ANATOMY OF LARYNX

KINJAL CHAHAL(723)

INTRODUCTION
‡ The larynx lies in front of hypopharynx opposite the 3rd -6th cervical vertebrae. ‡ It moves vertically and in anteroposterior direction during swallowing and phonation . ‡ It can also be passively moved from side to side producing a characteristic grating sensation called laryngeal crepitus ‡ In an adult ,the larynx ends at the lower border of C6 vertebra

‡ PAIRED: ARYTENOID. CRICOID.CUNEIFORM .LARYNGEAL CARTILAGES ‡ Larynx has 3 unpaired and 3 paired cartilages .EPIGLOTTIS. CORNICULATE. ‡ UNPAIRED : THYROID .

its two alae meet anteriorly forming an angle of 90 degrees in males and 120 degrees in females ‡ Vocal cords are attached to the middle of thyroid angle ‡ Most of the laryngeal forgein bodies are arrested above the vocal cords i.e.THYROID ‡ It is the largest of all . above the middle of thyroid cartilage and an effective airway can be provided by piercing the cricothyroid memberane -cricothyrotomy .

‡ Its posterior part is extended to form a lamina while anteriorly it is narrow forming an ARCH .CRICOID ‡ It is the only cartilage forming a complete ring.

elastic cartilage forming anterior wall of laryngeal inlet ‡ It is attached to the body of hyoid bone by hyoepiglottic ligament which divides it into suprahyoid and infrahyoid epiglottis ‡ Anterior surface of epiglottis is separated from thyrohyoid memberane and upper part of thyroid cartilage by a potential space filled with fat preepiglottic space ‡ The space may be invaded in CA of supraglottic larynx or the base of tongue .yellow.EPIGLOTTIS ‡ It is a leaf like .

articulate with cricoid cartilage ‡ Muscular process.attached to vocal cord ‡ Apex.supports corniculate cartilage .ARYTENOID CARTILAGES ‡ Pyramidal in shape ‡ Base.attached to intrinsic laryngeal muscles ‡ Vocal process.

completed at 65 years ‡ Epiglottis .little later in crecoid &arytenoids. cuneiform and tip of arytenoid are fibroelastic .CORNICULATE CARTILAGES ‡ Eeach articulate with apex of arytenoid cartilage CUNEIFORM CARTILAGE Each is rod shaped .situated in aryepiglottic fold Thyroid. crecoid and most of arytenoid cartilages are hyaline and undergo ossification which begins at 25 years in thyroid . corniculate .

closing or opening the posterior peart of glottis ‡ CRICOTHYROID JOINT-Synovial joint .on upper border of cricoid lamina ‡ MOVEMENTS-1) Rotatory-arytenoid cartilage moves around a vertical axis.LARYNGEAL JOINTS ‡ CRICOARYTENOID JOINT Synovial joint. formed by inferior cornu of thyroid cartilage with a facet on crecoid . formed between base of arytenoid & a facet .abducting or adducting vocal cord ‡ 2)Gliding movement-one arytenoid glides away or towards the other.

upper border free and forms vocal ligaments . lower border forms vestibular ligament which lies in false vocal vocal cord.peirced by superior laryngeal vessels & internal laryngeal nerve CRICOTHYROID-Connects thyroid cartilage to cricoid CRICOTRACHEAL-connects cricoid to first tracheal ring 2)INTRINSIC MEMBRANESCRICOVOCAL Triangular fibroelastic membrane .LARYNGEAL MEMBRANES ‡ 1)E ‡ XTRINSIC MEMBRANESTHYROHYOID. . from its lower attachment membrane moves upwards and medially & with its fellow on opposite side forms conus elsticus where subglottic forgein bodies get impacted QUADRANGULAR .lies deep to mucosa of aryepiglottic folds .lower border attached to crecoid.streches between epiglottic and arytenoid cartilages.Connects thyroid cartilage to hyoid bone .

interarytenoid. closers of laryngeal inlet-interaryteniod. ‡ Acting on larngeal inlet openers of laryngeal inlet-thyroepiglottic.aryepiglottic . EXTRINSIC:-attach larynx to surrounding structures INTRINSIC-act on vocal cords or laryngeal inlet Acting on vocal cords-abductors-posterior cricoarytenoid adductors-lateral cricoarytenoid.thr yroaryteniod tensors-cricothyroid vocalis.MUSCLES OF LARYNX ‡ ‡ ‡ ‡ ‡ TWO TYPES:INTRINSIC attach laryngeal cartilages to each other.

Contd.salpingopharyngeus.stylopharyngeus.pa latopharyngeus.omohyoid .divided into depressors &elevators of larynx ‡ Elevators-primary-act directly.digastric.attached to thyroid cartilage.sternothyroid. ‡ EXTRINSIC-connect larynx to neighbouring structures.thyrohyoid.secondary-act indirectly attached to hyoid bonemylohyoid.geniohyoid ‡ Depressors-sternohyoid.stylohyoid.

two pairs of foldsvestibular&vocal.when abnormally enlarged &distended forms-laryngocele.on sides-aryepiglottic folds. ‡ VENTRICLE(SINUS OF LARYNX)-deep elliptical space between vestibular&vocal cords.anterior wall-posterior surface of epiglottis.sides-aryepiglottic folds.posteriorly-interarytenoid ‡ VESTIBULE-extends from laryngeal inlet to vestibular folds.ends at lower border of cricoid cartilage. .CAVITY OF LARYNX ‡ Starts at larnygeal inlet-communicates with pharynx.ventricle.posterior-mucuos membrane of arytenoids.subglottic space ‡ INLET OF LARYNX-oblique opening bounded anteriorly-free margin of epiglottis.divide the cavity into 3 partsvestibule.

‡ Contd. ‡ GLOTTIS(RIMA GLOTTIDIS)-elongated space-narrowest part of laryngeal cavity.24mm-men. ‡ VOCAL FOLDS(TRUE VOCAL CORDS)-two pearly white sharp bands extending from middle of thyroid angle to vocal processes of arytenoids.from vocal cords to lower border of cricoid cartilage ‡ VESTIBULAR FOLDS(FALSE VOCAL CORDS)-each of the two is a fold of mucous membrane extending anteroposteriorly across laryngeal cavity containing vestibularligament.e. LARYNX)-extends SUBGLOTTIC SPACE(INFRAGLOTTIC .vocal processes.fibres of thyoarytenoideus&mucous glands.16mmwomen.posteriorly-base of arytenoids.true upper edge of cricovocal membrane.bounded anteriorly_vocal cords.each vocal cord has vocal ligament i.

mucous glands. .corniculate&cuneiform cartilages ‡ EPITHELIUM-ciliated columnar.true vocal cords.distributed all over the mucous lining except in vocal folds.MUCOUS MEMBRANES OF LARYNX ‡ Lines the larynx except over-posterior surface of epiglottis.stratified squamous type over vocal cords&upper part of vestibule.

‡ INFRAGLOTTIC LARYNX-below vocal cords-lymphatics piercing the cricothyroid membrane go to pretracheal& prelaryngeal nodes& then to lower deep cervical&mediastinal nodes. ‡ There are practically no lymphatics in vocal cords.some vessels pierce cricotracheal membrane& drain into lower deep cervical nodes. .hence CA of this site rarely shows lymphatic metastases.LYMPHATIC DRAINAGE ‡ SUPRAGLOTTIC LARYNX-above vocal cords-lymphatics piercing thyrohyoid membrane go to upper deep cervical nodes.

NERVE SUPPLY ‡ MOTOR-all the muscles which move the vocal cord-recurrent laryngeal nerve except cricothyroid muscle_external laryngeal nerve(branch of superior laryngeal nerve) ‡ SENSORY-above vocal cords-internal laryngeal nerve(branch of superior laryngeal)below vocal cords-recurrent laryngeal nerve. .

internal branch supplies. loops around it&ascends in to the neck in the tracheo-oesophageal groove. hooks around it.ascends between trachea &oesophagus. .Contd.LEFT-arises from vagus in mediastinum.larynx &hypopharynx.at the level of arch of aorta. divides in to external& internal branches at the level of hyoid bone. ‡ RECURRENT LARYNGEAL NERVE-RIGHT-arises from vagus at the level if subclavian artery.external branch supplies-cricothyroid. The left recurrent laryngeal nerve has a much longer course & is more prone to paralysis ‡ SUPERIOR LARYNGEAL NERVE-arises from inferior ganglion of vagus.descends behind external carotid artery.

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‡ REINKE S SPACE-bounded above& below-arcuate lines front-anterior commisure behind_vocal process of arytenoid Odema of this space causes fusiform swelling of membraneous cords-reinke s odema ‡ .upper part of thyroid cartilage&thyrohyoid membrane.areolar tissue. above-hyoepiglottic ligament ‡ behind-epiglottis&quadrangular membrane Contains-fat. ‡ .lymphatics.SPACES OF LARYNX PRE-EPIGLOTTIC SPACE OF BOYER-bounded front. ‡ PARAGLOTTIC SPACE-bounded laterally-thyroid cartilage inferomedially-conus elasticus ‡ medially-ventricle&quadrangular membrane ‡ Continuous with pre-epiglottic space.

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