The _cricoid cartilage_ was regarded by esophagoscopists as the chief
obstruction encountered on the introduction of the esophagoscope. As
shown by the author, it is the cricopharyngeal fold, and the
inconceivably powerful pull of the cricopharyngeal muscle on the
cricoid cartilage, that causes the difficulty. The cricoid is pulled
so powerfully back against the cervical spine, that it is hard to
believe that this muscles is inserted into the median raphe and not
into the spine itself (Fig. 68).
The _ventricular bands_ or false vocal cords vicariously phonate in
the absence of the true cords, and assist in the protective function
of the larynx. They form the floor of the _ventricles_ of the larynx,
which are recesses on either side, between the false and true cords,
and contain numerous mucous glands the secretion from which lubricates
the cords. The ventricles are not visible by mirror laryngoscopy, but
are readily exposed in their depths by lifting the respective
ventricular bands with the tip of the laryngoscope. The _vocal cords_,
which appear white, flat, and ribbon-like in the mirror, when viewed
directly assume a reddish color, and reveal their true shelf-like
formation. In the subglottic area the tissues are vascular, and, in
children especially, they are prone to swell when traumatized, a fact
which should be always in mind to emphasize the importance of
gentleness in bronchoscopy, and furthermore, the necessity of avoiding
this region in tracheotomy because of the danger of producing chronic
laryngeal stenosis by the reaction of these tissues to the presence of
the tracheotomic cannula.
The _trachea_ just below its entrance into the thorax deviates
slightly to the right, to allow room for the aorta. At the level of
the second costal cartilage, the third in children, it bifurcates into
the right and left main bronchi. Posteriorly the bifurcation
corresponds to about the fourth or fifth thoracic vertebra, the
trachea being elastic, and displaced by various movements. The
endoscopic appearance of the trachea is that of a tube flattened on
its posterior wall. In two locations it normally often assumes a more
or less oval outline; in the cervical region, due to pressure of the
thyroid gland; and in the intrathoracic portion just above the
bifurcation where it is crossed by the aorta. This latter flattening
is rhythmically increased with each pulsation. Under pathological
conditions, the tracheal outline may be variously altered, even to
obliteration of the lumen. The mucosa of the trachea and bronchi is
moist and glistening, whitish in circular ridges corresponding to the
cartilaginous rings, and reddish in the intervening grooves.
Public-domain text, read in full here on John Shaqi.
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