12 - Larynx Flashcards
The larynx is a hollow
musculoligamentous structure with a cartilaginous framework, capping the lower respiratory tract.
The larynx is both a valve (or sphincter)
to close the lower respiratory tract, and an instrument to produce sound.
We will see that the larynx is suspended from the
hyoid bone superiorly and attached to the trachea inferiorly by membranes and ligaments.
The pharynx is a
musculofascial half-cylinder that links the oral and nasal cavities in the head to the larynx and esophagus in the neck. The pharyngeal cavity is common for the respiratory tract and digestive tract.
The pharynx is the
common entry to the digestive and respiratory tracts, two systems that connect directly with the external environment and allow direct access the our internal environment.
Thyroid Cartilage: 2 lamina unite
anteriorly, forming a Single cartilage
Thyroid Cartilage: Superior thyroid notch sits
superior to the laryngeal prominence. This is a palpable landmark, as is the inferior thyroid notch.
Thyroid Cartilage: Stem of
epiglottic cartilage attaches posteriorly via the Thyro-epilgottic ligament
Thyroid Cartilage: Anterior ends of vocal ligaments converge
converge below epiglottis
Thyroid Cartilage: The oblique line, found on the lamina, is the attachment site for
extrinsic muscles of the larynx (sternothyroid, thyrohyoid, & inferior constrictor mm.)
Thyroid cartilage: Superior horn attaches
via the lateral thyrohyoid ligaments to the hyoid bone.
Thyroid cartilage: Inferior thyroid cartilage horns articulate with
cricoid cartilage (medial surface)
Thyroid cartilage lies
Lies between C4 & C6
Hyaline cartilage
Corniculate Cartilage
Paired, minor cartilage
Small horn-shaped cartilages
Corniculate cartilage: Rest on apices of
of arytenoid cartilages
Corniculate cartilage: Lie in
aryepiglottic fold
Corniculate cartilage: consists of
Elastic cartilage
Triticeal Cartilage: is a
Paired, minor cartilage
Triticeal Cartilage: consists of
Small rounded cartilages
Triticeal Cartilage: Lie in
posterior fold of thyrohyoid membrane = lateral thyrohyoid ligament
Triticeal Cartilage: these are
not always present
Cricothyroid Joints - Synovial joints between
cricoid & thyroid cartilages
Cricothyroid Joints - Held together by
cricothyroid ligaments
Cricothyroid Joints - Anterior movement & tilting of
thyroid cartilage
Cricothyroid Joints - Inferior laryngeal nn. run just
posterior to joints
Larynx: Internal Spaces: Aditus –
superior opening (inlet)
Larynx: Internal Spaces: Vestibule –
area superior to vestibular folds (false vocal cords)
Larynx: Internal Spaces: Ventricle –
area between vestibular folds & vocal folds
Larynx: Internal Spaces: Infraglottic cavity
– area inferior to vocal folds (true vocal cords)
Rima = space between
Vocal cords
the two folds R & L of the same pair
Forced inspiration:
Vocal cords
Vocal folds abducted and rima glottidus wide open
vestibule open
Vocal cords
Phonation:
vocal folds adducted and stridulating as air is forced between them
vestibule open
Vocal cords
effort (forced) closure
vocal folds and vestibular folds adducted
Rima glottidus and vestibule closed.
Food, etc. may enter
aditus & lodge in vestibule
Blockage may seal off
larynx & produce muscle spasms
Vocal cords then close – no air passes
Death results in ~5 min. if
larynx not opened
Vocalis and thyroarytenoid muscles action
shortening/relaxation of vocal ligaments
Laryngospasm: Posterior cryoarytenoid mm. vital in
maintaining open airway
Laryngospasm: Laryngospasm is
spasmodic closure of glottis
Laryngospasm: Life-threatening as breathing becomes
impossible
Laryngospasm: Spasm of laryngeal mm. may occur from
number of causes
Irritating chemicals, pharmaceutical side effects, etc.
Larynx: Arterial Supply: Superior Laryngeal a. – supplies
upper larynx
Larynx: Arterial Supply: Inferior Laryngeal a. – supplies
lower larynx
Superior Laryngeal a. – Br. of
Superior Thyroid a. (runs with Internal Laryngeal n.)
Inferior Laryngeal a. – br. of
Br. of Inferior Thyroid a. (runs with Inferior Laryngeal n.)
Superior thyroid a. branches to give
Superior laryngeal a. & Cricothyroid a.
Runs with the Internal Laryngeal n.
Inferior thyroid a. branches to give
inferior laryngeal a. (not shown here)
Runs with the Inferior Laryngeal n.
Larynx: Innervation (CN X): Superior Laryngeal n. –
gives rise to internal & external laryngeal nn.
Larynx: Innervation (CN X): Internal Laryngeal n. –
pierces thyrohyoid membrane
Larynx: Innervation (CN X): External Laryngeal n. –
runs superficial to cricothyroid m.
Larynx: Innervation (CN X): Recurrent Laryngeal n. –
descends to circle aorta or subclavian a. & then ascends to larynx
Larynx: Innervation (CN X): Inferior Laryngeal n. –
runs posterior to cricothyroid joint
injury to laryngeal nn.: Injury to Internal Laryngeal nn. – causes
sensory loss to superior larynx
may enable food to more easily enter larynx
injury to laryngeal nn. Injury to Inferior Laryngeal nn. – paralyzes
mm. ipsilateral, therefore paralysis of vocal fold ipsilateral
Paralysis of inferior laryngeal nn. leads to
Leads to hoarseness as vocal folds cannot meet in midline
Bilateral loss causes almost total loss of voice
thyroid cart stops at
superior/inferior horns
Thyroid cart type
hyaline cart
Thyroid cart oblique line attacment from
inferior p constrictor
Lamina is a big
flat surface
Signet ring shape
cricoid cart
Corniculate and cuneiform
elastic - involved with motion
Hyo epiglottic ligament is
firm enough, but very very mobile
Corniculate and cuneiform in
quadrangular membrane - have mucosa over them
Inferior border of quadrangular lig
vestibular lig
Cricothyroid joint affects
tension on ligaments - moved by cricothyroid muscles
Cricothyroid m innervated by
external laryngeal nerves
Lateral cricothyroid ligament thickened superiory to form
vocal cord
posterior cricoarytheniod
only muscle that opens airway - all intrinsic by inferior laryngeal, branch of recurrent laryngeal
Transverse and oblique arytenoid msucles
close rima glotidis, also closes epiglotis over inlet
Vocalis
contracts, loosening vocal cords
Inferior laryngeal - becomes this after passing
cricothyroid joint