Beruflich Dokumente
Kultur Dokumente
Structure of presentation
Larynx
Surface anatomy Cartilages Membranes / ligaments Muscles Innervation and blood supply Changes with age
The larynx
Laryngeal cartilages
3 unpaired
Epiglottis Thyroid Cricoid
3 paired
Arytenoid Cuneiform Corniculate
Epiglottis
Superior border of the larynx (C3) Leaf shaped
Thyroid
Largest of laryngeal cartilages C4-5 level
Laryngeal prominence
Inferior horn
Cricoid
Signet ring shaped (widest posteriorly) Only complete tracheal ring
Arytenoid
Sit on top of cricoid Key site of attachment of intrinsic muscles
Cricothyroid ligament
Joins outer edge of cricoid to anterior thyroid cartilage and arytenoids Superior border forms the vocal cords
Quadrangular membrane
Intrinsic muscles
Protective mechanisms (important in cough reflex) Role in deep breathing Valsalva Phonation
Muscles cont...
Muscle Cricothyroid Post. cricoarytenoid Lat cricoarytenoid Transverse arytenoid Oblique arytenoid Vocalis Thyroarytenoid Function Tenses vocal cords Abducts arytenoids and thus cords Adducts arytenoids and thus cords Adducts arytenoids and thus cords Narrows inlet by pulling arytenoids together Increases thickness of cords Narrows inlet Innervation Superior* Recurrent** Recurrent Recurrent Recurrent Recurrent Recurrent
* External laryngeal nerve, a branch of the superior laryngeal nerve ** Recurrent laryngeal nerve
Innervation
Sensory
Above epiglottis is glossopharyngeal (including valecula) Internal laryngeal nerve (branch of superior laryngeal nerve above vocal cords Recurrent laryngeal nerve below cords
Motor
Cricothyroid external laryngeal nerve (branch of superior) Others recurrent laryngeal nerve
Blood supply
Superior laryngeal artery, a division of the superior thyroid artery (branch of external carotid) Inferior laryngeal artery, a division of the inferior thyroid artery (branch of thyrocervical trunk) The arteries travel alongside the nerves
Larynx
Higher C2 to C3 (normally C4) Greater angulation, so appears more anterior Narrower U shaped epiglottis Cricoid is narrowest part of trachea, and being a complete cartilaginous circle, pressure at this point may easily lead to tissue necrosis
Trachea
Short trachea increases risk of accidental endobronchial or extubation
Trachea
12cm in length, 1.6 - 2cm diameter Descends from C6 to T4 15-20 incomplete cartilaginous rings, bordered by trachealis posteriorly Bifurcation angle <90 (>90 classically suggests mitral stenosis) Percutaneous and surgical tracheostomies are typically performed between 2nd and 3rd rings
The carina
Tracheobronchial tree
23 generations of divisions First 16 generations contribute to anatomical deadspace The right main bronchus is 1-2mm wider than the left, and angled more inferiorly The right upper lobar bronchus is extrapulmonary, all others arise intrapulmonarily
Tracheobronchial tree
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