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ANATOMY AND

PHYSIOLOGY OF
THE LARYNX
JULIE G. CEBRIAN, M.D., FPSO-HNS

LARYNX

voice box
sits approximately at
the level of 5th cervical
vertebrae in the adult

LARYNX
Subdivisions of larynx

Supraglottis
Glottis
Subglottis

LARYNX
Subdivisions of larynx
False vocal cords
Mucosal folds located
superior to the glottis and
are separated from the
true vocal cords by the
ventricle

LARYNX
LARYNGEAL
FRAMEWORK
A. Bone
B. Cartilages 1. unpaired

- hyoid
- thyroid
cricoid
epiglottis

2. paired

- arytenoid
corniculate
cuneiform

LARYNX
LARYNGEAL
FRAMEWORK
EPIGLOTTIS
HYOID
CORNICULATE
ARYTENOID
THYROID
CRICOID

Anterior

Posterior

LARYNX
LARYNGEAL
FRAMEWORK
EPIGLOTTIS
HYOID
CORNICULATE
ARYTENOID
THYROID
CRICOID

Lateral

Posterior

LARYNX
LARYNGEAL
FRAMEWORK

Hyoid bone -It is attached to the epiglottis and strap muscles.

LARYNX
LARYNGEAL
FRAMEWORK

Thyroid Cartilage
Largest cartilage of the larynx.
Shield shape and acts as the anterior protective housing of the vocal
mechanism.
Has anterior attachment of the vocal folds and posterior articulation with
cricoid cartilage

LARYNX
LARYNGEAL
FRAMEWORK

Cricoid Cartilage

Signet ring shape


1 cm in height anteriorly
and almost 2 cm in height
posteriorly.
Thicker and stronger than
the thyroid cartilage and
forms the lower and
posterior parts of the wall
of the larynx.
Articulates with the thyroid
and arytenoid cartilages.

LARYNX
LARYNGEAL
FRAMEWORK
Epiglottis

Broad and leaf shaped


mucosal-covered
fibrocartilage.
Projects obliquely
upward behind the
tongue in front of the
entrance to the larynx.
Level of C5 in adults
and C3 in children.

LARYNX
LARYNGEAL
Arytenoid
Cartilage
FRAMEWORK

A pair of two cartilages


that are situated along
the posterior cricoid
and are attached to
the posterior ends of
the vocal folds.
Pyramidal in shape
and function to open
and close the cords

LARYNX
LARYNGEAL
FRAMEWORK
Corniculate
Cartilage

A pair of small conical


nodules, which articulate
with the arytenoids and
serve to prolong them
backwards and
medialward.
Located in the posterior
aryepiglottic folds and
are fused with the
arytenoids sometimes.

LARYNX
LARYNGEAL
FRAMEWORK
Cuneiform Cartilage

A pair of elongated
pieces of cartilage
placed on each side of
the aryepiglottic fold in
front of the arytenoids
cartilages.

LARYNX
LARYNGEAL
FRAMEWORK
( Supporting Structures )

A. Ligaments

Eg. Cricothyroid ligament


Thyrohyoid ligament
B. Elastic Tissues (Membranes)
1. Quadrangular membrane
2. Triangular membrane (Conus Elasticus)

LARYNX
LARYNGEAL
FRAMEWORK
( Supporting Structures )
Ligaments/Membranes
Thyrohyoid Membrane -It is a broad, fibro-elastic layer which
connects the thyroid cartilage to the hyoid bone. It facilitates the
upward movement of the larynx during deglutition.
Hyoepiglottic Ligament -It connects the epiglottis with the hyoid
bone.
Cricotracheal Ligament -It connects the cricoid with the first ring
of the trachea.
Cricothyroid Membrane -It connects the cricoid to the front parts
of the thyroid cartilage. It is mainly avascular.
Thyroepiglottic Ligament -It connects the stem of the epiglottis
with the angle of the thyroid cartilage.

LARYNX
LARYNGEAL
FRAMEWORK
( Supporting Structures )
Thyrohyoid Membrane
Hyoepiglottic Ligament
Thyroepiglottic Ligament
Cricothyroid Membrane
Cricotracheal Ligament

LARYNX
LARYNGEAL
FRAMEWORK
( Supporting Structures )

Elastic Tissues (Membranes)


1. Quadrangular membrane
2. Triangular membrane
(Conus Elasticus)

LARYNX
LARYNGEAL
musculature
A. Extrinsic Muscles

- Depressors
Elevators

B. Intrinsic Muscles

- Abductors
Adductors
Tensors

LARYNX
EXTRINSIC MUSCLES
OMOHYOID
STERNOHYOID
STERNOTHYROID
MYLOHYOID
GENIOHYOID
GENIOGLOSSUS
HYOGLOSSUS
DIGASTRIC
STYLOHYOID
* THYROHYOID *

LARYNX
INTRINSIC
MUSCLES
ABDUCTORS

Posterior
cricoarytenoid

ADDUCTORS

TENSORS

interarytenoid

Cricothyroid
(external)

Lateral cricoarytenoid

Vocalis (internal)

cricothyroid

thyroarytenoid

LARYNX
Intrinsic muscles
POSTERIOR CRICOARYTENOID
INTERARYTENOID
LATERAL CRICOARYTENOID
CRICOTHYROID
VOCALIS
THYROARYTENOID

SUPERIOR VIEW

LARYNX
Intrinsic muscles
OBLIQUE ARYTENOID
TRANSVERSE ARYTENOID
POSTERIOR
CRICOARYTENOID
OBLIQUE CRICOTHYROID

Posterior
View

TRANSVERSE
CRICOTHYROID

Lateral
View

LARYNX
INTRINSIC
MUSCLES

Posterior Cricoarytenoid
Arises from the posterior aspect of the
cricoid to the arytenoids.
Causes external rotation of the arytenoids,
which result in abduction of the cords. PCApull the cords apart.

LARYNX
ACTION OF THE posterior
cricoarytenoid muscles

LARYNX
INTRINSIC
MUSCLES

Interarytenoid
Single muscle which fills up the posterior
concave surfaces of the arytenoid
cartilages.
Aids in adduction.

LARYNX
ACTION OF THE interarytenoid
muscle

LARYNX
INTRINSIC
MUSCLES

Lateral Cricoarytenoid
Arises from the upper border of the cricoid
to the arytenoids.
Causes internal rotation of the arytenoids,
which result in adduction of the cords.
LCA-leave the cords alone.

LARYNX
ACTION OF THE lateral
cricoarytenoid muscles

LARYNX
INTRINSIC
MUSCLES

Cricothyroid Muscle
Arises from the front and lateral part of the
cricoid.
Has a triangular form and when is contracts
it causes the larynx to shift which in turn
causes cord stretch and tension.
Causes laryngospasm which is total and
profound glottic closure

LARYNX
ACTION OF THE cricothyroid
muscles

LARYNX
INTRINSIC
MUSCLES
Thyroarytenoid
Broad and thin muscle, which lies parallel with
and lateral to the vocal fold.
Helps with phonation, fine-tuning, and it relaxes
the cords
Vocalis
Lies parallel with the vocal ligament.
Also helps with phonation and fine-tuning and
works in opposition to the thyroarytenoid muscle
and tenses the cords.

LARYNX
ACTION OF THE vocalis and
thyroarytenoid muscles

LARYNX
innervation

Derived from the Vagus Nerve (CN-X)

Superior Laryngeal Nerve -It leaves the vagus


nerve high in the neck

Internal -It provides sensation of the glottis and


supraglottis, which includes the pharynx,
underside of the epiglottis and the larynx above
the cords. Remember: SIS-superior internal
sensory.
External -It supplies motor function to the
crycothyroid muscle which tenses the vocal cords
and could cause laryngopasm.

LARYNX
innervation
Derived from the Vagus Nerve (CN-X)

Recurrent Laryngeal Nerve

provides sensation to the subglottic area which includes the


larynx below the vocal cords and upper esophagus.
provides motor function to the intrinsic muscles of the larynx.
branches from the vagus in the mediastinum and turns back
up into the neck.
On the right, it travels inferior to the subclavian and loops
up, and on the left it travel inferior to the aorta and loops up.

LARYNX
innervation
SUPERIOR LARYNGEAL
NERVE
Internal Branch
External Branch
INFERIOR LARYNGEAL NERVE

RIGHT LATERAL
VIEW

THYROID CARTILAGE LAMINA REMOVED

LARYNX
innervation

The right recurrent laryngeal nerve circumflexes around the first part of the
right subclavian artery.

The left recurrent laryngeal nerve circumflexes around the aortic arch.

LARYNX
Blood supply
Superior Laryngeal Artery
supplies the internal laryngeal structures and it comes off
of the superior thyroid artery which comes from the
carotid
Inferior Laryngeal Artery
supplies the surrounding laryngeal structures and comes
off of the inferior thyroid artery which is from the
subclavian artery
Superior Thyroid Vein
joins the superior laryngeal artery which open into the
internal jugular vein
Inferior Thyroid Vein
joins the inferior laryngeal artery and opens into the
innominate vein.

LARYNX
Blood supply
Superior Thyroid Artery and Vein
Superior Laryngeal Artery and
Vein

Inferior Laryngeal Artery and


Vein

LARYNX
LYMPHATIC DRAINAGE
SUPERIOR
upper lymph nodes of the deep cervical
chain at the level of the hyoid bone
VOCAL CORD AREA
poor lymphatic supply
INFERIOR
pretracheal nodes (Delphian node)
lower deep cervical nodes
supraclavicular nodes
superior mediastinal nodes

LARYNX
Major functions
1.

Protection of airway

2.

Respiration

3.

Phonation

other functions
1.

Valsalva maneuver

2.

Central intrathoracic pressure

LARYNX
During inspection:

INSPIRATIO
N

PHONATIO
N

LARYNX
Protection of airway

Seen during the act of swallowing


> Closure of the vocal folds and vestibular folds
> Elevation of the larynx under the base of tongue
> Epiglottis and aryepiglottic folds diverts food laterally

LARYNX
rESPIRATION

inhibited during swallowing owing to the reflex


mediated by receptors present in the mucosa of
the supraglottic area

prevents inhalation of food or saliva

LARYNX
PHONATION

Most complex and best studied laryngeal function

Adducted vocal cords serves as passive reed that vibrates

Cricothyroid plays a major role in adjustment of the pitch

LARYNX
PHONATION

LARYNX
Valsalva maneuver

serves as a pressure valve that, when closed allows


the build-up of intrathoracic pressure necessary
for straining acts ( eg. defecation, lifting )

upon sudden release, produces cough

LARYNX
Central intrathoracic pressure

During respiration, the intrathoracic pressure is


controlled by varying the degree of closure of
the true vocal cords.

Modulation of pressure assists the cardiac system


as it affects pulmonary and cardiac filling and
emptying.

Thank you !