Anatomy and Physiology of the Larynx Beta

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Anatomy andPhysiology of the

Larynx

Dr. Supreet Singh Nayyar, AFMC

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$%&e#tives

"o dis#uss the %asi# anatomy of the larynx

"o enumerate the main fun#tions of the larynx

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Laryngeal Cartilages

Paired Arytenoid

#artilage

Corni#ulate#artilage

Cuneiform#artilage

'npaired("hyroid #artilage

Cri#oid #artilage

!piglottis

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"hyroid Cartilage

)yaline #artilage

Largest !n#loses the larynx

anteriorly andlaterally

"o alae

$ssi*#ation

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Cri#oid Cartilage

)yaline #artilage

Dire#tly %elo thethyroid #artilage

Strongest

Shape( Signet ring

Lamina + at portion

$nly #omplete annularsupport of the larynx

Arti#ulates - nferior#ornu of the thyroid#artilage

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!piglottis

Fi%roelasti##artilage

Leaf/shapedstru#ture

Petiole + small

narro portion ofthe glottis

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Arytenoid Cartilage

Mostly hyaline #artilage

Smaller in si0e

1esponsi%le for opening and #losing ofthe larynx

Shape( pyramidal

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Arytenoid Cartilage

Anterior 2o#al pro#ess /

re#eives theatta#hement ofthe mo%ile end ofea#h 2C

Lateral Mus#ular pro#ess

Arti#ulation Cri#oarytenoid

&oint

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Corni#ulate Cartilages

Fi%roelasti#

Cartilages of Santorini

Small #artilages a%ove the arytenoid and in thearyepiglotti# folds 7/

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Cuneiform Cartilages

Fir%oelasti# #artilages

Cartilages of 3ris%erg

!longated pie#es of small yello

elasti# #artilage in the aryepiglotti#folds

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"riti#eous Cartilage

Cartilago triti#ea

Small elasti# #artilage

in the lateralthyrohyoid ligament

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Laryngeal Ligaments

!xtrinsi#"hyrohyoid

mem%rane and

ligaments Cri#othyroid

mem%rane andligaments

Cri#otra#healligament

!piglottis

ntrinsi# !lasti# mem%rane

4uadrangular

mem%rane Conus elasti#us

5#ri#ovo#almem%rane6

Median #ri#othyroidligament

2o#al Ligament

"hyroepiglotti#

ligament

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!xtrinsi# Ligaments

"hyrohyoid mem%ranepier#ed on ea#h side %y(

7. Superior laryngeal vessels

8. nternal %ran#h ofsuperior laryngeal nerve

Median thyrohyoid ligament

+ thi#9ened median portion

Lateral thyrohyoid ligament

+ thi#9ened posterior%order

/ here #artilago triti#ea is

often found

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!xtrinsi# Ligaments

Cri#othyroid mem%rane and ligaments May %e pier#ed for emergen#y

tra#heotomy 5#ri#othyrotomy67/15/2012

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!xtrinsi# Ligaments

Cri#otra#heal Ligament

Atta#hes the #ri#oid #artilage to the *rst atta#hedring

!piglottis suspended in position %y mem%ranous #onne#tions

to the hyoid %one, thyroid #artilage and %ase of thetongue

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ntrinsi# Ligaments

!lasti# mem%rane Divided into upper and loer parts %y the

ventri#le of the larynx

4uadrangular mem%rane 'pper part of the elasti# mem%rane

:oundaries

!piglottis , arytenoid, #orni#ulate #artilage, false #ord Forms part of all %eteen upper pyriform

sinus and laryngeal vesti%ule

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ntrinsi# Ligaments

Conus elasti#us 5#ri#ovo#al mem%rane6 Loer part of elasti# mem%rane

Composed mainly of yello elasti# tissue

:oundaries nferior( superior %order of #ri#oid #artilage

Superoanterior( deep surfa#e of angle thyroid #artilage

Superoposterior( vo#al pro#ess of arytenoid #artilage

Median #ri#othyroid ligament + thi#9ened anteiorpart

2o#al Ligament + free upper edge

"hyroepiglotti# ligament

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Cavity of the Larynx

Divided into ;

parts( 2esti%ule 2entri#le

Su%glotti# spa#e

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2esti%ule + %oundaries(

Anterior( posterior surfa#e ofepiglottis

Posterior( interval %eteenarytenoid #artilages

Lateral( inner surfa#e ofaryepiglotti# folds and uppersurfa#es of the false #ord

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Cavity of the Larynx Su%glotti# spa#e

Preepiglotti# spa#e :oundaries( Anterior( thyrohyoid mem%rane

Anteroasuperior( hyoid

Superior( valle#ula Posterior( part of the epiglottis

Lateral( hyoepiglotti# ligament

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False Cords 5ventri#ular %ands6Anteriorly( angle of the thyroid #artilage

Posteriorly( %odies of the arytenoid

#artilage

"rue #ords2oi#e produ#tion

Prote#tion of loer respiratory tra#t

Anteriorly,( angle of thyroid #artilage

Posteriorly( vo#al pro#esses of the arytenoid#artilages

!n#lose vo#al ligament and a ma&or part of thevo#alis mus#le

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Laryngeal =oints

Cri#othyroid =oint :eteen inferior

#ornu of thethyroid #artilage

and fa#et on the#ri#oid #artilageat the &un#tion ofthe ar#h and

lamina"o movements(

1otation


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Laryngeal Mus#les

ntrinsi# Mus#les nterarytenoid

mus#le "ransvers

$%li>ue

Post. Cri#oarytenoidm.

Lateral#ri#oarytenoid m.

"hyroarytenoid m.

Cri#othyroid m.

!xtrinsi# Mus#les

Depressor group

!levator groupConstri#tor

mus#les

Pharyngeal

mus#les

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Depressor Origin Insertion Action


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Depressormuscles

Origin Insertion Action

Sternohyoid5C8, C;6

manu%rium of

sternum and

medial end of

#lavi#le

o%li>ue line of

the thyroid

#artilage

depresses-sta%ili

0es the hyoid

%one

"hyrohyoid5C76

oblique line of thethyroid cartilage

lower border of thehyoid bone

elevates the larynx;depresses/stabilizes

the hyoid bone

$mohyoid 5C8,C;6

superior%order ofs#apula nearthesupras#apular

not#h

inferior %orderof hyoid %one

depresses,retra#ts andsteadies thehyoid duringsalloing and

spea9ing

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Elevator Origin Insertion Action


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Elevatormuscles



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Elevatormuscles


Stylopharyngeus

5CN @6

styloidpro#ess oftemporal%one

posterior andsuperior %ordersof thyroid#artilage ithpalatopharyngeusmus#le

elevates the pharynxand larynx andexpands the sides ofthe pharynx

Salpingopharyngeus 5pharyngealplexus6

#artilaginous part of theauditorytu%e

%lends ithpalatopharyngeusmus#le

elevates the pharynxand larynx and opensthe ori*#e of theauditory tu%e duringsalloing

Palatopharyngeus

hard palateandpalatineaponeurosis

lateral all ofpharynx

tenses the soft palateand pulls the alls ofthe pharynxsuperiorly, anteriorlyand medially during

salloing

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Mus#les Controlling theLaryngeal nlet

IntrinsicMuscles


nterarytenoid m., o%li>ue51LN6

muscular process

of the arytenoid

cartilage

posterior surface of

the contralateral

arytenoid cartilage,

near its apex

draws arytenoid

cartilages together,

adducting the vocal

folds (closure of

glottis)

"hyroepiglotti#5!LN6

inner surface of the thyroid

cartilage near the laryngeal

prominence

lateral surface of the epiglottic

cartilage

draws the epiglottic cartilage

downward

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Mus#les Controlling Movements of the


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Mus#les Controlling Movements of the2o#al Cords

Intrinsic

Muscles


Cri#othyroid5!LN6

ar#h of the

#ri#oid #artilage

inferior %order of

the thyroid

#artilage

dras the thyroid

#artilage forard,

lengthening the

vo#al ligaments,

tenses vo#al #ords

"hyroarytenoid5vo#alis, LN6

inner surfa#e of

the thyroid

#artilage

lateral %order of

the arytenoid

#artilage

relaxes and

addu#ts the vo#al

folds

Lateral#ri#oarytenoid5LN6

ar#h of the

#ri#oid #artilage

mus#ular pro#ess

of the arytenoid

#artilage

Addu#ts the vo#al

#ords %y rotating

the arytenoid

#artilage

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Mus#les Controlling Movementsof the 2o#al Cords

IntrinsicMuscles


Posterior#ri#oarytenoid5LN6

posteriorsurfa#e of the

lamina of the

#ri#oid #artilage

mus#ular pro#essof the arytenoid

#artilage

A%du#ts the vo#al#ords %y rotating

the arytenoid

#artilage

nterarytenoidm., transverse5LN6

posteriorsurfa#e of the

arytenoid

#artilage

posterior surfa#eof the #ontralateral

arytenoid #artilage

Closes posteriorpart of rima

glottidis %y

approximating

arytenoid

#artilages

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Mu#ous Mem%rane

Strati*ed s>uamous epith.( over vo#al #ords andupper part of vesti%ule of larynx

Ciliated #olumnar epith.( remainder of the #avity

Mu#ous glands(

2entri#les and sa##uli Posterior surfa#e of epiglottis

Margins of aryepiglotti# folds

1ein9es layer of #onne#tive tissue( No glands and

no lymph vessels

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2o#al Folds

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Nerve Supply

Supplied %y 2agus nerve(

Superior laryngeal n.

nternal %ran#h 5sensory6 + areas a%ove the glottis

!xternal %ran#h 5motor and sensory6

Motor + Cri#othyroid mus#le Sensory + Anterior infraglotti# larynx at level of#ri#othyroid mem%rane

nferior 5re#urrent6 laryngeal n.

Motor + all intrinsi# laryngeal mus#les of SAM! side5ex#ept #ri#othyroid6 and interarytenoid mus#le of:$") sides

Sensory + areas %elo the glottis

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:lood Supply

'pper Larynx !xternal #arotid artery

Superior thyroidartery

Superior laryngealartery

Loer Larynx Su%#lavian artery

"hyro#ervi#al artery

nferior thyroid artery

nferior laryngealartery

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2enouos Drainage

'pper Larynx Superior laryngeal

vein

Superior thyroidvein

nternal &ugularvein

Loer Larynx nferior laryngeal

vein

nferior thyroidvein

nnominate vein

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Lymphati# Drainage

Main( Deep Cervi#al group L.N.

Supraglotti# area

B( Pedi#le Ant. !nd of aryepiglotti# fold /E

pass laterally and leave the larynx through thethyrohyoid mem%rane /E'pper deep #ervi#alnodes 5%et. Digastri# tendon and omohyoidmus#le6

8( Loer #ervi#al #hain or spinal a##essory#hain

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Lymphati# Drainage

nfraglotti# area + ; pedi#les

7. Anterior pedi#le /E #ri#othyroid mem%rane/E prelaryngeal 5Delphian6 nodes /Edeep inferior#ervi#al nodes

8. 8 Posterolateral pedi#les /E #ri#otra#healmem%rane /E paratra#heal #hain-others toinferior &ugular #hain

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P)S$L$


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:asi# Fun#tions

Prote#tion

1espiration

Phonation

Fixation of #hest Closure of glottis

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Prote#tion

A#ts as a sphin#ter Closure of the laryngeal inlet

Closure of the glottis

Cessation of respiration

Cough relfex, expulsion of se#retions andforeign %odies

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Prote#tion

; Sphin#teri# tiers of airay prote#tion(

Contra#tion of superior division of the thyroarytenoid

mus#les Contra#tion of middle thyroarytenoid *%ers

Contra#tion of inferior division of thyroarytenoid

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1espiration

Assists in regulation of gaseous ex#hange ith thelung and maintenan#e in a#id/%ase %alan#e


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Phonation in %rief

2oi#e produ#ed%y vi%ration ofthe vo#al #ords

Fundamentaltone produ#ed atthe larynx

Modi*ed %y

resonating#ham%ers of theupperaerodigestive

tra#t

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Anatomy and Physiology of the Larynx Beta