Transcript VALUABLE ADVICE ON HOW TO TAKE THE HEAD AND NECK

LARYNX REVIEW: LOCATION
HYOID BONE
STERNOCLEIDOMASTOID MUSCLE
LARYNGEAL
PROMINENCE
OF THYROID
CARTILAGE =
ADAM'S
APPLE - LEVEL
C4
Larynx Functions
- produces sound
- regulates opening to trachea, respiratory system
CLINICAL - OBSTRUCTION OF LARYNX
CAN PRODUCE SUFFOCATION
THRYOID
GLAND
TRACHEA
LARYNX: IMAGING
CADAVER SECTION
CT SECTION
LARYNX
LARYNX
PHARYNX +
ESOPHAGUS
COMMON
CAROTID A.,
IJV
BODIES
OF CERVICAL
VERTEBRAE
CLINICAL: PALPATE CAROTID BIFURCATION LATERAL TO LARYNGEAL PROMINENCE
- NERVES TO LARYNX CAN BE DAMAGED DURING CERVICAL DISC REPAIR
LARYNX REVIEW: CARTILAGES
ARYTENOID - 2 pyramidal
shaped cartilages above
lamina of cricoid
Sup. Horn
Corniculate
Cartilages
Arytenoid
lamina
Laryngeal
prominence
= Adam's
apple
Cricoid
Inf. Horn
THYROID CARTILAGE
- shield shaped
- has Sup. and Inf. Horns
- Laryngeal prominence
CRICOID = signet ring
- complete ring of cartilage
- narrow Arch ant., broad Lamina
post.
LARYNX REVIEW: SYNOVIAL JOINTS
THYROID and CRICOID
ARYTENOID and CRICOID
SLIDING
ROTATION
TILT
SYNOVIAL
JOINT
BETWEEN
ARYTENOID
AND
CRICOID
HINGE
JOINT
JOINTS PERMIT TILTING OF
THYROID-CRICOID:
- CHANGE PITCH OF SOUND
(TENSE OR RELAX VOCAL
LIGAMENTS)
JOINTS PERMIT ROTATION AND
SLIDING:
- OPEN OR CLOSE LARYNX
(ABDUCT OR ADDUCT VOCAL
LIGAMENTS)
SOUND PRODUCTION: CONUS ELASTICUS
top view
CONUS
ELASTICUS
VOCAL LIGAMENTS =
FREE EDGE OF CONUS
RIMA GLOTTIDIS = opening
CONUS
ELASTICUS -=
INTERNAL
ELASTIC
MEMBRANE
ATTACHED TO
CRIOCID; UPPER
FREE EDGES =
VOCAL
LIGAMENTS
VOCAL
LIGAMENTS
EXTEND FROM
ARYTENOID TO
THYROID,
ACROSS
TWO JOINTS
CHANGE PITCH BY TILTING AT HINGE JOINT –
Thyroid cartilage tilts down; cricoid tilts up
THYROID
Tilting - STRETCHES
vocal ligaments
ARYTENOID
HINGE
JOINT
CRICOID
RELAX vocal ligament
DECREASE PITCH THYROARYTENOID
HINGE
JOINT
STRETCH vocal ligament
INCREASE PITCH CRICOTHYROID
MUSCLES OF LARYNX
Tilting - STRETCHES
vocal ligaments
HINGE
JOINT
CRICOTHYROID M. - Tenses
Vocal Ligament Increasing
Pitch
STRETCH vocal ligament
INCREASE PITCH CRICOTHYROID
MUSCLES OF LARYNX
NOT
SEE
THYROID
THYROARYTENOID
MUSCLES - adjacent to
vocal ligament Relaxes
Vocal Ligaments
Decreases pitch
HINGE
JOINT
CRICOID
RELAX vocal ligament
DECREASE PITCH THYROARYTENOID
OPEN AND CLOSE RIMA GLOTTIDIS BY
ROTATING/SLIDING ARYTENOIDS Rotate laterally opens; Rotate medially or slide closes
OPEN
ROTATE
LATERALLY
REST
POSITION
POSTERIOR
CRICOARYTENOID
CLOSE
CLOSE
ROTATE
MEDIALLY
SLIDE
LATERAL
CRICOARYTENOID
ARYTENOIDEUS
Larynx open for deep breathing; close for speech; completely
close to raise abdominal pressure (Valsalva maneuver)
ARYTENOIDEUS
MUSCLES OF LARYNX
5) ARYTENOID (Transverse and
oblique arytenoid) - Adduct
vocal folds
4) LATERAL CRICOARYTENOID - Adduct vocal folds
3) POSTERIOR CRICOARYTENOID – Abducts vocal
fold
POSTERIOR
CRICOARYTENOID
LATERAL
CRICOARYTENOID
Adduct closes rima glottidis
Abduct opens rima glottidis
LARYNGOSCOPE VIEW OF LARYNX
Post.
Vocal Folds
Corniculate
cartilage
(true vocal
folds)
Vestibular Folds
Ant.
(false vocal
folds)
Pyriform recess
Cuneiform
cartilage
Epiglottis
Tongue
NOSE
VIEW FOR INTUBATION
CORONAL SECTION
Quadrangular
membrane
VENTRICLE lateral
outpocketing
Conus
elasticus
VESTIBULE - inlet above
false vocal folds
VESTIBULAR (FALSE
VOCAL) FOLDS - overlie
vestibular ligaments
(lower edge of
Quadrangular
membrane)
VOCAL (TRUE VOCAL)
FOLDS - overlie vocal
ligaments (upper edge
of Conus elasticus)
CLINICAL - MUCOSA SWELLS IN
ANAPHYLAXIS; OBSTRUCTION
CAN RESULT FROM SWELLING
AT VESTIBULAR (FALSE VOCAL
FOLDS)
NERVES OF LARYNX – Branches of Vagus
SUP. LARYNG. N.
Int. Laryng. N.
Ext. Laryng. N.
RECURRENT
LARYNG. N.
1) Superior Laryngeal N.
a) Internal Laryngeal N.
Visceral Sensory (GVA) to Larynx
Above (true vocal folds)
b) External Laryngeal N.
Branchial motor (SVE) to
Cricothyroid
2) Recurrent Laryngeal n.
- Visceral Sensory (GVA) to Larynx
Below True Vocal Folds
- Branchial motor (SVE) to all other
Muscles of Larynx
Clinical - damage to Recurrent
Laryngeal nerve in Thyroid surgery
NERVES
OF
LARYNX –
Branches of
Vagus
X
SUPERIOR
LARYNGEAL
NERVE
RIGHT
RECURRENT
LARYNGEAL
NERVE - passes
under
Subclavian
Artery
X
SUPERIOR
LARYNGEAL
NERVE - pierces
thyrohyoid
membrane
LEFT
RECURRENT
LARYNGEAL
NERVE - passes
under
Arch of
Aorta
OBSTRUCTION OF LARYNX: CRICOTHYROTOMY
Cricothyroid
Membrane
CLINICAL - IN OBSTRUCTION OF LARYNX, EMERGENCY OPENING
MADE IN CRICOTHYROID MEMBRANE (CRICOTHYROTOMY);
AVOIDS BLLEDING THAT CAN OCCUR IN TRACHEOTOMY (FROM
INFERIOR THYROID VEINS)
Good luck!