neck

Narrow nares

Cricoid ring is narrowest region

Connects the larynx with the hyoid bone and other structures to move the larynx as a whole

(elevating and depressing during phonation, swallowing and breathing

List Intrinsic muscles

Posterior Cricoarytenoid

Lateral Cricoarytenoid

Arytenoids

Cricothyroid

Thyroarytenoid

Cricothyroid muscle

(action)

Produces cord tension, closure, and elongates the vocal cords.

(Can result in total and profound glottioclosure- Laryngospasm)

Intrinsic Muscle

Sternohyoid

Sternothyroid

Thyrohyoid

Omohyoid

Stylohyoid

Mylohyoid

Opthalmic division of trigeminal nerve (Cranial nerve V)

specifically the anterior ethmoidal nerve

Maxillary division of trigeminal nerve (cranial nerve V)

Specifically nasopalatine nerves and sphenopalatine ganglion

Glossopharyngeal Nerve

(Cranial nerve IX)

Describe the innervation of the tongue

(hint 2 different nerves)

Anterior 2/3: Lingual nerve (mandibular division of Trigeminal nerve- cranial nerve V)

Posterior 1/3: Glossopharyngeal Nerve (Cranial nerve IX)

List the innervations of the Facial Nerve

(cranial nerve VII)

Supplies muscles of facial expression

Taste to anterior 2/3 of tongue

Small amount of afferent conduction to oropharynx

Motor control of stylohyoid laryngeal muscle

Salivary gland (PNS = Increase in saliva)

Cranial Nerve X- Vagus Nerve

There are 2 branches:

Superior Laryngeal Nerve

and

Recurrent Laryngeal Nerve

Superior Laryngeal Nerve

Distinguish between function of internal and external branch

Internal branch provides sensation ABOVE vocal cords.

External branch provides motor innervation to Crycothyroid muscle

Unilateral- minimal side effects

Bilateral- hoarseness, vocal tiring

Unilateral- Hoarseness

Bilateral:

Acute- stridor, respiratory distress from unopposed tension on crycothyroid muscle

Chronic- Aphonia

Affects both SLN and RLN

produces flaccid, midpositioned cords resulting in aphonia

Superior Laryngeal Artery

(SLA)

Blood supply to supraglottic larynegeal structures

Carotid to the superior thyroid artery to SLA

Inferior Laryngeal Artery

(ILA)

Blood supply to infraglottic laryngeal structures

Subclavian to Inferior thyroid artery to ILA

Airway obstruction can be

_______ or _______

What sound is associated with

laryngeal obstruction?

lack of any air movement or breath sounds

diaphragmatic tugging or paradoxical movements of abdomen and rib cage

Diminished tidal exchange

Retraction of upper chest

head-tilt, chin-lift or jaw thrust maneuver

Positive pressure of subdose of Succs for laryngospasm

Oral or nasal airway adjunct

Pharynx

Epiglottis

Vocal Cords

(Most important mechanism is the glottic closure reflex)

Laryngospasm occurs from what?

How do you treat it?

glottic or supraglottic stimulation including secretions, foreign bodies, inhalation agents and noxious stimulis

Treatment: Remove stimulus, positive pressure, deepen anesthetic, muscle relaxants or intubation for severe

OPA

Oral axis

Pharyngeal Axis

Laryngeal Axis

Full view of glottic opening

Can see full pyramid or triangle like shape

Posterior portion of glottic opening and arytenoid cartilage visible

(botton of triangle/pyramid shape)

Soft palate visible

No recognizable laryngeal structures

Distance between incisiors in adults with mouth fully open (how widely a patient can open their mouth)

Should be 30-40 mm (2 large fingerbreadths)

Upper lip bite test

(Mandibular movement indicates amount of space for the tongue to be displaced anteriorly during laryngoscopy)

head in neutral position, patient asked to open mouth as wide as possible and extrude tongue

Phonation provides false data so NO saying Aaaaaaa

Hard palate, soft palate and portion of uvula

(tonsillar pillars and base of uvula hidden by tongue)

Distance from notch of thyroid cartilage to the tip of the mentum

Head should be fully extended and mouth closed.

Distance between sternal notch and mentum.

Exam should be done with neck fully extended and mouth closed.

Mask seal

Obesity

Aged

No teeth

Snores

Look externally

Evaluate mandibular space

Mallampati classification

Obstructions

Neck mobility