Hensley's Practical Approach to Cardiothoracic Anesthesia

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IV. Thoracic Anesthesia

Hard palate

Uvula Soft palate

Palatoglossal arch

Palatopharyngeal arch

Palatine tonsil

GPNB

GPNB

Tongue

Superior laryngeal nerve

Hyoid bone

SLNB

SLNB

Thyrohyoid membrane

Thyroid cartilage

Cricothyroid muscles

Cricothyroid membrane

Cricoid cartilage

TTB

Trachea

Recurrent laryngeal nerve

Copyright © 2024 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. FIGURE 26.1 Topicalization of the oropharynx and upper airway. The glossopharyngeal nerve innervates the oro pharynx, including the tongue and upper epiglottis; it mediates the afferent limb of the gag reflex. It can be blocked transorally by injecting just medial to the palatine tonsils bilaterally (GPNB). The superior laryngeal nerve can be blocked (SLNB) at the thyrohyoid membrane bilaterally; the internal branch provides sensation above vocal cords, and the exter nal branch provides motor function to the cricothyroid muscle. The recurrent laryngeal nerve can be blocked by transcri cothyroid (transtracheal) injection (TTB [transtracheal block]); it provides sensation to the trachea and motor function to all intrinsic laryngeal muscles, except the cricothyroid muscle. The superior and the recurrent laryngeal nerves are branches of the vagus nerve. (Courtesy of Julia Scarpa.)