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Anatomy S > Larynx > Flashcards

Larynx Flashcards

1
Q

The larynx (voice box) is an organ located in the

A

anterior neck. It is a component of the respiratory tract

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2
Q

and has several important functions, including

A

phonation, the cough reflex, and protection of the lower respiratory tract.

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3
Q

The structure of the larynx is primarily cartilaginous, and is held together by a series of

A

ligaments and membranes.

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4
Q

Internally, the laryngeal muscles move components of the larynx for

A

phonation and breathing.

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5
Q

The larynx is located in the… suspended from the …

A

The larynx is located in the anterior compartment of the neck, suspended from the hyoid bone,

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6
Q

What veterbre does the larynx spread from

A

and spanning between C3 and C6

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7
Q

It is covered anteriorly by the what muscles

A

infrahyoid

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8
Q

The larynx is laterally by the lobes of what

A

The thyroid gland

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9
Q

Posterior to the larynx is the

A

oesophagus

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10
Q

The oesophagus is posterior to the larynx this means pressure can be applied to the cricoid cartilage of the larynx to occlude the oesophagus, and thus prevent what

A

regurgitation of gastric contents (known as cricoid pressure or Sellick’s manoeuvre).

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11
Q

Anatomically, the internal cavity of the larynx can be divided into three sections:

A

Supraglottis
Glottis
Subglottis

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12
Q

Supraglottis lies where

A

From the inferior surface of the epiglottis to the vestibular folds (false vocal cords).

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13
Q

what is the Glottis and what does it do

A

Contains vocal cords and 1cm below them. The opening between the vocal cords is known as rima glottidis, the size of which is altered by the muscles of phonation.

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14
Q

where does the Subglottis lie

A

From inferior border of the glottis to the inferior border of the cricoid cartilage

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15
Q

The interior surface of the larynx is lined by …. what is the exception

A

pseudostratified ciliated columnar epithelium.

An important exception to this is the true vocal cords, which are lined by a stratified squamous epithelium.

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16
Q

The arterial supply to the larynx is via

A

the superior and inferior laryngeal arteries

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17
Q

Superior laryngeal artery

A

a branch of the superior thyroid artery (derived from the external carotid).
It follows the internal branch of the superior laryngeal nerve into the larynx.

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18
Q

Inferior laryngeal artery

A

a branch of the inferior thyroid artery (derived from the thyrocervical trunk). It follows the recurrent laryngeal nerve into the larynx.

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19
Q

Venous drainage is by the

A

superior and inferior laryngeal veins.

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20
Q

The superior laryngeal vein drains to the

A

internal jugular vein via the superior thyroid

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21
Q

whereas the inferior laryngeal vein drains to

A

the left brachiocephalic vein via the inferior thyroid vein.

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22
Q

The larynx receives both motor and sensory innervation via branches of the vagus nerve

A

Recurrent laryngeal nerve

Superior laryngeal nerve

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23
Q

Recurrent laryngeal nerve innervates where

A

provides sensory innervation to the infraglottis, and motor innervation to all the internal muscles of larynx (except the cricothyroid)

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24
Q

Superior laryngeal nerve innervates where

A

the internal branch provides sensory innervation to the supraglottis, and the external branch provides motor innervation to the cricothyroid muscle.
1

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25
Q

The vocal cords are responsible for the production of speech. Their movement is controlled by

A

the intrinsic muscles of the larynx – the majority of which are innervated by the recurrent laryngeal nerve (an exception is the cricothyroid muscle; innervated by the external laryngeal nerve).

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26
Q

What are the majority of the intrinsic muscles of the larynx innervated by

A

– the majority of which are innervated by the recurrent laryngeal nerve (an exception is the cricothyroid muscle; innervated by the external laryngeal nerve).

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27
Q

In unilateral RLN palsy, one vocal cord is paralysed. The other vocal cord tends to compensate, and speech is not affected to a great degree, although the patient may experience

A

hoarseness of voice

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28
Q

In cases of bilateral palsy, both vocal cords are paralysed in a position between adduction and abduction
What does this mean

A

Breathing is impaired, and phonation cannot occur.

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29
Q

In situations where the nerves are only partially damaged, the vocal folds become paralysed in what position

A

in a fully adducted position

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30
Q

In situations where the nerves are only partially damaged, the vocal folds become paralysed in a fully adducted position

What happens if this occurs bilaterally

A

If this occurs bilaterally, the rima glottidis (space between the vocal cords) is completely closed, and emergency surgical intervention is required to restore the airway.

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31
Q

There are how many cartilages, paired and unpaired, located within the larynx

A

9 total
6 paired
3 unpaired

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32
Q

The three unpaired cartilages are the

A

epiglottis, thyroid and cricoid cartilages.

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33
Q

The thyroid cartilage is a large, prominent structure which is easily visible in adult males. It is composed of two sheets (laminae), which join together anteriorly to form

A

the laryngeal prominence (Adam’s apple).

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34
Q

The posterior border of each sheet (of the thyroid gland) project superiorly and inferiorly to form

A

the superior and inferior horns (also known as cornu).

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35
Q

The superior horns are connected to the hyoid bone via

A

the lateral thyrohyoid ligament,

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36
Q

while the inferior horns articulate with the

A

cricoid cartilage.

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37
Q

The cricoid cartilage is

A

complete ring of hyaline cartilage, consisting of a broad sheet posteriorly and a much narrower arch anteriorly (said to resemble a signet ring in shape).

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38
Q

The cricoid cartilage completely encircles the airway, marking the inferior border of the larynx at the level of

A

C6

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39
Q

It articulates with the paired what cartilages posteriorly

as well as providing an attachment for …

A

arytenoid cartilages

as well as providing an attachment for the inferior horns of the thyroid cartilage.

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40
Q

What is th only complete ring of cartilage in the larynx or trachea

A

the cricoid

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41
Q

The epiglottis is a leaf shaped plate of what kind of cartilage

A

elastic

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42
Q

The epiglottis marks the entrance of what

A

which marks the entrance to the larynx

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43
Q

Its ‘stalk’ is attached to the back of

A

the anterior aspect of the thyroid cartilage

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44
Q

During swallowing, the epiglottis flattens and moves posteriorly to

A

close off the larynx and prevent aspiration.

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45
Q

There are three paired cartilages..

where are they situated

A

the arytenoid, corniculate and cuneiform

situated bilaterally in the larynx.

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46
Q

The arytenoid cartilages are what shape and where do they sit

A

The arytenoid cartilages are pyramidal shaped structures that sit on the cricoid cartilage.

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47
Q

What do the arytenoid cartilages consist of

A

They consist of an apex, base, three sides and two processes, and provides an attachment point for various key structures in the larynx:

48
Q

Apex

A

articulates with the corniculate cartilage.

49
Q

Base

A

articulates with the superior border of the cricoid cartilage.

50
Q

Vocal process

A

provides attachment for the vocal ligament.

51
Q

Muscular process

A

provides attachment for the posterior and lateral cricoarytenoid muscles.

52
Q

The corniculate cartilages are..

what do they articulate with

A

They articulate with the apices of the arytenoid cartilages.

53
Q

The cuneiform cartilages are located

what are they attached to and what is their purpose

A

within the ary-epiglottic folds

They have no direct attachment, but act to strengthen the folds.

54
Q

the larynx contains numerous ligaments and folds; the ligaments

A

support the cartilaginous skeleton of the larynx

55
Q

the larynx folds are involved in

A

airway protection and phonation.

56
Q

he extrinsic ligaments act to attach the components of the larynx to external structures e.g

A

the hyoid and the cricoid cartilage

57
Q

The intrinsic ligaments are responsible for holding

A

the cartilages of the larynx together as one functional unit internally

58
Q

Thyrohyoid membrane – Spans between

A

the superior aspect of the thyroid cartilage and the hyoid bone. It is pierced laterally by the superior laryngeal vessels and internal laryngeal nerve (branch of the superior laryngeal nerve).

59
Q

Median thyrohyoid ligament

A

Anteromedial thickening of the membrane

60
Q

Lateral thyrohyoid ligaments

A

Posterolateral thickenings of the membrane.

61
Q

Hyo-epiglottic ligament

A

Connects the hyoid bone to the anterior aspect of the epiglottis.

62
Q

Cricotracheal ligament

A

Connects the cricoid cartilage to the trachea.

63
Q

Median cricothyroid ligament

A

Anteromedial thickening of the cricothyroid ligament (see below), connecting the thyroid and cricoid cartilages.

64
Q

what is the Intrinsic membrane and ligament

A

Cricothyroid ligament and Quadrangular membrane

65
Q

Cricothyroid ligament – Originates from where and attaches to where

A

Originates from the cricoid cartilage and extends superiorly, where it terminates with an free (unattached) upper margin – which forms the vocal ligament. It is additionally attached anteriorly to the thyroid cartilage, and posteriorly to the arytenoid cartilage.

66
Q

Quadrangular membrane – Spans between what

A

Spans between the anterolateral arytenoid cartilage and the lateral aspect of the epiglottis. It has a free upper margin and lower margin. The lower margin is thickened to become the vestibular ligament.

67
Q

what is A cricothyroidotomy and how is it carried out

A

A cricothyroidotomy is an emergency procedure to provide a temporary airway. It is typically used in situations where there is an obstruction at or above the larynx (e.g foreign body, angioedema or facial trauma), and intubation has been unsuccessful.

To perform the technique, the thyroid cartilage is palpated in the neck – below which there is a depression representing the cricothyroid ligament. A small incision is made in the midline of this ligament, and an endotracheal tube is inserted to secure the airway.

68
Q

There are two important soft tissue folds located within the larynx –

A

the vestibular folds and
vocal folds.
They play a crucial role in protection of the airway, breathing, and phonation.

69
Q

Which are the more important of the two sets of folds in the larynx

A

the vocal folds (true vocal cords) are the more important of the two sets. Under the control of the muscles of phonation, they are abducted, adducted, relaxed and tensed to control the pitch of the sound created.

70
Q

What histologically are the vocal chords lined with and why

A

Non-keratinised stratified squamous epithelium – Stratified layer provides extensive protection against foreign bodies which may accidentally enter the larynx.

71
Q

What is Reinke’s space and whats is purpose

A

Reinke’s space – This watery, amorphous layer is rich in glycosaminoglycans. Due to its fluidity, the epithelium is able to vibrate freely above it to create sound.

72
Q

Where does the vocal ligament lie

A

Vocal ligament – Lies at the free upper edge of the cricothryoid ligament.

73
Q

where does the vocals muscle lie

A

Vocalis muscle – Exceptionally fine muscle fibres that lie lateral to the vocal ligaments.

74
Q

How are the vocal fold histologically structured: (superficial to deep):

A

1 Non-keratinised stratified squamous epithelium
2 Reinke’s space
3 Vocal ligament
4 Vocalis muscle

75
Q

The vocal folds are relatively avascular, and appear white in colour. The space between the vocal folds is known as the

A

rima glottidis.

76
Q

The vestibular folds (false vocal cords) lie ..

A

superiorly to the true vocal cords.

77
Q

what do the vestibular folds consist of and what do they do

A

They consist of the vestibular ligament (free lower edge of the quadrangular membrane) covered by a mucous membrane, and are pink in colour. They are fixed folds, which act to provide protection to the larynx.

78
Q

The muscles of the larynx can be divided into two groups:

What do each do?

A

the external muscles and the internal muscles.

The external muscles act to elevate or depress the larynx during swallowing.

In contrast, the internal muscles act to move the individual components of the larynx – playing a vital role in breathing and phonation.

79
Q

The extrinsic muscles act to move the larynx superiorly and inferiorly. They are comprised what groups

A

the suprahyoid and infrahyoid groups, and the stylopharyngeus (a muscle of the pharynx).

80
Q

The supra- and infrahyoid muscle groups attach to the

A

hyoid bone

81
Q

How is the hyoid bone bound to the larynx

A

by strong ligaments; allowing the whole of the larynx to be moved as one unit.

82
Q

As a general rule, the suprahyoid muscles and the stylopharyngeus do WHAT to the larynx

A

elevate it

83
Q

whilst the infra hyoid muscles do what to the larynx

A

depress

84
Q

The intrinsic laryngeal muscles act on the individual components of the larynx. They control the shape of the… and the

A

rima glottidis

and the length and tension of the vocal folds.

85
Q

What is the rima glottidis

A

opening between the vocal folds and the arytenoid cartilages

86
Q

All the intrinsic muscles of the larynx (except the cricothyroid) are innervated by the

A

inferior laryngeal nerve

87
Q

how is the inferior laryngeal nerve related to the recurrent laryngeal

A

it is the terminal branch of the recurrent laryngeal nerve, itself a branch of the vagus nerve

88
Q

he cricothyroid is innervated by the

A

EXTERNAL BRANCH of the superior laryngeal nerve – again derived from the vagus nerve.

89
Q

The cricothyroid muscle does what

A

stretches and tenses the vocal ligaments, and so is important for the creation of forceful speech. It also has a role in altering the tone of voice (along with the thyroarytenoid muscle), hence its colloquial name ‘singer’s muscle’.

90
Q

Attachments of the cricothyroid muscle

A

Originates from the anterolateral aspect of the cricoid cartilage, and attaches to the inferior margin and inferior horn of the thyroid cartilage.

91
Q

Actions of the cricothyroid muscle

A

Stretches and tenses the vocal ligament.

92
Q

innervation of the cricothyroid muscle

A

External laryngeal nerve (branch of superior laryngeal).

93
Q

The thyroarytenoid muscle acts to

A

relax the vocal ligament, allowing for a softer voice.

94
Q

Attachments of The thyroarytenoid

A

Originates from the inferoposterior aspect of the angle of the thyroid cartilage, and attaches to the anterolateral part of the arytenoid cartilage.

95
Q

Actions of The thyroarytenoid

A

Relaxes the vocal ligament.

96
Q

innervation of The thyroarytenoid

A

Inferior laryngeal nerve (branch of recurrent laryngeal).

97
Q

The posterior cricoarytenoid muscles are the sole WHAT of the vocal folds, and thus the only muscle capable of widening the rima glottidis.

A

abductors

98
Q

Attachments of Posterior cricoarytenoid

A

Originates from the posterior surface of the cricoid cartilage, and attaches to the muscular process of the arytenoid cartilage.

99
Q

Actions of the Posterior cricoarytenoid

A

Abducts vocal folds.

100
Q

Innovation of the Posterior cricoarytenoid

A

Inferior laryngeal nerve (branch of recurrent laryngeal).

101
Q

The lateral cricoarytenoid muscles are the major adductors of the WHAT.
What dies this do to the rima glottidis, modulating the tone and volume of speech.

A

Vocal chords

Narrows

102
Q

attachments of the Lateral cricoarytenoid

A

Originates from the arch of the cricoid cartilage, and attaches to the muscular process of the arytenoid cartilage.

103
Q

Actions of the Lateral cricoarytenoid

A

Adducts the vocal folds.

104
Q

innervation of the Lateral cricoarytenoid

A

Inferior laryngeal nerve (branch of recurrent laryngeal).

105
Q

The transverse and oblique arytenoids muscles adduct the arytenoid cartilages, closing the posterior portion of the what? and therfore doing what

A

rima glottidis.

This narrows the laryngeal inlet.

106
Q

Attachments of the Transverse and Oblique Arytenoids

A

Spans from one arytenoid cartilage to the opposite arytenoid.

107
Q

Actions of the Transverse and Oblique Arytenoids

A

Adducts the arytenoid cartilages.

108
Q

innovation of the Transverse and Oblique Arytenoids

A

Inferior laryngeal nerve (branch of recurrent laryngeal).

109
Q

Which structure stops liquid refluxing into the back of the nose during swallowing?

A

The soft palate.

110
Q

Which nerve carries sensation from the larynx below the vocal cords?

A

The recurrent laryngeal nerves.

111
Q

Describe the histology of the mucosa of the trachea?

A

Simple, columnar, pseudostatified, ciliated with goblet cells

112
Q

Which nerve travels through the parotid gland?

A

The facial nerve (cranial nerve VII)

113
Q

Where do the parotid and submandibular ducts enter the mouth?

A

Parotid; from the cheek adjacent to the second upper premolar Submandibular; under the tongue.

114
Q

Which nerve supplies the muscles of the tongue?

A

The hypoglossal nerve (cranial nerve XII)

115
Q

Order of the nerves from the anterior tongue to posterior tongue to epiglottis and down

A

Trigeminal (general of anterior tongue), facial (special of anterior tongue) , hypoglossal (general and special innervation of the posterior tongue), superior laryngeal nerve (from epiglottis to vocal chords i think lol) then recurrent laryngeal down trachea

Anatomy S (14 decks)

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