Clinically Relevant Anatomy to Elevate Your Airway Practice
The landmarks
A progressive identification of anatomic landmarks is a key part of successful laryngoscopy. Let’s review those anatomic structures.
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the uvula – 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.
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the epiglottis – 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.
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The Vallecula – 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.
Here is an example of what seating your blade in the valeculla and engaging the hyo-epiglottic ligament can do for your laryngeal view, and it highlights the important of this anatomic structure.
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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.
If there is one pearl we want to 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.
EPIGLOTTIS
VOCAL CORDS
INTER-ARYTENOID NOTCH
what’s next
Identification of anatomic landmarks is only part of the equation for successful intubation. Learn how to translate 2D images on your video laryngoscope into successful 3D tracheal access.
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