Anatomy and Physiology of

the Larynx

Sun Rong M.D. & Ph.D.

Department of Otolaryngology
Clinical college of Chongqing Medical University
 Outline
Laryngeal Cartilage

Laryngeal Joints

3 Laryngeal Membranes

Fibroelastic Musculature

Physiology
 Location of the larynx

The larynx lies in front of the hypopharynx opposite the third to sixth cervical vetebrae. It move
vertically and in anteroposteroir direction during swallowing and phonation. It can also be
passively moved from side to side producing a characteristic grating sensation called laryngeal
crepitus
 Laryngeal Cartilages
The laryngeal skeleton consists of nine cartilages.
whereas the thyroid, cricoid, and epiglottis are unpaired
The arytenoid, corniculate, and cuneiform cartilages are paired,
Laryngeal Cartilages

laryngeal cartilages
Laryngeal Cartilages
 Thyroid cartilage

The thyroid cartilage is the largest and forms a protective shield-like shape in front of the
vocal folds. Its two alae meet anteriorly forming an angle of 90˚ in males and 120˚ in
females. Its midline projection tends to be more prominent in men.
 Cricoid cartilage

The cricoid cartilage, which lies below the thyroid cartilage and above the entrance to the
trachea, is the only complete ring of the laryngeal skeleton. Its anterior part form arch, but
postetior part form lamina. The cricoid cartilage encloses the subglottic region of the
larynx.Stenosis may form if the mucosa in this region is injured
 Epiglottis cartilage

Th epiglottis is an oblong, feather-shaped elastic cartilage. A stalk-like process of epiglottis

attaches the epiglottis to the thyroid angle just above the attachment of vocal cords. Epiglottis
is not essential for swallowing and can be amputated in carcinoma with little aspiration.
 Arytenoid cartilage

the arytenoids are pyramidal-shaped cartilages , positioned on the upper border of the posterior
cricoid cartilage; The arytenoids serve as attachment sites for some of the intrinsic muscles of
the larynx and allow complex movement and fine adjustment of the vocal folds. Fibrosis or
fixation of the cricoarytenoid joint, can result in vocal fold immobility and respiratory or
phonatory impairment
laryngoscopy
Laryngeal Joints
 Laryngeal Joints -Cricothyroid Joint

It is a synovial joint. Each is formed by the inferior cornua of thyroid cartilage with
a facet on the cricoid cartilage .This motion increases the distance between the
anterior commisure and the vocal processes and serves to lengthen and tense the
vocal folds.
 Laryngeal Joints -Cricoarytenoid Joint

It is also a synovial joint. It is formed between the base of arytenoid and a facet on the
upper border of cricoid lamina. Two types of movement occur in this joint: Rotatory
(abducting or adducting the vocal cord) and Gliding movement (closing or opening the
posterior part of glottis)
Laryngeal Muscles
The muscles of the larynx are divided into extrinsic and intrinsic
muscles.
The extrinsic group, including the anterior strap muscles and digastrics,
affects the position of the entire larynx in the neck.
The intrinsic muscles are much more delicate and are responsible for
movement of the vocal folds . The main intrinsic muscles are: posterior
cricoarytenoid, lateral cricoarytenoid, interarytenoid, thyroarytenoid, and
cricothyroid.
 Intrinsic muscle of larynx
A. Acting on vocal cords
Abductors: Posterior Cricoarytenoid Muscle (PCA)
Adductors :
The Lateral Cricoarytenoid Muscle (LCA)
Thyroarytenoid Muscle ( TA)
Interarytenoid Muscle (IA)
Tensors: Cricothyroid Muscle
B. Acting on laryngeal inlet
Openers: Thyroepiglottic Muscle
Closers: Interarytenoid Muscle
Ahyroepiglottic Muscle
Adductor Muscles
 Abductor Muscles

the only abductor of the vocal folds

Tensor muscle
 Extrinsic muscle of larynx

thyrohyoid muscle digastric muscle stylohyoid muscle

Subhyoid group mylohyoid muscle geniohyoid muscle

Suprahyoid group: elevate larynx

digastric muscle
geniohyoid muscle
stylohyoid muscle
mylohyoid muscle
 Extrinsic muscle of larynx

sternothryroid muscle
omohyoid muscle sternohyoid muscle

Subhyoid group: depress larynx

omohyoid muscle
sternohyoid muscle
sternothryroid muscle
Laryngeal Membranes
Quadrangular Membrane

Conus Elasticus
 Microanatomy of the Vocal Fold
Consist of the following layers,
from superficial to deep:
1.Epithelium
2.Superficial lamina propria
3.Intermediate lamina propria
4.Deep lamina propria
5.Vocalis muscle
 Vasculature
1. Superior Laryngeal Artery
branch of superior thyroid artery - a branch of
external carotid artery.
Supplies the muscles and mucous membranes
in the superior portion of the larynx.
2. Inferior Laryngeal Artery
branch of thyrocervical trunk
Supplies the muscles and mucous membranes
in the inferior portion of the larynx.
 Innervation
Sensory
Above level of Vocal Cords:
Internal branch of Superior Laryngeal Nerve
Below Level of Vocal Cords:
Recurrent Laryngeal Nerve
Motor
All Intrinsic muscles (Except Cricothyroid )
are supplied by Recurrent Laryngeal Nerve
Cricothyroid is supplied by External laryngeal
nerve
Laryngeal cavity: three parts
1.Supraglottis
2. Glottis
3. Subglottis
1. supraglottis: above the vocal folds

Epiglottis
False vocal cords
Laryngeal ventricle
Usually covered with
respiratory epithelium
containing mucous
glands
 anterior commissure
2. glottis

Vocal cord

posterior commissure

It is the narrowest part of laryngeal cavity. Anterior two-third of Glottis are formed by
membranous cords, is called phonatory Glottis , while posterior one-third is formed by
vocal processes of arytenoids, is called respiratory Glottis.
3.subglottis

Below the vocal folds,

extending to the inferior border
of the cricoid cartilage
 Lymphatic drainage
supraglottic portion
Into upper deep cervical nodes

glottc portion
No lymphatics, Poor drainage

infraglottic portion
go to prelaryngeal and
paratracheal nodes and hence to
lower deep cervical nodes and
mediastinal nodes
 Physiology of larynx
Protection of lower airways: Phylogenetically,this is the earliest
function to develop
Phonation
Respiration
Fixation of the chest
 Paediatric Larynx
Infantʹs larynx is positioned high in the neck level being opposite
to C3 or C4 at rest and reaches C1 or C2 during swallowing, allow
breathing and feeding to go on simultaneously
Laryngeal cartilages are soft and collapse easily.
Thyroid cartilage in an infant is flat. Not easily discernible
Infant larynx is small and conical. In adults, the larynx is cylindrical
Submucosal tissues of infants larynx are comparatively loose and
easily undergo oedematous change.

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