Page 85 - Edited - Webster HEAD AND NECK - part 2-Merge PDF

HN 277 CLOSING THE LARYNGEAL INLET HN 277

(A. & B. Posterior aspect, with inferior
A. INLET OPEN constrictor m. incised & opened.)
GLOSSO-EPIGLOTTIC B. INLET CLOSED
FOLD (MUCOUS
TON GUE MEMBRANE) BETWEEN
POST TONGUE & ANTR The two piriform
EPIGLOTTIS. NOTE fossae form ready
POCKETS-THE paths to the
EPIGLOTTIS VALLECULAE (V)
EPIGLOTTIS
oesophagus.
GLOSSO-
V V PHARYNGEAL
FOLD
ARY-
EPIGLOTTIC
FOLD
PIRIFORM
FOSSA

POST EDGE
R
OF THYROID
CARTILAGE
ARYTENOID
CARTILAGE
INFERIOR CONSTRICTOR
MUSCLE
OESOPHAGUS
OESOPHAGUS

C. POSITIONING LARYNGOSCOPE; & EMERGENCY LARYGOTOMY
(Schematic lateral view.)
I. During swallowing, the ary-epiglottic muscles close
the laryngeal inlet (compare A and B, above). “Solid” GLOSSO-EPIGLOTTIC
food rolls down the incline “flipping” the epiglottis FOLD & LEFT
backwards. Liquids run through the piriform fossae: VALLECULA
foreign bodies lodged here may be removed by drinking.
(They cannot be coughed out because the fossae are
lateral to and below the laryngeal inlet.) In children the
inlet is accessible to the exploring finger - in an
emergency foreign bodies can be dislodged using a
finger. Foreign bodies trapped in one or other vallecula
are sheltered from coughing by the epiglottis. They can
be reached with a finger or forceps. PLANE OF

HYOID BONE LARYNGEAL
INLET

II. The illuminated, curved end of a laryngoscope
must be inserted behind the epiglottis if it is to
reach the laryngeal inlet. If the supraglottic larynx
is obstructed, an emergency inferior laryngotomy THYROID
can be performed by thrusting a hypodermic VOCAL CARTILAGE
needle or even a knife between the cricoid and LIGAMENTS
GLOTTIS
thyroid cartilages anteriorly, in the midline. This
position avoids any damage to the crico-vocal
membranes (which are attached laterally to the
cricoid arch) and is below the glottis. Proper
tracheostomy follows.
CRICOID OESOPHS.
CARTILAGE
TRACHEA
CRICO-THYROID
lcKewtech\glottis LIGAMENT.