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Awake Fibreoptic Intubation — FRCA Final MCQ

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ModerateAirway ManagementAwake Fibreoptic IntubationFRCA Final

A patient with a large base-of-tongue carcinoma and stridor is being prepared for awake tracheal intubation. Which nerve carries sensory afferents from the piriform recess and most of the supraglottic laryngeal mucosa, including the afferent limb of protective reflexes triggered at the laryngeal inlet?

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Correct answer: A — Superior laryngeal nerve (internal branch)

The internal branch of the superior laryngeal nerve is the sensory branch supplying the piriform recess and most laryngeal mucosa above the vocal cords. It carries afferent input for protective laryngeal reflexes; bilateral blockade can therefore anaesthetise the supraglottic inlet, although nerve blocks are not mandatory because topicalisation may be used. The glossopharyngeal nerve supplies the posterior tongue and oropharynx and forms the principal afferent limb of the gag reflex. The recurrent laryngeal nerve supplies sensation below the cords and motor innervation to nearly all intrinsic laryngeal muscles. The hypoglossal nerve is motor to the tongue. Although the superior laryngeal nerve arises from the vagus, blocking the vagal trunk would be non-selective and inappropriate.

Reference: Stephens RE, Wendel KH, Addington WR. Anatomy of the internal branch of the superior laryngeal nerve. Clinical Anatomy. 1999;12(2):79–83. https://pubmed.ncbi.nlm.nih.gov/32198941/