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Voice Disorders > A & P of Laryngeal System > Flashcards

A & P of Laryngeal System Flashcards

1
Q

framework of larynx

A

musculo-cartilaginous structure located at top of trachea
adjacent to C4-C6 vertebrae
44 mm in males
36 mm in females

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2
Q

inner larynx

A

constricted tube with smooth surface
cartilage connected by ligaments and membranes
lined with wet,smooth mucous membrane

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3
Q

extrinsic ligaments

A

provide attachment between hyoid or trachea and cartilage of larynx

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4
Q

intrinsic ligaments

A

connect cartilages within larynx and form support structure for cavity of larynx and VF

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5
Q

glottis

A

space between true VF

most important for speech; valving to phonate

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6
Q

cartilages of larynx

A 
3 unpaired:
cricoid
thyroid
epiglottis
3 paired:
arytenoids
corniculates
cuneiforms
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7
Q

cricoid cartilage

A

most inferior point of larynx - rests on trachea
ring-shaped
cricoid arch: low in front, allows VF to pass over
posterior quadrate lamina: point of arctic for arytenoids & thyroids

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8
Q

thyroid cartilage

A

largest laryngeal cartilage
anterior larynx
articulates with cricoid to allow it to rock back and forth
anterior point of attachment for VF
in posterior, inferior cornu artics with cricoid; superior cornu artics with hyoid

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9
Q

epiglottis

A

leaf-shaped
projects up beyond larynx and hyoid
protects larynx during swallowing
flops over larynx to divert food into esophagus

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10
Q

arytenoids

A

pyramid-shaped
sit on upper surface of cricoid
critical for normal phonation: provide attachment for VF & move them to midline

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11
Q

corniculates

A

sit on superior surface of arytenoids

prominent landmarks in aryepiglottic folds

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12
Q

cuneiforms

A

embedded in aryepiglottic folds above and anterior to corniculates

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13
Q

arytenoid landmarks

A

4 surfaces & 2 processes:
anterior surface: projects forward to form vocal process
lateral surface: surface for muscular process
medial surface: even surface for midline glottic closure
base: artics with cricoid
muscular process: attachment of LCA & PCA
vocal process: attachment of VF

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14
Q

hyoid bone

A

only bone in larynx
only bone in body that doesn’t artic with any other bone
U-shaped
link between tongue & larynx - extrinsic muscles attach via greater and lesser cornu and corpus

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15
Q

movement of the cartilages

A

cricothyroid joints: pitch adjustment

cricoarytenoid joints: VF abduction and adduction

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16
Q

structure of vocal folds

A

5 layers of tissue:

  1. epithelium
  2. superficial layer of lamina propria
  3. intermediate layer of lamina propria
  4. deep layer of lamina propria
  5. thyrovocalis muscle
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17
Q

epithelium

A

composed of nonkeratinizing stratified squamous epithelial cells (maintains hydration & protects during vibration)
most pliable layer of VF
glistening white appearance

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18
Q

Basement Membrane Zone (BMZ)

A

area between epithelium & SLLP
secures epithelium to lamina propria
most susceptible to injury due to vibration or shearing
leads to scars forming which may lead to nodules or benign tumor

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19
Q

Superficial Layer of Lamina Propria

A

elastin fibers in random orientation
can be extensively stretched during phonation
prone to swelling: Reinke’s Edema

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20
Q

Intermediate Layer of Lamina Propria

A

elastin fibers in A-P orientation

slightly less pliable than SLLP

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21
Q

Deep Layer of Lamina Propria

A

collagen fibers in A-P orientation

less elastic, provides more structure to VF

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22
Q

Thyroarytenoid Muscle (Vocalis Muscle)

A 
makes up bulk of VF
men: 17-21 mm
women: 11-15 mm
infants: 2.5-3 mm
only active portion of VF
moves to send other layers into vibration
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23
Q

Cover-Body Model

A

cover: epithelium + superficial layer of lamina propria
transition: intermediate + deep layers of lamina propria
body: vocalis muscle

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24
Q

intrinsic muscles of larynx

A

origins and insertions on laryngeal structures

responsible for: adduction, abduction, tensing, relaxing (fine movements)

25
Q

extrinsic muscles of larynx

A

one attachment on larynx and one outside
important for safe swallowing
big movements - elevation & depression of larynx

26
Q

rules about intrinsic laryngeal muscles

A
  1. All are paired EXCEPT transverse interarytenoid
  2. All are adductors EXCEPT posterior cricoarytenoid
  3. All are innervated by recurrent laryngeal nerve EXCEPT cricothyroid (superior laryngeal nerve)
27
Q

laryngeal adductors

A
  1. Lateral cricoarytenoid
  2. Transverse arytenoid
  3. Oblique arytenoid
28
Q

Lateral Cricoarytenoid (LCA)

A

origin: superior-lateral surface of cricoid
insertion: muscular process of arytenoid
function: adducts VF, increases medial compression

29
Q

Transverse Arytenoid (TA)

A

origin: lateral margin of posterior arytenoid
insertion: lateral margin of posterior surface of opposite arytenoid
function: adducts VF

30
Q

Oblique Arytenoid (OA)

A

origin: posterior base of muscular process
insertion; apex of opposite arytenoid
function: pulls apex medially
may be more important in swallowing or leftover from earlier in evolution

31
Q

laryngeal abductor

A

Posterior Cricoarytenoid (PCA)

origin: posterior cricoid lamina
insertion: posterior aspect of muscular process of arytenoid cartilage

32
Q

laryngeal tensors

A
  1. cricothyroid

2. thyrovocalis

33
Q

cricothyroid (CT)

A

pars recta
pars oblique
depresses thyroid in relation to cricoid & tenses VF

34
Q

thyrovocalis

A

tenses VF

35
Q

laryngeal relaxers

A
  1. Thyromuscularis

2. Superior Thyroarytenoid

36
Q

cortical areas involved in phonation

A
  1. Frontal lobe: movement
    - primary motor cortex (laryngeal/phonatory area)
    - premotor/supplementary areas
    - Broca’s
  2. Parietal lobe: sensory processing
  3. Temporal lobe: language processing
    - Wernicke’s
    - auditory cortex
    - auditory association area
37
Q

pyramidal tract

A

voluntary vocalization

  • sensory/motor cortexes, bilaterally
  • project via corticospinal corticobulbar pathways
38
Q

corticobulbar pathway

A

important for voice

  • CN V (trigeminal)
  • CN VII (facial)
  • CN X (vagus)
  • CN XII (hypoglossus)
39
Q

extrapyramidal tract

A

extends from cortex to brainstem or spinal cord via basal ganglia (inhibitory) & cerebellum

40
Q

cerebellum

A
  • integration and control over movement
  • background tone
  • feedback mechanism
41
Q

thalamus

A

integrating station between outgoing and incoming stimuli

42
Q

Periaqueductal Gray (PAG)

A
  • surrounds cerebral aqueduct
  • connected to many areas in cortex, medulla and pons, esp Nucleus retroambiguus (NRA)
  • coordinates breathing, laryngeal motor patterns
  • expression of emotion
  • damage to PAG = mutism or ventilator dependent
43
Q

Nucleus retroambiguus (NRA)

A

gives rise to cranial nerves

44
Q

Nucleus ambiguus (NA)

A
  • houses motor neurons of CN X
  • direct connection from cortex to NA unique in humans; allows for purposeful speech
  • motor pathway to limbic, PAG & NA: emotional vocalization (laughing, crying, screaming, coughing)
45
Q

CN X: Vagus

A

Innervates:

  • intrinsic muscles of larynx (except CT)
  • pharynx
  • palate
  • trachea
  • bronchi
  • lungs
  • heart
  • external ear
  • parts of GI tract
46
Q

superior laryngeal nerve

A

internal branch = sensory (upper larynx)
*important for swallowing
external branch = motor (CT muscle)

47
Q

recurrent laryngeal nerve

A

susceptible to injury from heart surgery, thyroid, lungs

48
Q

laryngeal reflexes

A 
Receptors in mucosa highly sensitive to:
-touch
-movement
-vibration
-changes in air pressure
-chemicals
React by initiating reflexive closure of larynx
Also aid in proprioceptive sense of larynx to control phonation.
49
Q

glottis

A

space between VF
anterior 3/5 is membranous
posterior 2/5 is cartilaginous
changes shape during breathing and phonation

50
Q

Myoelastic-Aerodynamic Theory of Phonation

A
  • describes one cycle of VF vibration as interaction of muscle forces, elastic recoil forces and aerodynamic forces
  • muscle forces = medial compression of LCA & IA that adduct VF
  • elastic recoil = VF displaced from adducted position
  • aerodynamics = positive & negative air pressures (positive opens glottis; negative closes it)
51
Q

Bernoulli Effect

A

when molecules flow thru a tube, pressures are constant. At point of constriction, speed of molecules increases and pressure decreases.

52
Q

Bernoulli Effect of Vocal Folds

A
  • air passing thru trachea
  • encounters constriction at VF
  • so molecules speed up
  • therefore air pressure drops
  • then VF sucked together
  • this conserves energy so muscles don’t have to continually contract and relax. muscles only have to initiate cycle by adducting; Bernoulli keeps them together.
53
Q

cycle of vibration

A 
one opening and one closing of glottis
"duty cycle"
sustained as long as there's sufficient medial compression: muscle action & Bernoulli
FO = rate of vibes/sec
men = 90-130 Hz
women = 180-230 Hz
kids = 250-300 Hz
infants = 500 Hz
54
Q

mucosal wave

A

vibration is very complex; rippling, wave-like motion
pliability of cover vs. stiffness of ligament/body
vertical phase difference: time lag between top and bottom of VF
longitudinal phase difference: time lag between posterior/anterior; zipper-like

55
Q

Phonation Threshold Pressure(PTP)

A 
amount of subglottic pressure required to blow apart VF
measured as cmH20
3-8 cmH20 minmum for normal convo
higher for higher pitch level
affected by hydration and fatigue
56
Q

changing pitch

A 
VF
-length
-density
-tension
Muscles involved synergistically
-CT: fine tunes FO
-TA: at loud and low FO
-Suprahyoid: aids higher FO
-Subhyoid: aids in lower FO
57
Q

Changing loudness

A

intensity measured in dB
interaction between respiration and laryngeal musculature
-degree of subglottal pressure
-fullness of medial compression
the greater the pressure, the higher the intensity

58
Q

vocal registers

A

particular range of vocal FO

  • Pulse (glottal fry): lowest register; 30-80 Hz; duty cycle = 90% closed/10% open
  • Falsetto (loft): highest; >300 Hz; duty cycle = never completely closed
  • Modal (middle):
  • male = 80-150 Hz
  • female = 170-230 Hz
  • child = 220-300 Hz

Voice Disorders (5 decks)

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