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1. Anatomy - BLOCK 4 > Larynx > Flashcards

Larynx Flashcards

1
Q

Larynx:

Hollow musculoligamentous structure with a cartilaginous framework

  1. continuous inferiorly w…?
  2. opens superiorly into …?
A
  1. Continuous inferiorly w **trachea **
  2. opens superiorly into pharynx
    * (postero-inferior to tongue + oral cavity)*
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2
Q

name the following in the larynx:

  • 3 unpaired cartilages
  • 3 paired cartilages
A

3 unpaired cartilages:

  • thyroid
  • cricoid
  • epiglottis

3 paired cartilages:

  • arytenoid
  • corniculate
  • cuneiform
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3
Q

what is the function of membranes and ligaments in relation to the larynx?

A

suspend larynx from hyoid above + trachea below

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4
Q

what is the function of extrinsic muscles in relation to the larynx?

A

move larynx

facilitate **closing laryngeal inlet **during swallowing

facilitate opening esophagus during swallowing

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5
Q

Thyroid Cartilage

what is the usual thyroid angle?

Is it larger in males or females?

A

90-129 degrees

usually smaller in males –>acute angle –> more pronounced bump

(“adam’s apple” laryngeal prominence - just inferior to superior thyroid notch)

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6
Q

Name 3 extrinsic mm. that attach to the oblique line on the lateral surface of the thyroid cartilage laminae?

A

sternothyroid

thyrohyoid

inferior constrictor

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7
Q

Cricoid Cartilage

(facts - 3)

A
  1. Inferiormost laryngeal cartilage
  2. Broad lamina posterior, and narrow arch anterior to airway
  3. Shallow depressions on posterior surface for posterior crico-arytenoid m. attachment
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8
Q

Epiglottis:

  • attached to thyroid angle by what ligament?
  • projects in which direction?
A

thyro-epiglottic ligament

Projects postero-superiorly; upper margin projects superiorly behind the pharyngeal part of tongue

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9
Q

Arytenoid Cartilage:

  1. Name the muscle and ligament that attach to the antero-lateral surface.
  2. where does the vocal ligament attach?
  3. Which 2 muscles attach to the muscular process (lateral angle of base)?
A

1. Vocalis m. and vestibular ligament

2. vocal process (anterior angle of base)

3. Posterior + lateral crico-arytenoid mm.

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10
Q

Corniculate and Cuneiform Cartilages:

  1. what dose the corniculate cartilage attach to?
  2. What does the cuneiform cartilage attach to?
A
  1. corniculate = apex of arytenoid cartilage
  2. cuneiform = Suspended in quadrangular membrane (anterior to corniculate)
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11
Q

Thyrohyoid Membrane

  1. what are the attachment points?
  2. what passes through the opening? (3)
  3. The thick posterior border is the ______________ ligament?
  4. The thick anterior midline is the _______________ligament?
A
  1. Superior edge of thyroid cartilage <—> Superior edge of hyoid
  2. internal laryngeal n. + superior laryngeal a. + lymphatics
  3. = lateral thyrohyoid ligament
  4. = median thyrohyoid ligament
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12
Q

What ligament goes from:

1. anterior surface of epiglottis <–> posterior surface of hyoid

2. Lower border of cricoid <–> Upper border of 1st tracheal ring

A
  1. Hyo-epiglottic ligament
  2. Crico-tracheal ligament
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13
Q

Quadrangular Membrane:

  1. what are the points of attachment?
  2. Free lower margin is _________ ligament
  3. Free upper margin is ____________ fold
  4. What overlies the vestibular ligament?
  5. What separates the vestibular ligament/fold from the vocal ligament/fold?
A
  1. Epiglottis (lateral margin) <–> Arytenoid cartilage (A-L surface)
  2. vestibular ligament (Arytenoid cartilage <–> Thyroid cartilage)
  3. Aryepiglottic fold
  4. Vestibular fold (false vocal cords)
  5. Ventricle
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14
Q
  • *Cricothyroid Membrane:**
    1. Where is it located/attached?
    2. what is the lateral part called?
  1. Upper free margin of conus elasticus forms _____ ligament?
  2. what ligamant is b/t the thyroid cartilage (angle) <–> Arytenoid cartilage (vocal process)
  3. What covers the vocal ligament and vocalis m?
A
  1. Between arch of cricoid cartilage + space enclosed by thyroid cartilage
  2. Conus elasticus
  3. vocal ligament
  4. Vocal ligament
  5. Vocal fold (= true vocal cord)
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15
Q
  1. Vestibular ligament is ________ to vocal ligament (superior view)?
  2. They are sepatated by __________?
A
  1. lateral
  2. ventricle
    * *NOTE: true and false FOLDS are mucouse membranes covering their respective LIGAMENTS)*
    * true = vocal*
    * false = vestibular*
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16
Q
  1. What synovial joint is b/t inferior horn of thyroid cartilage + cricoid cartilage?
  2. What actions does it allow?
A
  1. Crico-thyroid Joint
  2. forward movement + downward rotation of thyroid cartilage on cricoid cartilage
    * (increases length + tension of vocal ligaments)*
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17
Q
  1. What synovial joint is b/t cricoid cartilage (supero-lateral surface) + arytenoid cartilage (base)?
  2. What actions does it allow?
A

1. Crico-arytenoid Joint

  1. arytenoid cartilages slide away or towards each other, and to rotate
    * (Abduction/adduction of vocal ligaments)*
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18
Q

which joint increases length + tension of vocal ligaments?

A

crico-thyroid joint

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19
Q

Which joint sbducts/adducts of vocal ligaments?

A

Crico-arytenoid Joint

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20
Q
  1. What is the superior aperture of the laryngeal cavity?
  2. What are it’s borders?

(anterior, posterior, lateral)

A

1. laryngeal inlet

2. inlet borders:

anterior = superior epiglottic mucosa

posterior = interarytenoid notch b/t corniculate tubercles

lateral = aryepiglottic fold + cuniform + corniculate cartilages/tubercles

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21
Q

The inferior aperture of the laryngeal cavity is continuous with the___________ + encircled by _________?

A

trachea

cricoid cartilage

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22
Q

Name + locate the 3 major divisions of the laryngeal cavity:

A

1. Vestibule: between laryngeal inlet + vestibular fold

2. Ventricle: between vestibular folds (superior) + vocal folds (inferior)

3. Infraglottic space: between vocal folds + inferior aperture of larynx

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23
Q

THIS STRUCTURE IS….

- not part of the laryngeal cavity

- b/t aryepiglottic fold (medial) + thyroid cartilage + thyrohyoid membrane (lateral)

  • a channel to direct solids/liquids from oral cavity into esophagus
A

PIRIFORM RECESS

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24
Q

Laryngopharynx

  1. Where is it located?
  2. what opens into it’s anterior wall?
A
  1. from superior edge of epiglottis <–> top of esophagus
  2. Opening of laryngeal inlet
25
Q

Inferior to the laryngeal inlet, the anterior wall of the laryngopharynx is also….?

A

≈ posterior wall of larynx

26
Q

The reflection of muscous membrane b/t anterior surface of epiglottis + root of tongue forms 3 longitudinal ridges (b/t base of tongue + epiglottis) called…?

A
  • median glosso-epiglottic fold
  • lateral glosso-epiglottic folds (2)
27
Q

Epiglottic valleculae:

What are they?

Where are they?

What do they do?

A

● depressions on either side of medial fold (b/t root of tongue + epiglottis)

● posteriorly related to cavity of laryngopharynx

● temporary reservoir of saliva to prevent initiation of swallowing reflex

28
Q

What is the laryngeal ventricle?

What are the laryngeal saccule?

A

Laryngeal ventricle: space between vestibular and vocal folds

Laryngeal saccule: antero-superior extension of ventricle between vestibular fold and thyroid cartilage

Ÿ (Mucous glands cover wall of saccule)

29
Q
  1. What is the space between adjacent vocal folds; functionally similar to “glottis”?
  2. It can be opened/closed by movement of what structures? (2)
A
  1. Rima glottidis
  2. arytenoid cartilages + associated fibro-elastic membranes
30
Q

Intrinsic Laryngeal Muscles: Posterior crico-arytenoid

  • attachement/location?
  • action(s)?
A

LOCATION: cricoid cartilage (posterior surface) ↔ arytenoid cartilage (muscular process)

ACTIONS:

  • lateral (external) rotation of arytenoid cartilage
  • abduction of vocal fold/ligament
  • opening of rima glottidis

*ONLY PURE ABDUCTOR IN LARYNX*

31
Q

Intrinsic Laryngeal Muscles: Arytenoideus

  • attachement/location?
  • action(s)?
A

LOCATION: arytenoid cartilage ↔ contralateral arytenoid cartilage

ACTIONS:

  • adduction of arytenoid cartilages (transverse fibers)
  • narrowing laryngeal inlet by bringing arytenoid cartilages and epiglottis closer (oblique)
  • closure of posterior rima glottidis
  • *ONLY PURE ADDUCTOR IN LARYNX**
32
Q

Intrinsic Laryngeal Muscles: Thyro-arytenoid

  • attachement/location?
  • action(s)?
A

LOCATION: Thyroid angle + crico-thyroid ligament ↔ arytenoid cartilage (antero-lateral surface)

ACTIONS:

- sphincter of vestibule + laryngeal inlet

  • shortening (relaxation) of vocal fold/ligament
33
Q

Intrinsic Laryngeal Muscles: Vocalis

  • attachement/location?
  • action(s)?
A

LOCATION: arytenoid cartilage (vocal process) ↔ ipsilateral vocal ligament

ACTIONS:

- adjustment of tension in vocal fold/ligament:

  • ▪ relaxation of posterior part of vocal ligament*
  • ▪ maintaining/increasing tension of anterior part of vocal ligament*
34
Q

Intrinsic Laryngeal Muscles: Lateral crico-aryteniod

  • attachement/location?
  • action(s)?
A

LOCATION: arch of cricoid cartilage ↔ arytenoid cartilage (muscular process)

ACTIONS:

- lateral sliding of arytenoid cartilage on cricoid cartilage (abduction capability)

  • internal rotation of arytenoid cartilage (by upper fibers of lateral crico-arytenoid m.)
  • active during both abduction and adduction of vocal fold/ligament [synergist to posterior crico-arytenoid + (thyro-arytenoid + arytenoideus) mm.]
35
Q

Intrinsic Laryngeal Muscles: Cricothyroid

  • attachement/location?
  • action(s)?
A

LOCATION: arch of cricoid cartilage (antero-lateral surface) ↔ thyroid cartilage (posterior surface)

ACTIONS:

- forward and downward rotation of thyroid cartilage

  • increases tension of the vocal fold/ligament
36
Q

Name 4 functions of the Larynx:

A
  1. Sphincter for lower respiratory tract
  2. Mechanism for sound production (phonation)
  3. Changes in size of laryngeal cavity depend on dimensions of rima glottidis, vestibule, and laryngeal inlet
  4. Muscle actions and laryngeal mechanics determine functions
37
Q

What does normal respiration look like?

(in terms of rima glottidis, laryngeal inlet, laryengeal mm., etc.)

A
  • laryngeal inlet, vestibule, and rima glottidis are open
  • laryngeal muscles are relaxed

- narrow slit-shaped rima glottidis

38
Q

What does forced respiration look like?

(in terms of rima glottidis, laryengeal mm., vocal folds, etc.)

A

· posterior crico-arytenoid m. active (assistance from lateral crico-arytenoid) → lateral rotation of arytenoid cartilages

· abduction of vocal folds

· wide rima glottidis → increased diameter of laryngeal airway

39
Q

What does PHONATION look like?

(in terms of rima glottidis, vocal folds, cartilages, laryengeal mm., etc.)

A
  • adducted arytenoid cartilages and vocal folds → closure of rima glottidis (active muscles: arytenoideus and lateral crico-arytenoid)
  • stridulation of vocal folds against each other → sound production
  • adjustment of vocal fold tension by thyro-arytenoid, vocalis and cricothyroid mm.
40
Q

What does a WHISPER look like?

(in terms of rima glottidis, vocal folds, cartilages, laryengeal mm., etc.)

A
  • adduction of vocal folds by lateral crico-arytenoid m.
  • relaxation of arytenoideus allows air passage between arytenoid cartilages
  • modification of air into toneless speech by upper parts of airway and oral cavity
41
Q

What does an EFFORT CLOSE look like?

(in terms of rima glottidis, laryengeal mm., etc.)

when would this occur/be needed?

A
  • complete closure of rima glottidis + lower parts of vestibule → complete closure of airway

- related to retention of air in thorax for…

–> trunk stabilization (e.g., during heavy lifting)

–> increasing intra-abdominal pressure

42
Q

What does the functional precess of SWALLOWING look like?

A
  • closure of rima glottidis and vestibule
  • supero-anterior movement of larynx → downward movement of epiglottis (toward arytenoid cartilages) → narrowing/closure of laryngeal inlet
  • supero-anterior movement of larynx → opening of esophagus
  • prevention of food/liquid from entry into airway
  • movement of food/liquid through piriform fossa into esophagus
43
Q

What is the main function of laryngeal INTRINSIC MUSCLES?

A

opening/closure of rima glottidis

44
Q

What is the main function of laryngeal EXTRINSIC MUSCLES?

(infrahyoid mm. + suprahyoid mm. + stylopharyngeus)

A

movement of the entire larynx in the neck

45
Q

Which intrinsic mm. is responsible for ABduction of vocal fold?

A

**Posterior crico-arytenoid **

46
Q

Which intrinsic mm. is responsible for ADduction of vocal fold?

A

**Lateral crico-arytenoid + Arytenoideus **

47
Q

Which intrinsic mm. is responsible for Adjustment of vocal fold tension ?

A

**Thyro-arytenoid + Vocalis + Cricothyroid **

48
Q

SOMATIC MOTOR innervation of the larynx comes from what nerve(s)?

A

External laryngeal n.

Recurrent laryngeal n

(vagus n. –> superior laryngeal n. –> internal/external laryngeal nn.)

49
Q

SOMATIC SENSORY innervation of the larynx comes from what nerve(s)?

A

Internal laryngeal n. (through thyrohyoid membrane) → Supraglottic larynx (= laryngeal cavity down to the level of vocal folds)

Recurrent laryngeal n. → Infraglottic larynx (= laryngeal cavity below vocal folds)

50
Q

PARASYMPATHETIC (vasodilation) innervation of the larynx comes from what nerve(s)?

A

Internal laryngeal n. → Supraglottic larynx

Recurrent laryngeal n. → Infraglottic larynx

51
Q

How do the paths of the Left & Right Recurrent Laryngeal NN. differ from each other?

A
  • Left side = loops around aortic arch
  • Right side: loops around Right subclavian a.

*NOTE: Recurrent laryngeal nerve becomes Inferior laryngeal nerve once it pierces the inferior pharyngeal constrictor m.*

52
Q

Which INTRINSIC laryngeal mm. are innervated by the Recurrent Laryngeal N.?

A

Posterior crico-arytenoid

Arytenoideus (transverse + oblique fibers)

Thyro-arytenoid

Vocalis

Lateral crico-arytenoid

53
Q

Which INTRINSIC laryngeal mm. are innervated by the External Laryngeal N.?

A

Cricothyroid

54
Q

What are 2 main blood supplies to the larynx?

A

Superior laryngeal a.

(Common carotid** a. → External carotid a. → Superior thyroid a. → **Superior laryngeal a.** → (through thyrohyoid membrane along with internal laryngeal n.) **Larynx)

  • *Inferior laryngeal a.**
  • (Subclavian a. → Thyrocervical trunk → Inferior thyroid a. → Inferior laryngeal a. → (ascends in tracheo-esophageal groove along with recurrent/inferior laryngeal n.) Larynx)*
55
Q

Where do the superior + inferior laryngeal vv. drain to?

(hint: not the same place)

A

Superior laryngeal v. → Superior thyroid v. → Internal jugular v.

Inferior laryngeal v. → Inferior thyroid v. → L. brachiocephalic v.

56
Q

Trace the lymph drainage paths from the supraglottic + infraglottic larynx:

A

supraglottic larynx

follows superior laryngeal a. +drains into deep cervical nodes at the bifurcation of common carotid artery (C3-C4 intervertebral disc).

** infraglottic larynx**
drains into deep cervical nodes (typically associated with inferior thyroid a.)

57
Q

Trachea

  1. location?
  2. strucutre?
  3. surrounding structures?
A
  1. larynx to thorax; C6 to sternal angle (at T4-T5 intervertebral disc)
  2. incomplete tracheal C-shaped cartilages; Trachealis m. = posterior aspect
  3. Posterior surface adj. to esophagus; CCA + thyroid lobes are lateral
58
Q

Identify the yellow arrow structures:

A
59
Q

Identify the yellow arrow structures:

A

1. Anatomy - BLOCK 4 (6 decks)

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