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Ent - Larynx > Clinical Anatomy Of Larynx Part 2 > Flashcards

Clinical Anatomy Of Larynx Part 2 Flashcards

1
Q

Division of larynx by true vocal cords

A

Above the level of true vocal cords - supraglottis
At the level of true vocal cords - glottis
Below the level of true vocal cords - sub glottis

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2
Q

What are the subsites of supraglottis ?

A

Epiglottis
Aryepiglottic fold
Arytenoid
Quadrangular membrane
False vocal cords
Vestibule
Ventricle

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3
Q

What is epilarynx ?

A

Epilarynx is the inlet of larynx ; formed by
Anterior - epiglottis
Laterally - Aryepiglottic fold
Posteriorly - arytenoids

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4
Q

What is the anterior and posterior commissure of true vocal cords ?

A

Anterior commissure is the point of attachment to the thyroid cartilage

Posterior commissure is the attachment of true vocal cords to the vocal process of arytenoid

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5
Q

What are the parts of true vocal cords ?

A

Cartilagenous part and membranous part

Anterior 2/3 rd - membranous and vibrates during talking

Posterior 1/3 rd - cartilagenous and is responsible for adduction and abduction of vocal cords

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6
Q

What is the point of maximum vibration of true vocal cords ?

A

Mid point of membranous part ; this point is most commonly affected due to vocal abuse , most common site of nodule or polyp of formation

Anterior 1/3 rd and posterior 2/3

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7
Q

What are the boundaries of glottis ?

A

Upper boundary - lower border of ventricle
Lower boundary - 1 cm below the true vocal cord’s edge

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8
Q

With what the anterior commissure of true vocal cords is attached to the thyroid cartilage ?

A

It is attached with the help of BROYLE ‘ S LIGAMENT also known and ANTERIOR COMMISSURE LIGAMENT

Purpose of this tendon is to limit the spread of carcinoma ; all the membrane of larynx prevent the spread of tumour from the larynx

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9
Q

What are the cavities of larynx ?

A

From above downwards :

Inlet / epilarynx
Vestibule
Rima vestibuli
Ventricle
Rima glottidis
Subglottis

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10
Q

What is saccule of larynx ?

A

The lining epithelium of false vocal cords is not just continuous over the true vocal cords but before lining the true vocal cords , the epithelium is forming a sac like structure called saccule that is having mucous glands in it

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11
Q

What the other name of saccule and purpose of saccule ?

A

Saccule is also called as oil can of larynx

The purpose of this saccule is to lubricate the true vocal cords as it is constantly rubbing against one another

This lubrication is essentially by the saccule as the true vocal cords are lined by non keratinised stratified squamous epithelium which doesn’t have mucus glands

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12
Q

What is the ventricle otherwise called as ?

A

Sinus of morgagni of larynx

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13
Q

What is laryngocoele?

A

Laryngocele is the enlargement of saccule

This enlargement occurs when the person blows down against a closed glottis (glottis are closed when the person speaks) and air doesn’t find way to move down hence enters the saccule causing it’s enlargement

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14
Q

In whom laryngocoele is commonly seen ?

A

Weight lifters
Trumpet blowers
Glassblowers
Tumours of ventricles

CAN ALSO BE SEEN CONGENITALLY

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15
Q

What are the types of laryngocele ?

A

Intrinsic
Extrinsic : pierces the Thyrohyoid membrane

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16
Q

Clinical features of laryngocele

A

Difficulty in breathing (due to obstruction of lumen of larynx)
Voice change (due to compression of vocal cords)

Infection leads to the formation of laryngopyocele

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17
Q

How to identify that a neck swelling is laryngocele ?

A

The size of the swelling increases on Valsalva manoeuvre

Bryce sign : sudden gush of hissing sound produced on compression

18
Q

Management of laryngocele

A

Excision - either externally or endoscopically

19
Q

What is the primary function of larynx ?

A

The earliest function of larynx is protection of airways

This protection is achieved with the help of three sphincters

Inlet / epilarynx - MOST EFFECTIVE SPHINCTER
False vocal cords - PREVENTS ASPIRATION
True vocal cords

20
Q

Pre epiglottic space is also known as

A

Space of BOYER

21
Q

Boundaries of pre-epiglottic / space of Boyer

A

Anteriorly - hyoid , Thyrohyoid ,thyroid
Posteriorly - epiglottis (infra hyoid part)
Superiorly - Hyoepiglottic ligament

22
Q

Contents of pre epiglottic space

A

Fats , LYMPHATICS ,vessels

Important route of spread of carcinoma of larynx

23
Q

Para epiglottic space is also known as

A

Space of tucker

24
Q

Boundaries of para-epiglottic / space of tucker

A

Anteriorly - communicates with the pre-epiglottic space
Posteriorly - pyriform fossa
Laterally - thyroid ala
Medially - quadrangular membrane , ventricle , cricovocal ‘ conus elasticus

25
Q

Contents of para - epiglottic space

A

Same as pre - epiglottic space

26
Q

What is reinke’s space ?

A

Space in the true vocal cords bounded by the vocal epithelium medially and vocal ligament laterally

27
Q

Boundaries of reinke’s space

A

Medially : vocal epithelium
Laterally : vocal ligament
Anteriorly : anterior commissure
Posterior : posterior commissure

Contents : loose areolar tissue

Significance : enables the free movement of vocal cords

28
Q

Lymphatic drainage of larynx

A

Supra glottis - richest supply of lymphatics

Glottis - no lymphatics

Sub glottis - some lymphatics

29
Q

Where does supra glottis drain into ?

A

Upper and middle deep cervical (part of lateral group of lymph nodes) - level 2 & 3

30
Q

Where does glottis drain into ?

A

Glottis do not have lymphatics

So there will be , no spread of carcinoma and reinke’s edema is seen in vocal cords as there are no lymphatics

31
Q

Where does subglottis drain into ?

A

Lower deep cervical and anterior group of lymph nodes (level 4 and 6)

Anterior group - pre tracheal /pre cricoid also known as DELPHIAN NODES

32
Q

On the whole larynx drains into what levels of lymph nodes?

A

Level 2 , 3 , 4 ,6

33
Q

Common anterior lesions

A

Nodules and polyp

34
Q

Common posterior lesion

A

Granuloma

35
Q

Position for direct laryngoscope

A

Boyle’s position : extension at atlanto-occipital joint and flexion at cervicothoracic joint

36
Q

What is stroboscope used for ?

A

To find the even the smallest lesion of vocal cords

Light appears in flashes

37
Q

Average anteroposterior diameter of larynx for male and female

A

Male : 36mm

Female : 26mm

38
Q

What makes it possible for the infant to breathe simultaneously while suckling the milk?

A

High larynx

39
Q

What are the hyaline and elastic cartilages of larynx ?

A

Hyaline : will undergo calcification between 25-65 yrs of age
Thyroid
Cricoid
Most of arytenoid

Elastic cartilage : will not undergo calcification
Epiglottis
Corniculate
Cuneiform
Tip of arytenoid

40
Q

Muscle of whispering

A

Lateral cricoarytenoid

41
Q

Why vocalis is called the modulater?

A

Anterior part of vocalis - tense the vocal cords
Posterior part of vocalis - relaxes the vocal cords

Ent - Larynx (7 decks)

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