The presence of an air-fluid level in the sphenoid sinus following head trauma may be the only radiographic sign of the fracture. Laryngeal foreign bodies Epiglottitis Edema secondary to burns, chemical inflammation, or allergic reactions Trauma with secondary bleeding and swelling e.g.
THE PHARYNX Pharyngeal Facts • • • foreign bodies may lodge in the pharynx especially the laryngopharynx abscesses in this area may lead to airway obstruction swelling secondary to allergic reactions or burns may lead to airway obstruction The pharynx is the space extending from the base of the skull to the larynx. inexpert attempts at intubation Trauma with gross disruption of laryngeal structures with associated major airway obstruction.
FIGURE 6: CARTILAGES OF THE LARYNX Epiglottis Hyoid Bone Thyrohyoid Ligament Thyroid Cartilage Arytenoid Cartilage Cricothyroid Ligament Cricothyroid Membrane Cricoid Cartilage First Tracheal Ring ___________________________________________________________________________ OBHG Education Subcommittee 9 Take a moment to palpate your own neck while referring to Figure 7 and reading the discussion which follows.
FIGURE 7: LATERAL ASPECT OF THE LARYNX Tongue Vallecula Epiglottis Thyrohyoid Ligament Hyoid Bone Thyroid Cartilage Attachment of Epiglottis Arytenoid Cartilage Vocal Ligament Cricothyroid Ligament Cricotracheal Ligament Cricoid Cartilage First Tracheal Ring Immediately below your chin you will find a horseshoe-shaped, mobile bone of 4-5 mm in width which moves superiorly when you swallow. Immediately below the hyoid bone is the thyroid cartilage.
Its multiple perforations allow entry of the olfactory nerve fibres into the nose.
With facial or head trauma the cribiform plate may fracture allowing leakage of cerebrospinal fluid into the nose (CSF rhinorrhea).FIGURE 5: VIEW THROUGH OPEN MOUTH Soft Palate Uvula Tonsil Tongue THE LARYNX Don't be lax about the larynx • • • • • Airway obstruction, often due to foreign bodies at this level Any mucosal swelling of larynx can cause airway obstruction The larynx is very vulnerable to direct trauma Trauma to the larynx is often associated with cervical spine injury Emergency airway can be obtained by inserting cannulae through the cricothyroid membrane ___________________________________________________________________________ OBHG Education Subcommittee 8 Disruption of normal laryngeal function or structure may lead to airway compromise. It lies anterior to the cervical vertebrae between C3 and C6, hence the common association of laryngeal and cervical fractures.The larynx is composed of cartilages united by ligaments and moved by muscles. The four major laryngeal cartilages are the epiglottis, thyroid, arytenoids and cricoid.Each sinus is a mucous membrane lined, air-filled cavity within the bony architecture of the skull which drains into the nasal cavity.Obstruction of drainage from a sinus can lead to pain and infection called sinusitis.Attempting to pass any tube through the nose in such a patient may result in the tube passing through the fracture into the cranium with disastrous consequences.SINUSES Sinus Highlights • • • • sinus infections can lead to headache ethmoid sinuses occasionally rupture with pressure changes sinusitis may lead to brain abscess air-fluid level in the sphenoid sinus may indicate a basal skull fracture The nasal sinuses are the ethmoidal, frontal, maxillary and sphenoidal.It is easily identified by its most prominent protuberance, the "Adam's Apple".The thyroid cartilage acts as both an attachment for and protection to the vocal cords.UPPER RESPIRATORY TRACT The sequence of organs that comprise the upper respiratory tract are: • • • • Nasal cavity and sinuses Pharynx Larynx Trachea NASAL CAVITY Reasons to know the nose: • • • • Placement of nasopharyngeal airways Placement of nasotracheal tubes Nose bleeds Fractured nose The nasal cavities are separated from each other by the nasal septum.They open in front at the nostrils (anterior nares) and posteriorly into the nasopharynx through the posterior nares (choanae).