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Head and neck > Lecture 19- The larynx > Flashcards

Lecture 19- The larynx Flashcards

1
Q

the pharynx deals wtih a bit of a design flaw…

A

Air must pass through the nasopharynx and the oropharynx to get to the larynx= shared pathway (air and food)

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2
Q

function of the larynx

A
  • Airway protection
    • Larynx protects the airway when we eat and drink
  • Ventilation
    • Conduit for air to pass for breathing
  • Cough reflex
    • Rapidly expels anything inadvertently entering the airway
  • Production of sound (phonation)
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3
Q

Anatomy of the larynx

A
  • Larynx sits in front of the pharynx
  • Tube supported by cartilaginous tube, ligaments and membrane
  • Muscle also help support
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4
Q

the larynx is suspended fromt he

A

hyoid bone

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5
Q

where does the larynx begin

A
  • Begins at the laryngeal inlet and ends at the lower border of cricoid cartilage (C6- trachea)
  • Continues as the trachea

laryngeal inlet is circles in yellow makrer

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6
Q

larynx relationship between the suprahyoid and infrahyoid muscles

A
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7
Q

where does the larynx lie anteriro to

A

the laryngopharynx

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8
Q

posterior view of the larynx

A
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9
Q
  • Posterior-laterally to laryngeal inlet the ………. …………is found
A

piriform fossa

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10
Q
  • When we eat and drink the position of the epiglottis moves to a more
A
  • horizontal position–> directing food through the piriform fossa and into the oesophagus
    • Food can get stuck in the piriform fossa
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11
Q

Framework of larynx - Cartilage

A
  • Thyroid (2 lamina – superior and inferior horn)
    • When one lamina meets the other lamina = laryngeal prominences – Adams apple
  • cricoid cartilage -below thyroid
    • inferior horn of thyroid cartilage articulates with the cricoid cartilage- synovial joint
    • thicker at the back than front (signet ring)
  • Retinoid cartilage- sits on the cricoid cartilage
  • Epiglottis- attached by its stalk to the inner surface of the thyroid cartilage
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12
Q

Framework of the larynx: Membranes

A

Connective tissue sheet- named according to structures they are attached to

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13
Q

Surface anatomy : certain cartilages and membranes are palpable

A
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14
Q

laryngeal inlet

A
  • Oval shaped
  • Made up of
    • Epiglottis
    • Aryepiglottic folds
      • Formed by the superior border of the quadrangular membrane
      • Inferior border- false vocal cord
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15
Q

Cricothyroid membrane

A

Free superior margin of the cricothyroid membrane and quadrangular membrane- true vocal cord

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16
Q

Larynx is lined with a

A

mucous membrane

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17
Q
  • Internal anatomy is shaped by
A
  • folds formed by ligaments/membranes and cartilages
    • Quadrangular membrane (inferior boundary)- false vocal cord
    • Superior extension of the cricothyroid membrane- true vocal cord
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18
Q

Larynx can be separated into three regions by mucosal folds

A
  • Supraglottic
  • Glottis
  • Infraglottis
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19
Q

Supraglottic

x

A
  • From laryngeal inlet down to the false vocal cords
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20
Q
  • Glottis
A
  • True vocal cords to about 1cm below here
  • Narrowest part of larynx
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21
Q
  • Infraglottis
A

Below the glottis

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22
Q

betwen the vocal cords (false and true) there is an

A
  • Outpouching of mucous membrane from between the vocal cords–> saccule of larynx
    • Between vestibular and vocal folds in small recess (ventricle)–> leads laterally and upwards into saccule (or sinus)à contains mucous glands that keep the true vocal fold moist
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23
Q

truve vocal cords are covered in

A
  • Stratified squamous epithelium
    • More resistant to damage
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24
Q

the larynx with the excpetion of the true vocal cords are lined with

A

pseudostratified ciliated columnar epithelium

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25
Q

laryngoscopic view of larynx e.g. during intubation

A
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26
Q

when will the larynx be visualise

A

intubation

flexible nasoendoscopy

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27
Q

intubation

A

vocal cords mst be views for intubation: placement of an endotracheal tube in subglottic region (i.e. below vocal cords)

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28
Q

flexible nasoendoscopy

A

insert flexible endoscope via nasal cavity and pharynx to then visualise larynx

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29
Q

the intrinsic larngeal muscles have 2 main actions

A
  • to alter
    • Size/shape of laryngeal inlet
    • Tension/position of vocal cords
      • Protection- swallowing food
      • When speaking and coughing and breathing
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30
Q

when we swallow what happens to the laryngeal inlet and vocal cords

A

close laryngeal inlet and vocal cords

protecting resp tract

31
Q

during inspiration and expiration what happens to the laryngeal inlet and vocal cords

A

laryngeal inlet and vocal cords open

  • allowing movement of air
32
Q

what happens to the vocal cords during phonation

A

partially adducted - vocal cords come together

33
Q

what happens to the vocal cords during coughing

A

must go from foricble adduction 9to increase itnrthoarcic pressure) –> abducted

34
Q

outline how the vocal cords are moved to allow coughing and phonation i.e. adduction/abduction of the vocal cords

A
  • Vocalis muscle run along the length of the vocal cords
  • muscles associated with arytenoid cartilage causes widening of aperture
    • responsible for moving outwards and inwards of vocal cords
      • important one= posterior cricoarytenoid (only intrinsic muscle that acts to abduct vocal cords)
      • all the other intrinsic muscles will act to adduct vocal cords
35
Q

only intrinsic muscle that acts to abduct vocal cords

A

important one= posterior cricoarytenoid

the rest of the intrinsic muscles will act to adduct the vocal cords

36
Q
A
37
Q
  • intrinsic muscle move cartilage
A

relative to one another playing a key role in vocal cord movement

38
Q
A
39
Q
  • arytenoid position on cricoid determines
A

position of true vocal cords and therefore size of aperture (glottis)

40
Q

all intrinsic muscles are supplied by the …………. …………… …………… excet the ………………..

A
  • all muscles supplied by the recurrent laryngeal nerve of vagus (CN X) except cricothyroid muscle
41
Q

reight/left vocal cord muscles supplies by the

A

right/left recurrent laryngeal nerve

42
Q

cricothyroid muscle supplies by the

A

external branch of the superior laryngeal nerve

43
Q

Cricothyroid muscle summary

A
  • Intrinsic muscle
  • Found on the outside of the cartilages
  • external branch of superior laryngeal nerve
  • will icnrease tension on vocal cords- importan for reaching higher pitches
44
Q

vocal cord movements: inspiration and expiration

A
  • Vocal cords aBduct
  • Allows air to pass in and out
45
Q

Vocal cord movements:

  • Phonation
A
  • VC closely aDduct
46
Q

Vocal cord movements: Cough (explosion of compressed air)

A
  • insire and fill lungs with air
  • vocal cords the aDduct
  • expiratory muscles contract
  • intrathroaric pressure builds
  • then cords suddenly abducted
  • explisuve outflow of air
47
Q

both vocal cords have to emet in the midline (aDduct) to allow for

A

phonation and cought

48
Q
A
49
Q

if movement of one vocal cord is impaired (e.g. injury to nerve supplying muscles involved in its moveemnt) ….

A

phonation and cough will be impaired

50
Q

what is this patient doing

A

B- breathing in

51
Q

pitch of sound determined by

A

vocal cord tension

52
Q
  • High pitched sounds
A

Vocal cords taut

53
Q
  • Low pitched
A

Vocal cords less taut

54
Q

what will icnrease the tension of the vocal cords outside the larynx

A

Bilateral contraction of cricothyroid muscle

55
Q

cricothryoid muscle is innervated by

A

CNX - vagus

external branch of the superior largngeal nerve

56
Q

external branch of the superiro laryngeal supplying the cricothyroid muscle is closely associated to and at risk during

A

(closely related to superior thryoid artery)–> can be damaged during thryoid surgery

  • will cause hoarseness of voice particulalry when attempting higher pitched sounds
57
Q
A
58
Q

Action of cricothyroid muscle

A

Tilts thyroid cartilage forward on cricoid increasing tension on vocal cords–>important for reaching higher pitch

59
Q
  • When epiglottis is open
A

air, food and water can go into the larynx

60
Q
  • Epiglottis needs to close during
A
  • swallowing
  • Directs food to the oesophagus instead of the airway
61
Q

outline what happens to the larynx when we swallow

A
  • Hyoid bone elevated and moves anteriorly by suprahyoid muscles
    • Larynx moves up and forward
  • Tongue pushes epiglottis posteriorly and aryepiglottic muscles contract
    • Narrowing laryngeal inlet
    • Brining epiglottis from a vertical to a more horizontal position (longitudinal pharyngeal muscles)
    • Directs food into the piriform fossa into the oesophagus
  • Closure of vocal cords (glottis)
62
Q

Hyoid bone elevated and moves anteriorly by suprahyoid muscles

A

helps ensure patency of pharynx so food/fluid can be directed into it

63
Q

vagus nerve innervation to the larynx summary

A
  • Autonomics will also be delivered via CN X to mucosal glands within the larynx
64
Q

superior laryngeal nerve

A
  • a branch of the vagus
  • gives rise to an internal and external branch
  • runs very closely to the superior thyroid artery
65
Q

internal branch of the superior laryngeal nerve

A

purely sensory (supraglottic)

66
Q

external branch of the superior laryngeal nerve

A

motor to cricothyroid

67
Q
A
68
Q

recurrent laryngeal nerve route

A
  • arises distally from the vagus
  • passes anteriorly to then loops under right SCA (superior cerebellar artery) and on left, arch of the aorta
  • asends in tracheo-oesophageal groove
  • close anatomical relationship with thryoid gland and inferior thyroid arteries supplying the gland
69
Q

RLN has a close anatomical relationship with the thyroid gland and inferior thryoid arteries- how does the RLN ascend

A

in the tracheo-oesophageal groove

70
Q

Vocal cord palsies

A

Injury to recurrent laryngeal nerve

71
Q

example of causes of vocal cord palsies due to injruy to the RLN

A
  1. thyroid sugery- RLN closely related to inferior thyroid artery
  2. Aortic arch aneurysm (left RLN)
  3. Cancer involving apex of lung (right RLN) (pancoast tumour)
  4. Disease or surgery involving larynx, oesophagus or thyroid
72
Q
  • Unilateral lesions lead to unilateral vocal cord palsies
A
    • Hoarse voice
      • Ineffective cough

the paralysed vocal cord assumes a paramedian position

  • between fully abducted and fully adducted
  • often the contralateral side will compensate in tiem 9crosses midline to meet vocal cord on affecte dside)
73
Q
  • Bilateral lesions of the RLN
A
  • Both vocal cords paralysed and in paramedian position
  • Narrow glottis
  • Significant airway obstruction… emergency surgical airway e.g. cricothyroidotomy, tracheostomy
74
Q

Summary of the larynx

A

READDDD

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