Which structure in the neck is responsible for deflecting fluid and food away from the larynx and toward the esophagus?

Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always … More Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

You do not currently have access to this chapter.

Published online by Cambridge University Press:  05 November 2012

John DoyleAffiliation:

Cleveland Clinic Foundation

• Chapter

Summary

An understanding of anatomy is paramount to the ability to safely anesthetize the head and neck surgery patient. The basic underlying structure of the face is formed by the skull, facial bones and mandible. The cochlear hair cells activate the cochlear nerve, resulting in hearing transmission. The labyrinthine and tympanic portions of the facial nerve lie in close proximity to these structures and may be dehiscent, necessitating lack of neuromuscular blockade and close monitoring of facial movements during certain otologic procedures. The nose projects from the face largely based on the amount of cartilage. The oral cavity therefore includes the lips, buccal mucosa, maxillary and mandibular alveolar ridges/teeth/gingiva, floor of the mouth, hard palate, the retromolar trigone and the anterior oral tongue. Neck anatomy can be significantly altered by cancer or cancer treatments including surgery and radiation or chemoradiation therapy.

Type

Information

Publisher: Cambridge University Press

Print publication year: 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Overview

What is epiglottitis?

Epiglottitis is inflammation and swelling of your epiglottis. Your epiglottis is a thin flap of cartilage near the base of your tongue. It keeps food and liquids from going down your windpipe (trachea) when you swallow.

You may also hear the term “acute epiglottitis.” This refers to the very sudden and intense onset of symptoms, including difficulty breathing and swallowing.

Who does epiglottitis affect?

Epiglottitis can affect people of any age. It affects men and people assigned male at birth (AMAB) more than women and people assigned female at birth (AFAB) at a rate of 2.5 to 1.

How common is epiglottitis?

Before the widespread use of Hib vaccinations in 1985, epiglottitis mainly affected children between the ages of 3 and 5. By the year 2000, the annual incidence of invasive Hib infection, a primary cause of epiglottitis, in children ages 3 to 5 decreased 99%, to less than 1 case out of every 100,000.

Symptoms and Causes

What are typical signs and symptoms of epiglottitis?

Epiglottitis symptoms usually appear suddenly and get worse quickly. Sometimes, in older children and adults, it may take a few days for symptoms to fully develop. The most common epiglottitis symptoms include:

• Severe sore throat.
• Difficulty and pain when swallowing (a main symptom in older children and adults).
• Difficulty breathing (a main symptom in children).
• Abnormal or high-pitched breathing noises (a main symptom in children).
• Hoarseness or muffled voice.
• Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.
• Irritability and restlessness.
• Drooling (a main symptom in older children and adults).

What are the 4 Ds of epiglottitis?

Healthcare providers sometimes refer to the most common epiglottitis symptoms as “the four Ds”:

1. Dysphagia:Difficulty swallowing.
2. Dysphonia:Hoarseness or an abnormal voice.
3. Drooling:When saliva flows out of your mouth involuntarily.
4. Distress:Difficulty breathing or lack of oxygen.

What causes epiglottitis?

In most cases, Haemophilus influenza type b (Hib) bacteria cause epiglottitis. This is sometimes called acute bacterial epiglottitis. Hib bacteria can also cause pneumonia and meningitis.

Other possible epiglottis causes include:

• Bacterial infections from non-Hib sources, such as those from streptococcus pneumonia.
• Fungal infections, particularly in people with a weak immune system.
• Viral infections from varicella zoster virus (which causes chickenpox) or herpes simplex virus (which causes cold sores).
• Injury to your throat, either through a physical blow or by drinking a very hot liquid.
• Smoking.
• Chemical burns.
• Side effect of another disease or chemotherapy.

Is epiglottitis contagious?

It can be. If epiglottitis is the result of a bacterial, fungal or viral infection, then it can spread from person to person through droplets of saliva or mucus. When an infected person coughs or sneezes, droplets move through the air. If another person breathes in those droplets, or comes into contact with a surface where the germs have landed, they can also develop an infection.

People who develop epiglottitis from injury or from smoking can’t pass the condition to others.

Diagnosis and Tests

How is epiglottitis diagnosed?

Your healthcare provider will perform a physical examination and ask about your symptoms. They may also request certain tests that can help diagnose epiglottitis.

These tests may include:

• Laryngoscopy: During this test, your healthcare provider uses a small camera at the end of a flexible tube to examine your throat.
• Culture tests: Your provider takes a swab of your throat to test for bacteria or viruses.
• Blood tests: Your provider may perform a variety of blood tests to count your white blood cells or see if there are any bacteria or viruses in your blood.
• Imaging tests: An X-ray or CT (computed tomography) scan can help determine the level of swelling and to see if there’s an unwanted object in your airway.

Epiglottitis often shares a number of common symptoms with other conditions, such as croup. As a result, proper diagnosis and treatment are key.

Management and Treatment

How is epiglottitis treated?

Epiglottitis is a medical emergency. If you or someone you know exhibits epiglottitis symptoms — such as difficulty breathing, difficulty swallowing, hoarseness or drooling — call 911 or head to your nearest emergency room.

At the hospital, healthcare providers will begin epiglottitis treatment:

• The first step is to restore your airways to full capacity. Your healthcare provider will place an oxygen mask over your mouth and nose so your lungs can start getting air. If your air passages are already blocked, they’ll place a tube down your throat to deliver oxygen into your lungs. In severe cases, a person may need a tracheostomy (where your healthcare provider makes a small incision in your windpipe).
• Once your lungs are getting oxygen, your provider may insert a breathing tube through your nose and into your windpipe to make breathing more natural.
• Your medical team will give you plenty of fluids through an intravenous (IV) drip (a needle inserted into a vein).
• If you have a bacterial infection, they’ll give you antibiotics to help fight off infection.

How long does it take to recover from epiglottitis treatment?

For most people, it takes about one week to fully recover from epiglottitis. You’ll probably spend between five and seven days in the hospital.

Prevention

How can I prevent epiglottitis?

While you can’t prevent epiglottitis altogether, there are things you can do to significantly reduce your risk:

• Make sure vaccinations are up to date. In children, the best prevention is to ensure all childhood immunizations are up to date. Children have undeveloped immune systems. This makes them more vulnerable to infections, including Hib bacteria.
• Practice good hygiene. Wash your hands frequently, and avoid placing fingers in your eyes, nose and mouth.
• Protect yourself from infection.Take necessary precautions around people who are coughing and sneezing.
• Avoid injury to your throat. Drinking hot liquids or smoking can increase your risk of epiglottitis.

Outlook / Prognosis

What can I expect if I have epiglottitis?

Epiglottitis is a medical emergency. But when addressed quickly, treatment is typically successful. Most people recover in about a week.

Is epiglottitis fatal?

Rarely, epiglottitis can be fatal. Fewer than 1 in 100 cases of epiglottitis result in death.

Living With

When should I see my healthcare provider?

Epiglottitis can be life-threatening if swelling closes off air passages to your lungs. If you think you or someone you know might have epiglottitis, call 911.

You should never put anyone with epiglottitis on their back or allow them to have anything in their mouth. Try to remain calm, as stress can worsen the tightening of someone’s throat.

A note from Cleveland Clinic

Epiglottitis, or inflammation of your epiglottis, can result in several serious symptoms, including difficulty breathing and swallowing. It’s a medical emergency. If you or someone you know exhibits epiglottitis symptoms, call 911 or head to your nearest emergency room immediately. With prompt and proper care, epiglottitis treatment is usually successful. Most people recover quickly and can go home from the hospital within one week.

Which structure in the neck is responsible for deflecting fluid and food away from the larynx and towards the esophagus?

When examining the face the nurse is aware that the two pairs of salivary glands that are accessible on examination are?

When assessing the face which area is best for assessing symmetry of facial features?

Which proportion would be the best indication of a Normocephalic head size?