Anatomy and Physiology of the Larynx1

7/23/2019 Anatomy and Physiology of the Larynx1

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ANATOMY ANDPHYSIOLOGY OF

THE LARYNX

JULIE G. CEBRIAN, M.D., FPSO-HNS


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LARYNX

voice box

sits approximately at

the level of 5thcervical

vertebrae in the adult


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LARYNX

Supraglottis

Glottis

Subglottis

Subdivisions of laryn


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LARYNX

Subdivisions of larynFalse vocal cords

Mucosal folds locatdsu!"#o" to t$ %lott#s a&d

a" s!a"atd f"o' t$t"u (ocal co"ds )* t$(&t"#cl


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LARYNX

A. Bone - hyoid

B. artilages !. unpaired - thyroid

cricoid

epiglottis

". paired - arytenoid

corniculate

cuneiform

LARYNGEALFRAME!OR"


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LARYNX

EPIGLOTTIS

HYOID

CORNICULATE

ARYTENOID

THYROID

CRICOID

Anterior Posterior

LARYNGEALFRAME!OR"


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LARYNX

EPIGLOTTIS

HYOID

CORNICULATE

ARYTENOID

THYROID

CRICOID

Lateral Posterior

LARYNGEALFRAME!OR"


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LARYNX

LARYNGEALFRAME!OR"

Hyoid bone -It #s attac$d to t$ !#%lott#s a&d st"a! 'uscls.


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LARYNX

LARYNGEALFRAME!OR"

La"%st ca"t#la% of t$ la"*&+.

S$#ld s$a! a&d acts as t$ a&t"#o" !"otct#( $ous#&% of t$ (ocal'c$as'.Has a&t"#o" attac$'&t of t$ (ocal folds a&d !ost"#o" a"t#culat#o& #t$

c"#co#d ca"t#la%

Thyroid Cartilage


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LARYNX

LARYNGEALFRAME!OR" S#%&t "#&% s$a!

/ c' #& $#%$t a&t"#o"l*a&d al'ost 0 c' #& $#%$t!ost"#o"l*.

1$#c2" a&d st"o&%" t$a&t$ t$*"o#d ca"t#la% a&dfo"'s t$ lo" a&d!ost"#o" !a"ts of t$ allof t$ la"*&+.

A"t#culats #t$ t$ t$*"o#da&d a"*t&o#d ca"t#la%s.Cricoid Cartilage


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LARYNX

LARYNGEALFRAME!OR" B"oad a&d laf s$a!d

'ucosal-co("df#)"oca"t#la%.

P"o3cts o)l#4ul*u!a"d )$#&d t$to&%u #& f"o&t of t$&t"a&c to t$ la"*&+.

L(l of C5 #& adultsa&d C6 #& c$#ld"&.

Epiglottis


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LARYNX

LARYNGEALFRAME!OR" A !a#" of to ca"t#la%s

t$at a" s#tuatd alo&%

t$ !ost"#o" c"#co#d

a&d a" attac$d tot$ !ost"#o" &ds of

t$ (ocal folds.

P*"a'#dal #& s$a!a&d fu&ct#o& to o!&

a&d clos t$ co"ds

A"*t&o#d Ca"t#la%


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LARYNX

LARYNGEALFRAME!OR" A !a#" of s'all cocal

&oduls, $#c$ a"t#culat

#t$ t$ a"*t&o#ds a&d

s"( to !"olo&% t$')ac2a"ds a&d

'd#ala"d.

Locatd #& t$ !ost"#o"

a"*!#%lott#c folds a&d

a" fusd #t$ t$

a"*t&o#ds so't#'s.

Corniculate Cartilage


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LARYNX

LARYNGEALFRAME!OR"

A !a#" of lo&%atd!#cs of ca"t#la%!lacd o& ac$ s#d oft$ a"*!#%lott#c fold #&f"o&t of t$ a"*t&o#ds

ca"t#la%s.

Cuneiform Cartilage


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LARYNX

A. #igaments

$g. ricothyroid ligament

%hyrohyoid ligament

B. $lastic %issues &'embranes(

!. )uadrangular membrane

". %riangular membrane onus Elas$i%us(

LARYNGEALFRAME!OR"

& Su''or$in( S$ru%$ur)s *


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LARYNX

LARYNGEALFRAME!OR"

& Su''or$in( S$ru%$ur)s *Ligaments/Membranes Thyrohyoid Membrane -It #s a )"oad, f#)"o-last#c la*" $#c$

co&&cts t$ t$*"o#d ca"t#la% to t$ $*o#d )o&. It fac#l#tats t$u!a"d 'o('&t of t$ la"*&+ du"#&% d%lut#t#o&. Hyoepiglottic Ligament -It co&&cts t$ !#%lott#s #t$ t$ $*o#d

)o&. Cricotracheal Ligament -It co&&cts t$ c"#co#d #t$ t$ f#"st "#&%

of t$ t"ac$a.

Cricothyroid Membrane -It co&&cts t$ c"#co#d to t$ f"o&t !a"tsof t$ t$*"o#d ca"t#la%. It #s 'a#&l* a(ascula". Thyroepiglottic Ligament -It co&&cts t$ st' of t$ !#%lott#s

#t$ t$ a&%l of t$ t$*"o#d ca"t#la%.


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LARYNX

LARYNGEALFRAME!OR"


Thyrohyoid Membrane

Hyoepiglottic Ligament

Thyroepiglottic Ligament

Cricothyroid Membrane

Cricotracheal Ligament


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LARYNX

$lastic %issues &'embranes(

!. )uadrangular membrane

". %riangular membrane

onus Elas$i%us(

LARYNGEALFRAME!OR"



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LARYNX

LARYNGEAL+us%ula$ur)

A. $xtrinsic 'uscles - *epressors

$levators

B. +ntrinsic 'uscles - Abductors

Adductors

%ensors


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LARYNX

EXTRINSI# M,S#LESOMOHYOID

STERNOHYOID

STERNOTHYROID

MYLOHYOID

GENIOHYOID

GENIOGLOSSUS

HYOGLOSSUS

DIGASTRIC

STYLOHYOID

* THYROHYOID *


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LARYNX

INTRINSI#M,S#LESAB!CT"#$ A!CT"#$ TE%$"#$

&osteriorcricoarytenoid

interarytenoid Cricothyroid

'e(ternal)

Lateral cricoarytenoid *ocalis 'internal)

cricothyroid thyroarytenoid


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LARYNX

In$rinsi% +us%l)s

POSTERIOR CRICOARYTENOID

INTERARYTENOID

LATERAL CRICOARYTENOID

CRICOTHYROID

VOCALIS

THYROARYTENOID

S,PERIOR -IE!


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LARYNX

In$rinsi% +us%l)sOBLIQUE ARYTENOID

TRANSVERSE ARYTENOID

POSTERIORCRICOARYTENOID

OBLIQUE CRICOTHYROID

TRANSVERSECRICOTHYROID

Pos$)rior-i).

La$)ral-i).


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LARYNX

INTRINSI#M,S#LES&osterior Cricoarytenoid

A"#ss f"o' t$ !ost"#o" as!ct of t$

c"#co#d to t$ a"*t&o#ds. Causs +t"&al "otat#o& of t$ a"*t&o#ds,

$#c$ "sult #& a)duct#o& of t$ co"ds. PCA-

!ull t$ co"ds a!a"t.


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LARYNX

A#TION OF THE 'os$)rior%ri%oary$)noid +us%l)s


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LARYNX

INTRINSI#M,S#LES+nterarytenoid

S#&%l 'uscl $#c$ f#lls u! t$ !ost"#o"

co&ca( su"facs of t$ a"*t&o#dca"t#la%s.

A#ds #& adduct#o&.


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LARYNX

A#TION OF THE in$)rary$)noid+us%l)


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LARYNX

INTRINSI#M,S#LESLateral Cricoarytenoid

A"#ss f"o' t$ u!!" )o"d" of t$ c"#co#d

to t$ a"*t&o#ds. Causs #&t"&al "otat#o& of t$ a"*t&o#ds,

$#c$ "sult #& adduct#o& of t$ co"ds.

LCA-la( t$ co"ds alo&.


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LARYNX

A#TION OF THE la$)ral%ri%oary$)noid+us%l)s


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LARYNX

INTRINSI#M,S#LESCricothyroid MuscleA"#ss f"o' t$ f"o&t a&d lat"al !a"t of t$

c"#co#d. Has a t"#a&%ula" fo"' a&d $& #s co&t"acts

#t causs t$ la"*&+ to s$#ft $#c$ #& tu"&causs co"d st"tc$ a&d t&s#o&.

Causs la"*&%os!as' $#c$ #s total a&d!"ofou&d %lott#c closu"


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LARYNX

A#TION OF THE %ri%o$/yroid+us%l)s


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LARYNX

INTRINSI#M,S#LESThyroarytenoid B"oad a&d t$#& 'uscl, $#c$ l#s !a"alll #t$

a&d lat"al to t$ (ocal fold.

Hl!s #t$ !$o&at#o&, f#&-tu&%, a&d #t "la+st$ co"ds

*ocalis L#s !a"alll #t$ t$ (ocal l#%a'&t.

Also $l!s #t$ !$o&at#o& a&d f#&-tu&% a&do"2s #& o!!os#t#o& to t$ t$*"oa"*t&o#d 'uscla&d t&ss t$ co"ds.


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LARYNX

A#TION OF THE vo%alisand$/yroary$)noid+us%l)s


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LARYNX

inn)rva$ionD"#(d f"o' t$ 7a%us N"( 8CN-9:

$uperior Laryngeal %erve -It la(s t$ (a%us&"( $#%$ #& t$ &c2 +nternal -It !"o(#ds s&sat#o& of t$ %lott#s a&d

su!"a%lott#s, $#c$ #&cluds t$ !$a"*&+,u&d"s#d of t$ !#%lott#s a&d t$ la"*&+ a)o(t$ co"ds. R'')"; SIS-su!"#o" #&t"&als&so"*.

E(ternal -It su!!l#s 'oto" fu&ct#o& to t$c"*cot$*"o#d 'uscl $#c$ t&ss t$ (ocal co"dsa&d could caus la"*&%o!as'.


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LARYNX

inn)rva$ionD"#(d f"o' t$ 7a%us N"( 8CN-9:

#ecurrent Laryngeal %erve !"o(#ds s&sat#o& to t$ su)%lott#c a"a $#c$ #&cluds t$

la"*&+ )lo t$ (ocal co"ds a&d u!!" so!$a%us. !"o(#ds 'oto" fu&ct#o& to t$ #&t"#&s#c 'uscls of t$ la"*&+.

)"a&c$s f"o' t$ (a%us #& t$ 'd#ast#&u' a&d tu"&s )ac2

u! #&to t$ &c2.

O& t$ "#%$t, #t t"a(ls #&f"#o" to t$ su)cla(#a& a&d loo!s

u!, a&d o& t$ lft #t t"a(l #&f"#o" to t$ ao"ta a&d loo!s u!.


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LARYNX

inn)rva$ion

RIGHT LATERAL-IE!

THYROID #ARTILAGE LAMINA REMO-ED

SUPERIOR LARYNGEALNERVE

Internal Bran! E"ternal Bran!

IN#ERIOR LARYNGEAL NERVE


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LARYNX

inn)rva$ion

1$ right recurrent laryngeal nervec#"cu'fl+s a"ou&d t$ f#"st !a"t of t$"#%$t su)cla(#a& a"t"*.

1$ left recurrent laryngeal nervec#"cu'fl+s a"ou&d t$ ao"t#c a"c$.


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LARYNX

$uperior Laryngeal Artery

supplies the internal laryngeal structures and it comes off

of the superior thyroid artery ,hich comes from the

carotid

+nferior Laryngeal Arterysupplies the surrounding laryngeal structures and comes

off of the inferior thyroid artery ,hich is from the

subclavian artery$uperior Thyroid *ein

-oins the superior laryngeal artery ,hich open into theinternal -ugular vein+nferior Thyroid *ein

-oins the inferior laryngeal artery and opens into the

innominate vein.

0lood su''ly


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LARYNX

0lood su''ly

S$%erior T!&roi' Arter& an' Vein

S$%erior Lar&n(eal Arter& an'Vein

In)erior Lar&n(eal Arter& an'Vein


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LARYNX

LYMPHATI# DRAINAGE

SUPERIOR $%%er l&%! no'es o) t!e 'ee% er+ial !ain at t!e le+el o) t!e !&oi' ,one

VOCAL CORD AREA %oor l&%!ati s$%%l&

IN#ERIOR %retra!eal no'es -Del%!ian no'e.

lo/er 'ee% er+ial no'es s$%rala+i$lar no'es s$%erior e'iastinal no'es


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LARYNX

!. ,rotection of airay

". espiration

/. ,honation

Ma1or fun%$ions

o$/)r fun%$ions

!. 0alsalva maneuver

". entral intrathoracic pressure


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LARYNX

Durin( ins')%$ion2

INSPIRATION

PHONATION


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LARYNX

Seen during the act of salloing

1 losure of the vocal folds and vestibular folds

1 $levation of the larynx under the base of tongue

1 $piglottis and aryepiglottic folds diverts food laterally

Pro$)%$ion of air.ay


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LARYNX

inhibited during salloing oing to the reflex

mediated by receptors present in the mucosa of

the supraglottic area

rESPIRATION

prevents inhalation of food or saliva


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LARYNX

'ost complex and best studied laryngeal function

Adducted vocal cords serves as passive reed that vibrates ricothyroid plays a ma2or role in ad2ustment of the pitch

PHONATION


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LARYNX

PHONATION


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LARYNX

serves as a pressure valve that3 hen closed allos

the build-up of intrathoracic pressure necessary

for straining acts & eg. defecation3 lifting (

upon sudden release3 produces cough

-alsalva +an)uv)r


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LARYNX

*uring respiration3 the intrathoracic pressure is

controlled by varying the degree of closure of

the true vocal cords.

'odulation of pressure assists the cardiac system

as it affects pulmonary and cardiac filling and

emptying.

#)n$ral in$ra$/ora%i% 'r)ssur)


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T!an0 &o$ 1

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Anatomy and Physiology of the Larynx1