Larynx and Pharynx Flashcards
phayrnx
U shaped musculomembranous structure located posterior to the nasal cavity, oral cavity, and larynx
what does the pharynx join
joins the nasal and oral cavities TO the larynx and esophagus
location of pharynx
extends from base of skull to the C6 vertebral level, but is SUBDIVIDED into 3 regions
three subdivisions of the pharynx
nasopharynx, oropharynx, and laryngophayrnx
nasopharynx basic
posterior to nasal cavity and passageway for air
orophayrnx basic
posterior to oral cavity and passageway for air and food/liquid
laryngopharynx basic
posterior to larynx, passageway for food/liquid
air passes…
from the naso- and oro-pharynx –> through larynx–> trachea–> primary bronchi–> lungs
food liquid passes..
from the orophayrynx–> into the laryngopharynx –> esophagus –> stomach
nasopharynx specific location
base of skull –> to level of soft palate marked by the palatoglossal arch
torus tubarius
(lateral)
opening of pharyngotympanic tube or AUDITORY/EUSTACHIAN TUBE)
this allows communication between the nasopharynx and middle ear cavity
what assists in opening the pharyngotympanic tube?
the salpingopharyneus and levator veli palatini
pharyngeal recess
posterior to the torus tubarius; location of pharyngeal tonsils or adenoids; enlargement may interfer with nasal breathing
oropharynx specific
extends from the soft palate (palatoglossal arch) to the superior border of epiglottis C3
laryngopharynx specific
extends from the superior border of the epiglottis (C3) to the inferior border of the cricoid cartilage (C6)
this communicated with the larynx through the laryngeal inlet on its anterior wall
laryngeal inlet
how the laryngopharynx communicates with the larynx on is anterior wall
where is epiglottis
c3 pharynx itself (base of skull down to c6)
squamous cell carcinoma
can occur in orophaynx - 90% of this and oral cavity
circular skeletal muscles of the pharynx
superior, middle, and inferior pharyngeal constrictors
longitudinal skeletal muscles of the pharynx
stylopharyngeus, palatopharyngeus, and salpingopharyngeus
superior pharyngeal constrictor
attachments and action
pharyngeal tubercle (just anterior to the foramen magnum) and pharyngeal raphe (posterior) then moves anterior to attach to the pterygoid hamulus, and pterygomandibular raphe, and mandible
action - constrict the wall of the pharynx during swallowing - propel the bolus of food
middle pharyngeal constrictor
attachment and action
pharyngeal raphe (posterior) to the stylohyoid ligament and hyoid bone
constrict the wall of pharynx as swallow
inferior pharyngeal constrictor
attachment and action
attaches to the pharyngeal raphe (posterior) and goes to the thyroid cartilage and cricoid cartilage
action - constrict wall of pharynx as swallow
innervation to the pharyngeal constrictor muscles
CN X via the pharyngeal plexus (all 3)
inferior pharyngeal constrictor innervation
in addition to CN X via the pharyngeal plexus, this muscle also receives innervation from fibers of the external branch of the superior laryngeal nerve and recurrent laryngeal nerve
Opening associated with the superior to the superior pharyngeal constrictor
passage of the pharyngotympaninc tube and levator levi palatini muscle
opening between the superior and middle constrictor muscles of pharynx
passage of the stylopharyngeus and CN IX (9)
opening between the middle and inferior constrictor of the pharynx
passage of the internal branch of the superior laryngeal nerve and the superior laryngeal vessels
opening inferior to the inferior constrictor of the pharynx
passage of the recurrent laryngeal nerve
how to identify CN IX - the glossopharyngeal nerve
it sits RIGHT ON TOP OF THE stylopharyngeus muscle in a posterior view and will then pass between the superior and middle constrictor muscles to gain access to
action of the longitudinal pharyngeal muscles
elevate and widen the pharynx during swallowing
palatopharyngeal muscle
attach and innervation
longitidunal muscle
attaches - posterior to the hard palate and palatine aponeurosis to the muscular wall of the pharynx and thyroid cartilage
innervation - CN X via pharyngeal plexus
salpinogopharyngeus
attachment and innervation
attachement - cartilagenous part of pharyngotympanic tube (auditory/eustachian tube)–> to the muscular wall of pharynx
innervation is CN X via the pharyngeal plexus
Stylopharyngeus
attachment and innervation
styloid process to –> muscular wall of the pharynx and thyroid cartilage
INNERVATION IS XN IX - glossopharyngeal
CN IX
glossopharyngeal - sits on top of the stylopharyngeus muscle
non-contractile tissue of pharynx
non-contractile tissue “seals off” spaces so air, liquid and food do not “leak” from the pharynx
what lines the internal and external surfaces of the pharyngeal muscles?
fascia
pharyngobasilar fascia
INTERNAL fascial lining of the pharynx
this layer extends superior to the superior constrictor, where it is thickened and most obvious
from the pharynx to the basilar portion of the occipital bone
buccopharyngeal fascia
the EXTERNAL fascial lining of the pharynx
attachments of the pharyngobasilar fascia
superiorly this fascia attaches to the occipital bone (basilar portion), petrous temporal bone, cartilagenous portion of the pharyngotympanic tube (eustachian), and medial pterygoid plate
thins inferiorly as it lines the constrictor muscles
seals off the space posterior to the nasal and oral cavities
phases of deglutition (swallowing)
oral cavity–> pharynx–> esophagus–> stomach
oral phase
voluntary
tongue compresses the bolus successively against the hard palate –> soft palate to expel it from the oral cavity
pharyngeal phase 1st part
bolus enters the oropharynx and the SOFT PALATE IS TENSED AND ELEVATED (via the tensor veli palatini and levator veli palatini) therby BLOCKING communication between the nasal and oral cavities
is the pharyngeal phase of deglutition voluntary or involuntary?
involuntary
what blocks the communication between the nasal and oral cavities during swallowing
the elevation and tension in the soft palate which is brought out by the tensor veli palatini and the levator veli palatini of the soft palate
after the soft palate elevates and tenses the….
phaynx elevates which brings the laryngopharynx towards the descending bolus
elevation of the pharynx (longitudinal muscles) is through the stylophargeus, palatopharyngeus, salpinopharyngeus, and thyrohyoid muscles)
after the soft palate is tensed and elevated, the pharynx is elevated, and then..
contraction of the pharyngeal constrictors occurs which will constrict the walls of the inner pharynx and propel the food doen inferiorly towards the esophagus
esophageal phase
also involuntary like the pharyngeal phase and this occurs through sequential waves of contraction which propels the bolus through to the esophagus–> towards stomach
what brings the laryngopharynx towards the descending bolus?
the longitudinal pharyngeal muscles - elevating and widening the pharynx during swallowing
sensory fibers of the pharyngeal plexus
derived from CN IX - glossopharyngeal nerve and these fibers carry sensory information from the mucous membrane of the nasopharynx (in part), oropharynx, and laryngopharynx
sensory information from nasopharynx
CN IX - via the pharyngeal plexus AND additionally the mucosa of the nasopharynx also receives sensory fibers from the pharyngeal branch of V2 - from the PPG (pterygopalatine ganglion)
motor fibers of the pharyngeal plexus
derived from CN X which supplies all muscles of the pharynx BESIDES THE STYLOPHARYNGEUS which is innervated by CN IX
- also the inferior pharyngeal constrictor also receives motor fibers from the recurrent and external branch of the superior laryngeal nerves)
overview of the larynx
located in the anterior neck - anterior to the pharynx
composed of carilages, membranes, and ligaments and is moved by several muscles
necessary for voice production and plays a vital role in guarding the airway
location of larynx at rest
anterior to C3-C6 vertebra (superior extension of the epiglottis to inferior margin of the cricoid cartilage)
basically anterior to the laryngoppharynx portion (3) of the pharynx
The larygneal skeleton is a …..
CARTILAGENOUS SKELETON
how many cartilages of the larynx
9
three unpaired and three paired
unpaired cartilages of the larynx
epiglottis
thyroid
cricoid
paired cartilages of the larynx
arytenoid
corniculate
cuneiform
thyroid cartilage
located at C4-C5 level
largest of the laryngeal cartilages and formed by 2 laminae that fuse in the midline
does NOT completely encircle the airway
laryngeal prominence
prominent region on the external surface of the thyroid cartilage, where the two laminae fuse
- most dinstinct superiorly where it is distinct in males
- also known as the adams apple in males
angle of the thyroid cartilage
the angle is on the INTERNAL surface and also a result of the fusing of the two laminae
- the internal aspect is where the focal cords will attach
superior and inferior horns of…
the thyroid cartilage and these extend from the laminae
the inferior horn has an articular facet for the cricoid cartilage
epiglottic cartilage
most superior of the laryngeal cartilages at C3
the superior end is ‘free’
it bends to cover the airway during swallowing
inferior end of the epiglottic cartilage
attached to the angle of the thyroid cartilage by the thyroepiglottic ligament
thyroepiglottic ligament
connects the thyroid cartilage to the epiglottic cartilage
epiglottic is superior
T/F the epiglottis is sufficient in protecting the airway during swallowing because it covers the airway
FALSE - it assists but alone is not sufficient enough
cricoid cartilage
most inferior of the three unpaired cartilages and is at the level of C6
it is shaped like a signet ring (class ring) with the broad lamina positioned posteriorly and narrow arch anteriorly
it COMPLETELY encircles the airway and has articular surfaces for the inferior horn of the thyroid and the arytenoid cartilages
arytenoid cartilages
components
pyramidal shaped and paired
very important
base
vocal process
muscular process
apex - superior portion
base of arytenoid cartilage
articulates with lamina of the CRICOID CARTILAGE
vocal process of arytenoid cartilages
projects ANTERIORLY and is the attachment site for a ligament - vocal ligament and a muscle - vocalis
muscular process
of the arytenoid cartilage and projects LATERALLY and is teh attachment site for several muscles
corniculate and cuneiform cartilages and location
other sets of paired cartilages of the larynx
corniculate - at the apex of the arytenoid cartilages
cuneiform cartilages - located within a mucosal fold
cricothyroid joints
joint of the larynx which are synovial joints between the inferior horn of the thyroid cartilage and cricoid cartilage
cricoarytenoid joints
synovial joints between the arytenoid and cricoid cartilages
extrinsic ligaments and membranes of the larynx
thyrohyoid membrane
median thyrohyoid ligament
lateral thyrohyoid ligament
cricotracheal ligament
these are helping seal off the spaces
thyrohyoid membrane
extends from the thyroid cartilage to the hyoid bone (which is superior)
median thyrohyoid ligament
more anterior and is a thickening of the thyrohyoid membrane
lateral thyrohyoid ligament
thickening posterior aspect of the thyrohyoid membrane
cricotracheal ligament
extends from cricoid cartilage to 1st tracheal cartilage
more inferior
intrinsic membranes and ligaments of the larynx
quadrangular membrane
aryepiglottic ligament and vestibular ligament
cricothyroid ligament
vocal ligament
quadrangular membrane
drapes down from the epiglottis to the arytenoid cartilage
aryepiglotic ligament
free superior margin of the quadrangular membrane
vestibular ligament
free inferior border of the quadrangular membrane
FALSE VOCAL CORD
cricothyroid ligament
extends from the cricoid cartilage to thyroid cartilage and arytenoid cartilage
vocal ligament
free superior border of the cricothyroid ligament
TRUE VOCAL CORD
aryepiglotic fold
aryepiglotic ligament covered by mucosa
vestibular fold
vestibular ligament covered by mucosa
aka FALSE vocal cords
vocal fold
vocal ligament covered by mucosa aka TRUE vocal cords
this is positoned below the vesitbular fold
rima vestibuli
the opening between the vestibular folds
rima glottidis
the opening between the vocal folds
laryngeal inlet
marks the opening between the larynx and pharynx
- this is internal space in the larynx and air will pass through here
priform recess
depression located on either side of the laryngeal inlet, food may get trapped here
supraglottic cavity
aka vestibule and extends from the inlet to the vestibular fold - like an entrance way into the more functional portion of the larynx
middle laryngeal cavity
region between the vestibular folds and vocal folds
laryngeal ventricle
associated with the middle laryngeal cavity and extends laterally from this cavity
laryngeal saccule
elongated tubular extension of the ventricle; numerous mucous glands, which assist in lubricating the vocal folds
infraglottic cavity
below vocal folds (continous with trachea)
extrinsic laryngeal muscles
connect the larynx to neighboring structures and move it as a whole
infrahyoids and suprahyoids
infrahyoid muscles
extrinsic muscles of the larynx and will move the larynx inferior
thyrohyoid muscle action on larynx
elevates larynx - even though it is an infrahyoid
suprahyoid muscles
extrinsic muscle of the larynx and elevates the hyoid and larynx
intrinsic laryngeal muscles
move specific laryngeal cartilage, altering the length and position of the vocal ligaments and the size and shape of the rima glottidis
Cricothyroid muscle
attachment
action
innervation
Intrinsic muscles
attachment - crocoid arch and thyroid cartilage
action - pulls the thyroid cartilage anteriorly and inferiorly so LENGTHEN the focal cords
innervation - external branch of the superior laryngeal nerve - AKA the external laryngeal nerve
only muscle that opens the rima glottidis
posterior cricoarytenoid muscle - ABducts the vocal folds/ opening the rima glottidis
all of the intrinsic muscles of the larynx are innervated by what nerve? what is the exception and what is its innervation?
all are innervated by the recurrent laryngeal nerve EXCEPT the cricothyroid muscle which is innervated by the external laryngeal nerve (branch of the superior laryngeal nerve)
Posterior Cricoarytenoid muscle
attachment
action
innervation
attachment - POSTERIOR cricoid lamina and muscular process of the arytenoid cartilage
action - ABducts the focal folds/open the rima glottidis
can pull the aryentoids posteriorly and assist the cricothyroid muscles in tensing the vocal cords
innervation - recurrent laryngeal nerve
only muscle to open the rima glottidis
lateral cricoarytenoid muscle
attachment
action
innervation
attachment - lateral cricoid arch and muscular process of the arytenoid cartilage
action - close/ adduct the rima glottidis / close vocal cords
innervation - recurrent laryngeal nerve
transverse and oblique arytenoid muscles
attachment
action
innervation
instrinsic muscle
attachment - from one arytenoid cartilage to the contralteral arytenoid cartilage
action - adducts the arytenoid cartilages, so it closes the posterior part of the rima glottidis
innervation - recurrent laryngeal nerve
oblique - criss crossing and continues into the aryepiglottic fold and changes name to become the aryepiglottic muscle
aryepiglottic muscle
oblique fibers of the arytenoid muscle - cris-crossing and continues into the aryepiglottic fold and changes name to become the aryepiglottic muscle
has same action and innervation as the transverse and oblique arytenoid muscles
what muscle can make minor or minute adjustments to the vocal cords
vocalis
- lies adjacent to the vocal cords
vocalis and thyroarytenoid muscles
attachment
action
innervation
attachment - arytenoid cartilage (on the vocal process) to the angle of the thyroid cartilage
VOCALIS ALSO ATTACHES TO SOME OF THE VOCAL LIGAMENT
action - brings the arytenoid cartilage towards the thyroid cartilage so RELAXES the vocal ligaments
innervation - recurrent laryngeal nerve
describe male vs female vocal cords
males have longer and thicker vocal ligaments
females have relatively shorter and thinner vocal ligaments
when you first inhale what happens
vocal cords ABDUCT - open
what happens prior to speaking?
vocal cords approximate, which results in INCREASED pressure from below (the subglottic pressure)
then air from the subglottic space moves through the glottidis, which then causes VIBRATION of the vocal folds –> frequency of this vibration is related to the sounds we here
pitch of one’s voice is determined by?
determined by the length tension relationship of the vocal ligaments
high pitch?
INCREASED TENSION in vocal ligaments –> increase vibration of the vocal ligaments as air passes through the larynx –> HIGH PITCH
low pitch?
DECREASED TENSION in vocal ligaments –> decrease vibration of the vocal ligaments as air passes through the larynx –> LOW PITCH
what determines the volume (loudness) of a sound?
related to the FORCE with which air passes through the vocal folds
loud sound?
if a lot of air is forced through the rima glottidis - loud sound produced
soft sound?
if little air moves through the rima glottidis - soft sound produced
describe whispering
when you whisper, only the posterior part of the rima glottidis is opening and the vocal cords DO NOT VIBRATE, therefore all whispers have the same pitch
T/F there is no vibration of the vocal cords when you whisper
TRUE - and because there is no vibration - there is only one pitch to whispers
what does the larynx do during deglutition
elevates and moves anteriorly
what does the epiglottis do during deglutition?
it approximates the base of the tongue causing the epiglottis TO BEND POSTERIORLY which covers the laryngeal inlet - however the epiglottis alone is NOT sufficient enough by itself to protect
pathway of bolus at epiglottis
bolus slips over the ANTERIOR surface of the epiglottis before passing LATERALLY into the priiform recess (lateral food passageway) before entering the esophagus
what is required to protect the airwaY from fluid or food particles from entering the lungs?
brief CLOSURE OF THE RIMA GLOTTIDIS IS REQUIRED
piriform recess
lateral food passageway
food goes over anterior portion of the epiglottis and passes into the esophagus through the lateral openings which are called the piriform recess
sensory innervation to the larynx
all laryngeal sensation ABOVE the level of the vocal fold is provided by the INTERNAL BRANCH OF THE SUPERIOR LARYNGEAL NERVE (aka the internal laryngeal nerve)
all sensation BELOW the vocal fold is carried by the recurrent laryngeal nerve
motor innervation to the larynx
all intrinsic muscles EXCEPT THE cricothyroid muscle are innervated by the recurrent laryngeal nerve
crycothyroid muscle is innervated by the external branch of the superior laryngeal nerve (external laryngeal nerve)
inferior laryngeal nerve
name of the recurrent laryngeal nerve as it passes to the larynx
