Laryngeal Anatomy Flashcards by Melissa Kurrle

VF layers

5 layer scheme**

Epithelium
1. very thin
Superficial Layer (superficial lamina propria)
1. aka Reinke’s Space
Intermediate layer
Deep layer
Muscle

medial portion of the thyrarytenoid
Epithelium, superior and intermediate lamina propria have elastin fibers=stretching/recoil=movement
Deep lamina propria has collagen fibers=prohibits stretching
muscle=least compliant

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VF Layers

3 layer scheme

Mucosa
Ligament
Muscle

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VF Layers

2 layer scheme

Cover
Body

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Chart of how the 2/3/5 VF layer schemes align

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What are the dimensions of the inlet of the larynx?

top plane/upper rim of the laryngeal vestibule
aryeppiglotic fold to top of arytenoids to other aryeppiglotic fold and across top of eppiglottis

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What is the laryngeal vestibule?

Area of air space in larynx
Inlet to quadrangular membrane on both sides to true VFs

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What is the Rima vestibule and where is it located?

part of the larynx
plane from medial edge of ventrical fold, attaches to thyroid cartilage to other ventrical fold and along back around arytenoids

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What are the laryngeal ventricles?

Area of space between true and false VFs

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What are the instrinsic muscles of the larynx?

(5)

posterior cricoarytenoid (PCA)
lateral cricoartyenoid (LCA)
Interarytenoid (IA)
thyroarytenoid (TA)
cricothyroid (CT)

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Intrinsic Muscles of Larynx:

What nerve innervates them?

What do they connect?

What do they do to the VFs?

CN X
laryngeal cartilages to each other
adduction, abduction, tense, relax

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Posterior Cricoarytenoid:

Attachments

Movement

Function

Attachments: muscular process of arytenoids to P cricoid lamina

Movement: Pulls muscular process posteriorly and rocks arytenoid away from midline

Function: Abduction of FF

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Lateral Cricoarytenoids:

Attachments

Movement

Function

Attachments: Superior lateral surface of cricoid to muscular process of arytenoids

Movement: Draws muscular process forward and rocks arytenoids in and down toward midline

Function: ADduction

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Transverse Arytenoids:

Attachments

Movement

Function

Important for

Attachments: Unpaired muscle spanning from posterior surface of 1 arytenoid to posterior surfaceof the other

Movement: Pulls arytenoids closer to midline

Function: ADduction of VFs

Important for: medial compression

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Oblique Arytenoids

Attachments

Movement

Function

Attachments: runs from P base of 1 arytenoid to tip of the opposite arytenoid

Movement: pulls arytenoids closer to midline

Function: ADDuction of VFs

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Cricothyroid:

What are the parts?

Attachments

Movement

Function

Pars recta

Attachments: A surface of cricoid to lower edge of thyroid cartilage on the same side

Movement: rocks thyroid cartilage downward

Function: elongates the VFs

Pars oblique

Attachments: cricoid cartilage just lateral to pars recta up to thyroid lamina by the inferior horn

Movement: slides the thyroid cartilage forward

Function: tenses/elongates the VF

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Thyroarytenoid

What parts?

Attachments

Movement

Function

Thyrovocalis attachments: most medial muscle portion of true VF, runs from thyroid cartilage to vocal process of arytenoid

Thyromuscularis attachments: lateral to the thyrovocalis

Movement:

1) shortens the VFs (if less/no CT contraction) by drawing arytenoids toward A thyroid; loosens the VF cover and increase the mass per unit length
2) increased tension of VF when balanced by CT contraction

Function: Shorten VFs (if no CT contraction), increase tension VFs (with CT contraction)

Extrinsic muscles of the larynx

Suprahyoids

What is the purpose and what are some of the main ones

Many are important for swallowing
Elevates larynx and does an anterior pull and rocking of larynx which may elevate pitch

Muscles:

digastrics (A [CN V] and P [CN VIII]
stylohyoid [CN VIII]
mylohyoid [CN V]
geniohyoid [CN XII]
etc

Extrinsic muscles of the larynx

Infrahyoids

What is the purpose and what are some of the main ones

laryngeal depressors

sternohyid [ansa cervicalis]
omohyoid [ansa cerv]
sternothyroid [C1-2]
thyrohyoid [C1]

What muscles ABduct the VFs

PCA

What muscles ADDuct the VFs?

LCA

Transverse arytenoids (IA)

Oblique arytenoids (IA)

What muscles tense/elongate the VFs

CT (pars recta: e, pars oblqiue: t/e)

Thyroarytenoid if the CT is contracted as well

What muscles shorten the VFs

Thyroartenoid (if less/no CT contraction)-loosens the VF cover and increases mass per unit length

Innervation

PNS

Intrinsic laryngeal muscles controlled by which nerve?

What are its branches?

CN X

Branches: superior laryngeal nerve and recurrent laryngeal nerve

Is the superior laryngeal nerve branch of CN X motory, sensory, or both?

What does it innvervate?

Both

Motor: to cricothyroid

Sensory: all tissue above true VF

Is the recurrent laryngeal nerve branch of CN X motory, sensory, or both? What does it innvervate?

Both Motor: all other intrinsic muscles except CT Sebesory: tissue from the true VF into trachea

What is the course of the recurrent laryngeal nerve branches of CN X?

Left RLN: course down the neck, underneath the aorta, and ascends back up to the larynx (i.e., it recurs inthe neck) Right RLN: courses down neck, underneath subclavian artery, and ascends back up to larynx

What is the membranous glottis vs the cartilagenous glottis

Membranous glottis: * the "free margin" * 3/5 length of glottis from anterior commisure to tip of vocal process of arytenoid * portion involves in VF vibration Cartilagenous glottis: * P 2/5 of glottis * not part of VF vibration

VF layers info 5 layer

1. Epithelium 1. Epithelium very thin 2. Superficial Layer (superficial lamina propria) 1. aka Reinke's Space 3. Intermediate layer 4. Deep layer 5. Muscle * medial portion of the thyrarytenoid * Epithelium, superior and intermediate lamina propria have elastin fibers=stretching/recoil=movement * Deep lamina propria has collagen fibers=prohibits stretching * muscle=least compliant

Laryngeal Anatomy: Cartilages (7)

1. cricoid 2. thyroid 3. hyoid 4. arytenoids 5. corniculate 6. cuniform 7. epiglottis

Laryngeal anatomy: Membranes, linings, ligaments (3)

1. Quandrangular membrane + aryepiglottic folds 2. thyroid membrane 3. VF ligaments

Laryngeal Anatomy: Spaces (4)

1. laryngeal vestibule 2. Rima vestibule 3. laryngeal ventricles 4. glottis (membranous and cartilagenous)

Intrinsic Muscles of Larynx (6)

1. PCA 2. LCA 3. TrA 4. OA 5. CT 6. TA

What do suprahyoid extrinsic laryngeal muscles do? Infrahyoids?

Suprahyoids=laryngeal elevators Infrahyoids=laryngeal depressors

Innervation: CNS

Brainstem, cerebellum, BG, coretex all invovled

Innervation: PNS Instrinsic muscles controlled by which nerve? What are the 2 branches and what do they innervate?

CN X Vagus 1. Superior laryngeal nerve * Motor: to CT * Sensory: all tissue above true VFs 2. Recurrent laryngeal nerve * Motor: all intrinsic muscles except CT * Sensory: all tissue below true VFs to trachea 1. Left: goes under aorta and back up to larynx 2. Right: goes under subclavian artery and back up to larynx

How do you start phonation?

1. Get air in: * use diaphragm (prime) and intercostals to create larger thoracic space (may use accessory muscles if more air is needed), decrease in air pressure relative to outside of body, air rushes in to equalize pressure) 2. Get air out * Relaxation forces (gravity, elastic recoil, torque) + muscular checking of relaxation forces so we don't loose too much air at once. May have to actively engage expiratory muscles to push thoracic cavity past its normal resting place to sustain the sound 3. Obstruct airflow * Use LCA, CT, and TA to bring VFs together, subglottal air pressure builds until enough force is created to push VFs apart

What makes up the upper respiratory tract? The lower respiratory tract?

* URT: nasal cavity, oral cavity, pharynx, larynx * LRT: trachea, lungs