Objectives

To discuss the basic anatomy of the larynx

To enumerate the main functions of the larynx

Laryngeal Cartilages
Paired Arytenoid cartilage Corniculate cartilage Cuneiform cartilage Unpaired: Thyroid cartilage Cricoid cartilage Epiglottis

Thyroid Cartilage
Hyaline cartilage Largest Encloses the larynx

anteriorly and laterally Two alae Ossification

Cricoid Cartilage
Hyaline cartilage Directly below the

thyroid cartilage Stongest Shape: Signet ring Lamina flat portion Only complete annular support of the larynx Articulates w/ Inferior cornu of the thyroid cartilage

Epiglottis
Fibroelastic cartilage Leaf-shaped structure Petiole small narrow

portion of the glottis

Arytenoid Cartilage
Mostly hyaline cartilage
Smaller in size Responsible for opening and closing of the larynx

Shape: pyramidal

Arytenoid Cartilage
Anterior Vocal process receives the attachement of the mobile end of each VC Lateral Muscular process Articulation Cricoarytenoid joint

Corniculate Cartilages
Fibroelastic
Cartilages of Santorini Small cartilages above the arytenoid and in the

aryepiglottic folds

Cuneiform Cartilages
Firboelastic cartilages
Cartilages of Wrisberg Elongated pieces of

small yellow elastic cartilage in the aryepiglottic folds

Triticeous Cartilage
Cartilago triticea Small elastic cartilage

in the lateral thyrohyoid ligament

Laryngeal Ligaments
Extrinsic Thyrohyoid membrane and ligaments Cricothyroid membrane and ligaments Cricotracheal ligament Epiglottis
Intrinsic Elastic membrane Quadrangular membrane Conus elasticus (cricovocal membrane) Median cricothyroid ligament Vocal Ligament Thyroepiglottic ligament

Extrinsic Ligaments
Thyrohyoid membrane pierced on each side by: 1. Superior laryngeal vessels 2. Internal branch of superior laryngeal nerve Median thyrohyoid ligament thickened median portion Lateral thyrohyoid ligament thickened posterior border - where cartilago triticea is often found

Extrinsic Ligaments
Cricothyroid

membrane and ligaments

May be pierced

for emergency tracheotomy (cricothyrotomy)

Extrinsic Ligaments
Cricotracheal Ligament Attaches the cricoid cartilage to the first attached ring
Epiglottis suspended in position by membranous connections to the hyoid bone, thyroid cartilage and base of the tongue

Intrinsic Ligaments
Elastic membrane Divided into upper and lower parts by the ventricle of the larynx Quadrangular membrane Upper part of the elastic membrane Boundaries

Epiglottis , arytenoid, corniculate cartilage, false cord

Forms part of wall between upper pyriform sinus and

laryngeal vestibule

Intrinsic Ligaments
Conus elasticus (cricovocal membrane) Lower part of elastic membrane Composed mainly of yellow elastic tissue Boundaries

Inferior: superior border of cricoid cartilage Superoanterior: deep surface of angle thyroid cartilage Superoposterior: vocal process of arytenoid cartilage

Median cricothyroid ligament thickened anteior part Vocal Ligament free upper edge

Thyroepiglottic ligament

Cavity of the Larynx

Divided into 3 parts: Vestibule Ventricle Subglottic space

Cavity of the Larynx

Vestibule boundaries: Anterior: posterior surface of epiglottis Posterior: interval between arytenoid cartilages Lateral: inner surface of aryepiglottic folds and upper surfaces of the false cord

Cavity of the Larynx

Ventricle Saccule conical pouch at anterior part
Glottis (rima glottidis) Abduction: Respiration, wide and triangular

Adduction: Phonation, slit-like appearance

Cavity of the Larynx

Subglottic space Preepiglottic space Boundaries: Anterior: thyrohyoid membrane Anteroasuperior: hyoid Superior: vallecula Posterior: part of the epiglottis Lateral: hyoepiglottic ligament

Cavity of the Larynx

False Cords (ventricular bands) Anteriorly: angle of the thyroid cartilage Posteriorly: bodies of the arytenoid cartilage True cords Voice production Protection of lower respiratory tract Anteriorly,: angle of thyroid cartilage Posteriorly: vocal processes of the arytenoid cartilages Enclose vocal ligament and a major part of the vocalis muscle

Laryngeal Joints
Cricothyroid Joint Between inferior cornu of the thyroid cartilage and facet on the cricoid cartilage at the junction of the arch and lamina Two movements: Rotation Gliding Cricoarytenoid Joint bet. base of the arytenoid cartilage and the facet on the upper border of the lamina of the cricoid cartilage Two movements: Rotation Gliding

Laryngeal Muscles
Extrinsic Muscles
Depressor group Elevator group Constrictor muscles Pharyngeal muscles

Intrinsic Muscles Interarytenoid muscle

Transvers Oblique

Post. Cricoarytenoid m. Lateral cricoarytenoid

m. Thyroarytenoid m. Cricothyroid m.

Depressor muscles

Origin

Insertion
oblique line of the thyroid cartilage

Action
depresses/stabilizes the hyoid bone

Sternohyoid (C2, manubrium of sternum and C3)

medial end of clavicle

Thyrohyoid (C1)

oblique line of the lower border of the thyroid cartilage hyoid bone

elevates the larynx; depresses/stabilizes the hyoid bone

Omohyoid (C2, C3)

superior border of scapula near the suprascapular notch

inferior border of hyoid bone

depresses, retracts and steadies the hyoid during swallowing and speaking

Elevator muscles Geniohyoid (C1)

Origin

Insertion

Action
pulls the hyoid bone anterosuperiorly, and shortens the floor of the mouth and widens the pharynx depresses the mandible and raises the hyoid bone. Also, it steadies the hyoid bone during swallowing and speaking

inferior mental body of hyoid spine of mandible bone

Digastrics (Ant. CN V; Post. N. VII)

anterior bellydigastric fossa of mandible, posterior bellymastoid notch of temporal bone

intermediate tendon to body and greater horn of hyoid bone

Mylohyoid (V)
Stylohyoid (VII)

mylohyoid line of mandible

raphe and body of hyoid bone

elevates the hyoid bone, floor of the mouth and the tongue during swallowing and speaking
elevates and retracts the hyoid bone, thereby elongating the floor of the mouth

styloid process of the temporal bone

body of hyoid bone

Elevator muscles
Stylopharyngeus (CN IX)

Origin
styloid process of temporal bone

Insertion

Action

posterior and elevates the pharynx and superior borders of larynx and expands the thyroid cartilage with sides of the pharynx palatopharyngeus muscle blends with palatopharyngeus muscle elevates the pharynx and larynx and opens the orifice of the auditory tube during swallowing

Salpingopharyngeus cartilaginous (pharyngeal plexus) part of the

auditory tube

Palatopharyngeus

hard palate and palatine aponeurosis

lateral wall of pharynx

tenses the soft palate and pulls the walls of the pharynx superiorly, anteriorly and medially during swallowing

Muscles Controlling the Laryngeal Inlet

Intrinsic Muscles Interarytenoid m., oblique (RLN) Thyroepiglottic (ELN) Origin Insertion Action
draws arytenoid cartilages together, adducting the vocal folds (closure of glottis)
draws the epiglottic cartilage downward

muscular process posterior surface of of the arytenoid the contralateral cartilage arytenoid cartilage, near its apex
inner surface of the thyroid lateral surface of the epiglottic cartilage near the laryngeal cartilage prominence

Muscles Controlling Movements of the Vocal Cords

Intrinsic Muscles Origin Insertion Action

Cricothyroid (ELN)

arch of the cricoid inferior border of the draws the thyroid cartilage thyroid cartilage cartilage forward, lengthening the vocal ligaments, tenses vocal cords inner surface of the lateral border of the thyroid cartilage arytenoid cartilage relaxes and adducts the vocal folds

Thyroarytenoid (vocalis, ILN) Lateral cricoarytenoid (ILN)

arch of the cricoid muscular process of Adducts the vocal cartilage the arytenoid cartilage cords by rotating the arytenoid cartilage

Muscles Controlling Movements of the Vocal Cords

Intrinsic Muscles
Posterior cricoarytenoid (ILN) Interarytenoid m., transverse (ILN)

Origin

Insertion

Action

posterior surface of muscular process of Adducts the vocal the lamina of the the arytenoid cartilage cords by rotating the cricoid cartilage arytenoid cartilage

posterior surface of posterior surface of the arytenoid the contralateral cartilage arytenoid cartilage

Closes posterior part of rima glottidis by approximating arytenoid cartilages

Mucous Membrane
Stratified squamous epith.: over vocal cords and upper

part of vestibule of larynx Ciliated columnar epith.: remainder of the cavity Mucous glands:
Ventricles and sacculi Posterior surface of epiglottis Margins of aryepiglottic folds

Reinkes layer of connective tissue: No glands and no

lymph vessels

Nerve Supply
Supplied by Vagus nerve: Superior laryngeal n.

Internal branch (sensory) areas above the glottis External branch (motor and sensory) Motor Cricothyroid muscle Sensory Anterior infraglottic larynx at level of cricothyroid membrane Motor all intrinsic laryngeal muscles of SAME side (except cricothyroid) and interarytenoid muscle of BOTH sides Sensory areas below the glottis

Inferior (recurrent) laryngeal n.

Blood Supply
Upper Larynx External carotid artery Superior thyroid artery Superior laryngeal artery Lower Larynx Subclavian artery Thyrocervical artery Inferior thyroid artery Inferior laryngeal artery

Venouos Drainage
Upper Larynx Superior laryngeal vein Superior thyroid vein Internal jugular vein Lower Larynx Inferior laryngeal vein Inferior thyroid vein Innominate vein

Lymphatic Drainage
Main: Deep Cervical group L.N.
Supraglottic area

98%: Pedicle Ant. End of aryepiglottic fold -> pass laterally and leave the larynx through the thyrohyoid membrane ->Upper deep cervical nodes (bet. Digastric tendon and omohyoid muscle) 2%: Lower cervical chain or spinal accessory chain

Lymphatic Drainage
Infraglottic area 3 pedicles

1. Anterior pedicle -> cricothyroid membrane -> prelaryngeal (Delphian) nodes ->deep inferior cervical nodes 2. 2 Posterolateral pedicles -> cricotracheal membrane -> paratracheal chain/others to inferior jugular chain

Basic Functions
Protection
Respiration Phonation

Fixation of chest
Closure of glottis

Protection
Acts as a sphincter Closure of the laryngeal inlet Closure of the glottis Cessation of respiration Cough relfex, expulsion of secretions and foreign bodies

Protection
3 Sphincteric tiers of airway protection: Contraction of superior division of the thyroarytenoid muscles Contraction of middle thyroarytenoid fibers Contraction of inferior division of thyroarytenoid

Respiration
Assists in regulation of gaseous exchange with the

lung and maintenance in acid-base balance Glottis opens a fraction of a second before air is drawn in by descent of the diaphragm Posterior cricoarytenoids
Phasic inspiratory abduction Synchronous w/respiration

Cricothyroid muscle Phasic inspiratory contraction/adduction Increases AP diameter of glottic chink

Phonation
Voice produced by

vibration of the vocal cords Fundamental tone produced at the larynx Modified by resonating chambers of the upper aerodigestive tract

Phonation
Cricothyroid muscles Position the vocal cords near the midline Lengthens true cords as pitch increases Thyroarytenoid muscles Provide finer isometric modifications Increases internal tension of true cord, producing cord thinning

Afferent System
Greatest in the laryngeal inlet, especially the laryngeal

surface of the epiglottis serves as a protective function of the lower respiratory tract

Efferent System
Superior Laryngeal n. Innervates cricothyroid Recurrent Laryngeal n. Innervates all muscles EXCEPT cricothyroid Bilateral innervation to interarytenoid muscles Posterior Cricoarytenoid Innervated by inferior laryngeal nerve Sole abductor Thyroarytenoid and Lateral cricoarytenoid Major adductors Interarytenoid muscles Close the posterior gap in the glottis

Laryngeal Voice Production

Myoelastic-Aerodynamic Theory Laryngeal muscles position VC ->Muscular and passive forces of exhalation-> Increase subglottic pressure-> Exceeds muscular opposition -> Glottic chink forced open -> Release of air -> Decreased subglottic pressure > VC approximation Myoelastic forces of vocal cords exceed the aerodynamic forces, enhanced by Bernouillis effect Resulting waveform: sawtooth type; relaxation oscillator

Laryngeal Voice Production

Neuromuscular or Neurochronaxic Theory Suggested that each new vibratory cycle is initiated by central neuronal impulses via the vagus nerve to the appropriate laryngeal muscles Rate of impulses delivered to larynx = frequency of vocal cord vibration Disproved by physiologic and audiometric analysis

Components of Vocal Mechanism

Activator Energy produced by expiratory phase of breathing apparatus Generator Glottis vibrates at different frequencies Resonator Sound modulation occurring in resonating chambers Articulators Precise movements of palate, tongue, teeth, and lips

Thank You