USLS COLLEGE OF MEDICINE b) Quadrangular

E. Laryngeal Folds

ANATOMY 1. Vocal or True

2. Vestibular or False
F. Laryngeal Muscles
Upper Respiratory Tract 1. Extrinsic
DATE: 11/04/20 a) Suprahyoid
(1) Stylohyoid
LECTURER: Trinidad, MD (2) Digastric
(3) Mylohyoid
(4) Geniohyoid
b) Infrahyoid
I. NOSE
(1) Omohyoid
A. External Nose
(2) Sternohyoid
1. Muscles
(3) Thyrohyoid
a) Procerus
(4) Sternothyroid
b) Nasalis
(5) Stylopharyngeus
c) Depressor Septi Nasi
2. Intrinsic
2. Blood Supply
a) Cricothyroid
3. Venous Drainage
b) Thyroarytenoid
4. Lymphatic Drainage
c) Posterior cricoarytenoid
B. Nasal Cavity
d) Lateral cricoarytenoid
1. Divisions
e) Transverse and Oblique arytenoids
2. Nasal Conchae
f) Thyroepiglottic
3. Opening and Gateways
G. Arterial Supply
4. Nerve Supply
H. Venous Drainage
5. Arterial Supply
I. Nerve Supply
6. Venous Drainage
III. TRACHEOBRONCHIAL TREE
7. Lymph Drainage
A. Trachea
C. Paranasal Sinuses
1. Anatomical Position
1. Frontal
2. Neurovascular Supply
2. Sphenoid
B. Bronchi
3. Ethmoid
1. Neurovascular Supply
4. Maxillary
C. Bronchioles
II. LARYNX
A. Anatomical Structures
B. Cartilages
1. Unpaired
a) Thyroid
b) Cricoid
c) Epiglottis
2. Paired ● visible component of face, projecting over and allowing entrance
a) Arytenoid into nasal cavity
b) Corniculate ● have a pyramidal shape
c) Cuneiform ● parts:
C. Joints ○ Nasal Root
1. Cricothyroid ■ located superiorly
2. Cricoarytenoid ■ continuous with
D. Membranes and Ligaments forehead
1. Extrinsic ○ Apex of the Nose
a) Thyrohyoid ■ ends inferiorly in a
(1) Median rounded ‘tip’
(2) Lateral ○ Dorsum of the Nose
b) Hyo-epiglottic ■ between root and apex
c) Cricotracheal ○ Nares
d) Median cricothyroid ■ immediately inferiorly to apex
2. Intrinsic ■ piriform openings into vestibule of nasal cavity
a) Cricothyroid ■ bounded:
● medially - nasal septum
 TRANSCRIBER: ANTOLO, P., ARDIENTE, J., CARAM, M., ESTANOL, A., GONZAGA, E., KRAFT, R., TABABA, R. 1
REFERENCES: TEACH ME ANATOMY

● laterally - ala nasi (lateral cartilaginous wings of

nose) ○ I: major alar cartilage
○ Philtrum ● A: main driver for dilating or flaring or enlargement of the
■ groove between nasal septum all the way down the naris
upper border of the lip ○ assisted by Depressor septi nasi
○ Alar Nasal Sulcus 3. Depressor Septi Nasi
■ lateral boundary of ala nasi ● small muscle inserting into septum internally
○ Nasolabial Fold ● as it pulls down the nostrils -> creates a tightening or
■ important landmark to understand symmetries of face constrict the aperture of anterior naris
■ note: different from alar nasal sulcus
Clinical Notes: (not included in the lecture) ● skin of the external nose - facial artery -> branches to angular
Saddle Nose Deformity
artery and lateral nasal artery as it goes over the ala nasi
● occurs primarily as a result of nasal trauma
● septal support to the nose is lost, and subsequently the middle part of the nose
appears sunken ● skin of the nose - facial vein -> internal jugular vein
○ either a result of direct damage to the septal bone or cartilage, or a
consequence of nasal septal haematoma Clinical Notes: (not included in the lecture)
● as cartilage has no blood supply of its own -> relies on oxygen and nutrients Danger Triangle of the Face
diffusing from blood vessels in the surrounding perichondrium ● venous drainage of the nose and surrounding area - unique as a result of
● haematoma between these two structures -> destruction of the septum = communication between the facial vein and cavernous sinus via ophthalmic
deformity of the nose vein
● as cavernous sinus lies within the cranial cavity: enables infections from nasal area
to spread to brain
○ retrograde spread of infection - cause cavernous sinus thrombosis, meningitis
or brain abscess

● insert into external nose ● superficial lymphatic vessels - along facial veins
contributing to facial ○ drain into deep cervical lymph nodes
expression
● all are innervated by
branches of facial nerve (CN
● sensory innervation - trigeminal nerve (CN V) has 3 major
VII)
branches:
1. Procerus
○ external nasal nerve (CN V1) - supplies bridge and apex of
● O: fascia overlying the
nasal bone and lateral the external nose
nasal cartilage ○ infraorbital nerve (CN V2) - supplies the lateral sides of nose
● I: inferior forehead ○ CN V3
● A: ● motor innervation - nasal muscles of facial expression is via facial
○ depress the medial nerve (CN VII)
eyebrows
○ wrinkles the skin of the superior dorsum
● most superior part of the respiratory tract ● nose - olfactory and
○ brings down muscle to the forehead
respiratory organ
○ assists Nasalis in flaring or enlargement of the naris
● consists of nasal skeleton - houses the nasal cavity
2. Nasalis
○ has 4 functions:
● transverse part - assist Procerus
■ Warms and humidifies the inspired air
● alar part
■ Removes and traps pathogens and particulate matter
○ O: maxilla
from the inspired air
 ■ Responsible for sense of smell external opening to the
■ Drains and clears the paranasal sinuses and lacrimal nasal cavity
ducts ○ has hair follicles
○ Limen nasi - border
● Respiratory region
● extends from the ○ lined by ciliated
vestibule of the psudeostratified
nose to epithelium,
the nasopharynx, interspersed with mucus-secreting goblet cells
and has ○ lamina propia with many BVs - for warming of the air ●
3 divisions: Olfactory region – at the apex of the nasal cavity
● Nasal vestibule - ○ lined by olfactory cells with olfactory receptors
surrounding the
anterior

TRANSCRIBER: ANTOLO, P., 2

ARDIENTE, J., CARAM, M.,
ESTANOL, A., GONZAGA, E.,
KRAFT, R., TABABA, R.
REFERENCES: TEACH ME ANATOMY

●
conchae or turbinate - projecting out of the lateral walls of the
nasal cavity are curved shelves of bone
○ 3 conchae – inferior, middle and superior
○ project into the nasal cavity creating 4 pathways or meatuses
for the air to flow
■ Inferior meatus – between inferior concha and floor of
the nasal cavity
■ Middle meatus – between inferior and middle concha ■
Superior meatus – between middle and superior concha
■ Spheno-ethmoidal recess – superiorly and posteriorly to
the superior concha
● function of the conchae:
○ increase the surface area of the nasal cavity –> increases the
amount of inspired air that can come into contact with the
cavity walls
○ disrupt the fast, laminar flow of the air -> making it slow and
turbulent
■ air spends longer in the nasal cavity so that it can be
humidified
● Lateral wall
○ Superior meatus
■ posterior ethmoidal sinus
■ sphenoethmoidal recess
○ Middle meatus
■ sphenopalatine foramen - allows communication
between the nasal cavity and the pterygopalatine
fossa
■ paranasal sinuses’ drainage (semilunar hiatus) -
drain into the nasal cavity
■ ethmoidal bulla - bulge in the lateral wall formed by
middle ethmoidal sinus
○ Inferior meatus
■ nasolacrimal duct - drain tears from the eye
■ auditory or eustachian tube - allows middle ear to
equalise with atmospheric air pressure
■ incisive canal - pathway between the nasal cavity and
the incisive fossa of the oral cavity
● transmits nasopalatine nerve and greater
● Medial wall
○ superior - ethmoid
○ postero-inferior - palatine, crest and medial projections ○
inferior - vomer, maxilla and crest
○ septal cartilage - site of anastomoses of branches of internal
and external carotid arteries that supply the nose
palatine artery
 ○ Posterior ethmoidal artery

■ ethmoidal arteries - branch of the ophthalmic

artery
1. Olfactory nerves (CN II) - special sensory
innervation (ability of nose ● descend into the nasal cavity through the
to smell)
○ branches: run
through the
cribriform plate to
provide special
sensory innervation
to the nose
2. Nasopalatine nerve
(branch of maxillary nerve) and nasociliary nerve (branch of the
ophthalmic nerve) - general sensory to internal (septum and
lateral walls) cribriform
3. Trigeminal nerve (CN V) - general sensory to external skin of the plate
nose 2. External carotid artery
4. Facial nerve (CN VII) - parasympathetic to glands of respiratory ● branches:
epithelium ○ Sphenopalatine
artery
○ Greater palatine
1. Internal carotid artery artery
● branches: ○ Superior labial artery
○ Anterior ethmoidal artery ○ Lateral nasal arteries

TRANSCRIBER: ANTOLO, P., ARDIENTE, J., CARAM, M., ESTANOL, A., GONZAGA, E., KRAFT, R., TABABA, R. 3
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● most likely to occur in the anterior third of the nasal cavity “ Kiesselbach area” ●
cause can be local (trauma) or systemic (hypertension)
● form anastomoses with each other Cribriform Plate Fracture
○ prevalent in the anterior portion of the nose ● can occur as a result of nose trauma
○ either fractured directly by the trauma, or by fragments of the ethmoid bone
● can penetrate the meningeal linings of the brain -> leakage of cerebro-spinal fluid
● tend to follow the arteries ● drain into: ○ exposing the brain to the outside environment -> increases the risks of
○ pterygoid plexus meningitis, encephalitis and cerebral abscesses
○ facial vein ● olfactory bulb - lies on the cribriform plate and can be damaged irreversibly by the
○ cavernous sinus fracture
● in some individual: few nasal veins join with the sagittal sinus (a ○ may present with anosmia (loss of smell)
dural venous sinus)
○ represents a potential pathway by which infection can spread
from the nose into the cranial cavity
● air-filled extensions of the nasal cavity ● lined by a ciliated
Clinical Notes: (not included in the lecture)
pseudostratified epithelium, interspersed with mucus-secreting
Spread of Infection
● as the auditory tube connects the middle ear and upper respiratory tract -> path by goblet cells
which infection can spread from the upper respiratory tract to the ear ● infection of ● formed during development by the nasal cavity eroding into the
the auditory tube -> swelling of the mucous linings, and the tube becomes blocked = surrounding bones
diminished hearing ● function:
Epistaxis ○ lightening the weight of the head
● medical term for a nosebleed ○ supporting immune defence of the nasal cavity
● rich blood supply of the nose - common occurrence ○ humidifying inspired air
 ○ increasing resonance of the voice ● nerve supply:
● 4 paired sinuses: ○ anterior and posterior ethmoidal branches of
1. Frontal Sinuses the nasociliary nerve
● within the frontal bone of the skull ○ maxillary nerve
○ most superior of the paranasal sinuses ● arterial supply:
● triangular in shape ○ anterior and posterior ethmoidal arteries
● drainage: 4. Maxillary Sinuses
○ via the frontonasal duct ● largest of the sinuses
○ opens out at the hiatus semilunaris, within the ● laterally and slightly inferiorly to the nasal cavities
middle meatus of the nasal cavity ● drainage:
● nerve supply: ○ nasal cavity at the hiatus semilunaris,
○ supraorbital nerve - branch of the ophthalmic underneath the frontal sinus opening
nerve ○ potential pathway for spread of infection – fluid
● arterial supply: draining from the frontal sinus can enter the
○ anterior ethmoidal artery - branch of the maxillary sinus
internal carotid
2. Sphenoid Sinuses
● within the body of the sphenoid bone
● drainage:
○ open out into the nasal cavity in an area
supero-posterior to the superior cocha
“spheno-ethmoidal recess”
● nerve supply:
○ posterior ethmoidal nerve - branch of the
ophthalmic nerve
○ branches of the maxillary nerve
● arterial supply:
○ pharyngeal branches of the maxillary arteries
3. Ethmoidal Sinuses
● divided into 3:
○ Anterior – opens onto the hiatus semilunaris Clinical Notes: (not included in the lecture)
Transsphenoidal Surgery
(middle meatus)
● sphenoid bone - shares a close anatomical relationship with the pituitary gland
○ Middle – opens onto the lateral wall of the
○ pituitary - accessed surgically by passing instruments through the sphenoid
middle meatus bone and sinus “endoscopic trans-sphenoidal surgery (ETSS)” ■ usual
○ Posterior – opens onto the lateral wall of the treatment of choice for pituitary adenomas
superior meatus

TRANSCRIBER: ANTOLO, P., ARDIENTE, J., CARAM, M., ESTANOL, A., GONZAGA, E., KRAFT, R., TABABA, R. 4
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■ allows for the surgical management of pituitary pathology without

the need for a more extensive craniotomy
Sinusitis ○ posterior - esophagus
● as the paranasal sinuses are continuous with the nasal cavity -> upper respiratory ○ laterally - lobes of the thyroid gland
tract infection can spread to the sinuses ● component of the respiratory tract
○ infection of the sinuses - causes inflammation (particularly pain and
● important functions:
swelling) of the mucosa “sinusitis”
○ phonation
○ more than one sinus is affected: “pansinusitis”
● maxillary nerve - supplies both the maxillary sinus and maxillary teeth -> ○ cough reflex
inflammation of that sinus can present with toothache ○ protection of the lower respiratory tract
● primarily cartilaginous
● held together by a series of ligaments and membranes ●
internally: laryngeal muscles move components of the larynx for
phonation and breathing
● “voice box”
● in the anterior compartment of the neck, suspended from the Clinical Notes: (not included in the lecture)
hyoid bone (C3 - C6) ● during emergency intubation: as pressure can be applied to the cricoid cartilage of
the larynx to occlude the esophagus -> prevent regurgitation of gastric contents
● relations:
“cricoid pressure or Sellick’s manoeuvre”
○ inferiorly - trachea
○ superiorly - opens into laryngeal part of the pharynx ○
anteriorly - covered by infrahyoid muscles
 ○ marking the inferior border of the larynx at C6 ●
consists of:
○ posterior - broad sheet
○ anterior - much narrower arch (signet ring in shape) ●
articulates with paired arytenoid cartilages posteriorly ●
provides an attachment for the inferior horns of the thyroid
cartilage
3. Epiglottis - elastic
● leaf shaped plate of elastic cartilage
○ marks entrance to the larynx
● ‘stalk’ - attached to the back of the anterior aspect of the
thyroid cartilage
● during swallowing: flattens and moves posteriorly to close off
the larynx and prevent aspiration

● internal cavity divided into 3 sections:

1. Supraglottis
● inferior surface of the
epiglottis to the vestibular
folds (false vocal cords)
2. Glottis
● contains vocal cords and
1cm below them
● opening between the vocal
cords - rima glottidis (size of
which is altered by the
muscles of phonation)
3. Subglottis
● inferior border of the glottis
to the inferior border of the
cricoid cartilage
● interior surface of the larynx - lined by pseudostratified ciliated ● situated bilaterally in
columnar epithelium the larynx
○ exception: true vocal cords - lined by a stratified squamous 1. Arytenoid Cartilages
epithelium - hyaline
● major
cartilaginous
1. Thyroid Cartilage ● large, prominent structure -> easily structure
visible in adult males ● composed of 2 sheets (laminae) ● pyramidal
○ anteriorly - form the laryngeal prominence (Adam’s shaped
apple) structures that
○ posterior - project superiorly and inferiorly to form the sit on the cricoid cartilage
superior and inferior horns or cornu ● consist of: apex, base, 3 sides and 2 processes
■ superior horns - connected to the hyoid bone via ● provides an attachment point for various key structures in the
the lateral thyrohyoid ligament larynx:
■ inferior horns - articulate with the cricoid cartilage ○ Apex – articulates with the corniculate cartilage ○ Base
2. Cricoid Cartilage - elastic – articulates with the superior border of the cricoid
● complete ring of hyaline cartilage cartilage
○ only complete circle of cartilage in the larynx or trachea
● completely encircles the airway

TRANSCRIBER: ANTOLO, P., ARDIENTE, J., CARAM, M., ESTANOL, A., GONZAGA, E., KRAFT, R., TABABA, R. 5
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○ Vocal process – provides attachment for the vocal

ligament posterior and lateral cricoarytenoid muscles

○ Muscular process – provides attachment for the 2. Corniculate Cartilages - elastic
 ● minor cartilaginous structures it terminates
● articulate with the apices of the arytenoid cartilages 3. with an free
Cuneiform Cartilages - elastic (unattached)
● within the aryepiglottic folds upper margin ->
● no direct attachment forms vocal
● strengthen the folds ligament
○ relations:
■ anteriorly - thyroid cartilage
● 2 pairs of synovial joints: ○ cricothyroid joint - between inferior ■ posteriorly - arytenoid cartilage
cornu of thyroid cartilage and lateral side of the cricoid cartilage 2. Quadrangular membrane
○ cricoarytenoid joint - between base of the arytenoid cartilage ○ between anterolateral arytenoid cartilage and lateral
and superior border of lamina of cricoid cartilage ■ helps aspect of the epiglottis
with changing the tension of vocal cords ○ has a free upper margin and lower margi
● each joint allows multiaxial movements of rotation and gliding ○ ■ lower margin thickened to become vestibular
movements occur simultaneously or independently ligament
Clinical Notes: (not included in the lecture)
● laryngeal membranes and ligaments - support cartilaginous Cricothyroidotomy
skeleton of larynx ● an emergency procedure to provide a temporary airway ● used in situations
where there is an obstruction at or above the larynx (e.g foreign body,
angioedema or facial trauma), and intubation has been unsuccessful
● attach components of the larynx to external structures (eg. hyoid ● to perform the technique: thyroid cartilage is palpated in the neck – below
and cricoid cartilage) which there is a depression representing the cricothyroid ligament ○ small
incision is made in the midline of this ligament
1. Thyrohyoid membrane
○ endotracheal tube is inserted to secure the airway
○ between superior aspect of thyroid cartilage and hyoid
bone
○ pierced laterally by the superior laryngeal vessels and
internal laryngeal nerve (branch of the superior
laryngeal nerve)
a. Median thyrohyoid ligament
■ anteromedial thickening of the membrane
b. Lateral thyrohyoid ligaments
■ posterolateral thickenings of the membrane
2. Hyo-epiglottic ligament
○ connects hyoid bone to anterior aspect of the epiglottis
3. Cricotracheal ligament
○ connects cricoid cartilage to trachea
4. Median cricothyroid ligament
○ anteromedial thickening of the cricothyroid ligament ○
connects thyroid and cricoid cartilages

● crucial role in protection

of the airway, breathing,
and phonation
● 2 important soft tissue
folds located within the
larynx
1. Vocal Fold
● true vocal
cords - more
important
● * avascular ->
● holds cartilages of the larynx together as one functional unit
white in colour
internally
● space between
1. Cricothyroid
the vocal folds -
ligament
rima glottidis
○ originates
● under control of the muscles of phonation:
from
○ abducted
the
○ adducted
cricoid
cartilage ○ relaxed and tensed to control the pitch of the sound
○ extends created
superiorly ● histologically (superficial to deep)
where ○ Non-keratinised stratified squamous epithelium
 TRANSCRIBER: ANTOLO, P., ARDIENTE, J., CARAM, M., ESTANOL, A., GONZAGA, E., KRAFT, R., TABABA, R. 6
REFERENCES: TEACH ME ANATOMY

○ Branches of the
arterial artery
■ stratified layer - provides extensive ○ Branches of the occipital artery
protection against foreign bodies which ○ Branches of the lingual artery
may accidentally enter the larynx 1. STYLOHYOID - thin muscular strip superiorly to the posterior
○ Reinke’s space belly of the digastric muscle
■ watery, amorphous layer - rich in ● O: styloid process of the temporal bone
glycosaminoglycans
● I: lateral aspect of the hyoid bone
■ due to its fluidity -> epithelium is able to ● N: Stylohyoid branch of the facial nerve (CN VII) arises
vibrate freely
proximally to the parotid gland
○ Vocal ligament
● A: initiates swallowing action by pulling the hyoid bone
■ lies at the free upper edge of the
in a posterior and superior direction
cricothryoid ligament
2. DIGASTRIC - consists of 2 muscular bellies connected by a
○ Vocalis muscle
tendon (in some cadavers: this tendon can be seen to
■ exceptionally fine muscle fibres that lie
pierce the stylohyoid muscle)
lateral to the vocal ligaments
● O:
2. Vestibular Folds
● False vocal cords
● lie superiorly to
the
true vocal
cords
● consist of:
○ vestibular
ligament (free ○ anterior belly: digastric fossa of mandible
lower edge of ○ posterior belly: mastoid process of temporal bone
the quadrangular membrane) - covered by a ● I: 2 bellies are connected by an intermediate tendon
mucous membrane attached to the hyoid bone via a fibrous sling ● N:
○ *vascular -> pink in color ○ anterior belly: inferior alveolar nerve - branch of the
● fixed folds -> provide protection to the larynx mandibular nerve (derived from the
trigeminal nerve, CN V)
○ posterior belly: digastric branch of the facial nerve
● A: Depresses the mandible and elevates the hyoid bone
3. MYLOHYOID - broad, triangular shaped muscle, forms floor
of the oral cavity and supports floor of the mouth ● O:
Mylohyoid line of the mandible
● I: Hyoid bone
● N: Inferior alveolar nerve - branch of the mandibular
nerve (which is derived from the trigeminal nerve
● A: Elevates hyoid bone and floor of the mouth 4.
GENIOHYOID - close to the midline of the neck, deep to the
mylohyoid muscle
● O: Inferior mental spine of the mandible
● I: Hyoid bone
● N: C1 nerve roots - run within hypoglossal nerve ● A:
● elevate or depress the larynx during swallowing ● SUPRAHYOID Depresses mandible and elevates hyoid bone Infrahyoid Muscles
and INFRAHYOID - both attach to the hyoid bone ○ bound to the
● inferiorly to the
larynx by strong ligaments
hyoid bone in
■ allowing the whole of the larynx to be moved as one unit
the
● note:
neck
○ SUPRAHYOID & STYLOPHARYNGEUS - elevate the larynx ○
● arterial supply:
INFRAHYOID - depress the larynx ○ superior
Suprahyoid Muscles
● superior to the hyoid
bone of the neck
● elevate the hyoid bone
○ action involved in
swallowing
● arterial supply:
 and groups:
inferior ○ Superficial plane – omohyoid and sternohyoid muscles ○
thyroid Deep plane – sternothyroid and thyrohyoid muscles Superficial:
arteries 1. OMOHYOID MUSCLE - thin muscular strip located superiorly
● divided into 2 to the posterior belly of the digastric muscle ● O:

TRANSCRIBER: ANTOLO, P., ARDIENTE, J., CARAM, M., ESTANOL, A., GONZAGA, E., KRAFT, R., TABABA, R. 7
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○ Inferior belly: scapula

○ Superior belly: clavicle by the deep cervical
○ fascia
● I:
○ Inferior belly: runs superomedially underneath the
sternocleidomastoid muscle
○ Superior belly: hyoid bone
● N: Anterior rami of C1-C3 - carried by a branch of the
ansa cervicalis
● A: Depresses hyoid bone
2. STERNOHYOID MUSCLE
● control shape of the
● O: sternum and sternoclavicular joint
● I: hyoid bone rima glottidis
● N: Anterior rami of C1-C3 - carried by a branch of the (opening between
ansa cervicalis the vocal folds and
● A: Depresses hyoid bone the arytenoid
cartilages) and length
Deep:
and tension of the
1. THYROHYOID MUSCLE - short band of muscle, continuation
vocal folds
of the sternothyroid muscle
● all (except the
● O: thyroid cartilage of the larynx
cricothyroid) -
● I: hyoid bone
innervated by the inferior
● N: Anterior ramus of C1 - carried within the hypoglossal
laryngeal nerve (terminal
nerve
branch of the recurrent
● A: Depresses hyoid
laryngeal nerve, a branch
○ If hyoid bone is fixed: can elevate larynx
of
2. STERNOTHYROID MUSCLE - wider and deeper than the the vagus nerve)
sternohyoid, located within the deep plane ○ cricothyroid -
● O: manubrium of the sternum innervated
● I: thyroid cartilage by the external
● N: Anterior rami of C1-C3 - carried by a branch of the branch of
ansa cervicalis the superior
● A: Depresses thyroid cartilage laryngeal nerve
(derived from the vagus nerve)
STYLOPHARYNGEUS 1. CRICOTHYROID - stretches and tenses the vocal ligaments ●
● O: Medial base of styloid process of temporal bone ● I: important in creation of forceful speech
Blends with pharyngeal constrictors, lateral ● also has a role in altering the tone of voice (along with
glossoepiglottic fold, posterior border of thyroid cartilage the thyroarytenoid muscle) -> ‘singer’s muscle’ ● O:
● N: Glossopharyngeal nerve anterolateral aspect of cricoid cartilage
● A: Elevates pharynx and larynx ● I: inferior margin and inferior horn of thyroid cartilage
● N: External laryngeal nerve
● A: Stretches and tenses vocal ligament
2. THYROARYTENOID
● O: Inferoposterior aspect of the angle of thyroid
cartilage
● I: anterolateral part of arytenoid cartilage
● N: Inferior laryngeal nerve
● A: Relaxes vocal ligament
3. POSTERIOR CRICOARYTENOID - sole abductors of the vocal
folds -> only muscle capable of widening the rima glottidis
● O: posterior surface of cricoid cartilage
 ● I: muscular process of arytenoid cartilage ● A: widens inlet (aryepiglottic folds)
● N: Inferior laryngeal nerve
● A: ABDUCTS vocal folds
4. LATERAL CRICOARYTENOID - major adductors of the vocal 1. Superior laryngeal artery
folds ● branch of the superior thyroid artery
● narrows the rima glottidis, modulating the tone and ○ derived from the external carotid
volume of speech ● follows the internal branch of the superior laryngeal nerve
● O: arch of the cricoid cartilage into the larynx
● I: muscular process of the arytenoid cartilage ● N: ● Inferior laryngeal artery
Inferior laryngeal nerve ○ branch of the inferior thyroid artery
● A: Adducts the vocal folds ■ derived from the thyrocervical trunk
5. TRANSVERSE AND OBLIQUE ARYTENOIDS - adduct the ○ follows the recurrent laryngeal nerve into the larynx
arytenoid cartilages, closing the posterior portion of rima
glottidis -> narrows the laryngeal inlet
● Superior laryngeal vein - drains to the internal jugular vein via the
● O & I: from one arytenoid cartilage to the opposite
superior thyroid
arytenoid ● Inferior laryngeal vein - drains to the left brachiocephalic vein via
● N: Inferior laryngeal nerve the inferior thyroid vein
● A: Adducts arytenoid cartilages
6. THYROEPIGLOTTIC

TRANSCRIBER: ANTOLO, P., ARDIENTE, J., CARAM, M., ESTANOL, A., GONZAGA, E., KRAFT, R., TABABA, R. 8
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●
receives motor and sensory
innervation via branches of laryngeal
the nerve
● Causes of RLN palsy:
vagus nerve:
○ Apical lung tumour
○ sensory ○ Thyroid cancer
■ Recurrent laryngeal ○ Aortic aneurysm
nerve ○ Cervical
● infraglottis lymphadenopathy
■ internal branch of ○ Iatrogenic -
Superior laryngeal particularly during
nerve thyroid surgery due to the close relationship with the inferior thyroid
artery
● supraglottis
● in unilateral RLN palsy: one vocal cord is paralysed
○ motor
○ other vocal cord tends to compensate, and speech is not affected to a great
■ Inferior laryngeal degree, although the patient may experience hoarseness of voice ● in bilateral
nerve palsy: both vocal cords are paralysed in a position between adduction and
- terminal branch abduction
of ○ Breathing is impaired, and phonation cannot occur
recurrent laryngeal ● in where nerves are only partially damaged: vocal folds become paralysed in a
nerve - internal muscles fully adducted position
of larynx except ○ if occurs bilaterally: rima glottidis (space between the vocal cords) is
cricothyroid completely closed, and emergency surgical intervention is required to
restore the airway
■ external branch of Superior laryngeal nerve -
cricothyroid
Clinical Notes:
Vocal Cord Paralysis ● system of airways that allow passage of air into lungs ● where gas
● vocal cords - responsible for the production of speech exchange occurs
○ movement is controlled by the intrinsic muscles of the larynx ■ ● located in the neck and thorax
majority - innervated by the recurrent laryngeal nerve ● consist of:
● susceptible to damages due to its long course ○ trachea
■ an exception: cricothyroid muscle - innervated by the external
○ bronchi
○ bronchioles

● marks the beginning of the tracheobronchial tree ● arises at C6 -

lower border of cricoid cartilage as continuation of the larynx
 ● ends at T4-T5 - superior mediastinum and carina ● ○ produces mucus
relations: ● Mucociliary Escalator
○ anterior: ○ formed by the combination of sweeping movements by the
■ thyroid isthmus cilia and mucus from goblet cells
■ inferior thyroid veins ○ trap inhaled particles and pathogens, moving them up out of
■ thyroidea ima the airways to be swallowed and destroyed.
■ sternothyroid and sternohyoid muscles ● Carina
■ jugular arch ○ at the bifurcation of the primary bronchi
■ right common carotid artery ○ ridge of cartilage that runs anteroposteriorly between the
■ ascending arota openings of the two bronchi
○ posterior: ○ most sensitive area of the trachea-triggers cough reflex ○
■ esophagus seen on bronchoscopy
■ vertebral column
○ lateral:
■ thyroid lobes ● Inferior Thyroid Artery - tracheal arteries
■ inferior thyroid artery ● Superior and Middle Bronchial Artery
■ left common carotid artery ● Brachiocephalic, Azygos and Accessory Hemiazygos Veins -
■ recurrent laryngeal nerves venous drainage
■ vagus nerve ● Recurrent Laryngeal Nerve - sensory innervation

● C-shaped rings ○ trachea is held open by this cartilage ● main bronchi branch further
● Trachealis Muscle into secondary bronchi
○ supports the free ends of C-shaped rings ● supplies a lobe of the lung
● Goblet Cells ● gives rise to segmental
○ interspersed the ciliated pseudostratified columnar bronchi
epithelium lining of the trachea and bronchi

TRANSCRIBER: ANTOLO, P., ARDIENTE, J., CARAM, M., ESTANOL, A., GONZAGA, E., KRAFT, R., TABABA, R. 9
REFERENCES: TEACH ME ANATOMY

reach the hilum of the left lung

● Cartilage Rings
● branches of pulmonary artery and veins + main bronchi = roots of
○ main bronchi - completely encircle the lumen
the lungs
○ smaller lobar and segmental bronchi - crescent shapes
● Right Main Bronchus - starts at T5 (higher)

● Bronchial Arteries - arterial supply

● Bronchial Veins - venous drainage
● Vagus Nerve (CN X) - innervation

● numerous smaller airways resulted from further branching of the

segmental bronchi

● do not contain any cartilage or goblets cells

● Club Cells
○ produce a surfactant lipoprotein which prevents sticking of
walls during expiration
● Conducting Bronchioles
○ transport air but lack glands
○ not involved in gas exchange
○ end as terminal bronchioles
■ branch further into respiratory bronchioles
○ wider, shorter and descends more vertically ○ results in a ● presence of alveoli extending from their lumens ●
higher incidence of foreign body inhalation ○ where right Alveoli
superior lobar bronchus arises ○ tiny air filled pockets with thin walls (simple squamous
● Left Main Bronchus - starts at T6 epithelium)
○ narrow, longer ○ sites of gaseous exchange in the lungs
○ passes inferiorly to the arch of aorta ○ adult lungs: 300 million alveoli
○ anteriorly to the thoracic aorta and esophagus in order to
 Asthma (not included in the lecture)
Clinical Notes:
● chronic inflammatory
A boy swallowed a
disorder of the
coin. Is it in the
airways
Esophagus or the
● characterised by
Trachea? Why?
hypersensitivity,
● answer: it is in
reversible outflow
the
obstruction and
Esophagus
bronchospasm
○ trachea
● remodelling of the
is not a
small airways -> increased smooth muscle thickness around the bronchioles,
full
damaged epithelium and a thickened basement membrane
circle
● “Asthma attacks” - acute exacerbations of the condition whereby a trigger (e.g.
of
allergens, exercise) causes sudden inflammation and contraction of the
cartilage
smooth muscle around bronchioles (bronchospasm)
-> a C-ring
○ narrows the airways -> difficulty in breathing and wheezing (characteristic
○ open end of the C of the C-ring cartilage of the trachea faces your back ○
feature of asthma)
find the C below
● in normal anatomy (from the chest to back): trachea (which leads to the lungs
ahhh AIR) sits on top of the esophagus (which leads to the stomach ahhh
food)
● with almost 100% certainty a large coin will follow the path of least resistance if
it happens to go down your esophagus
● in the esophagus (like in this patient): face of the coin will sit flat against the
flatter C-ring portion of the abutting trachea just like below
○ an xray from the front to the back and from side to side - it will look like
the figure on top
● in the trachea: coin in the xrays (above) will be switched
○ it will sit end to end on the front to back view (AP) of the chest x-ray

TRANSCRIBER: ANTOLO, P., ARDIENTE, J., CARAM, M., ESTANOL, A., GONZAGA, E., KRAFT, R., TABABA, R. 10
REFERENCES: TEACH ME ANATOMY

End of Transcription

TRANSCRIBER: ANTOLO, P., ARDIENTE, J., CARAM, M., ESTANOL, A., GONZAGA, E., KRAFT, R., TABABA, R. 11
REFERENCES: TEACH ME ANATOMY