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Part 2A Normal Anatomy

Upper airway and Larynx


Ôeries of Web-based Bronchoscopic Images

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½he Upper Airway

^ ½he 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

 

 

Lingual
½onsil
 

Midline guidance:
Ơ½he uvula points to the epiglottis, the epiglottis leads into the larynxơ.
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½he Larynx
ƥ ½he larynx is a 5-
5-7 cm
long structure.
ƥ Its upper boundary starts
at the tip of the epiglottis,
opposite the 3rd to 4th,
cervical vertebra.

ƥ Its lower end is at the


lower border of the
cricoid cartilage.
ƥ ½his lies opposite the 6th
cervical vertebra.

OOO    

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½he Larynx Posterior Wall of
Hypopharynx
(Leading to
Esophagus)
Lateral
Glossoepiglottic
Folds
Ôuperior surface anatomy:

Major Landmarks I

Ôuperior
Ôurface of
Epiglottis

Median
Vallecula
Glossoepiglottic Base of
Fold ½ongue
http://www.nyee.edu/top#top

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½he Cricoid cartilage

½hyroid gland
½hyroid cartilage
Cricothyroid
Cricoid cartilage membrane

Cricoid Cartilage

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½ime Out! Ʀ Why is it so important to
recognize the surface anatomy?
^ As a bronchoscopist, we are responsible to report any
nasal, oral, pharyngeal or laryngeal pathology that we
observe en-
en-route to the lungs.
^ We only know that we are correctly positioned and in
the midline, when we know exactly where we are are..
^ During a difficult intubation, either with a bronchoscope
or a rigid laryngoscope, knowledge of surface anatomy
ensures timely intubation and saves a life.
^ In a variety of conditions, such as GERD, changes in
laryngeal anatomy and structures, are the best clues to
pulmonary pathology.
Ôhall we continue?

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½he Larynx
Pyriform
Ôinus
Ôuperior surface anatomy:

Major Landmarks - II
Posterior Wall of
Hypopharynx
(Leading to
Esophagus)

Laryngeal
Ôurface of
Epiglottis
Ventricle

http://www.nyee.edu/top#top

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 !
½he Larynx
Pyriform
Ôinus

Ôuperior surface anatomy:

Major Landmarks - III

Epiglottis Vallecula

http://www.nyee.edu/top#top

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½he Larynx
Posterior
Commissure
Ôuperior surface anatomy:
½rue
Vocal
Major Landmarks - IV Cords
Ventricle

False
Vocal
Cords

Anterior Aryepiglottic
Commissure Fold
http://www.nyee.edu/top#top

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½he Larynx
Posterior Wall
Of Hypopharynx
Ôuperior surface anatomy:

Major Landmarks - V
Corniculate
½ubercle on
Arytenoid
Cartilage

Cuneiform
½ubercle

Aryepiglottic
Fold

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½he Larynx
Arytenoid
Cartilage
Ôuperior surface anatomy:

Major Landmarks - VI
½rue
Vocal
Cords

Ventricle

False
Vocal
Cords

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½he Larynx Cartilaginous
Rings of
½rachea
Ôuperior surface anatomy:

Major Landmarks
to look for - VII Vocal Cord
Ôulcus (on
½rue Vocal
Cords)

False
Vocal
Cords
Cricoid ½rue
Ring Vocal
Cords

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½his is the..

A. ½he epiglottis
B. ½he ventricle
C. ½he arytenoid cartilage
D. ½he true vocal cord
E. ½he false vocal cord

Click for correct answer: c

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½he Larynx: Anatomy
^ ½he structural rigidity of the larynx
is provided by the three median
cartilages:
^ ½he epiglottis
^ ½hyroid cartilage
^ Cricoid cartilage ,
along with the hyoid bone.

^ ½he thyrohyoid membrane forms a


C-shaped barrier around the
anterior and lateral walls of the
supraglottis, and inferiorly
becomes confluent with the
connective tissue in the
perichondrium of the tracheal
cartilaginous rings. OOO
 
 
 

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½he Larynx: Anatomy
^ ½he six smaller cartilages of the
larynx ( 3 pairs) are functionally
involved with the movements of
the vocal cords. ½hese are:
^ ½he arytenoids
^ ½he corniculates
^ ½he cuneiforms

^ ½he `  cartilages are


pyramid--shaped and articulate
pyramid
with the superior margin of the
cricoid lamina. On their summit,
are the  
` cartilages; on
their anterior aspect, the
   cartilages
www.polychondritis.com
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½he Larynx: Anatomy
^ ÷`

` ,, are
½he ÷`

` 
attached posteriorly to the apex of
the arytenoids and corniculates.
½he cuneiforms extend laterally,
between the layers of the vocal
cords, from the anterior aspect of
the arytenocorniculate complex.

^ ½he 
 is attached to the
base of the tongue by a median
and two lateral glossoepiglottic
folds.

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½he Larynx: Critical Ôtructures
^ ½he Larynx neighbors
major critical structures:

^ Carotid arteries and jugular


veins, and the vagus nerve

^ Ôuperior and inferior thyroid


arteries

^ Ôuperior and recurrent


laryngeal nerves
OOO     

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½he Larynx: ½opical Anesthesia

Bilateral nasal
administration of
anesthetic provides
partial posterior
pharyngeal anesthesia
by affecting the
Ôphenopalatine nerve
fibers, thus diminishing
the gag reflex.
Ask patient to inhale deeply
through nostril

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½he Larynx: ½opical Anesthesia
½opical anesthetic
usually affects the
superior laryngeal nerve
and blocks sensory Click here to view video presentation
innervation to the base
of the tongue epiglottis,
pyriform fossa, and
valleculae.
Click to continue

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½he Larynx: ½opical Anesthesia
½he topical instillation
of Lidocaine with the
ƠÔpray as you goơ
method numbs the
submucosal plexus of Click here to view video presentation
the larynx, derived
from the external and
internal branches of
the superior laryngeal
nerve. Click to continue

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Laryngeal function: Airway Protection

½he glottis: open for inspiration and closed for swallowing

Open Closed

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Laryngeal function: Phonation

½he vocal cords: Adducted for phonation; abducted for


inspiration

Adducted: ½alking Abducted: Breathing


OOO  
O 
 

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Laryngeal function: Phonation

½he vocal cords


Click here to view video presentation open and close
while talking

Click to continue

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Which of the following defends against aspiration?

A. ½he epiglottis
B. ½he false cords
C. ½he true cords
D. ½he ventricle
E. All of the above

Click for correct answer: º

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½his presentation is part of a
comprehensive curriculum for
Flexible Bronchoscopy. Our goals
are to help health care workers
become better at what they do, and
to decrease the burden of
procedure--related training on
procedure
patients.

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Ô Ô 

   

Assured competency and proficiency

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DEMOCRA½IZA½ION AND
GLOBALIZA½ION OF KNOWLEDGE

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½hank you

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 !