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Applied Anatomy of Airway

Applied Anatomy of Airway. www.anaesthesia.co.in anaesthesia.co.in@gmail.com. Airway?. Pathway in which air passes Natural & artificial Natural airway = upper airway Nasal cavity, mouth, pharynx, larynx Trachea ,bronchus, bronchial division. Anatomical airway. Nasal cavity.

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Applied Anatomy of Airway

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  1. Applied Anatomy of Airway www.anaesthesia.co.in anaesthesia.co.in@gmail.com

  2. Airway? • Pathway in which air passes • Natural & artificial • Natural airway = upper airway • Nasal cavity, mouth, pharynx, larynx • Trachea ,bronchus, bronchial division

  3. Anatomical airway

  4. Nasal cavity • Phylogeniticaly breathing occurs through nose • Enables to smell danger, unconditional supply of air while feeding • Resistance to air flow twice that of mouth breathing • Exercise & respiratory distress mouth breathing is facilitated

  5. Nasal Cavity

  6. Floor of nose & Inferior turbinate • Oriented perpendicular to fascial plane • Nasal instrumentation should be done perpendicular to this plane • Major air passage lies beneath inf. Turbinate • Inf. Turbinate limits the size of NTT

  7. Vasculature of nose • Vasularized sub mucosa • Branches of internal carotid artery • Nasal packing only way to control bleeding • Antero inferior septum- site of epistaxsis • Orient leading edge of NTT away from septum

  8. Nasal airway calibre change Prior to vasoconstrictor After vasoconstrictor

  9. Innervation of nasal cavity

  10. The Kratschmer reflex • leads to bronchiolar constriction upon stimulation of the anterior nasal septum in animals. • Similar reflex seen in the postop period when a pt becomes agitated when the nasal passage is packed

  11. Mechanism of perforation & submucosal tunneling

  12. Tonsils – possible cause of airway obstruction

  13. Pharynx • Musculofascial tube connects nasal and oral cavity with larynx and esophagus • Lacks of bony / cartilagenous frame work • Patency maintained by muscle tone only • Common site of laceration during traumatic intubation • Lead to hematoma, cellulites and total airway collapse

  14. Pharynx

  15. Sites of airway obstruction

  16. Velopharynx – the site of airway obstruction

  17. Laryngeal frame work

  18. Direct layngoscopic view of larnyx

  19. Intrinsic muscles of larynx

  20. Normal vocal cord movement

  21. Vocal cord Palsies • Selmons law : nerve fibers to abductors are vulnerable to injury than adductors • Partial b/l RLN palsy leads to stridor • Pure adductor palsy, rare clinical entity

  22. Cadaveric position of cord • Combined b/l RLN & SLN palsy • Use of musle relaxants

  23. Cricothyroid membrane • Extends from inf. border of thyroid cartilage to sup. border of cricoid • 9 mm Ht / 22 mm width • Sup. 1/3 traversed by sup. Cricoid vessel • Laterally by ant. Jugular & inf thyroid veins • Midline neck, low 1/3 of CTM – safe site for performing cricothyroidotomy

  24. Appropriate position of ETT Endo tracheal tube tip follows tip of the nose position

  25. www.anaesthesia.co.in anaesthesia.co.in@gmail.com

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