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Anatomy of the Larynx
- 1. LARYNX
- 2. • Introduction • Situation & Extent • Size • Skeletal framework • Subdivison of larynx • Muscles • Movements of vocal cords • Histology • Blood supply • Nerve supply • Lymphatic drainage • Applied anatomy Objectives
- 3. Introduction • Organ of phonation • Part of air passage – Regulates passage of air in inspiration and expiration • Act as Sphincter at Inlet of Lower Respiratory Tract • Upper Respiratory tract?
- 4. Situation & Extent • Lies in anterior midline of neck • From root of Tongue to Trachea • From laryngeal inlet up to lower border of cricoid cartilage • Opp to C3 to C6 vertebrae in men • Slightly higher in female & children
- 5. Measurements In Males In Females Length 44 mm. 36 mm. Transverse diameter 43 mm. 41 mm. A-P diameter 36 mm 26 mm. Circumference 136 mm. 112 mm. Until puberty there is little difference b/w male & female larynx. After puberty:- Male larynx undergoes considerable increase; thyroid cartilage becomes prominent – Adam’s Apple
- 6. Constitution of larynx • 9 Cartilages: – Connected by • Joints • Ligaments • Membranes – Moved by • 8 Muscles(Intrinsic) • Cavity – Mucous membrane
- 7. Cartilages 3 Paired • Arytenoid • Corniculate • Cuneiform 3 Unpaired • Thyroid • Cricoid • Epiglottis
- 9. • Shield shaped, open posteriorly, angulated anteriorly • Largest cartilage of larynx • Protect larynx • Provide an attachment to vocal cords Thyroid Cartilage
- 10. Thyroid Cartilage Antero-lateral view ‘V’ shaped in cross section Laminae
- 11. Thyroid Cartilage Superior view 90° Male 120° female Posterior Anterior
- 12. Thyroid Cartilage Anterior Border Laryngeal Prominence Thyroid Notch Posterior Borders Superior Cornua Inferior Cornua
- 13. Thyroid Cartilage Lateral Thyro-hyoid Ligament Crico-thyroid Joint Cartilago Triticia
- 15. Thyroid CartilageOuter Surface Oblique Line Superior Thyroid Tubercle Inferior Thyroid Tubercle
- 16. Cricoid Cartilage • Encircle larynx below thyroid • Thicker & Stronger than Thyroid
- 17. Cricoid Cartilage Anterior Posterior Medial Arch Lamina Superiorly Facet for Inferior Cornu
- 18. Epiglottis • Leaf Shaped • Anterior wall of upper part
- 20. Ary-epiglottic Fold Epiglottis Median Glosso- epiglottic Fold Median Glosso- epiglottic Fold
- 21. Arytenoid Cartilage • Pyramidal Shaped • On upper border cricoid cartilage Apex Base
- 22. Processes of Arytenoid Cartilage Vocal Process Muscular Process
- 23. Corniculate And Cuneiform Cartilage Corniculate cartilage of Santorini Cunieform cartilage of Wrisberg Cartilage Tritiate Tritiate Cartilage
- 24. • Thyroid, • Cricoid • Base of Arytenoids Histology of Laryngeal Cartilages: • Hyaline Cartilage • May ossify after 25 yrs of age • Epiglottis, • Corniculate, • Cuneiform • Processes of Arytenoid • Elastic • They do not ossify
- 25. Joints: Rotatory Movements Around Vertical Axis Crico-thyroid Joint Crico-arytenoid Joint Rotatory Movements Around Transverse Axis Synoial
- 26. MEMBRANES & LIGAMENTS • Extrinsic • Thyrohyoid • Cricotracheal • Hyoepiglottic • Intrinsic • Quadrangular membrane & vestibular ligament • Crico-vocal membrane & vocal ligament
- 27. EXTRINSIC Thyrohyoid Membrane Superior Laryngeal Vessels Internal Laryngeal Nerve
- 29. Intrinsic • Part of Fibroelastic Membrane • Lies just outside of mucous membrane
- 30. Fibroelastic Membrane • Divided by Sinus of Larynx Quadrate Membrane Crico-vocal Membrane Conus Elasticus
- 31. Quadrate Membrane Arytenoid Cartilage Epiglottis Ary-epiglottic Ligament (Fold) Vestibular Ligament / Fold (False Vocal Cord)
- 32. Crico-Vocal Membrane Arch of Cricoid Cartilage Cricothyroid Ligament Vocal Ligament / Fold (True Vocal Cord)
- 34. Vocal Ligament Middle of Angle of Thyroid Cartilage Vocal Process of Arytenoioid Cartilage True Vocal Cord Anterior Posterior
- 35. Laryngeal Cavity Coronal section Posterior aspect From Inlet of Larynx to Lower border of Cricoid Cartilage
- 36. Laryngeal Inlet Above & In Front Upper Margin of Epiglottis Below & Behind Inter-arytenoid fold of Mucous Memb On Each Side Ary-epiglottic Fold Closure by apposition of Ary-epiglottic Fold
- 38. Laryngeal Cavity Rima Vestibuli Rima Glottidis
- 39. Anterior Posterior Rima Glottidis Anterior 3/5th Inter-membraneous Part Posterior 2/5th Inter-cartilageous Part
- 40. Laryngeal Cavity Supraglottic Part / Vestibule Above Vestibule Glottic Part / Sinus / Ventricle Between Vestibular & Vocal Folds Infraglottic Part Below Vestibule
- 41. Sinus / Ventricle of Larynx Vestibular Fold Sinus Of Morgagni Lamina of Thyroid Cartilage Saccule Of Larynx Mucous Glands Lubrication of Vocal Cords
- 42. Extrinsic Muscles Extrinsic attached to hyoid (Depressors) – Sternothyroid – Sternohyoid – Thyrohyoid
- 43. Extrinsic attached to thyroid (Elevators ) – Palatopharyngeus – Stylopharyngeus
- 44. Intrinsic Muscles acting on Vocal Cords: – Length and tension • Cricothyroid • Thyroarytenoids – Abductor • Post cricoarytenoid – Adductors • Lateral cricoarytenoid • Thyroarytenoid • Interarytenoideus / Transverse Muscles acting on epiglottis: – Aryepiglotticus – Thyroepiglotticus
- 45. Have 2 fiber types • Oblique • Vertical Action: lengthens and tenses VF Cricothyroid Antero-Lat
- 46. Action: Abduction of Vocal Cord Posterior Cricoarytenoid Post.
- 47. Action: Adduction of Vocal Cord Lateral Cricoarytenoid Lat, Thyroid lamina removed
- 48. Action: Close Laryngeal Inlet Oblique Arytenoid Ary-epiglotticus Post.
- 50. Action: Relax Vocal Cords ThyroArytenoid Thyro-epiglotticus Action: Open Laryngeal Inlet Post-lat, Thyroid lamina removed
- 52. Action Abduction of Vocal CodsAdduction of Vocal Cods Vocal Process Muscular Process Post.
- 53. Action Posterior Cricoarytenoid MuscleLateral cricoarytenoid muscle Ant. Post. Abduction of Vocal CodsAdduction of Vocal Cods
- 54. Ant. Post. Action Thyroarytenoid & Vocalis Relaxation of Vocal Cods
- 55. Action Rotate Thyroid ForwardTensioning of Vocal Cods Crico-thyroid Jt Med Crico-thyroid Muscle
- 56. Shape Of Rima Glottidis During Different Movements Of Vocal Cords Resting Condition During Forced Inspiration Post. Post.
- 57. During Phonation During Whispering Post. Post.
- 58. NERVE SUPPLY Internal Laryngeal Nerve : Only sensory – Above VC External Laryngeal Nerve : Only motor - Cricothyroid Recurrent Laryngeal Nerve : Sensory – Below VC Motor – All other muscles
- 59. Blood Supply Sup Laryngeal Sup Thyroid Inf Laryngeal Inf Thyroid
- 60. Lymphatic Drainage • Above VC upper deep cervical = anterosuperior group • Below VC lower deep cervical = posteroinferior group Upper deep cervical Lower deep cervical
- 61. Applied Anatomy
- 62. Requires laryngeal mirror and head mirror Structures seen…………… Laryngoscopy- Indirect Laryngoscopy
- 63. Done under GA Before endotracheal intubation Direct Laryngoscopy
- 64. Singers / Screamers/ Clergymens Nodules / Teacher’s Nodule
- 65. Reinke’s Edema
- 66. Classification Of Laryngeal Paralysis • May be unilateral or bilateral and may involve 1. Recurrent laryngeal nerve 2. Superior laryngeal nerve a. External LN b. Internal LN
- 67. RLN Paralysis • Moderate trauma produces only abductor paralysis. • Severe injury or section of nerve produces both abductor and adductor paralysis. • Vocal cords lies in cadaveric position – Bet Abducted & Adducted position • Phonation is completely lost • Semon's law: Progressive moderate lesion – Abductor: first to paralyzed & last to recover
- 68. Unilateral Abductor Paralysis Paralysis of recurrent laryngeal nerve. Vocal cord lies in median or paramedian position, doesn’t move on deep inspiration. Initial hoarseness. No regurgitation. Vocal cord compensation occurs leading to improvement of voice.
- 69. Laryngeal Obstruction • Produce severe protective cough reflex • If Internal laryngeal nerve is damaged • Break reflex arc • Allow entry of foreign body • Obstructiom
- 70. Laryngotomy
- 71. Inflammation Of Larynx • Produce Hoarseness of Voice
- 72. Malignancy Of Larynx • Supraglottic • Glottic • Subglottic