Professional Documents
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DR SAURABH VIJAY
RSO ENT I
IMCHRC, INDORE
Introduction
Male Female
Length 44 mm 36 mm
Transverse diameter 43 mm 41 mm
A-P diameter 36 mm 26 mm
Circumference 136 mm 112 mm
Child larynx & adult larynx
Feature Difference
Size Smaller in paediatrics
Position Higher
Shape Curled epiglottis, shorter vocal cords
Mucosa More reactive and prone to obstruction
Vocal cord structure immmature
Division of the Larynx
1 bone
9 cartilage
3 Paired
3 Unpaired
8 muscles
Hyoid
•U shaped Bone.
•Provide upper
attachment of extrinsic
muscles & suspend the
larynx in the neck.
•Parts
• Body
•Greater cornua
•Lesser cornua
Thyroid
Cartilage
•Composed of two
lamina
•Fuse anteriorly in
midline which gives
laryngeal prominace
Extrinsic ligaments
Intrinsic ligaments
Extrinsic ligaments
connects laryngeal cartilage to hyoid above and to
trachea below.
Superiorly thyrohyoid membrane stretch from upper
border of thyroid cartilage & posterior surface of the
body and greater cornua of hyoid.
The membrane is composed of fibroelastic tissue,
reinforced by fibrous tissue un midline as thyrohyoid
ligament & lateral thyrohyoid ligament posteriorly.
Lateral thyrohyoid ligament connects the superior
cornua of thyroid cartilage to the posterior end of
greater cornua of the hyoid.
The membrane is pierced by internal branch of
superior laryngeal nerve an by superior laryngeal
vessels.
Cricotracheal ligament unites the lower border of
cricoid cartilage with 1st tracheal ring.
Intrinsic Ligaments
Lies between the false & true vocal cord which cover
vestibular & vocal ligaments respectively.
Laterally a horizontal slit opens into elongated
recess, the laryngeal ventricle.
From the anterior part of the ventricle, the saccule of
the larynx ascends between the vestibular ligament
and inner surface of the thyroid cartilage.
The vestibular folds are two thick folds of mucous
membrane each enclosing the fibrous tissue band,
vestibular ligament which is lower limit of upper
qudrilateral membrane.
It is fixed in front at the angle of thyroid cartilage
just below the attachment of epiglottic cartilages and
behind the anterolateral surface of arytenoid
cartilage just above the vocal process.
Vocal folds extend from the middle of the angle of
thyroid cartilage to the vocal process of arytenoid
cartilage & underlying them is upper border of conus
elasticus.
Each fold has is layered structure consists of a
superficial layer of non keratinizing stratified
squamous epithelium and beneath this lamina
propria.
This has three distinct layer superficial layer (Rinke’s
space) contain fibrous substance, which has
characteristics of gelatin.
The intermediate layer contains fibrous layer.
Deep layer contains collagen fibers.
Intermediate and deep layer make up the vocal
ligament.
The vocalis muscle forms the main body of the vocal
folds lies laterally.
The layered structure of the vocal cord is not uniform
in its entire length.
At the anterior end a mass of collagen fibres present
which connect the inner perichondrium of the
thyroid cartilage and to the deep layer of the lamina
propria posteriorly.
Adjacent to this collagen fibres layer a mass of elastic
fibres continue with the intermediate layer of lamina
propria called macula flava.
Similar structure is also present in the posterior part
of the vocal folds.
These structure serve as the cushion to protect the
ends of the vocal folds from mechanical damage
caused by vocal fold vibrations.
Anterior three fifth of the vocal cord is between the vocal
folds and is called the inter membranous part of the cord.
Posterior two fifths are between vocal process of the
arytenoid and are called inter cartilagenous part.
The height of the vocal folds diminishes towards anterior
commissure mainly because inferior edge of vocal cord
slopes upwards.
At the anterior commissure the lower edge of the vocal
folds form the apex of triangular fixed part of the
epiglottis, so tumour involving anterior commissure
involve the subglottic.
Mucous membrane of Larynx
Preepiglottic space
Paraglottic space
Preepiglottic space