2 04 upper airways larynx english 2014-2
DESCRIPTION
anatomy of upper airwaysTRANSCRIPT
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Nasal cavities, paranasal sinuses, nasopharynx, larynx
Summary for dissection room
Csaba Szigeti, MSc, PhDDepartment of Anatomy, Histology and Embriology
Szeged, 2014
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AB
A. Semilunar hiatus (1), anterior- (2), middle- (3),and posterior (5) ethmoidal air cellsSuperior concha (4), sphenoidal sinus (6), ethmoidal bulla (7), opening of maxillary sinus (8)Perpendicular plate of palatine bone (9), torus tubarius (10), salpingopharyngeal fold (11)
B. Thyrohyoid membrane (1), vestibular fold (2), vestibule (3), ventricle (4), arytenoid m. (5)thyroid cartilage (6, 10), tracheal ring (7), cricoid cartilage(8), cricothyroid membrane (9)Piriform recess (11)
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The The laterallateral wallwall of of thethe nasalnasal cavitycavity
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Frontal sinus(1), nasal bone (2), middle nasal meatus (3), opening ofnasolacrimal duct (4), inferior nasal meatus (5), nasal vestibulum (6),inferior nasal concha(7), hard palate (8), semilunar hiatus (9),opening of middle ethmoidal air cells (10), ethmoidal bulla (11), superior nasal concha (12), Sphenoidal sinus (13),sphenoethmoidal recess (14), middle nasal concha (15)
Frontal sinus (1), superior nasal concha (2), nasal bone (3), superiornasal meatus (4), middle nasal concha (5), inferior nasal concha (6),sphenoethmoidal recess (7), sphenoidal sinus (8), hypophysis (9),choana (10), opening of pharyngo-tympanic tube (11), salpingopharyngeal fold (12) anterior cranial fossa (13)
Conchae partially removedSagittal section
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OPENINGS OF BONY NASAL CAVITY *
Opening or passage Where does it lead? Neurovascular structures :
Piriform aperture Face -
Choana Epipharynx -
Cribriform plate Anterior cranial fossa Fila olfactoria (CN.I.); Anterior ethmoidal a. & n.
Sphenopalatine foramen Pterygopalatine fossa Sphenopalatine a. & Sup. post. nasal nn.
Semilunar hiatus Maxillary sinus -
Infundibulum (ethmoidale) Frontal sinus -
Opening of sphenoidal sinus Sphenoid sinus -
Nasolacrimal canal Orbit Nasolacrimal duct
Incisive canal Oral cavity Nasopalatine a. & n. (V/2)
* from Andrea Czigner MD, PhD
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BloodBlood supplysupply of of thethe nasalnasal cavitycavity
Internal carotid artery
ophtalmic artery
Anterior ethmoidal and Posterior ethmoidal artery
External carotid artery
Maxillar artery
sphenopalatine artery
Septal rami +
r. septalis post.
nasopalatine artery Greater palatine artery
aa.nasales posttlat.
(Kisselbach area) ( incisive canal)
anterior-superior part of the nasal cavity
posterior-inferior partof nasal cavity
Nasopalatine artery
Kisselbach area
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NerveNerve supplysupply of of thethe nasalnasal cavitycavity
Ophtalmic nerve (V/1)
maxillar nerve (V/2)
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Frontal sinus
Sphenoid sinus
Maxillary sinus
Ethmoidal sinuses
PARANASAL SINUSES *
F: Frontal sinus
A: Anterior ethmoidal air cells
P: Posterior ethmoidal air cells
Sph: Sphenoid sinus
M: Maxillary sinus
NL Nasolacrimal duct
* from Andrea Czigner MD, PhD
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Nasopharynx
behind the nasal cavity and superior to the soft palate, covered with respiratory epithelia Elevation of the soft palate separate the nasopharynx from the oropharynx during swallowing There is a large collection of lymphoid tissue (the pharyngeal tonsil) in the mucosa covering the roof of the nasopharynx The opening of the pharyngotympanic tube is posterior to and slightly above the level of the hard palate the vertical salpingopharyngeal fold, which descends from the tubal elevation and overlies salpingopharyngeus muscle Tubar tonsil: the small follicles around the opening of the pharyngotympanic tube posterior rim of the opening of the pharyngotympanic tube forms an elevation on the pharyngeal wall torus tubarius
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Topography of the larynx
C3-C4
C6
clavicle
Jugular notchTendon of the
sternocleidomastoid
External carotid bifurcationUpper margin of thyroidcartilage
Arcus of the cricoidcartilage
Thyroid gland
Aorta
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Cartilages of the Larynx
Hyaline cartilages:
Thyroid cartilage
Cricoid cartilage
Arytenoid cartilage
Elastic cartilages:
Epiglottis
Corniculate cartilage
Cuneiform cartilage (in aryepiglottic fold)
Thyroid cartilage:
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Cricoid cartilage:
Arytenoid cartilage:
Cartilages of the Larynx
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Joints of the larynx
Cricoarytenoid joint:Articular facet of arytenoid + superior articular facet of cricoid
pivot joint (movements around the vertical axis )+ med. et lat. translation (gliding movement)
Cricothyroid joint:Inferior horn + lateral articular facet(Thyroid cartilage) (Cricoid cartilage)
hindge joint (movements around the transverse axis)
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Outer ligaments of the larynx(Attach the larynx to the hyoid bone and trachea)
Thyrohyoid membrane,
Median and lateral thyrohyoid lig.
Hyoepiglottic lig.
Thyroepiglottic lig.
cricotracheal lig.
cricopharyngeal lig.
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Quadrangular membrane
Vestibular lig.
Conus elasticus (triangular membrane)
Vocal lig.
Median cricothyroid lig. = lig. conicum = parslibera coni elastici CONICOTOMIA
Inner ligaments of the larynx(Membrana fibroelastica laryngis, stabilize the cartilages of the larynx)
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Muscles of the larynx
From Andrs Mihly MD. PhD. DSc.
Inferio
rlaryn
gealnerve
superior laryngealnerve
Narrowing the aditus(epiglottis and
arytenoid cartilagescome closer)
Arytenoideusobliquus, aryepiglotticus
Closes rima glottidisAdducts vocalfolds
Cricoarytenoideuslateralis (6)
Opens rima glottidisAbducts vocalfolds
Cricoarytenoideusposterior (5)
Closes rima glottidisAdductsarytenoidcartilages
Arytenoideustransversus (4)
Closes rima glottidisAdducts vocalfolds
Thyroarytenoid (3)
Tightensvocal folds
Vocalis (2)
Tightensvocal folds
Cricothyroid (1)
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Muscles of the larynx
Superficial layerDeep layer: cricothyroid m. and the lamina of thyroidcartilage removed, pharyngeal mucosa reflected
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Cavity of larynx1
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Laryngeal inlet: aryepiglotticfold, corniculate and cuneiformtubercle, interarytenoid notch.
(1) Vestibule, vestibular fold, rima vestibuli, laryngealventricle (Morgagni), laryngealsaccule
(2) Glottis: vocal fold, rima glottidis (parsintermembranacea, parsintercartilaginea).
(3) Infraglottic space.
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Arterial supply of the layrnx
External carotid artery
Superior thyroid artery
Superior laryngeal artery
Subclavian arteryThyrocervical trunk
Inferior thyroid artery
Inferior laryngeal artery
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Venous drainage of the larynx
Superior thyroid v.
Middle thyroid v.
Inferior thyroid v.
Internal jugular v.
Left brachiocephalic v.
Plexus thyroideus impar
Superior laryngeal v.
Inferior laryngeal v.
Left brachiocephalic vein
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Innervation of the larynx
Nodose ganglion
Superior laryngeal nerve
+ superior cervical ggl.
Internal ramus external ramus
Sensory function:mucosa abovethe vocal fold
motor function:Cricothyroid m.
n. vagus
recurrent laryngeal nerve(sin.: arcus aortae, dext.: a. subcl dext.)sensory: mucosa below the vocal foldmotor: all laryngeal muscles except cricothyroid
Nodose ganglion
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LaryngoscopyLaryngoscopy
Indirect method
Direct method
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LaryngoscopyLaryngoscopy
Open rima Open rima glottidisglottidis ReinkeReinkess edemaedema of of thethe vocalvocal foldsfolds
epiglottisepiglottis posteriorposterior
from Andrs Mihly MD, PhD, DSc.