nextgen learning to elevate your airway practice
The Detailed Anatomy
There is a lot of anatomic detail packed into this small space. Knowing it all is excellent, but some structures are more valuable for airway management than others. Let’s start by reviewing the general anatomy before moving on to identify what structures have the highest yields when it comes to airway management.
What You Need
A detailed understanding of airway anatomy is valuable, but that wealth of knowledge is not required in all clinical situations. This is especially true regarding laryngoscopy or the emergency surgical airway. In these time-critical moments, there are only a few fundamental structures that you need to be successful. Too much detail can slow you down.
So here, we cover the essential anatomic landmarks in the order you need to find them for laryngoscopy (we will cover critical landmarks for the surgical airway in another section). If you can progressively find these landmarks in the ORDER they appear here. Your chances for consistent intubation for success will go up.
1. The Uvula
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your north star
Diving too deep too quickly into the oropharynx with your laryngoscope (what we call the “plunge & pray” technique) makes finding your way harder. One way to avoid this is to ensure you see the uvula first. The uvula can be your North Star and point you in the direction of the epiglottis.
2. The Epiglottis
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the cornerstone of laryngoscopy
The epiglottis is considered the cornerstone of landmark identification during laryngoscopy. So much so, that it was nicknamed “epiglottoscopy” to highlight the importance of the epiglottis as an anatomic landmark. This is because once the epiglottis is identified, the intubator can be assured that the larynx (and the trachea beyond it) are nearby: located just posterior and inferior. .
As you can see here from this great video from 5 Minute Airway (another great FOAMed resource) a slow progressive movement with the blade around the base of the tongue reveals the tip of the epiglottis which leads ultimately to great laryngeal exposure. For most experts, identifying the epiglottis is the first critical step in laryngoscopy.
3. The Vallecula
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the key to laryngeal exposure
Once the epiglottis is identified, seating the blade in the vallecula (the anatomic groove above the epiglottis) and engaging the hyoepiglottic ligament will give usually give you great laryngeal exposure
In this video by AIME Airway, you can see how an incremental and deliberate movement around the base of the tongue into the valeculla helps “lift” the epiglottis to expose the larynx.
4. The Laryngeal Inlet
If there is one pearl we want you to take from this anatomy lesson, it’s to look for the structures above first, and the view below will happen more easily and more often. If you see the epiglottis above & the posterior arytenoids below, you know the vocal cords are between them, with the trachea beyond them.
Summary
If you notice, we have not even mentioned the vocal cords as a key anatomic landmark. Instead, we’ve highlighted the anatomic structures that will help you find them. Here they are one more time.
Curated MedEd
It’s a great video worth the ten extra minutes to watch if you would like a deeper dive on all the anatomy of the larynx.
The Bottom Line
The Physical Space
What’s Next
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