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Neuro Exam 3: Anatomy > Anatomy: Larynx > Flashcards

Anatomy: Larynx Flashcards

1
Q

general features of larynx?

A

serves both respiratory and phonation fns.

- connects pharynx to trachea, acts to prevent passage of food materials into airways

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2
Q

where is larynx located?

A

anterior to CV3-CV6

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3
Q

laryngeal aditus

A

= “laryngeal inlet”

  • superior opening from the pharynx
  • triangular shaped
  • directly above the laryngeal ventricles
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4
Q

vestibule

A
  • the area making up the laryngeal aditus that is directly superior to the vestibular folds
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5
Q

vestibular “false” folds

A

folds located directly inferior of the vestibule, and superior to the laryngeal ventricle

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6
Q

laryngeal ventricle

A

area between vestibular and vocal folds

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7
Q

true vocal folds

A
  • area underneath the laryngeal ventricle and superior to the infraglottic space
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8
Q

rima glottidis

A

= opening between the true vocal folds

  • shape varies depending on position of vocal folds
  • variation in tension and length of the vocal folds and width of rima produces changes in pitch of the voice
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9
Q

glottis

A

= rima glottidis plus vocal folds

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10
Q

infraglottic cavity

A

area below the true vocal folds

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11
Q

where is cricoid cartilage? anatomical relationships?

A

CV6

  • site where carotid artery can be compressed against CV6
  • junction of larynx and trachea
  • jn. of pharynx and esophagus
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12
Q

tracheotomy

A

obstruction of the upper airway –> pucturing the larynx or trachea

  • incision is made between cricoid cartilage and first tracheal cartilages
  • incision can also be made between the cricoid and thyroid cartilages (through cricothyroid ligament)
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13
Q

thyroid cartilage

A

lies anterior to CV4,5

  • features 2 side laminae that are fused anteriorly and remain open posteriorly
  • superior horn: attached to hyoid bone by lateral thyrohyoid ligament
  • inferior horn: articulates with cricoid cartilage
  • laryngeal prominence = “adams apple”
  • superior thyroid notch = superior to laryngeal prominence
  • oblique line
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14
Q

cricoid cartilage

A
  • lies anterior to CV6
  • it is an IMMOVABLE ring that is attached via membrane to first tracheal cartilage
  • anterior arch
  • posterior lamina
  • facets for articulation with arytenoid and thyroid cartilages
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15
Q

arytenoid cartilage

A
  • x2 of them
  • lie perched atop posterior portion of cricoid cartilage
  • apex: attaches to aryepiglottic fold
  • vocal processes: attach to vocal ligament
  • muscular processes: attach to posterior and lateral cricoarytenoid mm.
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16
Q

epiglottic cartilage

A

x1

  • leaf shaped, elastic cartilage that is situated posterior to the root of the tongue
  • broad superior end is free
  • inferior end attached to thyroid cartilage
  • muscles of pharynx pull the thyroid cartilage against the epiglottis during swallowing to prevent food from moving into the larynx
  • Ligaments: thyroepiglottic, hyoepiglottic, aryepiglottic, glossoepiglottic ligaments
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17
Q

corniculate cartilage

A

lies atop the apex of arytenoid cartilages

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18
Q

cuneiform cartilage

A

lies within aryepiglottic folds

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19
Q

what is the only fixed cartilage?

A

cricoid cartilage

- all others will move on this

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20
Q

vestibular fold

A

see from ppt.

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21
Q

quadrangular ligament? what two folds does it form? where does it attach?

A

intrinsic ligament

  • attaches anteriorly to thyroid/epiglottic cartilages, attaches posteriorly to arytenoid cartilage.
  • forms vestibular ligaments: covered with mucosa = vestibular fold
  • forms aryepiglottic ligament: covered with mucosa = aryepiglottic fold
22
Q

cricovocal ligament? attaches? what are its thickened regions?

A

aka “conus elasticus”

  • attaches cricoid cartilage to thyroid/arytenoid cartilages
  • contains thickened regions:
    1. median cricothyroid ligament
    2. lateral cricothyroid ligament
    3. vocal ligament = vocal fold when covered with mucosa (extends from internal surface of thyrooid lamina to vocal process of arytenoid)
23
Q

Vocal folds

A

formed from mucosa overlying the vocal ligament and vocalis muscle

  • vocal ligament = innermost portion of cricovocal ligament; extends from thyroid cartilage to vocal process of arytenoid cartilage
  • vocalis muscle = innermost portion of thyroarytenoid muscle
  • vocal ligaments change tension/length in order to control pitch of voice
24
Q

Vestibular folds

A

formed from mucosa overlying vestibular ligament

- covered with highly vascularized mucosa; contains many mucus secreting glands

25
Q

vestibular fold = ?

A

mucosa + vestibular ligament (lower part of quad membrane)

26
Q

vocal fold = ?

A

mucosa + vocal ligament (upper part of cricovocal membrane)

27
Q

ventricle = ?

A

sacculation created in wall of larynx between quadrangular membrane and cricovocal membrane

28
Q

cricothyroid joint

A

articulation between cricoid cartilage and inferior horn of thyroid

  • synovial - gliding movment
  • allows thyroid to glide on cricoid in order to change vocal cord length
  • ** allows for pitch of speech to be changed
29
Q

cricoarytenoid joint

A

articulation b/w cricoid and arytenoid cartilage

  • synovial- gliding and rotational mvmts
  • allows arytenoid to rotate and glide towards one another
30
Q

what are the primary movments of the laryngeal cartilages?

A
  • rotation of arytenoids to abduct/adduct vocal ligaments
  • gliding of arytenoids to adduct vocal ligaments and close rima glottis
  • rotation of thyroid cartilage to increase and decrease length and tension of vocal ligaments
31
Q

rotation of arytenoid cartilages?

A
  • rotation of arytenoid to abduct (posterior cricoarytenoid) and adduct (lateral cricoarytenoid) vocal ligaments
32
Q

gliding of arytenoid cartilages?

A

adduct vocal ligaments (close rimar glottitis) via the (transverse and oblique artenoids)

33
Q

rotating of thyroid cartilage on cricothyroid joint?

A

increased tension of vocal ligaments (cricothyroid m)

decreased tension of vocal ligaments (thyroarytenoid m.)

34
Q

cricothyroid muscle

A
  • Attaches to cricoid anteriorly
  • Inserts into thyroid posteriorly
  • Tilts thyroid forward to elongate and tense vocal ligaments.
  • Innervation = External laryngeal branch of superior laryngeal nn (**only laryngeal muscle not innervated by recurrent laryngeal n)
35
Q

transverse and oblique arytenoids

A
  • Extend from arytenoid to arytenoid
  • Adduct arytenoid cartilages
  • Close laryngeal inlet by approximating the arytenoid cartilages
  • Innervation = recurrent laryngeal n
36
Q

thyroarytenoid mm. (“vocalis”)

A

rotates thyroid cartilage back to shorten and loose the vocal ligament

37
Q

posterior cricoarytenoid

A
  • Attach to posterior cricoid
  • Insert at muscular process of arytenoid
  • Abduct vocal folds
  • Innervation – recurrent laryngeal n
    (opens rima glottidis)
38
Q

lateral cricoarytenoid

A
  • Attach to lateral cricoid
  • Insert at muscular process of arytenoid
  • Adduct vocal folds
  • Innervation – recurrent laryngeal n

(closes rima glottidis)

39
Q

vocalis muscle

A

innermost portion of thyroarytenoid m.
lateral to vocal ligament

  • Attach to thyroid anteriorly
  • Insert along anterior surface of arytenoid
  • Tilt thyroid posteriorly to shorten vocal ligaments
  • Vocalis mm fine tunes tension on vocal ligament
  • Innervation – recurrent laryngeal n
40
Q

what are all but one of the vocal muscles innervated by? which one is different?

A

recurrent laryngeal n (becomes inferior laryngeal n. in larynx)

  • cricothyroid is the ONLY muscle innervated by external branch of superior laryngeal n.
41
Q

internal branch of superior laryngeal n innervation?

A 
CN X
- pierces thyrohyoid membrane
- provides: 
GVE-P and VGA proximal to true vocal folds
SVA to epiglottic region of tongue
42
Q

what does external laryngeal branch of superior laryngeal n. provide?

A

CN X

SVE to cricothyroid muscle

43
Q

cough reflex

A

mediated by CN X in order to prevent food from entering airways
- when food gets in larynx, the superior laryngeal n. is stimulated (GVA) and causes contraction of laryngeal muscles which close the larynx.
- Vagus n. will stimulate a cough in order to force air out of larynx
- injury to superior laryngeal n. will ablate this fn (can be due to anesthesia of laryngeal mucosa
“in by X, out by X”

44
Q

superior laryngeal n. lesion

A

will result in loss of cough reflex, due to loss of sensation to supraglottic region
- the cricothyroid m. will also be paralyzed which often causes a monotonous voice

45
Q

superior laryngeal n. block

A

administered when inserting and endotracheal tube. the needle is inserted halfway between the hyoid and superior border of thyroid. neede pierces the thyrohyoid membrane

46
Q

lesion of recurrent laryngeal n.

A
  • can occur with neck or thoracic damage/surgery
  • the left recurrent laryngeal n. branches in the thorax (can be damaged via aortic aneurysms, tumors, enlarged lymph nodes in thorax)
    unilateral = raspy voice (hoarseness)
    bilateral = complete voice loss (aphonia)
47
Q

inferior laryngeal n.

A

= recurrent laryngeal n (CN X)

  • enters larynx by passing inferior to inferior constrictor m.
  • provides:
    1. GVE-P and GVA distal to true vocal folds (infraglottic region)
    2. SVE to all muscles of larynx, except cricothyroid
48
Q

3 arterial supplies to larynx?

A
  1. superior laryngeal a: branch of superior thyroid artery, pierces thyrohyoid membrane, supplies larynx above true vocal folds
  2. cricothyroid artery: branch of superior thyroid artery; supplies cricothyroid muscle
  3. inferior laryngeal a: branch of inferior thyroid artery, supplies larynx below true vocal folds
49
Q

venous supply of larynx?

A

superior laryngeal vein –> IJV

inferior laryngeal vein –> left brachiocephalic v.

50
Q

lymphatic drainage of larynx?

A
  • proximal (above) true vocal folds –> superior deep cervical lymph nodes
  • distal/below true vocal folds –> inferior deep cervical lymph nodes

Neuro Exam 3: Anatomy (12 decks)

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