Part 2A Normal Anatomy Upper airway and Larynx

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The Upper Airway 

The upper airway starts :  

At the nostrils, extends through the nasal conchae to the nasopharynx, over the uvula to the hypopharynx and larynx, or, At the lips, extends through the oral cavity, over the tongue and below the hard and soft palates, to the hypopharynx and larynx.

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Upper Airway: From Pharynx to Larynx Larynx Epiglottis Lingual Tonsil Uvula Midline guidance: The uvula points to the epiglottis. BI. the epiglottis leads into the larynx . All Rights Reserved. 2005 3 .

phon. cervical vertebra. All Rights Reserved.The Larynx The larynx is a 5-7 cm 5long 2005 4 . This lies opposite the 6th cervical vertebra. www. opposite the 3rd to BI. Its lower end is at the lower border of the cricoid cartilage. Its upper boundary starts at the tip of the epiglottis.ox.

All Rights Reserved. 2005 5 .edu/top#top BI.The Larynx Lateral Glossoepiglottic Folds Posterior Wall of Hypopharynx (Leading to Esophagus) Superior surface anatomy: Major Landmarks I Superior Surface of Epiglottis Vallecula Median Glossoepiglottic Fold Base of Tongue http://www.nyee.

2005 6 .The Cricoid cartilage Thyroid gland Thyroid cartilage Cricoid cartilage Cricothyroid membrane Cricoid Cartilage BI. All Rights Reserved.

are the best clues to pulmonary pathology. when we know exactly where we are. such as GERD. All Rights Reserved. changes in laryngeal anatomy and structures. pharyngeal or laryngeal pathology that we observe en-route to the lungs. either with a bronchoscope or a rigid laryngoscope. we are responsible to report any nasal. In a variety of conditions. 2005 7 . During a difficult intubation.Time Out! Why is it so important to recognize the surface anatomy?     As a bronchoscopist. knowledge of surface anatomy ensures timely intubation and saves a life. are. enWe only know that we are correctly positioned and in the midline. oral. Shall we continue? BI.

All Rights Reserved.nyee.II Posterior Wall of Hypopharynx (Leading to Esophagus) Pyriform Sinus Laryngeal Surface of Epiglottis Ventricle http://www.The Larynx Superior surface anatomy: Major Landmarks .edu/top#top BI. 2005 8 .

nyee.III Epiglottis Vallecula BI.The Larynx Pyriform Sinus Superior surface anatomy: Major Landmarks . 2005 9 . All Rights Reserved.

All Rights Reserved. 2005 10 .IV True Vocal Cords Posterior Commissure Ventricle False Vocal Cords Anterior Commissure Aryepiglottic Fold BI.The Larynx Superior surface anatomy: Major Landmarks .

The Larynx Superior surface anatomy: Major Landmarks .V Corniculate Tubercle on Arytenoid Cartilage Posterior Wall Of Hypopharynx Cuneiform Tubercle Aryepiglottic Fold BI. 2005 11 . All Rights Reserved.

All Rights Reserved. 2005 12 .The Larynx Arytenoid Cartilage Superior surface anatomy: Major Landmarks .VI True Vocal Cords Ventricle False Vocal Cords BI.

The Larynx Superior surface anatomy: Major Landmarks to look for . All Rights Reserved. 2005 .VII Vocal Cord Sulcus (on True Vocal Cords) False Vocal Cords Cartilaginous Rings of Trachea Cricoid Ring True Vocal Cords 13 BI.

E. All Rights Reserved. 2005 B 14 . C.This is the. D. B. The epiglottis The ventricle The arytenoid cartilage The true vocal cord The false vocal cord Click for correct answer: BI.. A.

BI. along with the hyoid bone.The Larynx: Anatomy  The structural rigidity of the larynx is provided by the three median cartilages:    The epiglottis Thyroid cartilage Cricoid cartilage . All Rights Reserved.  The thyrohyoid membrane forms a C-shaped barrier around the anterior and lateral walls of the 15 .throat-cancer-symptoms. and inferiorly becomes confluent with the connective tissue in the perichondrium of the tracheal cartilaginous rings. 2005 www.

On their summit. All Rights BI. 2005 16 . are the corniculate cartilages.polychondritis. on their anterior aspect.The Larynx: Anatomy  The six smaller cartilages of the larynx ( 3 pairs) are functionally involved with the movements of the vocal cords. These are:    The arytenoids The corniculates The cuneiforms  The arytenoid cartilages are pyramidpyramid-shaped and articulate with the superior margin of the cricoid lamina. the cuneiform cartilages www.

from the anterior aspect of the arytenocorniculate complex. 2005 17 .  The epiglottis is attached to the base of the tongue by a median and two lateral glossoepiglottic folds.The Larynx: Anatomy  The vocal ligaments. between the layers of the vocal cords. All Rights Reserved. attached posteriorly to the apex of the arytenoids and corniculates. are ligaments. BI. The cuneiforms extend laterally.

yoursurgery. and the vagus nerve Superior and inferior thyroid arteries Superior and recurrent laryngeal nerves www. 2005 18 .com   BI. All Rights Reserved.The Larynx: Critical Structures  The Larynx neighbors major critical structures:  Carotid arteries and jugular veins.

Ask patient to inhale deeply through nostril 19 BI. All Rights Reserved. 2005 . thus diminishing the gag reflex.The Larynx: Topical Anesthesia Bilateral nasal administration of anesthetic provides partial posterior pharyngeal anesthesia by affecting the Sphenopalatine nerve fibers.

and valleculae. 2005 20 . pyriform fossa. All Rights Reserved.The Larynx: Topical Anesthesia Topical anesthetic usually affects the superior laryngeal nerve and blocks sensory innervation to the base of the tongue epiglottis. Click here to view video presentation Click to continue BI.

All Rights Reserved. 2005 .The Larynx: Topical Anesthesia The topical instillation of Lidocaine with the Spray as you go method numbs the submucosal plexus of the larynx. derived from the external and internal branches of the superior laryngeal nerve. Click here to view video presentation Click to continue 21 BI.

Laryngeal function: Airway Protection The glottis: open for inspiration and closed for swallowing Open Closed BI. 2005 22 . All Rights Reserved.

edu BI. 2005 23 . All Rights Reserved.voice.Laryngeal function: Phonation The vocal cords: Adducted for phonation.northwestern. abducted for inspiration Adducted: Talking Abducted: Breathing www.

2005 24 . All Rights Reserved.Laryngeal function: Phonation Click here to view video presentation The vocal cords open and close while talking Click to continue BI.

All Rights Reserved. C. B. D.Which of the following defends against aspiration? A. E. 2005 . The epiglottis The false cords The true cords The ventricle All of the above E 25 Click for correct answer: BI.

and to decrease the burden of procedureprocedure-related training on patients.This presentation is part of a comprehensive curriculum for Flexible Bronchoscopy. BI. All Rights Reserved. Our goals are to help health care workers become better at what they do. 2005 26 .

didactic lectures. Guided apprenticeship. All Rights Reserved. BRONCHATLAS© DEMOCRATIZATION AND GLOBALIZATION OF KNOWLEDGE BI. 2. 4. 2005 27 . 5. competency testing. 3. Learning the art of Bronchoscopy. Bronchoscopy step-by-step©: Practical exercises. WebWeb-based Self-learning study guide. and image encyclopedia.Step by Step© A new curriculum Assured competency and proficiency 1. SelfComputerComputer-based simulations. step-byskills and tasks.

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