GSM 2: Laryngeal Anatomy and Physiology Flashcards
the importance of knowing laryngeal anatomy
- allows us to more fully appreciate the nature of the normal and pathologic voice, therapy allowing for appropriate and effective management
- allows us to demonstrate a knowledge-base when working with other professionals in the management of vocal pathologies/voice disorders
constituent structures of the phonatory system
- cartilaginous structure of the larynx
- hyoid bone
- all the muscles and ligaments that bind the larynx together and move its constituent parts
larynx
funnel shaped structure that sits below the base of the top of the trachea
dimensions of the larynx
- larynx prevents things from getting into the trachea
- when larynx is removed, the first ring of the trachea and some muscles within the base of the tongue is also removed
- tongue mobility becomes impaired
tongue mobility becomes impaired meaning
- dysphagia
- clearing the sides of residue
- articulation (important when addressing speech)
primary function of larynx is not voice production, what is it?
biologic and the preservation of life
2 concepts as to why the larynx is involved in voice production
- overlaid explanation
- adaptive function of the larynx
overlaid explanation of the larynx
the primary function of the larynx is biologic, however, its anatomy and physiology make it uniquely suited for voice production
adaptive function of the larynx
the primary function of the larynx is biologic, however, over time its anatomy and physiology have been modified so that it is also capable of voice production
biologic functions of the larynx
- controls air flow during respiration
- protection of the airway from foreign bodies
- thoracic fixation/glottal effort closure reflex
larynx controls air flow during respiration
- if your vocal folds are abducted, air from environment flows freely in and out of respiratory system
- if your vocal folds are abducted, there is no free exchange of air
larynx protects of the airway from foreign bodies
- stage actors when smoke is being used
- someone is choking
- allergies
thoracic fixation/glottal effort closure reflex
- occurs when there are things weight bearing
- allows you to bear weight
- people who lost larynx may not be able to do weight bearing activities
steps in order during weight bearing activities
- brief inhale in
- vocal folds close
- air pressure builds up
- when you lift, your shoulder girdle and the muscles of your neck fixate around the larynx
larynx represents the point of division between
the throat area and the digestive system
food goes through the ___, and air goes through the ___
pharynx, larynx
posterior wall of the larynx is the anterior wall of the…
esophagus (clefts can occur along this wall)
cartilages of the larynx
- cricoid cartilage
- thyroid cartilage
- epiglottis
- arytenoid cartilages
- corniculate cartilages
- cuneiform cartilages
cricoid cartilage
- unpaired
- most inferior cartilage
- ring of cartilage
- narrower in the front, wider in the back
where is the cricoid cartilage?
sits directly atop the trachea
landmarks of the cricoid cartilage
- anterior cricoid arch
- posterior quadrate/cricoid lamina
- articular facets
posterior quadrate/cricoid lamina
2 of which are the point of union between the cricoid cartilage and the arytenoid cartilage
cricoarytenoid joint of the posterior quadrate/cricoid lamina
formed by the combination of the facets and the 2 facets on 1 side of the lamina
articular facets
2 that are the point of union between the thyroid cartilage and the arytenoid cartilage
cricothyroid joint of the articular facets
formed by the combination of the facets and the thyroid cartilage
thyroid cartilage
- unpaired
- largest cartilage of the larynx
- functions like a shield protecting the entrance to the respiratory system
landmarks of the thyroid cartilage
- thyroid lamina
- thyroid horns/cornu
thyroid lamina
sides of the thyroid cartilages
thyroid lamina consists of…
- thyroid angle
- thyroid notch
- thyroid/laryngeal prominence
- oblique line
thyroid angle of the thyroid lamina
formed by the sides of the thyroid cartilages coming together at midline
thyroid notch of the thyroid lamina
atop of the thyroid angle
thyroid/laryngeal prominence of the thyroid lamina
the part that sticks out
oblique line of the thyroid lamina
- raised area diagonally on each side
- serves as a point of muscle attachment
epiglottis
- unpaired
- leaf shaped cartilage
where is the epiglottis?
- extends from just above the vocal folds
- up through the hyoid bone
- to the base of the tongue
epiglottis has no function in ___, it functions in ___
voice, swallowing
arytenoid cartilages
- paired
- sit atop the cricoid cartilages and form the cricoarytenoid joint
processes of the arytenoid cartilage
- vocal process
- muscular process
vocal process of the arytenoid cartilages
- projecting anteriorly
- towards the thyroid cartilage
vocal process of the arytenoid cartilage serves as the ___ point of attachment for the ___ ___
posterior, vocal folds
embedded in the vocal process is the…
upper 3rd of the vocal folds
muscular process of the arytenoid cartilage
on the base of each arytenoid projecting outward
muscular process is the point of attachment for the…
muscles that open and close the vocal folds
corniculate cartilages
- paired
- small horn-like cartilages
where are the corniculate cartilages?
atop each arytenoid cartilage
function of the corniculate cartilages
help support the vocal folds
cuneiform cartilages
paired, if present
where are the cuneiform cartilages?
- located anterior and superior to the arytenoid cartilages embedded in the epiglottic folds
- membrane extends from the arytenoids to the sides of the epiglottis
- serve no purpose and are dissappearing
cricothyroid joint
formed by inferior horns of the thyroid cartilage attaching to the cricoid cartilage
synovial joint: which direction does it rock the thyroid cartilage?
downward
synovail joint, rocking: physiologically, it decreases the distance between the ___ and the ___
thyroid, cricoid
synovial joint, rocking: physiologically, it increases the distance between the ___ and the ___
thyroid, arytenoid
synovial joint: functions of the rocking motion
- lengthen vocal fold
- decrease vf mass
- increase vf tension
- primary tensor of the vfs
- responsible for production of higher pitches
synovial joint: which direction does it glide
forward
synovial joint, gliding: it increases the distance between the ___ and the ___
thyroid, cricoid
synovial joint, gliding: it decreases the distance between the ___ and the ___
thyroid, arytenoid
synovial joint, gliding function
reinforces the rock, so it also helps increase the pitch
synovial joint, both functions
both rocking and gliding happen simultaneously
cricoarytenoid joint
formed by the union of the arytenoid and the cricoid cartilages
rocking motion of the cricoarytenoid joint
- arytenoids rock down and inward closing the vocal folds
- arytenoids rock back and outward opening the vocal folds
gliding motion of the cricoarytenoid joint
- gliding backwards, the vocal folds stretch (reinforce increase in pitch)
- gliding forwards, the vocal folds compress against each other
these joints are subject to…
anything else that other joints in our body are subject to (can get arthritis)
hyoid bone
- the only bone in the body that is not attached in some manner to another bone
- junction between tongue and the larynx
landmarks of the hyoid bone
- corpus (front)
- greater horns/cornu
- lesser horns/cornu
greater horns/cornu of the hyoid bone
projecting posteriorly off the corpus
lesser horns/cornu of the hyoid bone
projecting superiorly
membranes/linings of the larynx
- extrinsic membranes/ligaments
- intrinsic membranes/ligaments
function of extrinsic ligaments
used to hold the larynx together, attach laryns to other structures
functions of intrinsic ligaments
- completely line the internal larynx, which helps hold all of the structures of the larynx together
- increases arodynamic nature of the internal larynx
extrinsic membranes/ligaments of the larynx
- cricotracheal ligament/membrane
- middle cricothyroid ligament
- thyrohyoid membranes
- lateral thyrohyoid ligament
- median/middle thyrohyoid ligament
cricotracheal ligament/membrane
attaches the cricoid, and by extension the larynx, to the trachea
middle cricothyroid ligament
attach the thyroid cartilage to the cricoid cartilage
thyrohyoid membranes
- paired
- attach the thyroid lamina to the greater horn
lateral thyrohyoid ligament
- triticial cartilage
- attach superior horn of the thyroid to the end of the greater horn of the hyoid
median/medial thyrohyoid ligament
attach the front of thyroid cartilage to the corpus of the hyoid
intrinsic membranes/ligaments of the larynx
fibroelastic membrane
fibroelastic membrane of the larynx consists of
- quadrangular membranes
- aryepiglottis muscle
- conus elasticus
course of the quandrangular membranes
inferior to the aryepiglottic membrane, runs from the sides of the arytenoids anteriorly to the sides of the epiglottis
function of the quadrangular membranes
form the ventricular/false vocal folds
course of the aryepiglottic muscle
runs from the tips of the arytenoids/corniculates anteriorly to attach to the sides of the epiglottis
course of the conus elasticus
- most inferior
- drape over the true vocal folds and then continue downward and line up the upper trachea
function of the conus elasticus
outer most layer of the true vocal folds
length of true vocal folds: males
17-20 mm
length of true vocal folds: females
12-15 mm
layers of the true vocal folds
- stratified squamous epithelium
- lamina propria
- mucosa
stratified squamous epithelium
- thinnest layer
- gives the vocal folds their pearly-white color
lamina propria
composed of 3 different layers, each of which has a different tissue structure
3 layers of the lamina propria
- superficial layer/Reinke’s space
- intermediate layer
- deep/innermost layer
superficial layer/Reinke’s space: function
- vibrates most markedly during phonation
- will become increasingly stiff in the presence of pathologies
disorder of the superifical layer of the lamina propria is called
Reinke’s edema
superficial layer of the lamina propria also has what zone?
basement membrane zone
basement membrane zone
- series of filaments that connect the outer and middle layer
- easily injured due to the vibratory and shearing forces of the vocal fold movement
intermediate layer of the lamina propria
denser and stiffer than the superficial layer
deep/innermost layer of the lamina propria
denser and stiffer than intermediate layer
mucosa of the true vocal folds
deep layer demonstrates the least activity of any layer during vocal folds vibration
the vocalis muscle __ __ __ delineated from the deep layer of the lamina propria
is not clearly
purpose of the body-model by Hirano
wave of disturbance across the mucosa that travels from medially to laterally
structures of the true vocal folds per the body-cover model
- cover
- transition
- body
cover of the true vocal folds per the body-cover model
- superior ficial layer
- epithelium
transition of the true vocal folds per the body-cover model
- intermediate layer
- deep layer
body of the true vocal folds per the body-cover model
thyroarytenoid muscle
the true vocal folds as multilayered vibrators
each layer is uniquely deformed by the outgoing airstream
mucosal wave
- travels across the mucosa from medial to lateral
- direction of mucosal wave movement
ventricular/false vocal folds: location
above and to the sides of the true vfs
false vfs: structural composition
mucous membrane draped over a ligament
because of the structural composition, it is difficult to regulate the ___, ___, and ___ of the false vfs
mass, length, tension
do the ventricular folds typically vibrate during normal phonation?
no, they do not vibrate during normal phonation
ventricular phonation
- false vfs move toward midline
- atypical and aberant
- sign of using a lot of muscle tension
is there a space between true and false vfs?
yes, there should always be that space
cavities of the larynx (superior to inferior)
- aditus
- vestibule
- ventricles/laryngeal sinus/ventricles of mogagni
- glottis/true glottis/rima glottis
aditus: location
entrance from pharynx to larynx
boundaries of the aditus
space surrounded by the hyoid bone
vestibule is also called
laryngopharyx
boundaries of the vestibule
space extending from the aditus to the top of the ventricular vfs
ventricles/laryngeal sinus/ventricles of mogagni: boundaries
space between false vfs and true vfs
ventricles/laryngeal sinus/ventricles of mogagni contains laryngeal succules which
produce and secrete mucous
___ is the vfs natural lubricant and is directly related to ___
mucous, hydration
glottis/true glottis/rima glottis: location
space between true vfs
glottis is a ___ ___
variable sphincter
if open the glottis is
larger
if phonating, the glottis is
small
2 divisions of the glottis
- cartilagenous glottis
- membranous glottis
cartilagenous glottis: size
posterior 2/5ths of the glottal space
cartilagenous glottis: function during voice production
where the cartilagenous portion of the vfs are
membranous glottis: size
anterior 3/5ths of the glottal space
membranous glottis: function during voice production
portion bordered by membraneous vfs
