Larynx PDF

L a ry nx  L a ry nx is th e org a n o f v oi c e a n d a lso a p a ss a g e f or a ir.  L a ry nx c o m m u ni c a t e s with th e m o uth a n d n os e thro u g h th e l a ry n g e a l a n d or a l p a rts o f th e p h a ry nx.  Th e l a ry nx is a r e sp ir a t ory org a n lyin g b e t w e e n...

L a ry nx  L a ry nx is th e org a n o f v oi c e a n d a lso a p a ss a g e f or a ir.  L a ry nx c o m m u ni c a t e s with th e m o uth a n d n os e thro u g h th e l a ry n g e a l a n d or a l p a rts o f th e p h a ry nx.  Th e l a ry nx is a r e sp ir a t ory org a n lyin g b e t w e e n th e oro p h a ry nx a n d tr a c h e a.  Th e a irw a y m ust r e m a in o p e n a t a ll tim e s e x c e p t d urin g sw a llo win g a n d p h o n a tio n.  L a ry nx is lo c a t e d in th e a nt e rior p a rt o f th e n e c k.  It is r e l a t e d p ost e riorly t o th e b o d i e s o f C3 to C6 verte bra e.  Th e l a ry nx is sh ort e r in w o m e n a n d c hil dr e n a n d is situ a t e d slig htly m or e su p e riorly in th e n e c k.  This s e x d iff e r e n c e n orm a lly d e v e lo ps a t p u b e rty in m a l e s a n d th e c a rtil a g e s e nl a rg e.  3 o f c a rtil a g e s a r e sin gl e (th yroi d , c ri c oi d a n d e p iglo ttis).  3 a r e p a ir e d ( a ryt e n oi d , c orni c ul a t e a n d c u n e if orm).  Th yroi d , c ri c oi d a n d a ryt e n oi d c a rtil a g e s a r e h y a lin e th e r e f or e ossify b y a g e.  Th e e p iglo tti c , c orni c ul a t e a n d c u n e if orm a r e c o m p os e d o f e l a sti c fi bro c a rtil a g e , d o n o t ossify by a g e. The Thyroid C artila g e  Thyroid c artila g e is th e l a rg e st o n e  t w o q u a dril a t e r a l l a min a e ; l a min a e fus e d a nt e riorly in th e m e d i a n p l a n e a n d f orm a su b c ut a n e o us proj e c tio n c a ll e d laryng e al prominenc e (A d a m’s a p ple).  Su p e rior t o l a ry n g e a l pro min e n c e th e r e is a Vsh a p e d thyroid notch.  Th e p ost e rior b ord e r o f e a c h l a min a proj e c ts su p e riorly a s sup erior horn a n d inf e riorly a s inferior horn Cric oid c artila g e  Cric oid c artila g e is sh a p e d-lik e a sig n e t rin g with its b a n d f a c in g a nt e riorly.  Th e p ost e rior p a rt (sig n e t) is c a ll e d la mina a n d a nt e rior p a rt ( b a n d ) is c a ll e d arch.  It is th e m ost inf e rior o f th e c a rtil a g e s o f th e l a ry nx. Arytenoid C artila g e  Arytenoid C artila g es a r e p a ir e d , sh a p e lik e thr e e si d e d p yr a mi ds, a rti c ul a t e with th e l a t e r a l p a rts o f su p e rior b ord e r o f th e l a min a o f th e c ri c io d c a rtil a g e.  E a c h c a rtil a g e h a s a n a p ex su p e riorly, vo c al pro c ess a nt e riorly a n d muscular pro c ess l a t e r a lly. C orniculate and Cuneiform C artila g es  C orniculate and Cuneiform C artila g es a r e sm a ll c a rtil a g e s in th e p ost e rior p a rt o f th e a ry e p iglo tti c f ol ds.  C orni c ul a t e c a rtil a g e s a r e lo c a t e d a t th e a p i c e s o f th e a ryt e nio d c a rtil a g e s.  Th e c u n e if orm c a rtil a g e s li e in th e a ry e p iglo tti c f ol ds. Epiglottic c artila g e  Epiglottic c artila g e is a thin, l e a f sh a p e d stru c tur e.  Lo c a t e d p ost e rior t o th e ro o t o f th e t o n g u e a n d h y oi d b o n e a n d a nt e rior t o inl e t o f th e l a ry nx.  f orms th e su p e rior p a rt o f th e a nt e rior w a ll a n d th e su p e rior m a rgin o f th e inl e t o f th e l a ry nx.  Its su p e rior e n d is fr e e a n d inf e rior e n d is t a p e r e d a n d a tt a c h e d t o th e th yro e p iglo tti c lig a m e nt, lo c a t e d in th e a n gl e f orm e d b y th yroi d l a min a e.  Th e a nt e rior surf a c e o f e p iglo tti c c a rtil a g e is a tt a c h e d t o th e h y oi d b o n e b y h y o e p iglo tti c lig a m e nt. Joints  Cric othyroid joint  Cric o arytenoid joint Lig a m e nts  M e d i a n C ri c o th yroi d lig a m e nt  C ri c o tr a c h e a l lig a m e nt  Hy o e p iglo tti c lig a m e nt b in ds e p iglo ttis t o th e h y oi d bone.  Th yro e p iglo tti c lig a m e nt b in ds e p iglo ttis t o th e th yroi d c a rtil a g e.  Th e m u c o us m e m br a n e c o v e rin g e p iglo ttis t o th e p ost e rior p a rt o f th e t o n g u e a s o n e m e d i a n a n d t w o l a t e r a l glosso e p iglo tti c f ol ds.  B e t w e e n m e d i a n a n d l a t e r a l f ol ds a r e d e pr e ssio ns c a ll e d e p iglo tti c v a ll e c ul a e w h e r e s a liv a c oll e c ts fro m th e surf a c e o f th e t o n g u e. The mucous membrane that covers the epiglottis extends to the posterior (back) part of the tongue. This membrane forms folds called the glossoepiglottic folds. There are three glossoepiglottic folds in total: one median (in the middle) and two lateral (on the sides). Between the median and the lateral folds, there are depressions known as the epiglottic valleculae. These valleculae are where saliva from the surface of the tongue can collect. Me mbranes of the Larynx  Th e p ost e rior fr e e b ord e r o f this m e m br a n e is thi c k e n e d t o f orm lateral thyrohyoid lig a m ents  th e mi d lin e p a rt o f this m e m br a n e is thi c k e n e d t o f orm th e m e dian thyrohyoid lig a m ent.  Th e int e rn a l l a ry n g e a l n e rv e a n d su p e rior l a ry n g e a l v e ss e ls p e rf or a t e this m e m br a n e. 24 Larynx Epiglottis Lingual Tonsil Uvula Midline guidance: “The uvula points to the epiglottis, the epiglottis leads into the larynx”. Th e L a ry nx Lateral Glossoepiglottic Folds Posterior Wall of Hypopharynx (Leading to Esophagus) Superior Surface of Epiglottis Vallecula Median Glossoepiglottic Fold Base of Tongue Q uandrangular Me mbrane  Fibro elastic m e mbrane e xt e n ds b e t w e e n th e e p iglo ttis , th yroi d a n gl e a n d th e a ryt e n oi d c a rtil a g e.  Its fr e e inf e rior m a rgin c o nstitu e s th e vestibular lig a m ent str e c hin g b e t w e e n th e th yroi d a n gl e a n d v o c a l pro c e ss o f a ryt e n oi ds a b o v e th e a tt a c h m e nt o f v o c a l lig a m e nts.  Th e u p p e r fr e e b ord e r is in th e ary e piglottic fold. C onus Elasticus  e xt e n ds b e t w e e n th e a r c h o f th e c ri c oi d a n d th e v o c a l pro c e ss o f th e a ryt e n oi d a n d th e ju n c tio n o f th e 2 th yroi d l a min a e.  Th e fr e e thi c k e n e d u p p e r b ord e r is v o c a l lig a m e nt. C o n us e l a sti c us Interior of the Larynx  Su p e rior t o v e sti b ul a r f ol ds, th e c a vity c a ll e d vestibule of the larynx.  B e t w e e n th e v e sti b ul a r f ol ds o f m u c o us m e m br a n e o n e a c h si d e , c a ll e d ventricule of the larynx.  Th e inf e rior c o m p a rt m e nt is c a ll e d infra glottic c a vity. Vo c al folds  a r e c o n c e rn e d with th e pro d u c tio n o f th e so u n d.  E a c h v o c a l f ol d c o nsists o f v o c a l lig a m e nt, m us c l e fi b e rs a n d a c o v e rin g o f m u c o us m e m br a n e.  It is w hit e in c olor d u e t o l a c k o f su b m u c os a a n d b lo o d v e ss e ls.  Th e rim a glottidis is th e fissur e b e t w e e n th e rig ht a n d l e ft tru e v o c a l f ol ds.  Th e a nt e rior 3 / 5 w hi c h is b e t w e e n v o c a l f ol ds is c a ll e d m e m m bro n o us p a rt.  Post e rior 2 / 5, b e t w e e n a ryt e n oi d c a rtil a g e s is c a ll e d c a rtil a g e n o us p a rt.  Th e sh a p e o f rim a glo ttis v a ri e s a c c ord in g t o th e p ositio n o f v o c a l f ol ds.  D urin g ord in a ry br e a thin g , it is n a rro w a n d w e d g e -sh a p e d , d urin g f or c e d r e sp ir a tio n wi d e.  D urin g sp e a kin g it a p p e a rs a s a lin e a r slit. Pyriform Sinus Posterior Wall of pharynx (Leading to Esophagus) Laryngeal Surface of Epiglottis Ventricle http://www.nyee.edu/top#top BI, All Rights Reserved, 2005 37 Th e L a ry nx Pyriform Sinus Epiglottis Vallecula http://www.nyee.edu/top#top BI, All Rights Reserved, 2005 38 Th e L a ry nx Posterior Commissure True Vocal Cords Ventricle False Vocal Cords Anterior Commissure Aryepiglottic Fold http://www.nyee.edu/top#top BI, All Rights Reserved, 2005 39 Posterior Wall Of Hypopharynx Corniculate Tubercle on Arytenoid Cartilage Cuneiform Tubercle Aryepiglottic Fold BI, All Rights Reserved, 2005 40 Cartilaginous Rings of Trachea True Vocal Cords False Vocal Cords Cricoid Ring BI, All Rights Reserved, 2005 True Vocal Cords 41 L a ry nx M us c l e s   Extrinsi c m us c l e s  El e v a t ors o f l a ry nx  D e pr e ssors o f l a ry nx Intrinsi c m usc l e s  M us c l e s c o ntrollin g l a ry n g e a l inl e t  M usc l e s c o ntrollin g m o v e m e nts o f th e v o c a l f ol ds Extrinsi c m us c l e s   El e v a t ors o f l a ry nx  Dig a stri c  Stylo h y oi d  M ylo h y oi d  G e nio h y oi d  Stylo p h yr a n g e us  P a l a t o p h a ry n g e us D e pr e ssors o f l a ry nx  St e rn o h y oi d  Str e n o th yroi d  O m o h y oi d Intrinsi c m us c l e s  M us c l e s c o ntrollin g l a ry n g e a l inl e t › › ›  O b li q u e a ryt e n oi d ( c los e ) Th yro e p iglo tti c m usc l e (o p e n) Ary e p iglo tti c m usc l e ( c los e ) M us c l e s c o ntrollin g m o v e m e nts o f v o c a l f ol ds › M us c l e s th a t c h a n g e th e l e n g th o f th e v o c a l f ol ds C ri c o th yroi d (in c r e a s e th e l e n g th)  Post e rior c ri c o a ryt e n oi d (in c r e a s e th e l e n g th)  Th yro a ryt e n oi d ( d e c r e a s e th e l e n g th)  V o c a lis  › M usc l e s th a t a b d u c t or a d d u c t th e v o c a l f ol ds L a t e r a l c ri c o a ryt e n oi d ( a d d u c t or)  Tr a nsv e rs e a ryt e n oi d ( a d d u c t or)  Post e rior c ri c o a ryt e n oi d ( a b d u c t or)  Intrinsi c m us c l e s C ri c o th yroi d M us c l e A d d u c t ors o f th e V o c a l F ol ds A b d u c t or o f L a ry nx