Sasbel lariiing

Plica vocalis adalah dua lembar membrana mukosa tipis yang terletak di atas ligamenturn vocale,
dua pita fibrosa yang teregang di antara bagian dalam cartilago thyroidea di bagian depan dan
cartilago arytenoidea di bagian belakang.
Plica vocalis palsu adalah dua lipatan. membrana mukosa tepat di atas plica vocalis sejati. Bagian ini
tidak terlibat dalam produksi suara
FONASI
Suara dihasilkan oleh vibrasi plica vocalis selama ekspirasi. Suara yang dihasilkan
dimodifikasi oleh gerakan palatum molle, pipi, lidah, dan bibir, dan resonansi tertentu oleh
sinus udara cranialis.
Plica vokalis dilapisi oleh epitel gepeng berlapis.
Plica vokalis merupakan lipatan membrane mukosa yang didalamnya mengandung ligamentum
vokalis yang merupakan pengikat elastis. Epitel yang menutupi merupakan epitel gepeng berlapis.
Larynx
Larynx tersusun dari kartilago hyalin dan elastis yang membentuk tabung
panjang yang kurang teratur, dilapisi dengan jaringan ikat, otot seran lintang dan
membrana mukosa dengan glandulanya. Larynx merupakan penghubung pharynx
dan trachea.
Rangka larynx tersusun atas beberapa kartilago thyroidea, cricoidea dan
epiglotis bersifat tunggal, sednagkan cartilago arytenoidea, cornikulata dan
cuneiformis sepasnag. Otot-otot external larynx berhubungan dnegan otot-otot
dan ligamentum di sekitarnya dan membantu mekanisme menelan . Otot internal
menghubungkan kartilago satu dengan yang lain , dan kontraksinya menyebabkan
bentuk kavum larynx berubah-ubah dan memberikan type produksi suara
Mukosa vestibulum sampai margo cranialis dari plica vokalis dilapisi oleh
epithelium squomus komplek sednag bagian yang lain dilapisi oleh ep
pseudocomplek bersilia, sehingga permukaan epiglotis, arytenoidea dan plica
aryepiglotica dilapisi oleh ep squomus komplek.
Lamina propria dibentuk oleh jaringan ikat dengan banyak serabut elastis.
Disana banyak ditemukan jaringan lymphoid dengan nodulus lymphaticus dan
glandula yang bersifat serosa, mukosa dan campuran. Nodulus lymphaticus
banyak ditemukan pada sapi dan kemudian menjarang jumlahnya pada kuda, babi
dan karnivora.
17
Submukosanya tipis, otot larynx bersifat seran lintang. Pada ruminansia
tidak ditemukan saculus laryngis. Pada kuda bagian ini dilapisi ep pseudocomplek
bersilia, pada babi dan carnivora oleh ep squomus komplek.
Pembuluh-pembuluh darah membentuk plexus perichondral atau sub
mukosa, jala-jala priglanduler dan jala-jala padat sub epithelial. Pembuluh limphe
membentuk jala-jala padat superficialis dan provundal. Saraf-saraf sensorik
berasal di n laryngis inferior.



HISTOLOGI LARYNX
Larynx menghubungkan pharynx dengan trakea. Larynx mempunyai 4 komponen
yaitu lapisan mukosa dengan epitel respirasi, otot ektrinsik dan intrinsic, tulang rawan.
Tulang rawannya meliputi tulang rawan tiroid, krikoid dan arytenoids (merupakan tulang
rawan hialin). Otot intrinsik menentukan posisi, bentuk dan ketegangan dari pita suara, otot
ekstrinsik menghubungan tulang rawan dengan struktur lain dari leher.
Pita suara terdiri dari epitel berlapis pipih yang tidak kornifikasi, lamina propria
dengan jaringan ikat padat yang tipis, jaringan limfatik dan pembuluh darah.

Jakun ( Larynx )
Gerbang trakea ini ditunjang oleh beebrapa keping tulang rawan hialain
dan elastis, jaringan ikat, serat otot lurik, dan dilapisi sebelah kelumen oleh
tunica mucosa. Tunica mucosa itu memiliki kelenjar lendir.


Keping tulang rawan yang menunjang jakun ialah:
1. Tiroid
2. Krikoid tunggal
3. Epiglotis
4. Aritenoid
5. Kornikulat sepasang
6. Kuneiform
Permukaan depan dan sebelah belakang epiglotis dan pita suara diselaputi
epitel berlapis mengelupas. Didaerah lain yaitu dasar epiglotis, trakea dan
bronkhus, epitel itu bersilia.
Pada tunica mucosa banyak sel goblet. Kelenjar lendir disini tergolong
jenis tubulo-acinus. Sedikit kuncup rasa terdapat tersebar pada bagian bawah
epiglotis.
Pita suara berisi ligamen tiro-aritenoid, yang mengandung serat elastis
dan dibagian sisisnya silengkapi serat otot lurik tiro-aritenoid. Ditengah ditutup
dengan tunica mucosa yang tipis dari epitel berlapis mengelupas.
LARINGS
Dibalut oleh mukosa dan ditunjang oleh tulang rawan . Tulang rawan Larings
berhubungan satu sama lain dengan trakea dan hyoid apparatus melalui ligamen. Otot
kerangka ekstrinsik menggerkan larings selama menelan berlangsung,sedangkan otot
kerangka intrinsic menggerakan tulang rawan larings secara individu selama pernafasan
dan bersuara. Mukosa epiglotis , vestibulum larings dan plika vokalis dibalut oleh epitel
pipih banyak lapis bertanduk . Epitel tersebut membalut ventrikel larings kuda. Reseptor
saraf pada epitel larings memberikan respon terhadap cairan seperti air, susu, cairan
lambung ,dan air liur . Mengandung banyak serabut elastik , leukosit , sel plasma dan
sel mast . Pada babi dan ruminansia kecil, tonsila paraepiglotika terdapat pada basis
epiglotis. Tonsil ini sering terlihat pada kucing. Kelenjar tubuloasinar sederhana
bercabang terdapat dalam lamina propia dan submukosa; kelenjar ini tidak terdapat
pada vestibulum dan plika vokalis. Hampir seluruh tulang rawan larings betipe hyaline,
perikondriumnya bersatu dengan submukosa berbatasan . Epiglotis karnivora sering
terdiri dari dinding luar tulang rawan yang didalamnya berisi sel sel lemak , jalinan
serabut membentuk tunika adventisia mengitari tulang rawann larings dan otot
kerangka.


Very low magnification view of the vocal fold (cord) region of the larynx. Seen
here are the epiglottis (E) at the top, the false vocal folds (FVF), true vocal folds
(VF), lateral saccule (LS), vocalis muscle (VM) which is a skeletal muscle, and the
thyroid hyaline cartilage (TC).



Cross section of the Larynx
-Has stratified squamous epithelium due to air movement
-Notice Vocalis muscle which provides force to put tension and torque on
the cords

Slide #28 Larynx *H&E

Structures to Identify:

o vestibule
o true vocal folds
o false vocal folds
o cricoid cart
o vocal ligaments
o str columnar epith
o epiglottis
o rima glottidis
o quadrangular membrane
o vocalis m
o str. sq epith
o ventricles
o thryoid cartilage
o conus elasticus
o psuedo str. epith

Lower power:
can see greater horn of hyoid bone
hyaline cartilages:
cricoid cartilages
thyroid cartilages
b/w cartilages = laryngeal musc str. musc fibers
on outer side of thyroid cart = infrahyoid m can be seen
Vertical section thru larynx:
show 2 vocal folds, supporting cartilages & muscles
vestibule > vestibular folds > ventricle > true vocal fold > subglottic region
Function:
conducts air
origin of speech
helps in swallowing
sound production & resonance

Mucosa:
false vocal fold = made by mucosa,
lined pseudostr. columnar epith w/ ciliae & goblet cells = respiratory epith


vocal fold= str. squamous non epith, more resistant to strain bacteria
vocal ligament located just deep to it
rich in a/v, esp capillaries
subglottic region = respiratory epith again
Lamina Propia
in LP = mixed glands (mostly mucus)
excretory ducts from glands, open @ epith
lymphatic nodules on ventricular side of fold
is thinner in area of vocalis m = no glands or a/v

Fibromuscular layer = quadrangular membrane
cartilages = become ossified to bone w/ age
cricoid cart = perichondrium + chondrons surrounded by matrix (PGs) + type II collagen fibers
ext pharyngeal m = responsible to move & elevate larynx during swallowing
musc = thyroarytenoid m

Histologically, the most prominent structure of human larynx is its mucosa which includes epithelium
and lamina propria (figure 1). Cartilages and their adjacent connective tissues, perichondrium, are
found within the laryngeal lamina propria along with lymphatic nodules, secretary glands, connective
tissues (such as collagen and elastic fiber), blood vessels and sometimes muscles (figure 2). In most
area of larynx, submucosa and adventitia can be seen underbelow lamina propria, relatively thin
compared to mucosa and mainly contain connective tissues, adipose tissues and some blood
vessels. In true vocal fold however, the submucosa is absent.
[4]
However, as most of the space is
occupied by the mucosa layer, submucosa and adventitia of the larynx become relatively thin and
mainly contain connective tissues, adipose tissues and some blood vessels
[5]
.
True and False Vocal Folds


Figure 3: True and false vocal folds in coronal section.
[6]

Indicated by figure 3, the mucosa of larynx is divided into two different folds by a narrow cleft known
as the laryngeal ventricle which ends as laryngeal saccule. These structures of larynx can be seen in
an anatomical indication through figure 4.


Figure 4: Anatomical diagram corresponding to figure 3.
[1]

The upper fold is known as the false vocal fold (or vestibular fold) which is covered with
pseudostratified ciliated columnar epithelium with goblet cells which is the typical respiratory
epithelium. Seromucous glands are present in the mucosa layer in order to maintain the moisture of
airway surface. They are drained into ducts to reach the surface of epithelium. These ducts may be
lined by stratified squamous, ciliated columnar epithelia, or a mixture of both.
[6]
Most of the larynx
besides superior surface of epiglottis and true vocal cord are covered by the same type of epithelia.
The cilia of the epithelia lining on these structures are beating upward to transporting mucus and
trapped materials in order to expel them out of the airway.
[4]
The false vocal fold resembles a typical
respiratory pathway with the absence of the deepest layer of the mucosa.


Figure 5: Epithelial transition between true and false vocal folds.
[3]

The lower fold is called the true vocal fold which contains the vocalis muscle to enable alterations for
the distance and shape of true vocal folds during phonation as well as vocalis ligament for structural
support. In comparison with the false vocal folds, the true folds are covered by stratified squamous
epithelium for the purpose of resisting the abrasion caused by the rapidly moving air stream and
physical contacts between vocal folds.
[7]
In addition, Langerhans cells can be found in this stratified
squamous epithelium for immunological functions. Meanwhile, seromucous glands are also located in
the true vocal fold although they are not as prominent as those in the false fold. They are responsible
for fluid production to maintain moisture as well as to lubricate during friction. The transition of
epithelia from false to true vocal fold is shown in figure 5.
Hyaline Cartilage versus Elastic Cartilage
A very significant histological feature of larynx is that there are two types of cartilages present: hyaline
cartilages (figure 6) and elastic cartilages (figure 7). Within the cartilages, chondrocytes (darker
stained cells scattered in cartilage matrix in figure 6 and 7), which develop from chondroblasts, are
the main cells present within the matrix. Chondroblasts synthesize cartilage matrix and extracellular
materials at first but eventually become trapped within compartments known as lacunae (shown more
obvious in figure 7 as the hollow space trapping chondrocytes) formed by the surrounding
extracellular materials. At this point, they become chondrocytes. Occasionally, multiple chondrocytes
are trapped within the same lacunae to be called the isogenous group. The main function of
chondrocytes is to maintain the cartilage structure. Overall, hyaline and elastic cartilages have similar
histological strucutres and their differences are indicated in table 1.