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Week 14- SHANE > Larynx > Flashcards

Larynx Flashcards

1
Q

What vertebral levels in the larynx present at?

A

The larynx lies anterior to cervical vertebrae 4, 5 and 6 and ends at the lower border of the cricoid cartilage (i.e. at C6), where it becomes the trachea.

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2
Q

The larynx is suspended from the hyoid bone by what?

A

the thyrohyoid membrane

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3
Q

The thyroid cartilage is suspended from the hyoid bone via what?

A

the thyrohyoid membrane. It is composed of two laminae that meet in the anterior midline at an angle, but that are open posteriorly

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4
Q

The superior aspect of the angle where the laminae of the thyroid cartilage meet forms what?

A

the laryngeal prominence (Adam’s apple)

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5
Q

The thyroid cartilage have superior and interior horns posteriorly. What do the inferior horns articulate with?

A

the lamina of the cricoid cartilage via a synovial joint, the ‘cricothyroid joint’.

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6
Q

What does the cricothyroid joint do?

A

enables the thyroid cartilage to rock anteriorly and posteriorly over the cricoid, stretching or relaxing the vocal folds during the creation of high pitched or low pitched sounds

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7
Q

What three muscles attach to the oblique line of the thyroid cartilage?

A

the sternothyroid, the thyrohyoid and the inferior pharyngeal constrictor.

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8
Q

The attachment of the epiglottis to the tongue creates three small folds. What are they?

A

lateral and median glossoepiglottic folds

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9
Q

The small pockets between the glossoepiglottic folds are called?

A

vallecula. Small objects can get trapped in these pockets

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10
Q

What structures does the epiglottis attach to?

A

the base of the tongue, hyoid bone, and thyroid cartilage

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11
Q

The inferior border of the thyroid cartilage is connected to the cricoid in the anterior midline by?

A

the median cricothyroid ligament

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12
Q

What structures line the laryngeal inlet?

A

the superior border of the epiglottis, the interarytenoid notch, the aryepiglottic folds, and the arytenoid cartilages

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13
Q

Where does the supra epiglottic space/vestibule of the larynx span?

A

from the laryngeal inlet to the vestibular folds

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14
Q

Where is the entrance to the ventricle located?

A

Between the vestibular and vocal folds

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15
Q

Where does the infra epiglottic space of the larynx span?

A

extends from the vocal folds to the inferior aspect of the cricoid cartilage where the trachea begins

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16
Q

What is the glottis?

A

the vocal folds and the space between them

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17
Q

The space between the vocal folds in the glottis is called what?

A

the rima glottidis

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18
Q

What are “false vocal cords”?

A

the vestibular folds at the bottom of the supra epiglottic space

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19
Q

What are “true vocal cords”?

A

the vocal folds at the top of the infra epiglottic space

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20
Q

What are the attachments of the vocal folds?

A

The vocal ligament attaches to the thyroid cartilage anteriorly and to the vocal process of the arytenoid cartilages posteriorly

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21
Q

What forms the inferior free margin of the quadrangular membrane?

A

The vestibular ligament, and mucosa draped over the vestibular ligament forms the vestibular fold

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22
Q

What forms the aryepiglottic fold?

A

Mucosa draped over the superior free border of the quadrangular membrane and the aryepiglottic muscles

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23
Q

What are the attachments of the quadrangular membrane?

A

the lateral aspects of the epiglottic cartilages and the arytenoid cartilages

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24
Q

T or F. Everything below the vocal folds in the larynx (including the ventricles) creates speech.

A

F. Everything ABOVE the vocal folds in the larynx (including the ventricles) creates speech.

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25
Q

What is the origin of the cricothyroid muscles?

A

from the anterior and lateral aspects of the cricoid arch

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26
Q

What is the insertion of the cricothyroid muscles?

A

inferior margin and inferior horn of the thyroid membrane

27
Q

What is the innervation of the cricothyroid muscles?

A

external branch of the superior laryngeal nerve

28
Q

What is the main action of the cricothryoid muscles?

A

The cricothyroid pulls down on the thyroid cartilage, causing it to rotate anteriorly along an axis that passes through the two cricothyroid joints. This movement increases the distance between the anterior and posterior attachments of the vocal ligaments, thereby increasing tension on the ligaments and increasing vocal fold length. Increasing tension leads to sounds with a higher pitch.

29
Q

What is the main function of the thyroarytenoids?

A

The main function of the thyroarytenoids is to bring the arytenoid and thyroid cartilages closer together, shortening the vocal cords and, essentially, opposing the action of the cricothyroid muscles

30
Q

What muscles help pull down on the epiglottis to close it?

A

the aryepiglottic muscles, the thyroarytenoid muscles, and the thyroepiglottic muscles.

31
Q

What are the insertions of the lateral and posterior cricoarytenoids?

A

muscular process of the arytenoid cartilage (anterior and posterior surfaces)

32
Q

What is the innervation of the posterior and lateral cricoarytenoids?

A

the inferior laryngeal nerve

33
Q

What is the origin of the posterior cricoarytenoids?

A

posterior surface of the cricoid lamina

34
Q

What is the original of the lateral cricoarytenoids?

A

superior surface of the arch of the cricoid cartilage

35
Q

What is the main function of the posterior cricoarytenoid muscles?

A

Vocal abduction. they are almost always contracting to ensure that the glottis remains open. In deep breathing, they expand even more.

36
Q

What is the main function of the lateral cricoarytenoid muscles?

A

Vocal adduction. Antagonists of the posterior cricoarytenoids. They contract to close the glottis either in speaking or in coughing.

37
Q

What is the main function of the transverse arytenoid muscle?

A

it attaches to the medial aspect of the arytenoids and contracts to narrow the gap of the vocal folds

38
Q

Do the oblique arytenoids muscles lie deep or superficial to the transverse arytenoid?

A

superficial, just on top

39
Q

Where do the oblique arytenoids span?

A

They arise from the posterior aspect of one arytenoid’s muscular process and insert into the other arytenoid’s apex.

40
Q

What is the function of the oblique arytenoids?

A

Acting together, the oblique arytenoids have essentially the same action as the transverse arytenoid, bringing the arytenoids to the midline

Contraction of just one of the oblique arytenoid muscles would tilt the arytenoid apex posteriorly.

41
Q

What is the innervation to the transverse and oblique arytenoid muscles?

A

inferior laryngeal n. (both)

42
Q

What muscles function as sphincters of the laryngeal inlet?

A

The transverse and oblique arytenoids acting together with the aryepiglottic muscles

Some of the fibers of the oblique arytenoids are continuous past the apices of the arytenoids to the epiglottis. These are the aryepiglottic muscles.

43
Q

What are the two parts of the glottis?

A

An intermembranous glottis and an intercartilaginous glottis

44
Q

What are the two parts of the glottis composed of?

A

The intermembranous glottis is made up of the true vocal folds and the space between them.

The intercartilaginous glottis is made up of the vocal processes of the arytenoid cartilages and the space between them

45
Q

During normal breathing, which muscles are contracted?

A

the posterior arytenoid muscles are contacted (and the lateral, transverse, and oblique arytenoid muscles are relaxed)

This causes opening of both the intermembranous and intercartilaginous regions of the glottis to be open, maximizing air flow. Since we spend most of our time breathing, the posterior arytenoids are contracted most of the time.

46
Q

During normal breathing, which parts of the vocal folds are open? closed?

A

both parts are open

47
Q

During normal speech, which parts of the vocal folds are open? closed?

A

both the intercartilaginous and the intermembaneous are closed

48
Q

During normal speech, which laryngeal muscles are contracted?

A

lateral, oblique, and transverse (posterior is relaxed)

49
Q

How is sound produced by the larynx?

A

Pressure beneath the vocal folds builds until it eventually exceeds the pressure holding them together. A burst of air escapes through the folds and the rapid flow if air causes decreased pressure (Venturi effect) that brings the vocal folds together. Pressure rises again, and the process repeats itself. Rapid opening and closing produces vibration and the jets of air produced create a rapid changes in air pressure that produces sounds. The sounds are used by the pharynx, oral cavity and nasal cavity to make speech.

50
Q

The vibrations of the vocal folds that result in speech are controlled by what 5 things?

A

(1) The level of adduction. How strongly are the lateral cricoarytenoids contracting? Not strong enough and the vocals do not seal well and you get a breathy tone.
(2) The thickness of the vocal folds. How strongly are the cricothyroid muscles contracting? The vocalis muscle fibers? Thick vocal folds create low pitched sounds, thin vocal folds create high pitched sounds.
(3) The length of the vocal folds. The longer they are, the faster they vibrate and the higher the tone. The shorter they are, the slower they vibrate and the lower the tone.
(4) Tension on the vocal folds. Too much generates a feeling of tightness in the throat and a harsh tone. It also affects the tone pitch.
(5) Breath. What is the pressure of air coming from the lungs and trachea? Excessive pressure or insufficient pressure can affect tone and voice quality. From low to high tones, length increases, tension on vocal folds increases and the thickness of the vocal folds decreases.

51
Q

The intermembranous glottis can be closed independent of the intercartilaginous glottis by contraction of what muscles?

A

the lateral cricoarytenoids, but not the transverse and oblique arytenoid muscles

52
Q

When would the lateral cricoarytenoids contract, but not the transverse and oblique arytenoid muscles to produce sound?

A

whispering

53
Q

Do you vocal folds vibrate during whispering? If not, how is speech made?

A

The vocal cords do not vibrate under these conditions when air is passed through at moderate pressures. However, the air passing through (whisper) can be shaped into recognizable sounds by structures superior to the larynx.

54
Q

Which parts of the vocal folds are closed during the coughing reflex? Rather, how does the coughing reflex work at the level of the larynx?

A

The intermembranous and intercartilaginous parts of the glottis are tightly closed until pressure builds up to a high level, and then opened rapidly. The resultant rush of air sweeps material out of the airway.

55
Q

The external branch of the superior larygneal n. innervates what structures of the larynx?

A

just the cricothyroid m. (BE)

56
Q

What artery does the external branch of the superior laryngeal n. run with at the level of the larynx?

A

the superior thyroid a.

57
Q

The internal branch of the superior larygneal n. innervates what structures of the larynx? Functional components?

A

GSA- mucosal lining of the laryngopharynx down to the vocal folds
GSA and SA- epiglottis and the root of the tongue
GVE- glands of the pharynx

58
Q

What artery does the internal branch of the superior laryngeal n. run with at the level of the larynx?

A

the superior laryngeal

59
Q

The inferior/recurrent larygneal n. innervates what structures of the larynx? Functional components?

A

GSA- mucosal lining of the larynx below the vocal folds
BE- all other muscles of the vocal folds besides the cricothyroid
GVE- glands below the vocal folds

60
Q

Where does the recurrent laryngeal n. become the inferior laryngeal n.?

A

as it passes the level of the cricothyroid joint

61
Q

What are the main risk factor for developing laryngeal cancer?

A

The major risk factors are smoking tobacco and drinking alcohol. Poor eating habits (not enough vitamins from fruits and vegetables), a weakened immune system, exposure to chemicals and certain substances (e.g., wood dust, paint fumes, soot), and GERD (acid reflux) also contribute. More than twice as many men as women are diagnosed with laryngeal cancer. Most cases occur between the ages of 50 and 70.

62
Q

Sloppy thyroid surgery can affect which parts of the vagus nerve?

A

the external branch of the superior laryngeal nerve, or the inferior laryngeal nerve

63
Q

A Pancoast tumor (tumor at the apex of the lung) can affect which parts of the vagus nerve?

A

the right recurrent laryngeal nerve

64
Q

Lung tumors that lead to metastasis to the mediastinum or inferior tracheobronchial lymph nodes can affect which parts of the vagus nerve?

A

the left recurrent laryngeal nerve.

Week 14- SHANE (11 decks)

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