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

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Series of Web-based Bronchoscopic Images


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.


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


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


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


The Cricoid The Cricoid cartilagecartilage

Cricoid Cartilage

Cricothyroid membrane

Thyroid glandThyroid

cartilageCricoid cartilage


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?


The LarynxThe LarynxSuperior surface anatomy: Superior surface anatomy:

Major Landmarks - IIMajor Landmarks - II

Ventricle

PyriformSinus

Laryngeal Surface ofEpiglottis

Posterior Wall ofHypopharynx(Leading toEsophagus)



The LarynxThe Larynx

Superior surface anatomy: Superior surface anatomy:

Major Landmarks - IIIMajor Landmarks - III

Vallecula

PyriformSinus

Epiglottis




Major Landmarks - IVMajor Landmarks - IV


AryepiglotticFold

Posterior Commissure

Anterior Commissure

Ventricle

TrueVocalCords

FalseVocalCords



Major Landmarks - VMajor Landmarks - V

AryepiglotticFold

Posterior Wall Of Hypopharynx

CorniculateTubercle onArytenoidCartilage

CuneiformTubercle



Major Landmarks - VIMajor Landmarks - VI

Arytenoid Cartilage

TrueVocal Cords

FalseVocalCords

Ventricle



Major Landmarks Major Landmarks to look for - VIIto look for - VII

Cartilaginous

Rings ofTrachea

TrueVocal Cords

Vocal Cord Sulcus (onTrue Vocal

Cords)

CricoidRing

FalseVocalCords


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


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/


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


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.


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


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



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.

Click to continue

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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.

Click to continue



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


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


Laryngeal function: PhonationLaryngeal function: Phonation

The vocal cords open and close while talking

Click to continue



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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anatomy upper airway & larynx

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