midline and ascend as the trigeminothalamic tract to VPM of thalamus. 3
neurons project topost central gyrus cerebral cortex.
Lymphatics and vessels of pharynx (Moore pp 1058 Fig 8.41, Netter Plate 63/64/66)
There are lymphoid aggregations in the pharynx, described above. These are: palatine,lingual & adenoids (pharyngeal + tubal tonsils). Lymphatic drainage of the pharynx occurs viathe retropharyngeal nodes
deep cervical nodes along IJV (within the carotid sheath). Bloodsupply to the pharynx: ascending/descending palatine artery, superior and inferior thyroidartery.
Larynx (Moore pp 1038, Netter Plate 71)
The larynx forms superior to the trachea, and inferior to oropharynx. It is part of therespiratory system and is responsible for phonation. It continues from the laryngeal inlet andis continuous with the trachea.
Skeleton of larynx (Moore pp 1038, Netter Plate 71)
The skeleton of the larynx is made up of several cartilages, joined by ligaments andmembranes. These cartilages are: (single) – thyroid, cricoid, epiglottic, (paired) – arytenoid,corniculate, cuneiform. The membranes and ligaments are: thyrohyoid, cricothyroid,cricotracheal, thyroepiglottic & vocal ligaments. Identify these structures on Nettwe Plate 71,Moore pp Fig 8.27A-D.
Interior of larynx (Moore pp 1041, Fig 8.29 – Netter Plate 72)
The larynx is split into three subdivisions: 1) vestibule of larynx – superior to the vestibular fold (false vocal cords – Netter Plate 75) up to laryngeal inlet, 2) ventricle – between thevestibular fold and vocal fold, 3) Infraglottic cavity – from vocal folds to inferior border of cricoid cartilage.The aryepiglottic fold is a mucosal fold from the arytenoid cartilage
epiglottic cartilage.Note that it contains the cuneiform tubercle (i.e.: cuneiform cartilage).
Vocal folds (Moore pp 1041 Netter Plate 72)
Note that the arytenoid cartilage has a muscular process (laterally) and vocal process(medially). The vocal fold (true vocal cords) is made up of this vocal process of the arytenoidcartilage, vocal ligament, and vocalis muscle (most medial part of thyroarytenoid muscle). Theglottis is the vocal folds + rima glottidis (aperture in between). The shape of the rima glottidisvaries according to the position of the vocal cords.During normal respiration the vocal folds are slightly abducted. During forced expiration – thevocal chords are fully abducted. During phonation the vocal folds are closely opposed –adducted - (not tightly).
Muscles of the larynx (Moore pp 1044, Netter Plate 72/73)
Note that the arytenoid cartilages can slide medially and laterally or rotate in order to produceabduction/adduction of vocal cords. Therefore these cartilages control abduction/adduction.The laryngeal muscles can be divided into intrinsic/extrinsic groups. The extrinsic musclegroups (discussed as part of the anterior triangle) move the larynx as a whole. Theinfrahyoids depress the cricoid cartilage and larynx, while the suprahyoids elevate the cricoidcartilage and larynx. The
move the vocal cords – controlling the length andtension of vocal cords – and size of rima glottidis.There are six intrinsic laryngeal muscles in all. They are: posterior cricoarytenoids: onlymuscle that abducts vocal folds (i.e.; pulls muscular process together), lateral + transversecricoarytenoids adduct the vocal folds
phonation (i.e.: former – pushes muscular processapart, latter – slides arytenoid cartilage medially), cricothyroid tenses (
length) vocal folds(i.e.:
pitch), vocalis muscle located within vocal folds adjusts tension on vocal cord,thyroarytenoid muscle relaxes vocal cords (i.e.: shortens it), oblique aryntenoid, aryepiglottic,thyroepiglottic – all close off laryngeal inlet during swallowing by adducting aryepiglottic foldsand pulling epiglottis posteriorly (wrapping movement – Netter Plate 72 – posterior view).