Laryngeal Biornechanics

This volume is published as part of a long-standing cooperative program

between Harvard University Press and the Commonwealth Fund, a phil-
anthropic foundation, to encourage the publication of significant schol-
arly books in medicine and health.
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Medial sagittal section of the upper air p assages.

 s Laryngeal Biomechanics
\

/
B. Rayrnond Fink
(
) and - -
Robert J. Dernarest

A Commonwealth Fund Book

HARVARD UN IVERS ITY PRESS
Cambridge, Massachusetts, and London, England
1978

on of the upper air passages.

 Preface
Nature has lavished on the larynx several of its most subtle
rnechanical inventions. For its size the human larynx is a re-
markably versatile instrument-a cavernous duct for venti-
lation, a vibratile slit for varied sound generation, an exit plug
for gas-tight postural effort, and an entrance barrier and de-
flector of potential invaders.
Contrary to earlier doctrine, it is now clear that the human
larynx possesses some mechanical properties that diverge
rnore and more rnarkedly from those of other air-breathing
vertebrates as phyletic distance increases. lt is true that, for
want of fossil larynges, this conclusion is mainly inferred from
sident and Fellows of Harvard College comparative anatomy. But enough of the dynamic behavior of
the organ is observable in living species to persua de one that
America evolution of mechanism and evolution of structure have in-
deed gone hand in hand. We may safely assume that the capa-
'.g in Publication Data
bilities of our larynx developed slowly over the rnillennia, as
the anatomical machinery and th e brain directing it acquired
increasing, matched sophistications.
book." The noti on that the body is ·a machine composed of ma-
chines originated with Descartes in 1637. If, with Jeans
(1943) and Hall (1969), we divide the world of nature into
1echanics. l. Demarest,
fitle. [DNLM: 1. Lar- 0 macromachinery (galaxies, solar system, planets), mesoma-
'..L chinery (animals, organs), and micromachinery (cells, organ-
:hanics. WV501 F499L]
77-26937 t elles, molecul ar arrays), then the behavior of the larynx be-
a longs in the realm of mesornechanics.
l V
The ab ility to switch srnoothly and rapidly from one laryn-
geal behavior to another and to produce finely graded respira-
tory airflows, vocal tones, and postural efforts is very rnuch a
part of the fiber of human existence, but its laryngeal corre-
lates have received little notice in recent years. The refine-
rnents of the peripheral mesomachinery of the larynx have
tended tobe underestimated and th eir complex behavior imag-
inately oversimplified to degrees of sphincteric closure. Ex-
perience has shown that the sphi ncteric theory of laryngeal
biomechanics has little analytic or predictive power. If, how-
ever, the larynx is viewed as a folding system, many interest-
ing new leads open into its history and mechanics.
That the larynx is a folding system was one of the main po-
sitions established in a recent study by Fink (1975). Starting
from that position-without repeating the evidence, but
not without adding to it-we have developed the same
viewpoint into a systematic account of the mesomechanical
organization and function, with new ramifications in areas as
diverse as the anatomy of the suspensory mechanism of the
larynx, the mechanical basis of professional vocal training,
the postural significance of effort closure, the mechanism of
whispering, and the evolutionary rationale of such develop-
ments.
After an introductory survey of th e dynamic anatomy of the
larynx, the biomechanics of each of the main behaviors-
breathing, v01cmg, effort closure, swallow closure-is out-
lined. We conclude with a chapter on relevant elements of
physics and mechanics. The discussion generally follows lines
pioneered (for different topics) by Gans (1974 ). Each chapter
begins with representative radiological observations from
which a schema of the biomechanical behavior is derived.
Diagrams define the important forces involved and lead to
free-body diagrams that idealize the equilibrium at each perti-
nent phase of activity. Because the subject demands a liberal
use of illustrations, we have attempted to rnake the mecha-
nism understandable from the figures and legends alone.
Together, the text and the figures present an annotated pic-
torial model of the larynx as a working machine, explanatory
of observed behaviors and perhaps predictive of some still un-
observed (Peterson and Shoup, 1966). The model is developed
primarily from photographs of the machine in life, principally
from radiographs because these reveal the behavior under
study without disturbing it. The portrayed attachments of the
muscles and ligaments that have been added to the pictures
are of course those specified by gross anatomy. We aim at fi-
delity to biomechanics rather than meticulous morphological
accuracy and feel that our artistic structural simplifications
are appropriate to the level of analysis we are undertaking.
Inevitably, the model generalizes from the few to the many
and will require modification in the light of additional data.
Although we did not set out to furnish a guide to clinical
practice, we have provided useful background for assessing
PREFACE
and managing rnechanical malfunctions encountered in pa-
tients. For example, although available techniques in surgery
and anesthesiology are equal to the dernands of microsurgery
of the arytenoid cartilage, such demands are still few, perhaps
because progress in the field of laryngeal biomechanics has
tended to lag. With a wider appreciation of the refinements of
the mechanism, corresponding refinements in the diagnosis
and correction of malfunctions may be expected to follow.
Our principal aim is to stimulate understanding of the
adaptations by which the larynx mediates the distinctive
human abilities to work and speak and whisper and sing.
These pages must also surely evoke pleasure and wonder at
the elegance of the machinery that produces such extraordi-
nary effects.
1
The illustrations were prepared with the aid of a grant from
the Commonwealth Fund. We gratefully acknowledge this
2
support and the continuing interest of Dr. Reginald H. Fitz
in the project, as weil as the boundless efforts of Dr. William
Bennett and the Harvard University Press in producing the 3
book. Some of the studies leading to the present manuscript
were made possible by Grant RO-08511 from the National
Institutes of Health. 4
B. R.F. 5
R.J. D.
VI
 :tions encountered in pa-
ib le techniques in surgery
demands of microsurgery
ands are still few, perhaps
ryngeal biomechanics has
ation of the refinements of
tnements in the diagnosis
y be expected to follow. Contents
ate understanding of th e
mediates th e distinctive
1 k and whisper and sing.
:e pleasure and wonder at
r produces such extraordi- 1 Anatomical Background 1
Figures 9
Nith the aid of a grant from 2 Respiratory Folding 15
ratefully acknowledge this
:st of Dr. Reginald H. Fitz
Figures 23
dless efforts of Dr. William
3 Effort Closure 45
;ity Press in producing the
; to th e present manuscript Figures 49
>-08511 from the National
4 Phonatory Folding 65
Figures 76

B. R. F.
5 Swallowing 97
R.J.D. Figures 103

6 Elements of Biomechanics 113

Glossary of Anatom ical Terms 119
Glossary of Physical Terms 125
References 127
Index 131
 1
Anatornical Background
The larynx is a constrictor mechanism between the throat,
or pharynx, and the windpipe, or trachea. In man it unfolds
and folds cyclically for ventilation and folds episodically and
in increasing degrees for voice production, physical effort,
and deglutition. The framework of the apparatus (fig. 1.1)
consists of hyaline cartilages-the thyroid, the two aryte-
noids, and the cricoid- articulated at synovial joints and
suspended by muscles and ligaments from the hyoid bone and
ultimately from the skull and mandible (figs. 1.2-1.4). Be-
cause the elastic suspensory ligaments are activated more con-
tinuously than the suspensory muscles (which are only acti-
vated intermittently), the suspension pattern is clearest in the
arrangement of the ligaments. The suspended framework
tapers from the pharynx downward to the trachea and is lined
with eight folds of softer tissues whose degree of folding or
unfolding determines the function performed.
At the base of the suspended system is the ringlike cricoid
cartilage, from which the trachea is suspended. Posteriorly,
the ring rather precariously supports the two small, mobile
arytenoid cartilages, to which are attached the posterior ends
of three pairs of folds, the aryepiglottic, vestibular, and vocal.
Each of the arytenoid cartilages in turn supports two tiny car-
tilages, the corniculate and cuneiform. Externally and on each
side, the ring articulates with the downward projection (infe-
rior horn) of the thyroid cartilage, which is formed by two
sra
plates (laminae) that converge and fuse anteriorly. The paired
folds end at the back of the fused region and at the margins of
the epiglottic cartilage; this cartilage projects upward behind
the body of the hyoid bone and is tethered to the hyoid bone
and thyroid cartilage by ligaments (fig. 2.10).
The corniculate, cuneiform, and epiglottic cartilages, unlike
the main framework, are composed of flexible elastic cartilage
and form part of the laryngeal system of springs. After a fold-
ing or unfolding performance, the springs serve to return the
folded or unfolded walls of the cavity automatically toward
the partially folded, partially conductant configuration, seen
at the end of a normal expiration. Thus, in general terms, the
larynx is a suspended system of articulated cartilages lined in-
ternally by folds whose collective shape is altered by muscles
and restored by springs. Each of the subunits abounds in
structural refinements adapted to varied mechanical roles.
Thyroid Cartilage
The thyroid cartilage shields the open canal and supports
seven of the eight folds that serve to close the passage. lt is
composed of two plates of hyaline cartilage that fuse and meet
above at an angle of about 90 degrees in men (the angle is
somewhat !arger in warnen). The fused region, or isthmus,
usually called the "angle of the cartilage," slopes downward the flare, or divergence of the laminae, these muscles also tend The lurnen of the cricoid ring is eJ
and backward at an angle of about 60 degrees to the horizon. to bend the lamina (fig. 2.14, 2.15). The extrinsic muscles and tapers downward but, neverth
lts upper end forms the prominence of the larynx (pro minen- whose fibers are directed upward away from the line tend to the trachea. The elongation and ta
tia laryngis). The posterior margin of each lamina bears an bend the lamina in ward; those with fibers directed down ward tendency of the ring to bend durin
upward and a downward proj ection, or horn (cornu). The tend to bend it outward. The site of the oblique line, approxi- cothyroid muscle.
upper horn, or cornu superior, serves to suspend the thyroid mately equidistant from the prominence of the larynx and the
cartilage from the hyoid bone; the lower, to suspend the cri- cricothyroid joint of the same side, is probably the most ad-
coid cartilage from the thyroid cartilage. The back of the vantageous site available for bending the lamin~. How such
angle gives attachment to a duster of five elastic ligaments- bending reinforces closure or opening of the air passage is dis- Cricoarytenoid A
from above downward, the median thyroepiglottic ligament, cussed in chapters 2 and 5 (figs. 2.14, 2.15, 5.7). Just how well the architecture of
the bilateral vestibular ligaments, and the bilateral vocal liga- adapted to the suspensory biome
ments, respectively part of the median thyrohyoid fold, the will become apparent in chapter 2.
vestibular folds, and the vocal folds. This ligamentous conver- facet for the arytenoid cartilage is
gence constitutes a nodal point of the elastic suspensory sys-
Cricoid Cartilage located at the posterolateral extre

tem; it presumably prevents the development of twisting cou-
ples on the thyroid cartilage when the various ligaments are
simultaneously placed under tension, as happens with inspira-
tion.
Below the attachment of the vocal ligaments, the isthmus,
or angle, is thickened and is part of the wishbone-shaped Jever
form ed by the lower part of the thyroid cartilage. The arms of
the wishbone extend along the lower part of each lamina into
the inferior horn and end on each side at the cricothyroid
joint, where the pivot of the lever is situated. The vocal liga-
ments, once their posterior end is immobilized by arytenoid
adduction, are rendered tense when the Jever pivots down to-
ward the cricoid (fig. 4.5). The same effect on the ligaments,
however, will be achieved if the articular surfaces of the joint
slide appropriately on each other, that is, if the thyroid articu-
lar facet slides forward and pa rtly off the cricoid facet. The
flatness of the facets and the oblique direction of some of the
cricothyroid muscle fib ers seem weil adapted to produce such
sliding, or subluxation, and the elastic strength of the capsular
ligaments appears ample to energize the automatic return
slide. Externally, the surface of the thyroid cartilage lamina
has a faint ridge called the "oblique line" (linea obliqua). The
ridge is the site of attachment of powerful extrinsic muscles
that move the larynx relative to its surroun dings. By virtue of
The thyroid cartilage, which is the primary anterior support
of the laryngeal folds, and the arytenoids, which are the pri-
mary posterior support, are themselves supported in part by
the cricoid ring of cartilage. The ring is broad and tall at the
back where it supports the arytenoids, but low anteriorly
where it forms what is called th e "arch of the cricoid carti-
lage." The rirn of the ring diverges downward and forward
from the lower border of the thyroid lamina to define an im-
portant angle, the cricothyroid angle, sometimes called the
"visor" angle. The resting, or reference, size of this angle is
that prevailing during respiration, throughout which the
angle remains invariant. In fact, the angle is apparently in-
1 variant at all times except during phonation. Closing the
angle rotates the top of th e cricoid plate and the attached ary-
tenoids away from the isthmus (fig. 4.11). That is, closing the
cricothyroid angleinc1eases the dist~nce between the opposite
ends of the vocal li_gam en ts and thereby increases the tension
in the ligaments, raising the pitch of the voice. The angle is
restored to its prior respiratory size by elastic recoil of the lig-
aments but is prevented from opening more widely than this
by the restraining action of the median cricothyroid ligament.
This ligament bridges the front of the cricothyroid angle and
suspends the arch of the cricoid from the isthmus of the thy-
roid cartilage.
l
long axis of the facet follows the m<
ward, outward, and forward (fig. 1.
be carefully noted because of 1ts im1
f\ tenoid movernent during respirati
j track on which the arytenoid cartih
of the slide track is directly above tr
cular facet for the thyroid inferior
outward slide of the arytenoid comt
noid articular facet reaches the plan
from the thyroid cartilage.
A great part of the rnass of the c
trated in its posterior plate; this h,
placing the transverse axis of bala
very close to the axis transfixing tr
lt has been suggested that this mini
advantageous inertial rnoments of ·
chanical regulation of pitch (fig. 4.
The outstanding mech anical pro]
tilage is the smallness of its rnass an
In the role of posterior support oJ
arytenoid has to be accelerated m
virtually every respiratory cycle, e
fort, and every swallow. The irnpo1
derlined by the fact that in the co1

LARYNGEAL BIOMECHANICS 2
,e laminae, these muscles also tend
.14, 2.15). The extrinsic muscles
Jward away from the line tend to
~se with fibers directed downward
,e site of the oblique line, approxi-
. prominence of the larynx and the
me side is probably the most ad-
)r bending the lamin~. How such
ir opening of the air passage is dis-
(figs. 2.14, 2.15, 5.7).
id Cartilage
ich is the primary anterior support
the arytenoids, which are the pri-
e themselves supported in part by
:. The ring is broad and tall at the
1e arytenoids, but low anteriorly
led the "arch of the cricoid carti-
diverges downward and forward
he thyroid lamina to define an im-
,roid angle, sometimes called the
, or reference, size of this angle is
spiration, throughout which the
n fact, the angle is apparently in-
>t during phonation. Closing the
cricoid plate and the attached ary-
mus (fig. 4.11). That is, closing the
, the dist~ce betw~~n the opposite
; and thereby increases the tension
1e pitch of the vo1ce. The angle is
tory size by elastic recoil of the lig-
Jm opening more widely than this
· the median cricothyroid ligament.
iont of the cricothyroid angle and
:icoid from the isthmus of the thy-
The lumen of the cricoid ring is elongated anteroposteriorly
and tapers downward but, nevertheless, is !arger than that of
the trachea. The elongation and tapet probably minimize any
tendency of the ring to bend during tensor activity of the cri-
cothyroid muscle.
Cricoarytenoid Articulation
Just how weil the architecture of the cricoarytenoid joint is
adapted to the suspensory biomechanics of the air passage
will become apparent in chapter 2. Anatomically, the cricoid
facet for the arytenoid cartilage is oblong and convex and is
located at the posterolateral extremity of the cricoid rim.✓The
lang axis of the facet follows the inclination of the rim t:lown-
ward, öutward, and forward (fig. 1.1), a direction that should
[ be carefully noted because of its importance in regulating ary-
V\ tenoid movement during respiration. This facet forms the
! track on which the arytenoid cartilage shdes. The lateral limit
of the slide track is directly above the middle of the nearly cir-
cular facet for the thyroid inferior horn. In other words, the
outward slide of the arytenoid comes to a halt when the aryte-
noid articular facet reaches the plane of transmission of thrust
from the thyroid cartilage.
A great part of the mass of the cricoid cartilage is concen-
trated in its posterior plate; this has the interesting result of
placing the transverse axis of balance of the cartilage at or
very close to the axis transfixing the two cricothyroid joints.
lt has been suggested that this minimizes the incidence of dis-
advantageous inertial moments of the cricoid during the me-
chanical regulation of pitch (fig. 4.11).
The outstanding mechanical property of the arytenoid car-
tilage is the smallness of its mass and of its moment of inertia.
In the role of posterior support of the laryngeal folds, each
arytenoid has to be accelerated medially and laterally with
virtually every respiratory cycle, every phonation, every ef-
fort, and every swallow. The importance of small mass is un-
derlined by the fact that in the course of articulated speech,
3 ANATOMICAL BACKGROUND
adduction or abduction of the arytenoids is performed in less
than 0.1 second (Netsell, 1973). Accordingly, the arytenoid
cartilage is mechanically equivalent to an upside-down T-bar,
whose anteroposterior horizontal segment transports the
vocal ligament and vocal fold and slides on the cricoid facet
and whose vertical segment transports the vestibular ligament )
and fold and the aryepliglottic fold. Furthermore, the vertical ;G_
segment at its apex bears the corniculate cartilage. This coni- / J
cal piece of elastic cartilage projects backward and medially
and, when compressed against its fellow of the opposite side,
functions as a spring whose recoil aids in pushing the ad-
ducted arytenoids apart and restores the respiratory conduct-
ance of the larynx.
The epiglottic cartilage is a leaf-shaped lamella whose nar-
row end (stem, or petiole) is intralaryngeal and bears an elon-
gated, median convexity called the "epiglottic tubercle,"
which projects backward into the laryngeal cavity. The broad
upper end of the epiglottic cartilage projects into the pharynx
behind the tongue. This part, the epiglottis proper, is concave
facing backward, and the transition between its curvature and
the reverse curvature of the epiglottic tubercle endows the
epiglottic cartilage with the remarkable property of folding
over backward automatically with deglutition (see chapter 5).
Folding System-The Eight-Fold Way
The folds of soft tissue, which by their configuration deter-
mine the condition of the laryngeal cavity (fig. 1.2), constitute
a folding system. The tautology is deliberate and serves to un-
derline the nonsphincteric character of the arrangements and
the desirability of using the anatomical terms, vocal folds and
vestibular folds, in preference to the colloquial equivalents,
vocal cords and false vocal cords. The term folds was intro-
duced in 1745 by E. J. Bertin but has hitherto failed to sup-
plant its predecessor cords, even though internationally
agreed on in 1895. In present anatomical usage, a laryngeal
fold is simply a reduplication of mucous membrane; however,
 we have extended the usage to include the subjacent enfolded
tissues as weil. Our object is to unify anatomy with biome-
chanics and complete the description of the folding system-
classically restricted to the bilateral vocal, vestibular, and
aryepiglotti c folds-by identifying and naming two addi-
tional, unpaired folds. One, the interarytenoid fold (Testut,
1949), separates the paired folds posteriorly; th e other, the
I median thyrohyoid fold, separates the aryepiglottic folds an-
teriorly.
Functionally, the laryngeal folds segregate into two groups,
separated by the sinus of the larynx (also called the "sinus
laryngis," "ventricle," or "sinus of Morgagni"): (1) a group
of six folds above the sinus, forming a ring around the cavity
of the larynx and (2 ) a group of two folds below the sinus,
consisting simply of the left and right vocal fold s. The lower
group, the vocal folds, when dragged to the median line by th e
arytenoids, form a curtain that closes the glottis except for a
narrow median slit called the "rima glottidis" (literally, the
"crack of the glottis"). The substance of the vocal fold con-
sists principally of the stout elastic vocal ligament (fig. 1.3) in
:;
the free median edge of the fold and the vocal muscle (~. vo-
calis) elsewhere. The vocal ligament is continuous below with
a submucosal elastic membrane, the cricovocal membrane,
which ends at the rim of the cricoid cartilage.
The rima glottidis faces downward into the subglottic space
and upward into the sinus laryngis (or ventricle) and beyond
that into the vestibule and entrance (aditus) of th e laryngeal
cavity. The supraglottic part of the passage is surrounded by
the upper group of six folds: on either side, the vestibular
folds continued above into the aryepiglottic folds; in front,
the median thyrohyoid fold; behind, the interarytenoid fold .
The vestibular fold is a wedgelike shelf of tissue, broad pos-
teriorly at the arytenoid, and tapering forward to the ligamen-
tous confluence at the isthmus of the thyroid cartilage. lt con-
tains the elastic quadrangular membrane (membrana quad-
rangularis), which terminates at the lower border of the fold
as the vestibular ligament. Anterol aterally, the fold rec;:eives
an extension of the sinus called the " saccule"; posteriorly, the
LARYNGEAL BIOMECHANICS
vestibular fold contains a rod of elastic cartilage called the
1 "cun eifo rm
the median thyroh yo id fo ld, th is bo
cartilage," which is attached to the anterolateral
1 the aryepiglottic and median thyro
facies of the arytenoid cartilage. The rod and its attachment
teriorly, the back bou ndary of the 111
form a spring that retains the vestibular fold laterally except
attachment of the membrane to th
when the fold is forced medially by contraction of the
quadrangular membrane and vesti
thyroarytenoid muscle external to it. Lateral to the quad-
aryepiglottic and vestibular folds
rangular membrane, the tissue of the vestibular fold consists
/) brane and vocal ligament do for th
partly of mucous glands, many of which empty into the sac-
/ elastic deformability and support.
cule and distribute lubricating mucus to the surfaces of the la-
Complementary to these paired,
ryngeal folds. More laterally still, as just indicated, the exter-
lateral folds and completin g the fo
nal thyroarytenoid muscle sweeps from near the angle of the
paired transverse fold s. Th e anteri
thyroid cartilage backward and upward to the arytenoid car-
hyoid fold (fig. 1.2), in cludes and is
tilage (figs. 1.5, 3.3). When this muscle shortens, it pushes the
the lower part of the epiglottic car
substance of the vestibular fold medially and also a little
this cartilage, the epiglottis prop
downward, closing that part of the vestibule and sinus.
projection of the fold . Although the ,
Because of its attachment to the arytenoid cartilage a short ../
tic, it is almost inextensible; the foU
distance above and lateral to the vocal process, the vestibular
quite extensible because elastic ligan
fold is a satellite of the vocal fold, following it part way to the
cartilage to its upper and lower su
median line when the arytenoid is adducted.
ligament attaches to the body of the
The aryepiglottic fold is a thinner upward continuation of
, glottic ligament, to the angle of the t
the vestibular fold and occupies the triangle between the ves-
' these, anterior to the epiglottic cart
tibular fold and the lateral margin of the median thyrohyoid
and, finally, another elastic ligamen
fold. lts upper free edge contains the aryepiglottic muscle,
ligament. This construction conver
which is attached to the external surface of the quadrangular
fold into an elastic wedge-broad
membrane. When contracted, the muscle raises the edge of the
hyoepiglottic ligament; thin end dov
aryepiglottic fold into a ridge and indirectly lifts the vestibular
Because of its construction, the wed,
fold. The aryepiglottic fold also contains sorae submucosal
?S a tension spring and as a compres
muscle fibers, called the "thyroepiglottic muscle," that proba-
which way it is stressed.
bly control the overlying mucosa.
Finally, the posterio r median fol,
The elastic quadrangular membrane (fig. 1.3 ) in the vestib-
(fig. 1.2), containing the arytenoid
ular fold is continued upward in the aryepiglottic fold all the
cosa, attains an extreme of foldab
way to the entrance of the larynx. Its upper boundary is the
mucosa forward into the cavity anc
free edge of the aryepiglottic fold, at the entrance to the laryn-
mucosa backward into the hypopha
geal cavity; its lower boundary, the vestibular ligament, is the
are adducted (fig. 3.3 ). lt gains a c
thickened lower edge of the membrane and borders on the
corniculate cartilages and a flim sy ·
sinus or ventricle. In front, the quadrangular membrane ex-
ligament that is thought to constra
tends to the lateral border of the epiglottic cartilage down to
ward and medially toward the cricc
the ligamentous confluence. Because the cartilage is part of
is often difficult to find.
4
 rod of elastic cartilage called the
eh is attached to the anterolateral
ilage. The rod and its attachment
:he vestibular fold laterally except
medially by contraction of the
ernal to it. Lateral to the quad-
;sue of the vestibular fold consists
rnny of which empty into the sac-
ing mucus to the surfaces of the la-
ly still, as just indicated, the exter-
sweeps from near the angle of the
and upward to the arytenoid car-
this muscle shortens, it pushes the
1r fold medially and also a little
part of the vestibule and sinus.
to the arytenoid cartilage a short _,, ,
to the vocal process, the vestibular
11 fold, following it part way to the
enoid is adducted.
a thinner upward continuation of
upies the triangle between the ves-
. margin of the median thyrohyoid
contains the aryepiglottic muscle,
:ternal surface of the quadrangular
ed, the muscle raises the edge of the
.ge and indirectly lifts the vestibular
.d also contains sor,1e submucosal
hyroepiglottic muscle," that proba-
nucosa.
r membrane (fig. 1.3) in the vestib-
·ard in the aryepiglottic fold all the
: larynx. lts upper boundary is the
ic fold, at the entrance to the laryn-
dary, the vestibular ligament, is the
:he membrane and borders on the
t, the quadrangular membrane ex-
. of the epiglottic cartilage down to
:e. Because the cartilage is part of
the median thyrohyoid fold, this border marks the junction of
the aryepiglottic and median thyrohyoid folds. Finally, pos-
teriorly, the back boundary of the membrane is formed by the
attachment of the membrane to the arytenoid cartilage. The
quadrangular membrane and vestibular ligament do for the
) aryepiglottic and vestibular folds what the cncovocal mem-
v1 brane and vocal ligament do for the vocal fold: they supply
1 elastic deformability and support.
/ Complementary to these paired, roughly anteroposterior
lateral folds and completing the folding system are two un-
paired transverse folds. The anterior one, the median thyro-
hyoid fold (fig. 1.2), includes and is supported posteriorly by
the lower part of the epiglottic cartilage. The upper part of
this cartilage, the epiglottis proper, is a mucosa-covered
projection of the fold. Although the epiglottic cartilage is elas-
tic, it is almost inextensible; the fold as a whole, however, is
quite extensible because elastic ligaments attach the epiglottic
cartilage to its upper and lower supports: the hyoepiglottic
ligament attaches to the body of the hyoid bone; the thyroepi-
glottic ligament, to the angle of the thyroid cartilage. Between
these, anterior to the epiglottic cartilage, there is fatty tissue
and, finally, another elastic ligament, the anterior thyrohyoid
ligament. This construction converts the median thyrohyoid
fold into an elastic wedge-broad end upward, against the
hyoepiglottic ligament; thin end downward, against the angle .
, Because of its construction, the wedge is able to function both
as a tension spring and as a compression spring, depending on
wh ich way it is stressed.
Finally, the posterior median fold, the interarytenoid fold
(fig. 1.2), containing the arytenoid muscle and covering mu-
cosa, attains an extreme of foldability. lt folds its internal
mucosa forward into the cavity and its muscle and posterior
mucosa backward into the hypopharynx when the arytenoids
are adducted (fig. 3.3). lt gains a certain elasticity from the
corniculate cartilages and a flimsy Y-shaped cricopharyngeal
ligament that is thought to constrain the corniculates down-
ward and medially toward the cricoid cartilage; this ligament
is often difficult to find.
5 ANATOMICAL BACKGROUND
Suspensory System
The suspensory system binds the supports and the folds of
the larynx into a working unit. lts elastic ligaments and mem-
branes divide into a main suspensory system, supporting the
hyoid bone and the thyroid and cricoid cartilages, and a sub-
sidiary suspensory system, supporting the arytenoid carti-
lages.
The principal suspensory system (figs. 1.4, 2.1, 2.2) com-
mences with the stylohyoid ligaments, which suspend the
hyoid bone from the cranium, and continues with the struc-
tures that suspend the thyroid cartilage from the hyoid bone,
principally the lateral and median thyrohyoid ligaments. The
median thyrohyoid ligament has already been noted as form -
ing part of the median thyrohyoid fold. This fold does duty
both as part of the suspensory mechanism and as part of the
closing mechanism referred to in chapter 3. The suspensory
system continues below the thyroid cartilage with the liga-
ments that suspend the cricoid cartilage: laterally, the crico-
thyroid articular ligaments (the ceratocricoid, or lateral crico-
thyroid, ligaments) and anteromedially, the anterior cricothy-
roid ligament.
The suspension of the hyoid bone allows it considerable
mobility. The bone is a median structure suspended princi-
pally at the junction of the hyoid body and the minor and
major horns (cornua). The stylohyoid ligament is attached to
the cornu minor, and the pulley of the digastric muscle is at-
tached to the side of the junctional area. Together, these de-
fine a transverse axis around which the hyoid bone is able to
tilt in response to stresses from various sources (figs. 1.4, 2.3 ),
while still retaining free mobility in anteroposterior, lateral,
and vertical directions. Continuing downward, the ligamen-
tous suspension of the thyroid cartilage from the hyoid bone
may be regarded as a three-point suspension, less extensible
than the two-point hyoid suspension but still allowing moder-
ate movement in all planes between the hyoid bone and the
thyroid cartilage. Below this, however, the three-point sus-
pension of the cricoid from the thyroid cartilage provides only
 a limited amount of movement between the two cartilages,
and lower still, between the cricoid and the trachea and be-
tween the tracheal rings, the mobility is minimal.
Mechanically, the rnain ligamentous suspension tran sfers to
the !arge cartilages (the cricoid and thyroid cartilages) the
brunt of the cyclic stresses generated by the vertical respira-
tory excursion of the larynx. The subsidiary suspension is
thus left free to regulate th e delicate excu rsion of the aryte-
noid cartilages.
The subsidiary ligamentous suspension, consisting essen-
tially of the highly elastic and extensible membrana quadran-
gularis, suspends the arytenoid from the margin of the epi-
glottic cartilage. The epiglottic cartilage is part of the median
thyrohyoid fold and, thus, is part of the anterior main suspen-
sion. The arytenoid cartilage slides on the cricoid facet, which
ends directly above the cricothyroid joint in the lateral subdi-
vision of the main suspension; thus, it is apparent that the
subsidiary suspension slings the arytenoid cartilage between
the anterior and lateral subdivisions of the main suspension.
The subsidiary suspension is neither sufficiently substantial
nor appropriately oriented in space to support the full weight
of the arytenoid and its attached folds, but two small muscles,
·the posterior and lateral cricoarytenoid muscles, provide
critical added support and link the cricoid to the arytenoid
cartilage and stabilize the posture of the latter. The sus-
pension does perform the equally critical function of convert-
ing vertical momentum of the larynx into transverse momen-
turn of the arytenoid cartilage and, according to our model, is
therefore indispensable to abduction of the arytenoid. Suspen-
sion of the thyroid and cricoid cartilages by the main suspen-
1 sion is in operation at all times. Suspension of the arytenoid
cartilage by the subsidiary train prevails during respiration
but is overridden whenever the arytenoids are adducted and
apposed to each other. Apposition, as shown in chapter 4,
clamps the arytenoids to the cricoid.
LARYNGEAL BIOMECHANICS
Muscles rnuscles is uncertain. The cricoaryt -
sertions on the arytenoid muscular
The muscles of the larynx are customarily divided into two geal muscles are aten dinous.
groups: (1) intrinsic muscles, which connect different parts of The intrinsic muscles are all sup
the larynx with one another (fig. 1.5), and (2) extrinsic mus- nerve, and , with one exception, b
cles, which attach the larynx to outside structures (figs. 2.14, nerve-th e recurrent Iaryngeal brat
2.15). Our interest in the muscles relates to their role in the ralysis, see chapter 4 and fig. 4.3).
folding operations of the larynx; the details of where the mus- muscl e receives its supply from the e
cles are and what they do will be more readily understandable perior laryngeal branch. This mus
after the nature of the foldings has been considered. latecomer and is foun d only in ma
1 In man certain intrinsic muscles act in agonist-antagonist The nerve supply of the extrinsic
pairs to stabilize posture at the laryngeal joints. The lateral cludes the glossopharyngeal nerve (
and posterior cricoarytenoid muscles stabilize the posture of pharyngeal plexus of the vagus (M.
the arytenoids at the cricoarytenoid joint when the cartilages
-Y
are unadducted. (When adducted, the arytenoids are clamped
to each other and to the cricoid by the adducting muscle, the
M. arytenoideus.) The two oblique or crossed arytenoid bun-
dles conjointly reinforce the"'a dductor action of the transverse
arytenoid fibers; individually, one oblique bundle exerts an
approximately axial force at one cricoarytenoid joint and an
approximately normal force at the other. The cricothyroid .J
{ and vocal muscles stabilize the posture at the cricothyroid
j joint.
The basic reflex for the regulation of posture is the stretch
reflex. Stretching a muscle stretches and stimulates the muscle
spindles, the specialized sensory organs that lie among and
parallel to the muscle fibers. A stimulated spindle sends affer-
ent impulses up the sensory fibers of the muscular nerve to the
region of the motor neurons, causing the motor cells to excite
the skeletal muscle to contract. This reflex serves to maintain
body posture, and, in the case of the cricoarytenoid muscles,
our model postulates that it serves to maintain the posture of
the arytenoid cartilages.
Postural reflexes are also triggered by sensory endings in
tendons, but the extent of stretch necessary to evoke a re-
sponse from the Golgi tendon organ is greater than for the an-
nulospiral ending of the muscle spindle (Best and Taylor,
1973). How far this may be relevant to the intrinsic laryngeal
6
·,•'· ~=-=. ·:·. .. : . : . :: :: : .-:-~· : : . . : . ·. -"'!';;. • : •• • :, • ~

mu scles is uncertain. The cricoarytenoids have tendinous in- ferior), and the cervical plexus (M . sternothyro ideus and M.
Muscles
sertions on the arytenoid muscular process. T he other laryn- th yrohyoideus).
1rynx are customarily divided into two geal muscles are atend in ous. The sensory supply of the larynx down to the level of the
1scles, which connect different parts of
The intrinsic muscles are all supplied by the tenth cranial vocal folds is derived from the intern al branch of the superior
other (fig. 1.5), and (2) extrinsic mus- nerve, and, with one exception, by a single branch of that laryngeal; below this level, from the recurrent laryngeal.
arynx to outside structures (figs. 2.14, nerve-the recurrent laryngeal branch (for the effects of pa- There is also a sympathetic innervation.
the mu scles relates to their role in the ralysis, see chapter 4 and fig. 4.3 ). However, the cricothyroid The arteries of the larynx are laryngeal branches of the su-
1e larynx; the detail s of where the mu s-
muscle receives its supply from the external division of the su- perior and inferior thyroid arteries. Of special note is a trans-
:io will be more readily understand ab le perior laryngeal branch. This muscle is phylogenetically a verse arterial branch along the upper border of the crico-
foldings has been considered. latecomer and is found only in marnmals. thyroid membrane, which is liable to be injured and cause
nsic muscles act in agonist-antagonist The nerve supply of the extrinsic muscles is diverse; it in- troublesome hemorrhage in an ernergency cricothyrotorny.
,re at th e laryngeal joints. The lateral cludes the glossopharyngeal nerve (M. stylopharyngeus), the The patterns of the veins and lymphatics follow those of the
:enoid muscles stabilize the posture of pharyngeal plexus of the vagus (M. constrictor pharnygis in- arteries.
ricoarytenoid joint when the cartilages
1 adducted, the arytenoids are clamped

1e cricoid by the adducting muscle, the

two oblique or crossed arytenoid bun-
:e the„adductor action of the transverse
idually, one oblique bundle exerts an
,rce at one cricoarytenoid joint and an
force at the other. The cricothyroid
bilize the posture at the cricothyroid

the regulation of posture is the stretch

scle stretches and stimulates the muscle
:d sensory organs that lie among and
1bers. A stimulated spindle sends affer-
tsory fibers of the muscular nerve to the
urons, causing the motor cells to excite
:ontract. This reflex serves to maintain
the case of the cricoarytenoid muscles,
hat it serves to maintain the posture of
:s.
~ also triggered by sensory endings in
nt of Stretch necessary to evoke a re-
tendon organ is greater than for the an-
the muscle spindle (Best and Taylor,
ay be relevant to the intrinsic laryngeal

7 ANATOM IC AL BACKGROUND
·· ···-'··· ._:.:_--,::.;,,:.,:=' :'•.-· .. :<:~. -...,•.. :·.~

cornu minor
hyoid bone

cornu major

Q
criticea cartilage - -

arytenoid
cartilage
superior horn thyroid cartilage

corniculate cartilage ~

inferior horn
cricoid cartilage

facet for arytenoid

facet for thyroid

Fig. 1.1 Lateral view of the hyaline cartilages of the larynx. Le(t;
assembled; right; disassembled. Collectively, the cartilages compose
the fram ework of a suspended , occludable funne l of soft tissue that
channels the respiratory gases to and from the lungs. The cricoid
fonns th e stem and the thyroid the main armature of the funnel; the
I mobile arytenoids ass ure the plasticity of the passage. Hyaline carti-
lage combines lightness, strength, and elasticity but tends to ossify.
What determines the onset of ossification of the laryngeal hyaline
cartilages is unclear, but bending and tensile Stresses may be impor-
tant factors. Ossification seems to begin early in sites where relatively
severe stresses are predicted by the present model, notably at the sur-
faces of the cricoarytenoid joint and the an terior and posterior re-
gions of the thyroid cartilage, where the brunt of the suspensory
Stresses is borne.

1'

L
9 ANATOMICAL BACKGROUND
 lateral
thyro hyoid ligamen

'.
thyrohyoid mem bran

quadrangul ar me mbran
median thyrohyoid fold
aryepiglottic fold 7
vestibular fold posterio r
cricoarytenoi d ligam

interarytenoid fold
Fig. 1.2 Soft tissue folds lining the left hemilarynx. Th ree folds, re-
spectiveiy termed the aryepiglottic, vestibular, and vocal folds, are bi-
laterally paired, and two, rhe median thyrohyoid and interatytenoid
fold s, are median and unpaired. T he deformations undergone by
vocal fold these eight folds determine the various functional behaviors of the
larynx. T he description of the lining structures as folds accords with
the collective foldin g-u nfolding, or plicatory, behavior of the soft tis-
sues.

Fig. 1.3 Elastic membran es and liga

The thyroid cartilage is connected to
membrane, the thyrohyoid membran
teriorly and posterolaterally by ligar
function . The anterior ligament is p;
fold. Tbis fold also includes th e epiglo
ament, tbyroepiglottic ligament, a111
pended from it is another elasti c meml

LARYNGEAL BTOMECHANICS 10
 '.,.: .·.-.:,·.: :.·:.: :,· . ,:, '' .,,, .....,:
·... ·:~

lateral
thyrohyoid ligament
hyoepiglottic I igament

thyrohyoid membrane
median
thyrohyoid I igament

quadrangular membrane thyroepiglottic ligament

vestibular ligament

posterior
cricoarytenoid I igament
vocal ligament

anterior cricothyroid ligament

(conus elasticus)

ng ehe left hemilarynx. Three folds, re-

ottic, vestibular, and vocal folds, are bi-
median thyrohyoid and interatytenoid cricothyroid membrane
ired . The deformations undergone by (cricovocal membrane)
he various functional behaviors of the
~ lining structures as folds accords with
1g, or plicatory, behavior of the soft tis- cricotracheal I igament

Fig. ] .3 Elastic membranes and ligaments of the left hemilarynx.
The thyroid cartilage is connected to the hyoid bone by an elastic
membrane, the thyrohyoid membrane, which is strengthened an-
teriorly and posterolaterally by ligaments that have a suspensory
function . The anterior ligament is part of the median thyrohyoid
fold. This fo ld also includes the epiglottic cartilage, hyoepiglottic lig-
ament, thyroepiglottic ligament, and intervening adiposity; sus-
pended from it is another elastic membrane, the quadrangular mem-
brane, which is thickened below by the vestibular ligament bordering
the sinu s. This rnembrane and li gament suspend the arytenoid carti-
lage and regulate its respiratory excursion. The cricoid cartilage is
suspended from the thyroid carti lage by a median anterior ligament
and posterolateral articular cricothyroid ligaments. The thyroid, ary-
tenoid, and cricoid cartilages support a bilateral triangular mem-
brane, the cricovocal mcmbran e, whose upper border is strengthened
to form the vocal ligament, principal acoustic oscillator of the larynx.

11 ANATOM ICAL BACKGROUND

Fig. 1.4 Suspensory system of the hyoid
bone. The hyoid bone is suspended from the
base of the skull on each side by the stylo-
hyoid ligament. Part of the muscular sup-
port for this two-point ligamentous suspen-
sion comes from the stylohyoid and digas-
tric muscles, which stress the hyoid bone in M. aryten oi
the same general direction as the ligament. transverse
and oblique
The two-point ligamentous suspension
gives considerable craniocaudal mobility to
the hyoid and, to a lesser extent, to the lar-
ynx, which is suspended from the hyoid by
a three-point suspension (the median and
posterolateral thyrohyoid ligaments). At the M. posteric
cricoaryten
same time, the design implies that the stylo-
hyoid ligament can serve as a check liga-
ment limiting excessive caudad displace-
ment of the hyoid bone and, indirectly, of
the larynx. Clinical note: The partial sus-
pension of the hyoid bone from the mandi-
ble by means of muscles enables the anes-
thesiologist to improve the exposure o f rhe
operative site for rracheostomy. Because of
this suspension, closure of the patient's
mouth combined wirb extension of rhe ~ tylohyoid ligament
head appreciably elevates rhe hyoid, the lar- Fig. 1.5 lntrinsic muscles, poseerol at
~,.,-.. -., " pulley" of
ynx, and the trachea and renders the latter ro id muscle is shown transected; ehe V(
digastric tendon
more accessible to ehe surgeon. pa rt of the external thyroarytenoid) is r
tion of these muscles is to stabilize th
attach ed fo lds durin g respiration (crico,
phonation (arytenoid muscl e, fig. 4.2).
posterior belly
of d igastric oblique arytenoid muscle and its contit
cl e. T he timing of the activity of th cse f

LARYNGEAL ßlOMECHANICS 12
-·-. .- ·.. -_., . . . . - .. -.:--:~

M. aryepiglottic

M. arytenoid
transverse
and oblique
----- M. thyroarytenoid

M. lateral
M. posterior cricoarytenoid
cricoarytenoid
M. cricothyroid

ent

Fig. 1.5 Intrinsic muscles, posterolateral view. The right circothy-
roid muscle is shown transected; the voca l muscle (deep in the lower
part of the externa l thyroarytenoid) is not visible. An important func-
tion of these muscles is to stabilize the arytenoid cartilages and the
attached folds during respiration (cricoarytenoid muscles, fig. 2.6) and
phonation (arytenoid muscle, fig. 4.2). Attention is drawn here to the
oblique arytenoid muscle and its continuation, the aryepiglottic mus-
cle. The timing of the activity of these fib ers has not bcen defined, but
morphologically, they form a truss able to Support the adducted ary-
tenoids against the median thyrohyoid fo ld during effort closure of
the larynx (fig. 3.8 ). The aryepiglottic fibers support the aryepiglottic
fold and produce a ridge that is particu larly noticeable during phona-
tory closure of the glottis (fig. 4.1) . So me support probably extends
down to th e vestibular fold via th e quadrangular membrane (fig.
4.9). (After Sobotta, 1964.)

13 ANATOMICAL BACKGROUND
 2
Respiratory Folding
T he dynamic rationale of laryngeal anatomy is plication,
that is, the process by which the internal surfaces of the larynx
fold or un fold to varying degrees. The touchstone of plication
resides in the contour of the internal surface of a fold. Folding
involves an increased angularity of the internal surface; un-
fold ing, a decreased angularity.
Comparative studies indicate that the foldability of the
human larynx is exceptional. Although fossil data are lacking,
the morphological development of the human laryngeal folds,
particularly the human median thyrohyoid fold, and the wide
range of human laryngeal performance in respiratory con-
ductance, sound generation, and effort closure, imply a
lengthy evolutionary history.
One especially tempting hypothesis ascribes the versatility
of human laryngeal gymnastics overwhelmingly to the versa-
tility of the brain. The argument goes something like this: the
brain is big, the larynx is small; the cerebral differences are
big, the laryngeal differences are small; big differences are
more significant than small differences. Historically, this as-
sumed unimportan ce of the small differences in the larynx
was th e source of a surprisingly persistent error concerning
the abduction of the hum an arytenoids. In experimenta l ani-
\ rnab it had been noted that abduction is predominantly by ro-
tat1on at the cricoarytenoid joint, and the same was long
1thought to be true of man, although the evidence of the
1
15
laryngoscope showed that, in fact, the human arytenoids
abduct from the midline without rotation, that is, the vocal -
process~ of the abducting aryte1;-oids ~e;;;in parallel until
widely separated. 1
Abduction of the vocal processes in parallel results in a five- ~
sided rima glottidis (fig. 2.7), whereas abduction by rotation t-.J
yields a more nearly quadrilateral opening. Other things being
equal, any difference in cross-sectional area is in favor of the 1
pentagonal rima, at least for respiratory flow, since under \
conditions of streamlined flow the excess size of a pentagonal
over the quadrilateral glottis would make a substantial differ-
ence to the average maximal air inflow rate and power output
of the body. The excess might well improve an animal's over-
all chances of leaving descendants, particularly if the anima l's
life style included prodigal demands for energy associated
with arboreal acrobatics. This abduction of arytenoid vocal
processes in parallel, apparently a familial trait of the primate
larynx, probably vouchsafes its owners a !arge increase in
total energy flux. If so, the pentagonal glottis also must have
given an advantage to the human lineage and must have be-
come even more of an asset when the flow capacity of aryte-
noid abduction in parallel was further augmented by a supple-
mentary phase of glottic enlargement with arytenoid diver-
gence. Doubtless, the extra power output and physical effort
permitted by the extra oxygen inflow occasionally made the
 difference between having and not having a meal, between
having a baby and not having any babies. Bur the primate lar-
ynx lacks any muscle or combination of muscles capable of
abducting the arytenoids in parallel-hence, the hypothesis,
supported by much evidence (Fink, 1975), that abduction and
adduction in parallel are products of the folding mechanism.
Plication couples the transverse excursion of the arytenoid to
the vertical respiratory excursion of the larynx. In other
words, mechanical coupling built into the suspensory systern
V1 controls the respiratory movements of laryngeal cartilages.
, Arytenoid abduction then no longer requires arytenoid ab-
ductor muscles but does require inspiratory descent of the lar-
ynx and arytenoid stabilizer muscles.
Suspensory System in Respiration
The bronchial tree, trachea, and larynx, which are sus-
pended from the hyoid bone (figs. 2.1, 2.2), move in unison
during every respiratory cycle (figs. 2.3, 2.4 )-downward with
inspiration and upward with expiration. The excursion is
small during eupnea, !arge during !arge inspiratory effort, and
seems to be, in part, a direct function of the intrathoracic
pressure drop. Electromyography has shown that the cyclic
excursion can also be accelerated by the accessory muscles of
respiration attached to the thyroid cartilage (sternothyroid
and thyrohyoid muscles) and hyoid bone (sternohyoid mus-
cle), but the cyclic excursion is not completely dependent ei-
ther on thoracic suction or muscular traction since a percepti-
ble laryngeal oscillation rnay persist even when the lungs are
inflated passively, for example, in artificial ventilation of a
paralyzed, anesthetized subject.
h~ atory descent of the trachea increases the longitudinal "
tension in the walis of the trachea and stretches the elastic sus-
pensory ligaments of the larynx and the X-ray shaclows c~ t
by the laryngeal folds (figs. 2.1-2.4 ). The hyoid bone de-
scends and tilts downward anteriorly, and distraction of the
LAR YNGEAL B IOMECHAN lCS
thyroid cartilage from the hyoid is observable in the lateral
forces first drags the aryten oid lateral
v1ew.
length of the cricoid facet. This is rh
From the front (fig. 2.1) th e directions of th e stylohyoid lig-
parallel, which is terminated by the ri
aments noticeably converge on the same region of the thyroid
teriof cricoarytenoid check ligament.
cartilage where no less than seven of the eight laryngeal folds
ment, though it halts the lateral slid
(the median thyrohyoid, aryepiglottic, vestibular, and vocal
not bring to an end the increase in ten
folds ) as weil as five ligaments converge. This region (fig. 2.5 )
membrane. The reactive tension in t
is evidently an important node of folding and of tensile
to rise as the inspiratory descent pro
stresses and will be discussed further in chapter 3 in connec-
tion with the prominentia laryngis (Adam's apple).
the vocal process upward and outwar
arytenoid backward around the curv
The longitudinal tension that develops in the main suspen-
cricoid facet. Th e direction that the vo
sory ligaments with inspiration is also reflected in the subsidi-
determined by the orientation of the
ary suspension. The quadrangular membrane is elongated
1rhe arytenoid rocks (fig. 2.6). The long
(figs. 2.1, 2.3), the arytenoids are abducted, and the laryngeal 1in a forward, downward, and outwal
cavity widens dramatically at the glottis. The mechanical cou-
f
axis around which the arytenoid-a1
pling hypothesis asserts that this association is not fortuitous
rocks. The tip of th e rocking vocal
but causal and that transverse separation of the arytenoids is 1
scribes an arc upward, outward, and
the net result of iricreased tensile stress from the cricoid carti-
from above, loo ks like rota tion arou1
lage and cricoarytenoid tissues on the arytenoid cartilage and
\ that is an illusion du e to foreshortenin
the reactive tension of the quadrangular membrane. The sepa-
ticular facets clearly preclud es any sud-
ration of the arytenoids by these rneans occurs in two phases,
backward rocki ng is to make the bodi,
defined by the orientation of the vocal processes. In the first )
verge upward, outward, and backward
phase (labeled "inspiration i" in the figures), the vocal pro-
cesses separate but retain their anteroposterior end-expiratory
l,, .,- ,
process diverge upward, ou tward, an
/ label " abduction in divergence."
orientation, with their medial borders parallel or slightly con-
Telltale evidence of arytenoid roc
vergent. This is the phase of separation in parallel. In the sec-
shadow of the sinus (fig. 2.8) . ln deer
ond phase (labeled "inspiration ii"), the already widely sepa-
margin of the sinus, containi ng the vest
rated vocal processes proceed to diverge, further enlarging the
upward. T he posterior end, where the 1:
rima glottidis. This is the phase of separation in divergence.
arytenoid just above the vocal process
Because the coupling is effected by elastic ligaments, elastic re-
nial location relative to the cricoid thar
coil automatically reverses the phases, in reverse order, when
it has been carried upward (as weil as o·
inspiration is discontinued.
by aryten oid rocking.
According to the model, neither phase is a direct product of
laryngeal muscular activity. Both are due to passive laryngeal
tensions, and the existence of two phases of inspiratory ab-
duction of the arytenoids depends on the biomechanics of the Cricoarytenoid Mt
cricoarytenoid joint, not on any sudden change in the trans- Figure 2.6 sho ws the arytenoid rnair
rnitted force. As diagrammed in fig. 2.5, the interplay of these the cricoid by the posterior cricoaryt
16
 .--: ·. : . . .. :. . . ..,, . .. . -.--./!":
1yoid is observabl e in the lateral
1e directions of the stylohyoid lig-
on the sarne region of the thyroid
seven of the eight laryngeal folds
yepiglottic, vestibular, and vocal
1ts converge. This region (fig. 2.5)
node of fo lding and of tensile
d further in chapter 3 in connec-
uyngis (Adam's apple).
:hat develops in th e main suspen-
ion is also reflected in the subsidi-
·angular rnembrane is elongated
s are abducted, an d the laryngeal
.t the glottis. The mechan ical cou-
. this association is not fortuitous
·se separation of the arytenoids is
nsile stress from the cricoid carti-
1es on the arytenoid cartilage and
1adrangular membrane. The sepa-
hese means occurs in two phases,
,f the voca l processes. In the first
i" in rhe figures ), th e vocal pro-
:ir anteroposterior end-expiratory
l /"/ process diverge upward, outward, and forward-hence the
11 bord ers parallel or slightly con-
separation in parallel. In the sec-
:ion ii"), the already widely sepa-
d to diverge, furth er enlarging the
hase of separation in divergence.
ted by elastic ligaments, elastic re-
he phases, in reverse order, when
~ither phase is a direct product of
Both are du e to passive laryngeal
of two phases of inspiratory ab-
pends on the biomechanics of the
any sudden change in the trans-
:i in fig. 2.5, the interplay of th ese
forces first drags the arytenoid laterally by sliding it along the
length of the cricoid facet. This is the phase of abduction in
parallel, which is terminated by tn~ rise in tension in the pos-
terioi cricoarytenoid check ligament. But tension in this liga-
ment, though it halts the lateral slide of the arytenoid, does
not bring to an end the increase in tension in the guadrangular
membrane. The reactive tension in this membrane continues
to rise as th e inspiratory descent proceeds; eventually it lifts
the vocal process upward and outward and tips, or rocks the
arytenoid backward around the curved cross section of the
cricoid facet. The direction that the vocal process then takes is
determined by the orientation of the cricoid facet on which
" flie arytenoid rocks (fig. 2.6). The long axis of this facet slopes
b a forward, d~wnward, and outward direction and is the
axis around wh1ch the aryteno1d-and 1ts vocal process-
' rocks. The tip of the rocking vocal process therefore de-
/scribes an arc upward, outward, and backward that, viewed
from above, looks like rotation around a vertical axis. But
that is an illusion due to foreshortening! The shape of the ar-
ticular facets clearly precludes any such rotation. The effect of
backward rocking is to make the bodies of the arytenoi ds di-
) verge upward, outward, and backward and to make the vocal
'/ labe! "abduction in divergence."
Telltale evidence of arytenoid rocking is found in the
shadow of the sinus (fig. 2.8). In deep inspiration the upper
margin of the sinus, containing the vestibular ligament, arches
upward . The posterior end, where the ligament attaches to the
arytenoid just above the vocal process, assumes a more cra-
nial location relative to the cricoid than in expiration because
it has been carried upward (as weil as outward and backward)
by arytenoid rocking.
Cricoarytenoid Muscles
Figure 2.6 shows the arytenoid maintained on the edge of
the cricoid by the posterior cricoarytenoid and lateral cri-
17
~15 ~:.bCQ,\. 1r
coarytenoid muscles. During slidi ng phases the two muscles
generate opposing moments of the arytenoid around the cri -
coid facet and together stabilize the posture of the arytenoid
reflexively. The posterior cricoarytenoid is notably !arger in
cross section than the lateral cricoarytenoid, probably be-
cause it has to do most of the work to support the weight of
the vestibular and vocal folds. Paralysis of the muscles lets the
vocal process and attached folds sag (fig. 4.3F,G ). The dis-
crepancy between the curvatures of the arytenoid and cricoid
facets, somewhat exaggerated in the sketches (fig. 2.6), leads
to rocking of the arytenoid around the cricoid in phase ii
rather than to sleevelike rotation.
The reader will have noticed that the motion of the vocal
process in phase ii of inspiration is exactly what one would
expect from contraction of the posterior cricoarytenoid mus-
cle. The available electromyographic evidence, however, does
not demonstrate any increase in activity of this muscle with
inspiration; on the contrary, its activity often diminishes at
that time. How the activity in the lateral cricoarytenoid mus-
cle varies is unknown. The rnechanical coupling hypothesis
regards these muscles as stabilizers of the arytenoid cartilage
during the sliding phases of abduction and adduction (in
parallel), and as being overridden or reflexively inhibited dur-
ing the rocking phases of abduction or adduction (in diver-
gence). With mechanical coupling the force for both phases of
abduction is derived from the much stronger muscles respon-
sible for the inspiratory descent of the trachea and larynx.
The slight mismatch between the curvatures of the aryte-
noid and cricoid facets (figs. 2.6, 2.16) puts one in mind of the
mismatch between condyles of the knee joint. At the knee
joint, McCutchen (1966-1967) proposed, the mismatch per-
rnits "weeping lubrication." Weeping lubrication is a tech-
nique alien to engineers. Synovia! fluid, asserts McCutchen,
fills the pores of the articular cartilage but gets squeezed
out and lubricates the surfaces where these press against each
other. With rocking, the zone of pressure is constantly shifting
and this gives the squeezed out area of cartilage a chance to
soak up fluid in readiness for the next load-bearing phase.
RESPIRATORY FOLDING
Surprisingly, the normal force per unit area on the bearing ture of their internal surfaces and therefore are classifiable as fortably fit a similar scheme, alth
surfaces of the tiny cricoarytenoid joint is of the same order of unfolding. The unfolding is a mechanical consequence of the sets of springs cann ot be identifie
magnitude as at the huge knee joint. This can be inferred from downward excursion, so it is quite literally true that, in this Figures 2.2, 2.4, and 2.9 depic
the force applied when the check ligament of rock is fully ex- system, separation of the arytenoids and general enlargement nents as coil springs that becom
tended. The magnitude of this force is approximately 1 kg, of the laryngeal cavity are mechanically coupled to inspira- enlargement of the laryngeal ca
the force required to Stretch the vocal ligament (the check lig- tory descent (fig. 2.9). The advantage of this in terms of re- springs automatically energizes th
ament) nearly to its elastic limit (Harless, 1853; van den Berg duced resistance to airflow and the excellent timing of the ad- inspiratory muscles relax.
and Tan, 1959). Per unit area of the surfaces in contact, the vantage in relation to cyclical need are evident. Figures 2.10, 2. 11, and 2.12 giv
gravitational force withstood at the knee joint is not very dif- But, one may ask, why have a respiratory excursion? Why actual dispositions of the major
ferent. not keep the cavity wide open throughout the respiratory the laryngeal elastic tissu e is so di
cycle? The reason, rooted in history, is protection. Prudence ways under tension . In Fig. 2.10,
figuratively dictates that the hole should not be more widely body of the hyoid in one pair of fi
open than necessary. In the lungfish the larynx is kept shut other and pull or push in opposit
Respiratory Enlargement of the Cavity against the invasion of water and only opens intermittently, spiration) stresses the tissues in o
The inspiratory enlargement of the larynx is not confined to during gulps of air. Presumably there was from the very start (reserve expiration ) stresses them i
\
the rima glottidis. From figs. 2.5 and 2. 7 it is apparent that the a crude respiratory rhythm of the larynx-shut, open, shut, elastic tissue is stressed and stretch
entire supracricoid cavity of the larynx expands. ln laryngeal open-analogous to what, in more evolved form, we still ob- intermediate end-expiratory equil
phase i of inspiration, separation of the arytenoids in parallel serve in amphibians and reptiles. Birds and mammals, hot force is removed .
(fig. 2.5A,B) carries all the folds attached to the arytenoids lat- blooded, energetic, and avid for oxygen, have further modi- Functionally, th e elastic memb
erally. In phase ii, separation in divergence (fig. 2.5C) further , fied the rhythm to partly open, open, partly open, open. The two groups separated by the lary
1
stretches the interarytenoid fold and tilts it backward. At the advantage to these animals is a !arger average laryngeal aper- subglottic group consists of the
same time the backward rocking ranges the aryepiglottic folds ture, the possibility of continuous airflow, and lower average thickened upper free border of th
more laterally while laryngeal descent is stretching them and resistance to airflow. Birds, however, never acquired a thyroid ment, the anteri or cricothyroid lig:
rendering them thinner. Backward rocking also lengthens the cartilage or vocal and vestibular folds and are restricted to the thyroid or ceratocricoid ligam ent
vestibular and vocal folds and ligaments at the very moment flows permitted by a triangular orifice. Perhaps this is one rea- cricothyroid ligaments are stron
that it carries them further laterally. In fact, it is the increase son why their intellectual development has been more limited change in the relative orientation
in anteroposterior length of these folds that sets a limit to the than that of mammals. cartilages during respiratory or ot
rocking because the vocal and vestibular ligaments in the of the larynx. The cricovocal me1
folds, are of limited extensibility. These ligaments therefore support the vocal fo ld and define t:
do duty as check ligaments for backward rocking, somewhat glottidis and subglottic cavity. (:
as the posterior cricoarytenoid ligament function s as the Elastic Membranes and Ligaments
group of elastic structures defines
check ligament fo r lateral sliding. The strength of th ese liga- The mechanics of breathing are known to pit the elasticity praglottic cavity. It consists prin<
ments is one indication of the magnitude of th e fo rces they of the lung against the elasticity of the ehest wall-lung membrane, the thickened lower
have to resist. Simultaneously, descent and distraction of the springs against ehest springs-in a continuously shifting bal- called the "vestibular ligament, " 1
larynx from the hyoid bone stretches the median thyrohyoid ance of passive and active forces. The balance is regulated by corniculate cartilage, an d the rne
fold, rendering it thinner and addition ally increasing the an- muscular forces, and the equilibrium at the end of an ordinary plex. The quadrangular rnembran
teroposterior diameter of the entrance (fig . 2.8) . expiration (eupneic end-expiration ) is regarded as the refer- and vestibular folds.
All these inspiratory effects on th e folds diminish the curva- ence condition. The respiratory mechanics of the larynx com-

LARYNGEAL BIOM ECHANICS 18

... · . ··-. . . . --,. . · ..
:s and therefore are classifiable as
a mechanical consequence of the
is quite literally true that, in this
ytenoids and general enlargement
mechanically coupled to inspira-
advantage of this in terms of re-
md the excellent timing of the ad-
:al need are evident.
we a respiratory excursion? Why
open throughout the respiratory
n history, is protection. Prudence
: hole should not be more widely
~ lungfish the larynx is kept shut
er and only opens intermittently,
1bly there was from the very start
of the larynx-shut, open, shut,
.n more evolved form, we still ob-
eptiles. Birds and mammals, hot
d for oxygen, have further modi-
)en, open, partly open, open. The
is a !arger average laryngeal aper-
nuous airflow, and lower average
however, never acquired a thyroid
ular folds and are restricted to the
tlar orifice. Perhaps this is one rea-
~velopment has been more limited
anes and Ligaments
ing are known to pit the elasticity
lasticity of the ehest wall-lung
:s-in a continuously shifting bal-
orces. The balance is regulated by
1ilibrium at the end of an ordinary
piration) is regarded as the refer-
tory mechanics of the larynx com-
;; . ; . ~
fortably fit a similar scheme, although two neatly separated
sets of springs cannot be identified.
Figures 2.2, 2.4, and 2.9 depict the several elastic compo-
nents as coil springs that become loaded during inspiratory
enlargement of the laryngeal cavity. Elastic recoil of these
springs automatically energizes the return excursion when the
inspiratory muscles relax.
Figures 2.10, 2.11, and 2.12 give a more realistic idea of the
actual dispositions of the major elastic elements. In essence,
the laryngeal elastic tissue is so disposed that some of it is al-
ways under tension. In Fig. 2.10, one can mentally seize the
body of the hyoid in one pair of fingers and the cricoid in the
other and pull or push in opposite directions: distraction (in-
spiration) stresses the tissues in one pattern, approximation
(reserve expiration) Stresses them in another; either way some
elastic tissue is stressed and stretched and tends to recoil to the
intermediate end-expiratory equilibrium when the stressing
force is removed .
Functionally, the elastic membranes and ligaments form
two groups separated by the laryngeal sin us. (1) The lower,
subglottic group consists of the cricovocal membrane, the
thickened upper free border of the membrane or vocal liga-
ment, the anterior cricothyroid ligament, and the lateral crico-
thyroid or ceratocricoid ligaments. The anteri or and lateral
cricothyroid ligaments are strong enough to prevent any
change in the relative orientation of the cricoid and thyroid
cartilages during respiratory or other nonphonatory activities
of the larynx. The cricovocal membran e and vocal ligament
support the vocal fold and define the configuration of the rima
glottidis and subglottic cavity. (2) The upper or vestibular
group of elastic structures defines the configuration of the su-
praglottic cavity. lt consists principall y of the quadrangular
membrane, the thickened lower border of this membrane
called the "vestibular ligament," the cuneiform cartilage, the
corniculate cartilage, and the median thyrohyoid fold com-
plex. The quadrangular membrane supports the aryepiglottic
and vestibular folds.
19
Mechanical Coupling Force
In the mechanical coupling hyP.9thesis, arytenoid ab._duc-
tion is mechanic;lly coupl; d to laryngeal descent, and any
fo rce pulling th~ larynx caudally will tend to abduct the aryte-
1).0isJs (fig. 2.9). Two such sources of force are available:
(1) the muscles of inspiration, which tend to suck anything
movable, including the trachea and larynx, into the ehest and
(2) the strap muscles of the neck, particularly the sterno-
thyroid muscie, which tends to pull the thyroid cartilage to-
ward the Sternum.
The tracheal coupling force transmitted to the cricoid carti-
lage is represented schematically in fig. 2.13 by the force vec-
tor parallel to the tracheocricoid axis. Tensile stress due to
this force is transmitted from th e cricoid to the thyroid carti-
lage along the lateral and anterior cricothyroid ligamen ts, be-
longing to the main suspensory system of the larynx. These
ligam en ts are so tough as to be practically inextensible in the
axial direction. Bur tensile stress is also transmitted from th e
cricoid to the arytenoid cartilage, along structures joining
these two cartilages, including the articular capsule strength-
ened by the insertions of the cricoary tenoid muscles. T he ten-
sile stress in the arytenoid frorn below gives rise to stress in its
suspensory system, diagrammed as stress in the quadrangular
membrane (GM). The construction in fig. 2 .13 shows how,
assuming a uniform distribution of reactive stress in the quad-
rangular membrane, the direction of the GM reaction vector
ca n be evaluated, and the resulting direction of motion of th e
arytenoid obtained by bisecting the angle between the direc-
tions of the tracheocricoid axial force GT and the reactive
component force GM. The projections in fig. 2.13 show that
in the living body the abductor trajectory of the arytenoid will
tend to take a downward, outward, and forward direction;
this is also the general orientation of the cricoid articular facet
for the arytenoid. The fact that in the body the facet is some-
what more sharply inclined to th e horizontal than the dia-
grammed trajectory can be explained as an allowance necessi-
tated by frictional and viscous resistance.
RESPIRATORY FOLDING
 Besides a direction favorable to mechanical coupling, the
cricoid facet has a location favoring enlargement of the rima
glottidis to the full width of the cricoid ring. Also notable is
the termination of the facet directly over the middle of the
cricothyroid joint, that is, in the coronal plane of the inferior
horn of the thyroid cartilage; it is along this horn and in this
plane that force from the sternothyroid muscle is transmitted
to the cricoid and thence to the arytenoid cartilage. Thus, the
stress on the arytenoid emanating from the sternothyroid
muscle during reserve inspiratory effort will be greatest when,
at the end of laryngeal phase i of inspiration, the arytenoid
articular facet has slid to the plane of the inferior horn; me-
chanical coupling will then be operating at peak efficiency to
initiate the rocking of phase ii. lt is apparent that the model
satisfyingly integrates much otherwise arbitrary morphology.
The main elements in the changing equilibrium of forces
acting on the arytenoid cartilage in mechanical coupling are
summarized in fig. 2.16, which shows them at the end of eup-
neic expiration (A), at the end of the sliding phase of inspi-
ration (inspiration phase i, B), and the end of the rock-
ing phase of inspiration (inspiration phase ii, C) . The direc-
tions of the force vectors in these diagrams are based on fig.
2.13. In 2.16A and B, it is evident that the tracheal tension T
and the reactive tension M in the quadrangular mernbrane do
not balance and that a third force is necessary to produce
equilibriurn. The third force is represented here as vector A, in
th e direction of the transverse arytenoid rnuscle fibers, which
connect the two arytenoid cartilages and constitute the princi-
pal adductor of these cartilages. lt happens that electromyo-
graphy (Faaborg-Andersen, 1957) has proved that th ese fibers
are also active during inspiration, when the arytenoids are
separating. Although inspiratory activity of an adductor mus-
cle seerned paradoxical at the time it was observed, it is ac-
counted for and, indeed, required by the mechanical cou-
pling hypothesis.
The forces acting on the arytenoid in fig. 2. l 6A and B rep-
resent net forces, as the respiratory activity in the individual
rnuscles attached to the arytenoid is as yet either unquantified
LARYNGEAL BIOMECHANICS
or, 111 sorne cases, undetermined; an equilibrium of rocking larninae, notably the vocal, vestibt
rnornents at the cricoarytenoid joints (LM = 0), assured by Accelerated laryngeal expansion p
th e cricoarytenoid muscles, is assumed to exist throughout the would be negligible un der eupne
sliding phases of arytenoid respiratory motion. According to cant in a respiratory emergency.
the rnodel, a net mornent of force or torque does not intervene gles for supremacy, such as cham
to produce angular acceleration of the arytenoid until the
fraction of a millimeter of glottic
phase of rocking begins (2.16C). At the start of this tional increment of respiratory flo
phase, inspiratory sliding has been terminated by the reaction is interesting to speculate that th
in the posterior cricoarytenoid check ligament: the quadran- of the thyroid cartilage detected r
gular membrane reaction cornponent M, operating with mo- decade of life involves a reduction
rnent arm a, increases sufficiently to override or inhibit the lete's larynx and consequently in
postural activity of the cricoarytenoid muscles and imparts possibly this is one reason why
angular acceleration to the arytenoid around the surface F1 F2 best efforts require the ultimate i
of the cricoid facet. A limit to the rocking rnotion, suggested past their prime.
in fig. 2.12B, is set by check ligament action of the vestibular
and vocal ligarnents. The model postulates that rocking
occurs only when the arytenoid is at the outer end of its slide.
At present, no objective evidence exists that, in health, rock-
ing ever occurs in any other position.
Oblique Line
The forces of irnportant extrinsic muscles, including the
1 sternothyroid, converge in the _linea obliqua of the thyroid
cartilage. The sternothyroid, whose infens ity of activation
often rises during inspiration, is accordingly classified as an
accessory muscle of respiration. Its fibers, coursing down to
the back of the manubrium sterni (figs. 2.14, 2.15), accelerate
the descent of the larynx and the mechanically coupled widen-
ing of the air passage. Moreover, as indicated in fig. 2.15B,
their course relative to the flare and angularity of the thyroid
cartilage (respectively, the divergence of the laminae upward
from the cricothyroid articulation and backward from the
isthmus) makes them exercise a bending moment on the
laminae that widens the flare and opens the space within the
laminae. Thus, indirectly, contraction of the sternothyroids
tends to drag apart the tissues internal to the thyroid cartilage
20
 _· ·. ··= · ·-·:• : ;. •: -..,.. .....,;. :·.~·

tined; an egu ilibrium of rocking
)id joints (LM = 0), assured by
; assumed to exist throughout the
·espiratory moti on. According to
·orce or torgu e does not intervene
1tion of the arytenoid until th e
(2. 16C). At the start of this
, been terminated by the reaction
>id check ligament: the quadran-
mponent M, operating with mo-
:iently to override or inhibit the
oarytenoid muscles and imparts
trytenoid around the surface F1F2
to the rocking motion, suggested
ligament action of the vestibular
model postulates that rocking
oid is at the outer end of its slide.
ience exists that, in health, rock-
. position.
laminae, notably the vocal, vestibul ar, and aryepiglottic folds.
Accelerated laryngeal expansion produced by this mechanism
would be negli gible under eupneic conditions but is signifi-
cant in a resp iratory emergency. For examp le, in some strug-
gles for supremacy, such as championship swimming, the last
fraction of a millim eter of glottic enlargement, the last frac-
tional increment of respiratory flow rate, could be decisive. lt
is interestin g to speculate that the ossification of the laminae
of the thyroid cartilage detected radiographically in the third
decade of life in volves a reduction in the flexibility of th e ath-
lete's larynx and consequently in its peak conductance. Quite
possibly this is one reason why O lymp ic swimmers, whose
best efforts require the ultimate in rapid airflow, are so soon
past their prime.
The ro le of the sternothyroid muscle in governing the flow
resistance through the la rynx is not performed in isol ation.
Th is muscle is only one of a number of muscles organized to
act in concert. Of these, the sternohyoid, the sternothyroid,
and the thyrohyoid are easily accessible to electromyographic
observation and are better understood than others. This mus-
cle group regulates the position of the thyroid cartilage rela-
tive to the hyoid bone and the position of both relative to the
sternum (and skull and mandible), and thereby parti cipa tes in
regulating the degree of folding of the thyrohyoid and ary-
epiglotti c folds. The real significance of governing the position
of the larynx, for example, in swallowing and voicing (War-
wick and Williams, 1973, p. 508), resides in govern in g the
configuration of the laryngeal cavity and constitutes these
muscles as extrinsic muscles of laryngeal folding.

que Line
extrinsic muscles, including the
the lin ea obliqua of the thyroid
:i, whose infeiisity of activation
,n, is accordingly classified as an
:ion. lts fibers, coursing down to
sterni (figs. 2.14, 2.15), accelerate
1the mechanically coupled widen-
·eover, as indicated in fig. 2.15B,
lare and angularity of the thyroid
livergence of the lam inae upward
:ulation and backward from the
·eise a bending moment on the
:e and opens th e space within the
:ontraction of the sternothyroids
es internal to the thyroid cartilage

21 RESPIRATORY FOLDING
1
/ /
j,

mandible
/
epiglottic
cartilage

quadrangular
,___ _ _ thyroid membrane
cartilage

cricoid - - - - - + -
cartilage

A 8

Fig. 2.1 Suspensory support of the larynx, posterior view. A, pos-
teroanterior rad iographic tracing of laryngeal skeleton in expiration.
B, the ligaments (shown as coiled springs) and the cricoid and aryte-
noid c;,rtilages have been added, and the position of the subsidiary
suspension that supports the arytenoids and regulates their motion is
indicated. Note that the subsidiary suspension begins at the lateral
border of the epiglottic cartilage, that is, at the lateral border of the
anterior main suspension train. The subsidiary suspension is com-
posed primarily of the quadranglular membrane and its thickened
lower border, the vestibular ligament. Notice the orientation of th e
cricoid facet for the arytenoid in this and the succeeding figure. The
facet often has a roughly cylindrically curved surface, whose long
axis is directed downward, outward, and forward. This orientation
constrains th e mechanics of the respiratory movements of the aryte-
noids (see also fig. 2.6 ).

23 RESPIRATORY FOLDING
 Fig. 2.2 Suspensory support of the larynx, lateral view. Lateral out-
line of the skeleton and ligamentous suspensory system of the larynx
of subject 1 at the end of eupneic expiration (hereafter termed ex-
piration ). B is traced frorn A, a radiograph. ln C the ligamentous
connection s are added, schematized as coil springs. The stylohyoid
ligament is partly ossified in this subject, perhaps a rerninder that the
phylogenetic source of the ligarnent is the skelton of the second, or
/
hyoid, branchial arch. Extensibility, mobility, and elastic recoil are
essential properties of the suspensory system. Note, however, that
the extensibili ty of the ligarnents is not uniform but tends to increase
from below up: it is least at the cricothyroid joints, where the crico-
thyroid ligaments do not stretch appreciably with respiration. Above
the hyoid bone, however, the extensibil ity of the ligarnentous suspen-
sion frorn the skull (stylohyoid ligarnents) accornmodates consider-
able anteroposterior, craniocaudal, and rotatory or tilting displace-
ments. The li garnentous connections between the hyoid bone and the
thyroid cartilage and between the th yroid cartilage and the cricoid
cartilage define three main suspension trains (two posterolateral, one
median anterior) and constitute the principal ligamentous suspensory
system of the larynx. The three-point suspension confers both mobil-
ity and stabili ty on these skeleta l cornponents. The elasticity of the
vario us ligaments enables a reference configuration of the parts to be
maintained alrnost independentl y of associated muscles, yet re.1ders
the configuration arnenable to a wide range of functional deforrna- 1

tions by those rnuscles. Starting from the posterior end of the cornu
rna jor of the hyoid bone, the posterolateral suspension train begins
1
with the posterolateral thyrohyoid ligament. The superior horn, lam-
ina, and inferior horn of the thyroid cartilage are suspended below
this ligament. The inferior horn in turn gives attachment to the stout
capsu lar ligaments that suspend the cricoid carti lage at the cricothy-
l
t
roid joint. The anterior median suspension train of the larynx starts
out in the same general forward and downward direction as the liga-
mentous suspension of the hyoid bone. This part, the median thyro-
hyoid fold, is a wedge of tissue bounded by the hyoepiglottic liga-
ment, the lower or intralaryngeal petiole of the epiglottic cartilage, 1cm
and the thyroepiglottic and thyrohyoid ligaments. lt suspends the an-
terior angle of the thyroid cartilage, whose angle or isthmus inclines
sharply backward as weil as downward. The anterior suspension
train continu es from the bottom of the isthmus as the anterior crico-
thyroid ligament, a strong band from which is suspended the arch of A
the cricoid cartilage. T he lower margin of the cricoid cartil age as a
whole gives attachment to elastic ligamentous tissue, which suspends
the trachea.

LARYNGEAL BJOMECHANICS 24
 \
\
2 _,_J
postemla~e,al~~ J
thyrohyo1

ligameot ~

median
thyrohyoid
thyroid ligament
cartilage
erior horn
su P 'd
of thyro1
cartilage

angle of
thyroid
cartilage

cricoid cricothyroid
cartilage ligament

B C

25 RESPIRATORY FOLDING
Fig. 2.3 Suspensory supports in inspiration, lateral view. Radio-
graphie outline (A) of the skeletal (B) and suspensory (C) system of
the larynx in deep inspiration (subject 1). B illustrates the descent of
the trachea and larynx that is integral to inspiration. Inspiratory
movement at the larynx comprises two phases: phase i when the ary-
tenoid ca rtilages slide laterally and phase ii when the arytenoids rock
backward. This radiograph was taken la te in a slow deep inspiration
and illustrates the end of phase ii of inspiration. A radiograph of the
en d of phase i of inspiration is not available because the end of this
phase is too transient tobe photographed on a still X-ray picture. It
is, however, observable by high-speed light cinematography (see fig.
2. 7). T he descent may be pureiy passive, secondary to the inspiratory
descent of the trachea, or may be accelerated by the strap muscles-
the sternothyroid, thyrohyoid, and sternohyoid muscles. Descent is
faci litated by rhe extensibility of the suspensory ligaments (C), which
enables the larynx to be drawn away from the hyoid bone, and the
hyoid bone away from the mandible and sku ll. Note, however, that

J
the excursion does not affect the orientation of the cricoid cartilage
relative to the thyroid cartilage, which remains the same as in expira-
tion . Traction of the trachea on rhe cricoid does not alter this orienta-
tion, in part because the strong cricothyroid ligament anteriorly pre-
vents any enlargement of the cricothyroid angle, the angle between
the th yroid lamina and the arch of the cricoid. This angle is some-
times spoken of as the cricoth yroid visor angle. J
~-----
1cm
----... (
A B

LARYNG EAL BJOMECHANICS 26

. - . -#

Ugameotj
stylohyoid - -

J
/

,!
I
/

J J
J
----.., 1
--l
crico thyro id
angle

B C

27 RESPIRAT ORY FOLDING


subsidiary
suspension main suspens ion
Inspiration ii (Posterior View)
Fig. 2.4 Suspensory supports in inspiration, posterior view. Outline
based on a radiograph of the skeletal and suspensory systems in deep
inspiration. The positions of the epiglo ttic, arytenoid, and cricoid
cartilages are inferred from the lateral view shown in fig. 2.8. The
downward inspiratory excursion of the larynx has stretched the main
suspensory ligaments of the hyoid bone and thyroid and epiglottic
cartilages, and also the subsidiary suspension supporting the aryte-
noid. The increased tension in the subsidiary suspension first dragged
the arytenoids apart along the long axis of the cricoid facet and then
caused them to rock backward around the sloping, cylindrically
curved surface of the facet (see fig. 2.5). These effects occur by virtue
of the mechanical coupling of the transverse excursion of the aryte-
noids to the cranioca ud al excursion of the trachea. The folds of soft
tissues attach ed to the arytenoids are thereby stretched, or unfolded,
and a general inspiratory en largmen t of the laryngeal cavity results
(see figs. 2.7, 2.8, 2.9). The mechanism requires the cooperation of
ehe posterior an d lateral cricoarytenoid muscles, shown in fig. 2.6.
LARYNGEAL BIOMECHANICS
End Expiration
Fig. 2.5 lnspiratory unfo lding, posterior view. A and B are model
modifications of C, which is based on the same radiograph as fig. 2.4.
A, posteroanterior view of the reference condition of the laryngeal
soft tissues, partly folded in expiration. B, in phase i of inspiration
the arytenoids slide outward, forward, and downward along the cri-
coid facet, and the vocal processes retain their roughly parallel
forward orientation. This is the phase of inspiratory abduction in
parallel. C, in phase ii of inspirati on, the arytenoids rock backward
around the cylindrical curvature of the cricoid facet, and, constrained
by the orientation of the long axis of the facet, the vocal processes
diverge upward and outward. In this phase of inspiratory abduction
in divergence, the layrngeal soft tissues become fully unfolded. D. A
Posterolateral close-up view of th e motion of the right arytenoid rela-
tive to the facet on the cricoid . Left: expirati on. Middle: inspiration,
phase i. Right: inspiration, phase ii. The inspiratory descent of the
larynx stretches and unfolds the various soft tissue folds that line the
laryngeal cavity. This figure illustrates the behavior of the interary-
tenoid fold. The term interarytenoid fold defines a biomechanical
in terarytenoid fold
unit consisting of the soft tissues (m uscl e and mucosa) that join and
cover the back of the arytenoid cartilages. The outline of the interary-
tenoid fold is indicated in the bottom row of sketches. In the upper D
row of sketches, the tissues of the interarytenoid fold ha ve been re-
moved in order to clarify the position of the other laryngeal folds.
T he change in shape of the interarytenoid tissue with in spiration can
be interpreted as an unfolding, since its internal, anterior surface be-
comes flatter and ceases to bulge into the laryngeal lumen (see fig.
2.8).
End 1
28
 -- ..,, ______ -~

End Expiration Inspiration i Inspiration ii

, posterior view. A and B are model

~d on the same radiograph as fig_ 2.4_
reference condition of the laryngeal
Jiration_ B, in phase i of inspiration
rward, and down ward along the cri-
:esses retain their rough ly parallel
~ phase of inspiratory abduction in
1tion, the arytenoids rock backward
of the cricoid facet, and, constrained
xis of the facet, the vocal processes
1 this phase of inspiratory abduction
t tissues become fully unfolded. D_
A B C
1e motion of the right arytenoid rela-
,eft: expiration. Middle: inspiration,
;e ii_ The inspiratory descent of the
various soft tissue folds that line the
strates the behavior of the interary-
?noid fold defines a biomechanical
; (muscle and mucosa) that join and interarytenoid fold
:utilages. The outline of the interary-
Jttom row of sketches. In the upper
D
1e interarytenoid fold have been re-
Jsition of the ocher laryngeal folds. lateral slide rock
1rytenoid tissue with inspiration can
_nce its interna l, anterior surface be-
:e into the laryngeal lumen (see fig.

End Expiration Inspiration i Inspiration ii


posterior latera l
cricoarytenoid cricoarytenoid
muscle muscle
Fig. 2.6 Arytenoid stabiliza tion. Stabilization of th e posture of th e
arytenoid cartilage during the sliding phases of its respiratory excur-
sion is effected by reflex equalization of the Forward and backward
ro cking moments produced by the intrinsic muscles. The model pos-
tul ates that throughout the sliding phase, reflexes mediated by kin-
esthetic receptors automati c;a ll y adjust the tensions in the posterior
and lateral cricoarytenoid muscles (A, B) to the degree required for
postural equilibrium. lt also postulates, however, that at the start of
the rock in g phase, th e acti o n of rh e equilibrium stabilizing muscles is
either inhibited or overridden, and rocki ng sets in abruptly. No mea-
surements of the angular velocity of respiratory rocking exist, but vi-
suall y it seems tobe completed " in the twinkling of an eye." From B,
one can appreciate that mo re work is required of the posterior cri-
coary tenoid than of the lateral cricoarytenoid mu scle because th e
posterior cricoa rytenoid mu scle has to perfo rm th e bulk of the an-
LARYNGEAL BIOMECH ANICS
C
Co urtesy of Dr. G. F . Tucker, Jr.
tigravity work. T his helps to ex plain wh y the posterior cricoaryte-
no id muscle has more tb an twice tbe cross-sectional area o f tbe lat-
eral cricoaryteno id . The curvatures of the arytenoid and cricoid
facets do not necessaril y match exactly. In infancy, and usually in
adults, th e cylindrical curvature of the arytenoid facet is distin ctl y
shallower than th at of th e cricoid facet (C and fig. 2.16 ). This mis-
match determines that rocking rather than concentric rotation takes
p lace. Note that the lateral cricoarytenoid muscle fibers are almost
tangential to th e ary ten oid facet, whereas the fib ers of the posterior
cricoarytenoid mu scle are almost perpendicular to the face t. Aryte-
no id stabilization by th e cricoarytenoid muscles is required during
the sliding phases of the respiratory cycle but is less important in the
closed la rynx when adduction locks the arytenoids to th e cricoid (sce
fig. 4 .3 ).
30
/ '\
aryepi glottic \,
f o ld
ri ma glottidis
Expirati on
Fig. 2. 7 Inspiratory unfolding, cranial v
laryngeal folds of a middle-agcd male,
through a laryngeal mi rror (Bell Tclephc
ture). Th e presence of considerable foresf
mind. Compare inspiration phase i (B) v
spiratory increase in the width of the ri
tween th e medial borders of thc vocal fo.
the rima glottidis is cut off from view by 1
separation of th e vocal processes occurre,
spiratory ca udad displ acement of the lar,
is furth er away from the mirror in B th an
in C. In phase ii of inspiration (C), the vo,
ever, this divergence is not th e res ult of
axis but is due to backward rockin g of tl
to the inclination of the cricoid facet, ca1
ward and upward toward the viewer. Fo
like simpl e outward rotation (Farnswor
rocking, phase of the inspiratory arytenc
seen durin g quiet respiration but accomp,
forts. Note also that the change in loca t
cuneiform tubercl es follows that of th e a
a ttached . In phasc i of in spirati o n (B), Ü

Co urtesy of Dr. G. F. Tucker , Jr.
:xplain why the posterior cricoaryte-
ice the cross-sectional area of the lat-
atures of the arytenoid and cricoid
h exactly. In infancy, and usually in
:e of th e arytenoid facet is distin ctly
oid facet (C and fig. 2.16 ). This mis-
rather than concentric rotation takes
coarytenoid muscle fib ers are almost
~t, whereas the fibers of the posterior
)St perpendicular to the facet. Aryte-
arytenoid muscles is required during
1tory cycle but is less important in the
ocks the ary tenoids to the cricoid (see
B
epig lottis
A aryepiglottic
fold
vestib u lar
~
fold
cornicu late
tubercle
aryep ig lottic Inspiration i
fo ld vocal fo ld
vocal process
rim a glottidis
C
Expiration
Fig. 2. 7 Inspiratory unfolding, cranial view. Outlines of the paired
laryngea l folds of a middle-aged ma le, photographed from above
through a laryngeal mirror (B ell Telephone high-speed motion pic-
ture). The presence of considerable foreshortening should be kept in
mind. Compare inspiration phase i (B) with expiration (A): the in-
spiratory increase in the width of the rima glottid is (the space be-
tween the medi al borders of the vocal folds) is evident. The apex of
vocal
th e rima glottidis is cut off frorn view by the epiglottis. Note that the
separation of the vocal processes occurred in parallel, effected by in-
spiratory caudad displacement of the larynx. Thus the rima glottidis
Inspiration ii
is further away from the rnirror in B th an in A, and still further away
in C. In phase ii of inspiration (C ), the vocal processes diverge. How-
ever, this divergence is not the result of rotation aro und a vertical
axis but is due to backward rocking of th e arytenoid, which, owing but in phase ii (C), they rock latera ll y and backward, obeying the
to the inclination of the cricoid facet, carried the vocal process out- movement of the arytenoid, and leave the field of view. Throughout
ward and upward toward the viewer. Foreshortening makes it look respiration the human rima glottidis maintains a broadly pentagonal
like simple outward rotation (Fa rnsw orth, 1940). The second, or outlin e. Herein resides a rnajor dividend of mechanical coupling: this
rocking, phase of the inspiratory arytenoid excursion is not always mode of abduction of the arytenoids results in an efficient enlarge-
seen during quiet respiration but accornpan ies reserve inspiratory ef- ment of the laryngeal bottleneck and permits intensive air flows be-
forts. Note also that the change in location of the corniculate and cause a pentagonal orifice offers less resistance than a quadrilateral
cuneiform tub ercles follows that of the arytenoid to which they are orifice of the sarne diameter, such as would be achieved by simple
attached. In phase i of inspiration (B ), the tubercles rnove laterally, rotation of the arytenoids aro und a vertical ax is.
31 RESPIRATORY FOLDING
·,:· :--•:+_._·:•:: . :_ ·: '.'.·'-:·::'.;:-.-::~:_:·._:;;.:. ..• _. ____ " :c:.-- ..·c· .••-: :,• .. ,_.,_., • ... · -- :. ;,.••;:':J•::_ ·_..:;:;,':c-·:.:·,.., :·:,: ·. :: :: . :•.:. ,.. ,:.. • ·· ~'.:'" •. :. ·:: : ....·-, ..... ,.-,- ~

I
2 2__ j l
/
1
median

J_4)
th yroh yoid
fol d

4
-- ✓

- j
) C
5i
.)

A B

Expiration Inspiration ii

Fig. 2.8 Inspiratory unfolding, lateral view. Lateral radiographic from the vocal fold. The vocal fold is mounted 011 a separate mem-
configurato11 of the lary11geal soft tissues in subj ect 1 duri11g expira- brane, the cricovocal membra11e, whose thickened upper border is
tio11 (A ) and after deep i11spiration (B), showi11g i11spiratory unfold- tbe vocal ligament. The vertical sections G, H throu gh the latter fold
ing. Th e unfolding takes place anteriorly in th e median thyrohyoid at YZ in E and F schematize the surface outlin es. When descent of
fo ld (C, D ) and laterally (from above downward ) in the aryepiglottic, the larynx stretches the main suspension, it also stretches th e subsidi- y quadran g ular m
vestibu lar, and vocal folds, by the distraction of the larynx down- ary suspension, specifi cally, the quadrangular membra11 e. When
ward away from the hyoid bone (E, F). Posteriorly, the interaryte- stretched, tbe folds mounted on the membrane drag the a rytenoid ves t ibu lar lig
noid fold (fig. 2.5 ) u11folds from the same cause, since separatio11 of laterally and then cause it to rock backward, thereby stretching th e
the arytenoids is mechanically coupled to desce11t of the larynx. The cricovocal membrane and the fo ld based on it. Tbus the forc e that vocal ligame,
aryepiglottic and vestibular folds are mounted in commo11 011 the pulls the larynx down ward (see /ig. 2.13) is the force that stretches, un -
quadrangular membra11e (I, .!), which exte11ds from the lary11geal e11- fo ld s, and thins all eight laryngeal folds and produccs a gcneral en-
G cr icovocal merr
trance to the sinus of the larynx, where its lower edge is thicke11ed to largement of the respiratory passage above the cricoid ca rti lage.
form the vestibular ligament. The sinus separates the vestibular fo ld
Expiration

LARYNGEAL BIOMECHANICS 32
 . -- . . . ""'

medi an
t hyro hyo id
f o ld laryngeal
sinus

C D

fold is mo u11ted 011 a sepa rate mem- F

e, whose thi cke11 ed upp er border is z
sectio11s G, H th ro ugh th e latter fo ld
e surfa ce o utli11es. Whe11 descent o f
pe11sio n, it also stretches th e subsidi - y quadrangular membrane y
e quadra11gula r membra11 e. W hen laryngeal
1 the membran e d rag th e arytenoid
vestibular ligament
v sinus
::k backward, th ere by stre tching th e
)!d based 011 it. T hus th e fo rce that
g. 2.13 ) is th e force th at stretches un-
vocal ligament b
:al fo lds and p ro du ces a general en-
sage a bove the cri coid ca rtilage. G cricovocal membrane H
z

Exp iration Inspiration ii

33 RESPIRATORY FOLDTNG
 thyrohyoid
ligament hyoid
bone

End
thyroid - -- - -- +- Expiration _,__ _ _ _ __ thyroepiglottic
cartilage ligament

cricoid
vestibular
cartilage
ligament

vocal
ligament

hyoepiglottic
ligament
Inspiration i

"--- -- -- - cricothyroid
ligament

latera l voca l
cricothyroid ligament
ligamen t
Inspiration ii

Craniocauda l
A B Projection

Posteroanterio r Latera l
Projection Projection

LARYNGEAL BIOM ECHAN ICS 34

 : .. ..,, .... -,~
. •

epiglotti s
Fig. 2.9 Mechanical coupling. These diagrams of the nonm uscular
- - - - thyroepiglottic laryngeal suspensory system il lustrate how the system effects the me-
ligament chanical coupling of the more or less transverse respiratory excursion
of the arytenoids to the roughly vertical respiratory excursion of the
larynx.
A, posteroanterior projection showing how downward tracheal
ves ti bular stress accompanying inspiration is transmitted to the main suspen-
li gament sion trains (two lateral and one med ian ) ending at the hyoid bone.
The ligaments of the main suspension trains are indicated as broad
vocal springs. T he median train includes the epigiottic cartilage from
li gament subsid iary su s pension
(quadrangular membrane) whose margins the arytenoid cartilages are suspended by the subsidi-
ary system. This suspension is constituted by the quadrangular mem-
brane, symbolized by narrow springs. lncreased tension in the sub-
sidiary suspension in the first phase of inspiration causes the aryte-
noids to slide sideways. Further increase in tension with continuing
inspiratory effort (deep inspiration ) then makes tbe arytenoids rock
backward. T he mechanism that restricts rocking is explained in fig.
vocal process 2.12B. T he eiastic properties of the suspensory system ensure that
restitution of the reference configuration of eupneic expiration will
- - - cricothyroid automatically follow when tbe inspiratory deforming stress ceases.
ligament B, lateral projection showing in addition how the vocal (and ves-
tibular) ligaments act as check ligaments limiting the backward rock-
ing of the arytenoid.
C, craniocaudal projection emphasizing that at the end of la-
ryngeal phase i of inspiration, tbe vocal processes are still approxi -
mately parallel to each other. T his is the phase of sliding abduction,
voca l or abduction in parallel. Lateral sliding is limited by the posterior cri-
/ ligamen t coarytenoid ligament, which functions as tbe check ligament for tbis
phase of abduction. Laryngeal phase ii of inspiration is the phase of
voca l process rocking abduction, or abduction in divergence. Because of the incli-
nation of the cricoid facet downward, forward, and outward, back-
ward rocking of the body of the arytenoid in phase ii carries the vocal
C process upward, outward, and backward and produces a wide open,
pentagonal rima glottidis. As shown in B, backward rocking is also
limited by check ligaments, nam ely, the vocal and vestibular liga-
Cranioca udal ments.
Projectio n

35 RESPIRATORY FOLDING
:~--. _::-- :--::•·-·:::, ·-: .. ·: .:"-"::::._:;:::;_~ ·:;-+-'·'--·---- :c:-.,,-:.,, ··.:·,-·:- - ..: ''.i-:;,,:•:::.J-::a:.r:·<c·-•.. --!; :-: .c: :· .:.:: ·· _._ •.. •.· •.: :---•.: .. : · • .. • ·-,,. . · . . .. /?':

epiglottis
hyoepiglottic ligament

aryepiglottic fold
thyrohyoid ligament
cuneiform cartilage triticea cartilage
thyrohyoid
membrane with in lateral vocal
thyrohyoid ligament
corniculate cartilage
thyroepiglottic ligament
ligament

laryngeal sinus
corn icu late quadrangular
inferior horn cartilage membrane
thyroid cartilage
cricovocal membrane
ceratocricoid
ligament
cricoarytenoid cricovocal
median cricothyroid joint ligament
ligament

Figure 2.10 Elastic recoi l, lateral view. Anatomy of the elastic mem-
branes and ligaments of the larynx in a lateral radiograph. Elastic
recoil of these structures ensures automatic return to the end-
expiratory configuration as soon as a deforming stress ceases to act.
B vesti
Fig. 2.11 Elastic recoil, posterior view. Anatomy of the laryngeal ligar
elastic tissu es and ligaments in a posteroanterior tomogram at end-
expiration. The positions of the arytenoid and cricoid cartil ages are /
inferred. In general , the orientation of the quadrangular membrane
connecting the arytenoid to the margin of the epiglottic cartilage is vocal
upward, outward, and forward . This is therefore the effective di- ligament
rection of the reaction to the down ward inspiratory force on the ary-
tenoid transmitted from the cricoid and trachea. The downward
force and the membrane's reaction to it govern the respiratory excur-
sion of the arytenoid cartilage. By the parallelogram rule, during in-
spiration the resultant of these stresses is directed downward,
forward, an d outward, approximately in the same direction as th e
lang axis of the cricoarytenoid articulation. lt is therefore in the lat-
posterior - - -_::_::_-->:+_::_-,,,___,,,
--
ter direction that the arytenoid slides during inspiration. Cessation of cricoarytenoid
th e inspiratory force is automatically succeeded by elastic recoil to ligament
the end-expiratory cond ition .

Expiration

LARYNGEAL BIOMECHANICS 36

triticea cartilage
within lateral
thyrohyo id
ligament
quadrangular
membrane
cricoaryten oid
joint
erior vi ew. Anatomy of the laryngeal
1 a posteroanterior tomogram at end-
1e arytenoid an d cricoid cartil ages are
:ation of the quadrangular membrane
1e margin of the epiglottic cartilage is
rd. This is therefore the effective di-
ownward inspiratory force on the ary-
cricoid and trachea. The downward
tion to it govern the respiratory excur-
. By the para ll elogram rule, during in-
1ese stresses is directed downwa rd,
ximately in the same direction as the
articulation. lt is therefore in the lat-
slides during inspiration. Cessation of
aticall y succeeded by elastic recoil to
A
quadrangular membrane
vocal Fig. 2.12 Elastic recoi l, cranial view. A,
ligament anatomica l diagram of laryngeal elastic tis-
sues viewed from above; left, the cricovocal
vestibular ligament
mernbrane and its boundaries; right, the
quadrangular rnernbrane. The substance of
the vocal fold is rnainly rnuscular and is lat-
eral to th e cricovocal membrane. The glan-
dular substance of the vestibular fold is lat-
eral to the quadrangular rnembrane. B, dia-
grarns of the li ga mentous restraints upon
the right arytenoid ; left to right, end-
cricovocal
ligament expiration, end of inspiration phase i, end
of inspiration phase ii . In the first ph ase of
inspiratio n, the arytenoid cartilage slides
posterior cricoaryten oid caudolateroan terio rly along the cricoid
ligament facet, until it is stopped by tension in th e
B posterior cricoarytenoid ligament. In this
vestibular rnodel the ligament acts as a check ligarnent
ligament
whose action continues through the next
phase, the phase of rocking. In phase ii of
/
inspiration, the arytenoid rocks backward
until stopped by the tension in the vocal and
vocal
ligament
vestibu lar ligarnents. The res train ing action
of these ligamen ts continues throughout the
reminder of inspiration. During expiration
elastic recoil of ligaments returns the aryte-
noid to its previous upright posture .
poster i o r - - -_-,::;:;:::::_
cricoarytenoid
ligament
Expiration Inspiration i Inspiration ii
37 RESPIRATORY FOLDING
·,:_::-•·c---.·_ ·.: ~ . : .. ?·--:;··:::..
1.••:::::·__;.':_;.;_;::._ • .,:;___ ,_;
C'
Fig. 2.13 Mechanical coupling forces. The forces moving the aryte-
noid during respiration are (1) a set of distributed downward forces
on the cricoarytenoid articular capsule and its attached structures,
derived from the downward force on the cricoid cartilage (itself
derived from down ward force on the trachea or 011 the thyroid carti-
lage), and (2) a set of distributed reactions in the quadrangular mem-
brane. Each set may be respresented by a sin gle vector radiating from
the center of gravity G of the arytenoid cartilage (A ). The cricoid
force is represented by vector GT, parallel to the longitudinal airway
axis AA '. The direction of this vector passes through the center of
gravity of the cricoid cartilage; otherwise, it would be necessary to
include another force to prevent movement at the cricothyroid join t.
The reaction CR is equa l and opposite to GT, and is effective in GM,
the direction of the resultant tension in the quadrangular membrane.
To define GM we assume that the reaction is distributed evenly from
the upper to the lower borders of the quadrangular membrane; then
GM should bisect the angle BOC between the upper and lower bor-
LARYNGEAL BlOMECHANICS
;_: '!:-:.,',1,:•,•····F·.·.-· ..: •'-3:.!··;:.':J···.:_·:::-'"::-.-.•:: :: ! .· ,::::: . . • . . ,. , .. ·-·. . ·· ,•, . -'"":: • . ./1!'
A'
ders of the membrane at its attachment to the arytenoid. Signifi-
cantl y, BO happens to be nearly parallel to the tracheal airway axis.
The vector GM is the reactive tension in a direction parallel to OM
and is equal to CR x cos BOD. If GM were an inextensible rod, then
at the start of inspiration an increase in GT would tend to move G
down ward and forward (as seen in lateral projection) in an arc of cir-
cle around M to G' (B). Now triangle GMG' is an isosceles triangle,
and, since all triangles GMG' are similar regardless of the magnitude
of GM, the direction CC' is invariant. In practice, however, GM is
situated in a viscoelasti c extensible membrane, so that any increase in
the cricoid force will bring G lower than in the inextensibl e condi-
tion, and the cricoid articular fact is more steeply inclin ed than CC '.
Note that diagram B is not a free-body diagram, since the forces
GT, GM alone are not in equilibrium. C and D, the same forces as
in diagrams A and B shown in anteroposterior projection; E and F,
the correspond ing craniocaudal projections.
38
 M

C D E

1 -· G'

F
T

attachment to the arytenoid. Signifi-

ly parallel to th e tracheal airway axis.
tension in a direction parallel to OM
. If GM were an in extensible rod , then
l
1erease in GT wo uld tend to move G
n in lateral p ro jection ) in an arc of cir-
triangle GMG' is an isosceles triangle,
1re similar regardless of the magnitude
wariant. In practice, however, GM is
.ible memb rane, so that any increase in ,..
lower than in the inextensible condi-
:act is more steeply inclined than G G '.
1 free-body diagram, since the forces

ilibrium . C and D, the same fo rces as

1 anteroposterior projection; E and F ,
al projecti ons.

39 RESPIRATORY FOLDING
-··,.;__ c:-••: c:-:_::< .-. : : :~~~-=·:~;,_;;:::;.____:':,;_;·.c .. _~,----·; -'-C:--·::· ,•!,,-.·,__:_:'.:-_···· .~ ••:
Fig. 2.14 Extrinsic respiratory forces, lateral projection. Represen-
tation of extrinsic forces operative in mechanical coupling. Th e
sources of these forces consist of the muscles that determine the respi-
ra to ry excursi on of the cricoid cartilage: (1) the thoracic respiratory
mu scles, which determine the resp iratory excursion of the trachea
and (2) the accessory muscles of respiration attached to the thyroid
cartilage. A, The sternothyroid and thyrohyoid muscles are sketched
on a lateral X-ray tracing; B , their site of attachment to the obliq ue
line on the lamina of the th yroid cartil age is shown. Judged by th e
direction of the fibers in lateral projection, the thyroh yoi d muscle ap-
pears to exert a pull almost parallel to the axis of the subglottic air-
way and almost diametrically opposite to the direction of the tra-
cheal force; the sternothyroid lin e of stress, however, is inclined to
the axis at a considerable angle. Thus, the sternothyroid muscle,
alon e or in con junction with the thyrohyoid muscle, tends to draw
the thyroid cartilage anteriorly and, if the cricoid and arytenoids
were restrained in the opposite direction, wo uld increase the tension
in the vocal ligaments. Such an effect has been postulated to occur in
th e external frame function discussed in fi g. 4.1 5. More than likely,
any such tensor activity will be relatively emde because of the !arge
size of the muscles and the lack of an effective an tagonist. In respira-
tion, however, the forward displacement would be advantageous be-
LARYNGEAL BIOMECHANICS
·-;_:· ·--·•:::J···:,c·_;::·;'·,-.-...: ':: ::,_: : ::::: ··. __ :: _...,,_: . ·-'- .... •. . ·. . --, .. ,• . . ;II'
cause it makes room for, and presumably faci litates, th e backward
rocking of the arytenoids. C, axial down ward tensile stress on the cri-
coid transmitted from the trachea. This stress increases with inspira-
tion because inspiration tends to draw the trachea deeper into the
thorax. The thyrohyoid and sternothyroid muscles also generate op-
posing moments of the thyroid cartilage about the cricothyroid artic-
ulation (D); the axis through th e two cricothyroid joints is approxi-
mately the anteroposterior axis of balance of the cricoid ca rtilage.
H ence, force transmitted along the inferior horn of th e th yroid carti-
lage does not generate a turning moment of the cricoid cartilage but
tends to accelerate the asse mbl y in the same direction as the force.
The distributed longitudinal tracheal stress may also be regarded as
applied at the cricothyroid joints, since the cricothyroid angle re-
mains constant throughout the differen t phases of the respirato ry C
cycle. The obliqu e line is roughly equidistant from the isthmus of the
thyroid laminae and the cricoarytenoid joint. The attachment of the
extrinsic muscles at the obliqu e line presumably enhances their abil-
ity to deflect the lamin ae outward (sternothyroid) or inward (thyro-
hoid and inferior constrictor). A respiratory role of the stylopharyn-
ge us, palatopharyngeus, and inferior constrictor muscles, also in- sternothyroid
serted on the thyroid cartil age, is undetermined. force
tra chea l ~
force l
40
 A B
M. thyrohyoid
insertion

M. sternothyroid
insertion

M . inferior constrictor
of pharyn x
presumably facilitates, the backward
,ial down ward tensile stress on the cri-
hea. This stress in creases with inspira-
to draw the trachea deeper into the
ernothyro id muscles also generate op-
cartilage about the cricothyroid artic-
he two cricothyroid joints is approxi-
is of balance of the cricoid cartilage.
; th e inferior horn of the thyroid carti-
1g moment of the cricoid cartilage but
,ly in the same direction as the force.
acheal stress may a lso be regarded as
ints, since the cricothyroid angle re-
,e different phases of the respiratory C D
dy equidistant from the isthmus of the thyrohyoid
thyrohyoid
.rytenoid joint. The attachment of the force
e line presumably enhances their abil-
·ard (sternoth yroid) or inward (thyro-
A respiratory ro le of the stylopharyn-
inferior constrictor muscles, also in- sternothyroid
, is undetermined. force

cricothyroid
pivot

trachea

41 RESP IRA TORY FOLD ING

. --· · ~.·.····' · : · :---~·~-c:-::::_: ·;;;'_ : ~:.-::. :.·.• ..:s ·.,.. . ,- ·· :- .. : ··· : ·. ···:i·.. c.... ·• • : : : ··- · ·· · · · · · · · · ·~ ~

A B C A

T.H.

~
M . thyrohyoid

M. sternothyro id l
T
T

End Expiration

Fig. 2.16 Arytenoid coupling forces. Frc

tenoid cartilage in th e respiratory mode,
end of eupneic expiration; B, end of slidi
end of rocking phase of inspiration . Be~
slides on the cricoid facet in a plane perp
F,F2 to F' 1F' 2 • GM is the quadrangular m
reaction to the cri coid force GT. In A an
Fig. 2.15 Extrinsic respiratory forces, an terior projection. A, the cricoid is indicated by th e th ree equal vectors T, which suggests that essa ry for equilibrium, as are equal and o
sternothyro id and thyroid muscles superimposed on a tomographic this force is distributed evenly to the three main suspension tra in s. C, from the posterior and latera l cricoaryter
ou tli ne of the hyoid bone, thyroid cartilage, and air passage; the thyrohyoid (T. H .) and sternothyro id (S. T.) stresses divided into tan- creases to GA' in the course of thc sliding
angle of fl are of the thyroid laminae is indicated by the upward diver- gential and normal components. The normal components tend to de- supp lied by the transverse arytenoid musc
gence of the edges of the laminae. B, the general direction of the crease and increase the angle of fl are of the lamin ae, correspondin gly ductor throughout inspi ration (Faaborg-
Stresses o n the thyroid cartilage generated by the thyrohyoid and reinforcing other larynx-closing or larynx-opening mechanisms. viously thought to be rath er paradoxical.
sternothyroid muscles. The distributed fo rce from th e trachea on the

LARYNGEAL BIOMECHANICS 42
 C A B C

T.H.

l
T
T

T'
T"

End Expiration Inspiration i Inspiration ii

e equa l vectors T, which suggests that
to the three main suspension trains. C,
hyroid (S. T.) Stresses divided into tan-
:s. The normal components tend to de-
f flare of the lamin ae, correspondingly
,g or larynx-opening mechanisms.
Fig. 2.16 Arytenoid coupling forces. Free-body diagrams of an ary-
tenoid cartilage in the resp iratory mode, anterolateral projection. A,
end of eupneic expiration; B, end of sliding phase of inspiration; C,
end of rocking phase of inspiration. Between A and B the arytenoid
slides on the cricoid facet in a plane perpendicular to the page, from
F1F2 to F' 1F' 2 • GM is the quadrangular membrane component of the
reaction to the cricoid force GT. In A an additional force GA is nec-
essary for equi librium, as are equal and opposite moments CA 1 , CA 2
from the posterior and lateral cricoarytenoid muscles. Force GA de-
creases to GA' in the course of the sliding transition from A to B. lt is
supplied by the transverse arytenoid muscle, whose activity as an ad-
ductor throughout inspiration (Faaborg-Andersen, 1957) was pre-
viousl y thought to be rather paradoxical. During the sliding inspira-
tory transition, the angle TGM decreases to T'GM'. Slide beyond
F'iF' 2 is prevented by the cricoarytenoid check ligament (posterior
cricoarytenoid ligament). When eh e magnitude of the cricoid force
increases beyond the magnitude shown in B, the arytenoid-stabilizing
activity of the cricoarytenoid muscles is either overcome or inhibited
(C) . The moment caused by the resultant of the forces GT", GM" im-
med iatel y rocks the arytenoid ti ll the condition shown in the diagram
is approximated. At this point backward rocking is terminated by an
equa l forward moment produced by the tension in the vocal and
vestibular ligaments. In expiration the rocki ng and sliding displace-
ments of the arytenoid are reversed and accelerated by the potential
energy that was stored in the elastic tissues during the inspiratory dis-
placements.

43 RESPIRATORY FOLDING
. :- . _. -. : : · -.,--~--·''·~::. _ ··:::.:..: ~---"-· :::· .:a · ·,:- :- ,- - .- •. ··=· ··.:·-, ,,._ .. · :::- :: - : . : : · ·· · .· · · . · ..• · ·. · -- .·. - . . . -- lt

Effort closure of th e larynx, like

tinctive act of human bodily mecha
onerous physical efforts is undoubtl
larynx closes hermetically to prev
pressed pulmonary gas. Indeed, a ca
/
1\ fort closure of the larynx was one of
velopment of Neolithic civilization,
ning agriculture was based on back-!
hardly have been sustained without
ynx.
Biblically, the curse of tilling the
Adam's retribution for mel onophag
lightful apocryphal legend perspiec
prominence of the larynx marks th
Adam's apple lodged in his throat.
biomechanics finds that the prornim
structural aptitude for hard labor-
vanced type of laryngeal folding.

Effort Foldi
\, rr-,, Schematized, the folding takes pla
S.,..l(-1\ stages (figs. 3.1 and 3.2): it begins w
tenoid cartilages, bringin g (and fold
 3
Effort Closure
Effort closure of the larynx, like voice production, is a dis-
tinctive act of human bodily mechanics. The performance of
onerous physical efforts is undoubtedly facilitated when the
larynx closes hermetically to prevent the escape of com-
pressed pulmonary gas. Indeed, a case could be made that ef-
fort closure of the larynx was one of the essentials for the de-
velopment of Neolithic civilization, for from th e very begin-
ning agriculture was based 011 back-breaking work that could
hardly have been sustained without effort closure of the lar-
ynx.
Biblically, the curse of tilling the ground for a living was
Adam's retribution for melonophagy (Gen. 3:17), and ade-
lightful apocryphal legend perspicaciously asserts that the
prominence of the larynx marks the place where a piece of
Adam's apple lodged in his throat. As we shall see, modern
biomechanics finds that the prominence does indeed confer a
structural aptitude for hard labor-one dependent on an ad-
vanced type of laryngeal folding.
Effort Folding
~ Schematized, the folding takes place in several overlapping
~st ages (figs. 3.1 and 3.2): it begins with adduction of the ary-
tenoid cartilages, bringing (and folding) the vocal folds into
45
L
apposition at the median line (fig. 3.2). At this stage, the su-
praglottic larynx between the vestibular and aryepiglottic
folds is narrowed but still open, the vestibular folds being re-
strained laterally by elastic tissue and the cuneiform carti-
lages. In the next stage, the vestibular folds are folded and
pushed into apposition by contraction of the thyroarytenoid
muscle (fig. 3 .3C), which at the same time obliterates the sinus
by drawing the vestibular folds down against the vocal folds
(fig. 3.4). Finally, this folding is reinforced by vertical shorten-
ing of the laryngeal entrance, resulting from thyroid cartilage
- hyoid bone approximation by the thyrohyoid muscle. The
vertical shortening folds the medial surface of the aryepiglot-
tic folds (figs. 3.4, 3.5D) and compresses the median thyro-
hyoid fold down against the top of the adducted vestibular
folds.
Judging by the appearance of the aryepiglottic ridge in fig.
3.6D, the aryepiglottic muscle is contracted and shortened
and must be operating at the lower end of its length-tension
curve, so that its tendency to bend the epiglottis is small. The
direction of its fibers also diminishes any capability in this re-
spect. In discussions of deglutition (see chapter 5), the ary-
epiglottic muscle has nevertheless often been reputed to cause
the downfolding of the epiglottis (Saunders, Davis, and
Miller, 1951).
The cricothyroid visor angle does not alter during effort
•- ·- o· .... ·: - : • • . •.• -- . : . :: ·. . . :· . • . ••• . . • . :: . . . . .• . . : . : - . . . . . • " • • ~

closure but remains the same as during respiration (fig. 3.4). become shortened with effort closure. The powerful part they Closure of the laryngeal passage
This means that the vocal ligaments are neither rendered tense . play is easily imagined, especially in light of the conditions in apposes the vestibular and vocal f
nor slackened. Enlargement of the cricothyroid angle, which the next subject. closure (fig. 3.7H). However, the v
would shorten the vocal folds, is opposed by the stout ante- Figure 3.7E shows an ostensibly maximal closure effort by ward the trachea so that the sinus a
rior cricothyroid ligament. Instead, during effort closure the a young adult female. Here adduction has closed the larynx at When the larynx is distracted dow
joints between the laryngeal cartilages are stabilized at the the level of the vocal and vestibular folds and the sinus is hyoid and the arypeglottic fold s ar
shortest feasible length of the folds-the cricothyroid joints again obliterated, but there is little or no hyoid bone to thy- and the upper larynx therefore re
by the simultaneous activity of the vocal and cricothyroid roid cartilage approximation or deformation of the thyro- whereas phonatory cl osure is co
muscles, the cricoarytenoid joints by the apposition that hyoid fold. Above the vestibular folds, at the aryepiglottic glottis, that is, to apposition of the v
clamps the arytenoids to the cricoid (see chapter 4 and fig. level, the larynx is still widely open anteroposteriorly, and the the arytenoid cartilages, effort clos
4.3). The contraction of the vocal and thyroarytenoid muscles free margin of the aryepiglottic folds is quite long and con- apposition of the vestibular folds a
stiffens them into a cork plugging the passage. spicuous. cartilages by the thyroaryten oid rnu
Glimpses of how the tissues of the larynx fold to block the In figs. 3.7B and D the bulges of the air column anteriorly amount of apposition of the rnedia
expulsion of air are obtained in the lateral radiographs of in the cricothyroid notch and between the rings of the trachea top of the adducted vestibular fold
three subjects in fig. 3.7, where füms of expiration and effort are signs of considerable effort and rise in subglottic pressure. apposition determines the firrn nes
closure are aligned in pairs at the vertebrae. In effort closure In fig. 3.7E such bulges are missing, indicating a lesser effort from a corresponclingly markecl ap
all three subjects are deliberately straining as hard as possible. and a lesser rise in pressure. The conclusions drawn from bone ancl thyroicl cartilage. The el,
In subject 1, a middle-aged male (fig. 3.7, A and B), effort clo- these and other data are that complete, forceful closure of the /\ cartilages ancl neighborin g connecl
sure draws the hyoid bone down to the thyroid cartilage and larynx demands thyroid -hyoid approximation by the thyro- 1 rnatic reopening of the vestib ule whe
opacifies the laryngeal cavity above and below the sinus hyoid muscles and that this presses the epiglottic tubercle of (fig. 3.8) .
laryngis, and also at the level of the sinus itself. Opacification the median thyrohyoid fold against the top of the adducted The role of the thyrohyoid rnuscle
here implies replacement of air by a plug of soft tissue- vestibular folds and also folds the medial surface of the ary- counts for the observation that patie
below the sinus by apposition of the vocal folds, above the epiglottic fold into the gap lateral to the tubercle. recurrent laryngeal nerves are still a
sinus by apposition of the vestibular folds, and at the sinus by One can verify the presence of thyroid-hyoid approxima- tively. The paralysis of the nerves iI
apposition of the inferior surface of the vestibular folds to the tion in laryngeal effort closure by placing one's fingertip in the muscles of the larynx except the ,
superior surface of the vocal folds. A vestige of air remains in notch above the laryngeal prominence, or Adam's apple, dur- partly succeecls because the folcling
the sinus anteriorly. The approximation of the hyoid bone to ing a straining effort. The extent of the approximation be- hyoicl, whose nerve supply is not afü
the thyroid cartilage has deformed the median thyrohyoid tween the hyoid bone and the prominence will depend on how close the larynx at the vestib ule.
fold and forced (folded) its posterior surface against the top of strong an effort one makes: the greater the effort, the greater
the vestibular folds; the aryepiglottic folds are no longer rec- the approximation and also the stronger the contraction of
ognizable. The orientation of the cricoid cartilage relative to the abdominal wall and the greater the increase in sublaryn-
the thyroid cartilage has not changed. geal pressure. Simultaneous electromyograms have shown
In subject 2 (fig. 3.7C and D), also a middle-aged male, a that the electrical activation of the thyrohyoid muscle is pro- Laryngeal Prom
similar set of changes occur with effort, except that in this portional to the strength of activation of the abdominal wall Compression of the median thyro
case the larynx is pulled up to the hyoid rather than the other 1 , rnuscles. This probably means that when the subglottic pres- creases the tension in the thyroepiglc
way around as in subject 1. In these tracings, the site of the sure is raised by the contraction of the rnuscles of the trunk, teresting to note that the tension ren
thyrohyoid muscles has been sketched in at the normal ana- ; the strength of the glottic closure that resists the pressure is dicular to the junction of th e larnin a
tomical attachments to emphasize how much these muscles automatically and appropriately increased. uration minimizes the tencl ency to sl

LARYNGEAL BIOMECHANICS 46
)rt closure. The powerful part they
ecially in light of the conditions in
tensibly maximal closure effort by
adduction has closed the larynx at
vestibular folds and the sinus is
: is little or no hyoid bone to thy-
on or deformation of the thyro-
tibular folds, at the aryepiglottic
:ly open anteroposteriorly, and the
lottic folds is quite lang and con-
,ulges of the air column anteriorly
1d between the rings of the trachea
:ort and rise in subglottic pressure.
: missing, indicating a lesser effort
,re. The conclusions drawn from
tt complete, forceful closure of the
,oid approximation by the thyro-
, presses the epiglottic tuberde of
:l against the top of the adducted
,lds the medial surface of the ary-
lateral to the tuberde.
:nce of thyroid-hyoid approxima-
1re by placing one's fingertip in the
1rominence, or Adam's apple, dur-
extent of the approximation be-
1e prominence will depend on how
: the greater the effort, the greater
o the stronger the contraction of
: greater the increase in sublaryn-
1s electromyograms have shown
1 of the thyrohyoid muscle is pro-
: activation of the abdominal wall
ms that when the subglottic pres-
ction of the muscles of the trunk
:losure that resists the pressure i;
iately increased.
Closure of the laryngeal passage in inspiration (fig. 3. 7G)
apposes the vestibular and vocal folds, as in ordinary effort
closure (fig. 3 .7H). However, the vocal folds are sucked to-
ward the trachea so that the sinus above them remains patent.
When the larynx is distracted downward, the median thyro-
hyoid and the arypeglottic fold s are prevented from folding,
and the upper larynx therefore remains open. In summary,
whereas phonatory closure is confined to dosure of the
glottis, that is, to apposition of the vocal folds by adduction of
the arytenoid cartilages, effort closure implicates in addition
apposition of the vestibular folds and bases of the cuneiform
cartilages by the thyroarytenoid muscles, as well as a variable
amount of apposition of the median thyrohyoid fold to the
top of the adducted vestibular folds . The extent of the latter
1 apposition determines the firmness of closure and derives
/ from a correspondingly marked approximation of the hyoid
bone and thyroid cartilage. The elasticity of the cuneiform
cartilages and neighboring connective tissue ensures auto-
matic reopening of the vestibule when the dosing effort ceases
(fig. 3.8) .
The role of th e thyrohyoid muscle in closing the larynx ac-
counts for the observation that patients with paralysis of both
recurrent laryngeal nerves are still able to cough fairly effec-
tively. The paralysis of the nerves incapacitates all the small
muscles of the larynx except the cricothyroid. The cough
partly succeeds because the folding produced by the thyro-
hyoid, whose nerve supply is not affected, is almost enough to
close th e larynx at the vestibule.
Laryngeal Prominence
Compression of the median thyrohyoid fold necessarily in-
creases the tension in the thyroepiglottic ligament, and it is in-
teresting to note that the tension renders the ligament perpen-
dicular to the junction of the laminae or isthmus. This config-
uration minimizes the tendency to shearing at the attachment
47
to the thyroid cartilage. Evidently, the forwa rd proj ection of
the angle of the cartilage (described in chapter 1) is in part a
means of minimizing shearing strains at the ligamentous con-
vergence.
In fig. 4. 12A, illustrating the phonation of the vowel [a] ,
the thyroid-hyoid distance is about the same as in effort clo-
sure and the angle of the ligam ent to the isthmus is indeed al-
most exactly 90 degrees. Accurate coaptation of the median
thyrohyoid fold to the top of th e adducted vestibular folds re-
quires that, when adducted, the top of these folds also meet
the isthmus at an angle of about 90 degrees. That this is the
case is also indicated by fig . 3.7G. Here, in closure of the lar-
ynx with inspiratory effort, the top of the adducted vestibular
folds is discernible and does in fact meet the isthmus at the
specified angle. During deep inspiration the elongation of the
median thyrohyoid fold markedly enlarges the laryngeal en-
trance anteroposteriorly (fig. 2.7). This, of course, decreases
the angle that the ligament makes with the isthmus and sets
up a shearing stress at the junction. Without the forward
inclination of the isthmus, the shear would be considerably
magnified and the ability of the fold to elongate would be
decreased.
Thus, the 30-degree forward inclination of the angle of the
thyroid cartilage, which produces the prominence of the
human larynx (prominentia laryngis), seems nicely adjusted
to serve both strong effort closure and high ventilatory flow,
two functions that often go hand in hand. Further, the inclina-
tion of the isthmus to the oblique line enables extrinsic muscles
attached at the line to reinforce both of these functions.
As a final detail, note the overlap in 3.lB between the upper
horn of the thyroid cartilage and the cornu major of the hyoid
bone. Inward bending of the thyroid horn, whether by the
pull of the attached musdes or by pressure against th e hyoid
cornu, would tend to narrow the space internal to the laminae
and reinforce closure. Independent evidence that such a
mechanism is active during swallow closure is reproduced in
fig. 5.7. lt reinforces the lamina-bending tendency of muscles
attached to the oblique line.
EFFORT CLOSURE
:- . - . · : .: : .• . ".c·~• ••• c ... •-: . · .:·- •• -;:..·--· •• : .:-: •·;.· • • s- ••••: •·: _ _- 0 ·.··-:·· • ,-.••:.-.· !; . . • . . • • . • •· • • •-. : ·~. . . /;'

An engmeering problem of considerable magnitude was The specialized human type of laryngeal closure (fig. 3.9)
solved through the evolutionary development of effort clo- permits a sustained rise in sublaryngeal pressure as part of a
sure. The solution provides both rapid assembly of a gas-tight general rise in intrathoracic and intrabdominal pressure. The
plug in support of straining efforts and rapid disassembly to postural effort produced by the parietal muscles of the abdo-
give untrammeled passage to the consequent increased air men and thorax (fig. 3 .11) pressurizes the contents of the trunk
flow. Partial assembly enables the plug to generate the varied and braces and stiffens its framework, forming a base for
sound utilized by humans in the planning of effort. All this efforts by the limbs-somewhat as pressurizing an inflatable
evolved without prejudice to protection against deglutitional rowboat stabilizes it for efforts with the oars. In the human
invasion of the passage from above (chapter 5 and fig. 5 .3). ecological niche, this postural support is particularly exploited
The strategy of the solution consists of folding, and the tac- during lifting or dragging efforts by the arms while the indi-
tical innovation that implements it in the human larynx is the vidual is standing or striding orthograde. A second advantage
_me_dian thyrohyoid fold (fig. 3.8). Unfortunately, the signifi- of a pressure-proof seal of the larynx is that it allows a high
cance of this structure was imperfectly appreciated in classical and sustained rise in internal pressure (fig. 3 .10) that multi-
anatomical science. A name for it is lacking in earlier ac- plies the effort that can be applied to expelling the contents of aryepiglottic
counts, in part, perhaps, because the animals (nonprimates) a viscus. Coughing, vomiting, urination, defecation, child- fo ld
studied experimentally lack such a fold. In monkeys part of birth all exploit the same basic type of expulsive effort. The
the site of the fold is expanded into a thyrohyoid air sac. In adaptive value of supportive laryngeal closure to a male occu-
some pongids the fold is conspicuously !arge anteropos- pied in killing a prey may be no less critical to successful re-
teriorly but less developed craniocaudally; it is presumably production of the species than expulsive laryngeal closure is
less extensible than in man because of the closer proximity of to a female giving birth to a big-brained baby.
the thyroid cartilage to the hyoid bone.

Fig. 3.1 Skeletal supports in effort clo

Outlines of cervical anteroposterior ton
(A) and effort closure (B). The approxim a
and hyoid bone has taken pl ace mainly
downward, with consequent elongation c

LAR YNGEAL B IOMECHANICS 48

y-pe of laryngeal closure (fig. 3.9)
;ublaryngeal pressure as part of a
and intrabdominal pressure. The
the parietal muscles of the abdo-

I
ressurizes the contents of the trunk
framework, forming a base for
what as pressurizing an inflatable
·orts with the oars. In the human
al support is particularly exploited
fforts by the arms while the indi-
~ orthograde. A second advantage
the larynx is that it allows a high
al pressure (fig. 3.10) that multi-
pplied to expelling the contents of aryepiglottic aryepiglottic
ing, urination, defecation, child- fold fold

asic type of expulsive effort. The

: laryngeal closure to a male occu-
ie no less critical to successful re-
1an expulsive laryngeal closure is
a big-brained baby.

/
B

Fig. 3.1 Skeletal supports in effort closure, anteroposterior view.
Outlines of cervical anteroposterior tomograms during expiration
(A) and effort closure (B). The approximation of th e thyroid cartilage
and hyoid bone has taken place mainly by movement of the hyoid
downwa rd, with consequent elongation of the lower uncalcified part
of the stylohyoid ligament. In B note th e fo lding of the medial sur-
fac e of the aryepiglottic fold , tb e mo re medi al position of th e un-
fo lded lateral surface of the fo ld , and tb e associated widening of the
left piriform recess. The widening is clearer in the outlines of fig. 3.2,
fr om a different subject.

49 EFFORT CLOSURE
,·.=· ·· -._ ·.. ' .• . ·.·----:·.·:.~·2::.. · ·.::.·.. : -·-·--· :.:. :: ·. ,.. ,........ ,., __. .. ,.,,-.··.·~,- -., ·. · '; .. . . :··. . ·-· . . . . : - ;J!'

, I
sacculus
1- -· 1
\ \ ,'; /
\ \ 1 /
\ \ / I
\ ..,' I
' ,_,I plica
vocalis
vestibular
fold
plica
piriform vestibu laris
fossa

vocal
Expiration
fold

Inspiration ii Expirati on Phonat ion Elfort Closure

y
Phonation

Fig. 3.2 Pli cation. Upper row, posteroanterior outlines of the laryn- reciprocal effects on the diameters of the piriform recesses and air-
geal cavity in various types of folding. Note the interdependence of way. Lower row, idealized outlines to emphasize that changes in an-
the transverse and vertical dimensions of the laryngeal cavity and the gu lation at the inner surface are equivalent to changes in folding.

Effort

LAR YNGEAL B IOMECHAN !CS 50

•l
 sacculus M. thyroarytenoid

cuneiform
plica
vocalis Fig. 3.3 Apposition. Model drawings of a
larynx sectioned horizontally at the level of
plica
the vestibu lar folds during expiration (A),
vestibularis phonation (B), and effort closure (C). Glot-
piriform
fossa tic closure, modeled in B, is effected by con -
traction of the arytenoid muscle, which ap-
interarytenoid poses the arytenoid vocal processes (as weil
Expiration
mucosa as rh e corniculate tubercles) and causes the
mucosal covering of the interarytenoid fold
to bu lge, or fold, backward into the hypo-
pharynx and forward between the aryte-
noids. The rumpled (folded) interarytenoid
mucosa is accommodated posteriorly to the
voca l processes, within the divergence of
Elfort Closure
the articu lar processes. With effort closure,
vocal modeled in C, contraction of the external
process thyroarytenoid muscles displaces the glan-
dular structures in the vestibular fold me-
dially into apposition. The fibers of the
thyroarytenoid muscle ascend as rhey
course backward toward the arytenoid and
) M . arytenoid cross the cuneiform cartilage obliquely.
Phonation Thus, when contraction of the fibers pushes
the cuneiforms medially, the cartilages are
brought into contact only at their bases;
C they will recoil elastically to their latera l lo-
cation when the external thyroarytenoid
M. thyroarytenoid muscles relax, and the ves tibule will auto-
(external division) matically reopen. Compression of the sac-
cule in C, for example, in the act of clearing
cuneiform
the throa t, squeezes mucus out of the sac-
cule and onto th e vocal fold.

ters of the piriform recesses and air-

ines to emphasize that changes in an-
·e equivalent to changes in folding.

Elfort
M . inferior constrictor

51 EFFORT CLOSURE
.- .·. : . . .. , •: ·-· '·:·~ .. _:;:_ : ~;___c_·. : .: :: ..... •, . .• . : ••.... ·. ··•: ':··· .· ,·. -:. • ,: . . . . . . . ·. . ·- . - . ,

epiglottis hyoid
median
thyrohyoid E
aryepiglottic fold
fold

thyroid

cricothyroid
angle
A B

aryepiglotti c /
ridge

C D
aryepiglotti c - -
fold

Fig. 3.4 Effort folding, additional details. Semidiagrammatic trac-
ings from lateral radiographs taken durin g expirati o n (A) and effort
closure (B). In B vertical compression and backward bulging in the
anterior wall of th e vestibule are present as a result of the thyrohyoid
approximation. The elasti city of the hyoepiglotti c ligament enables
the median thyrohyoid fo ld to rebound to the open configuration
when the compressing effort terminates. C and D, the approximate
limits of the paired hyo-epiglottic (stippled), vestibular (unstippl ed),
and vocal (strippled ) folds. The upper margin of the aryepiglottic
fo ld shortens and becom es rectilinear in effort closure, indicating
that the aryepiglottic muscle within it has contracted and th at aryepi-
glottic tissue below it has fo lded inward to obliterate the vestibule,
as noted in E-H and fig. 3.6. The cricoth yroid angle is the same in all cuneif orm -
the di agrams, emphasizing that there is no movement at the cricothy- cartilage
roid joint with effort closure. E and F are illustrations of the junc-
tion of the fold with the epiglottis; G and H, a sketched cross-
sectional appearance at tt. I, enl arged from a direct laryngoscopy cuneiform
photograph, shows th e bulging (fo lded) medi al surface of the aryepi- tubercle
glottic fo ld anterior to the foreshortened cuneiform cartilage, itself
anterior to the cornicul ate tubercle. Allowing for the foreshortening,
it can be seen that the cuneiform cartil age arches medially down into
the lower vestibule, where it contacts its fe llow during effort closure.
 hyoepiglottic
ligament

I
median
thyrohyoid E F
fold

r-----_ cricothyroid
angle

G H

aryepig lottic ~a,yepiglotHc

ridge fold
(folded)

cuneiform
aryepiglottic - - - - - - -
cartilage
fold

~d inward to obliterate the vestibule

ehcncothyroid angle is the same in all cuneiform
t t ere 1s no movement at th · h y- cartilage
E and F . e cncot
. are Illu strations of the . -
glott1s· G d H 1unc
'd f an , a sketched cross-
en 1arge rom a d. l cuneiform
1 (folded) medial irect aryngoscopy
. h surface of the aryepi- tubercle
es ortened
'rcle All .cun; 1·form cartilage, itself corniculate tubercle
' · . owmg or the foreshortenin and cartilage
rn cartd age arches mediall d . g,
mtacts its fellow du ri ng ef;or;~:s':::

53 EFFORT CLOSURE
-- •, ' : , .s---.. -···s·-, . , .· C ~=---- : : , ·: .,:, , , .. , ...... .:. ·. _,.,....., .. - : : .. . .. , , .... , , • - , ~

Fig. 3.5 Grades of laryngeal fo lding. Frames from

a Bell Telephone motion picture selected to com-
pare th e arra ngement of the fo lds viewed from
above during whisper (A) , phonation (B), coup de
glatte, that is, a phonation initiated with partial clo-
sure of the larynx to build up pressure (C), and
)
--........._ arytenoid
i
,.
cough (D ). The diagrams on the right provide a key
to the boundaries of the folds . Shading identifies the
eminence
( corn icu late
I:
J.
vestibul ar fold. Medial to it is the voca l fold; lateral, A Whisper tubercle) 1

th e aryepiglottic fo ld. In A the arytenoids and the

vestibular and vocal folds are partly abducted as
compared with B, but on the left side the anterior
surface of the aryepiglottic folds bulges into the ves-
tibu le. T he probable explanation for the bulge is
th at in whispering the thyroid carti lage and hyoid
bone are partly approximated, and this causes the
upper laryngeal folds to bulge inward into th e cav-
ity. A mo re marked degree of aryepiglottic bulging laryngeal
or fo lding is seen in C, a coup de glatte, or closed si nus
A
attack, where conspicuous backward bu lge of the B Phonation
epiglottic tubercle gives evidence of considerable
th yroid-hyoid approximation. There is also partial
adduction (fo lding) of the ves tibu lar fo lds, indicat-
ing that phonation is taking place through a partly
closed vestibule. Note that the bases of th e cunei-
form cartilages, foreshortened but visibl e in the medi
depth of the vestibule, are closer to each other in C ~hyoic
than in B. T he elastic recoil of these structures will
fully reopen the vestibule when the closiog stress
desists. D shows the larynx just beginn ing to reopen
after complete closure durin g a cough. The antero-
posterior length of the entrance appears shortened
'-\
C Coup de Glatte
if1:
because of the approximation of the larynx to the aryepiglottic ~voc
hyoid bon e, wh ich brings the arytenoids up toward fold
the strongly bulging epiglottic tubercl e. In D the
fo lding of the medial surface of th e aryepiglottic
fo ld is so great that it entirely obscures th e sub ja-
cent vestibular fo ld. The com bin ed vertical and B
transverse compression has ob literated the lary n-
gea l sinus and forced the bases of the adducted cu-
neiforms aga inst the epiglottic tubercle.

D
\~ Cough

LARYNG EAL BIOMECHANlCS 54

 ~ . h . .. ... - .. -. -

) Fig. 3.6 Effort fo ldin g. Lateral and anteropos-

. _.,______ arytenoid terior radiograph ic tracings of laryngeal fo lds in
eminence
(cornicu late
expiration (A, C) and effort closure (B, D ), al igned
Whisper tuberc le) vertically at the median axis and horizontall y ac the
upper border of ehe body of the hyoid bone. T he
alignments demonstrate that effort closure emai ls
(1) apposition of the vestibular and vocal fo lds; (2)
almost comp lete ob literation of the laryngeal sinus
by the adducted, thickened vestibular folds; and (3)
apposition of the median thyrohyoid fo ld to the top
of the adducted vestibular folds. The first two are
attributed to contraction of the thyroarytenoid
muscle; the last, to the activity of the extrinsic laryn-
laryngeal
sinus geal muscles, preponderantly the th yrohyoid, in ap-
A C proximating the thyroid cartilage and hyoid bone.
Phonation
In terms of what happens to the adjacent surfaces,
the formation of the plug that closes the larynx is a
process of fo lding. The inferomedial surfaces of the
adducted vestibular folds become folded down and
contact the top of the vocal folds, obliterating ehe
ventricle; the posterior surface of ehe median thyro-
?< median thyro-
hyoid fold
hyoid fo ld (epiglottic tubercle) becomes partiall y
folded and pushed back medially against ehe top of
\ vestibular
ehe vestibular folds, and ehe internal surface of ehe
fold aryepiglottic fo ld fo lds laterally into ehe remaining
.
gap. This mechanism enables pressures exceed ing
Coup de Glotte 160 mm Hg to be built up below ehe closed larynx
during explusive efforts such as cough or childbirth .
aryepiglottic ocal fold
The effort closure mechanism is also activated in
fold
supportive efforts that stabilize and rigidify ehe
trunk and convert it into a firm base for efforts by
ehe limbs.
I
B D

~ Cough

55 EFFORT CLOSURE
f
•_ . . . .. : ; . . . ·.c · c•..•. c .o· •· . • . : _ . . ;;_ •••.. ; . : .. :c •• . . . ... . • _- •·:• .. ·: .. ":•• .. • .,..0 .; • • ; • • • • • • • • • • ·~ _11,

_J hyoid bon

,j I
;J
2~
j _J
j thyro

J _J 6~

?
cartil

_J
hyoid bone
J
-~]
]
thyroid
cartilage
--,9 ~isorangle
C

~;
Expiration
-!
__
cricoid
carti lage 1

A B
Expiration Effort

Fig. 3.7 Skeletal supports in effort closure, lateral view. Tracings of ferred position of the thyrohyoid muscle, shortened in effort closure, fig. 2.6, invariance of the angle is ensure
late ral cervical radiographs of male subject 1 during eupneic end- is shown . activity of the vocal and cricothyroid mt
expira tion (A ) and effort closure (B). Effort is marked by the approx- E is traced from a latera l cervical radiograph of a twenty-one-year- the visor angle by equalizing the opposin
imation of the hyoid bone eo the thyroid cartilage and by opacifica- old woman (subj ect 3) during effort closure and during whisper (F). muscles about the cricothyroid joint.
tion of the ai r passage between the trachea and pharynx. In B, note Closure of the larynx is evidenced by opacification at the level of G and H, the role of thy roid-hyoid apJ
the bulges in the profile of the trachea and cricothyroid region an- vocal fo lds, laryngeal sinu s, and vestibular folds. T here is little or no comparing inspiratory and expiratory e
teriorly, indicative of high subglottic air pressure. The orientation of sign of thyrohyoid approximation, and the adital space between the kept hi s larynx closed. In G the vestib u
the cricoid to the thyroid cartilage (cricothyroid visor angle) is the vestibular and medi an thy rop hoid folds contains air. The rim of th e are apposed, but inspiratory effort has
same as in respiration . C and D, tracings of lateral cervical radio- entrance formed by the aryepiglottic folds is sharply o utlin ed and ap- the hyoid bone an d thyroid cartilage, :
graphs of subject 2, a fifty-nine-year-old male, during (C) expiration pears rectilinear, hinting th at the aryepiglottic muscle in the free bor- above the adducted vestibular folds rem
and (D) effort. Effort closure is again marked by the approximation der of the folds is contracted . The absence of sublaryngeal bulging of air (arrow ), as is part of th e laryngeal sin
of the hyoid bone and thyroid cartilage but is achieved in this subject the anterior wall of the airway suggests that the effort was less in - ing of the medi an thyrohyoid fold in G ,
by elevating the larynx toward the hyoid. In D, bulges caused by tense than in the male subjects (E, F, tracings from I, J ). drawing in of the skin above and belov
compression of the air are conspicuous anteriorly below the area of Stability of eh e cricothyroid visor angle, exemplified in thi s figure, (Figs. 3.7G, H, l, J are overleaf on P•
opacifi cation. The cricothy roid visor angle is unchanged. The in- prevails during all nonphonatory laryngeal behaviors. As discussed in

LARYNGEAL BIOMECHANICS 56
 ·- ~ .. . . ..... . . -····. .

_J hyoid bone
_J aryepiglottic
fold
median

J thyrohyoid fold

u
aditus

_] vestibular fold

6-:J thyroid
cartilage

?
area
(sinus effaced)
cricoid
cartilage
cricoid
cartilage

C D E
J visor angle
Expiration Effort Effort
'-

id muscle, shortened in effort closure,
,ical radiograph of a twenty-one-year-
effort closure and during whisper (F ).
nced by opacification at the level of
:l vestibular fo lds. T here is little or no
ion, and the adital space between the
oid folds contains air. The rim of the
lottic folds is sharply outlined and ap-
1e aryepiglottic muscle in the free bor-
'he absence of sub laryngeal bulging of
1 suggests that the effort was less in-
; (E, F, tracings from [, ]).
visor angle, exemplified in this figure,
:y laryngeal behaviors. As discussed in
fig. 2.6, invariance of the angle is ensured by appropriately balanced
activity of the vocal and cricothyroid muscles. This activity stabilizes
the visor angle by equalizing the opposing moments generated by the
muscles about the cricothyroid joint. sinus
G and H, the role of thyroid-hyoid approximation in effort closure
comparing inspiratory and expiratory efforts made while subject 1
kept his larynx closed. In G the vestibu lar folds and the vocal folds
are apposed, but inspiratory effort has preserved the separation of
the hyoid bone and thyroid cartilage, so that the laryngeal cavity cricothyroid
above the adducted vestibular folds remains open and is outlined by visor angle
air (arrow), as is part of the laryngeal sinus. Note the absence of fold-
ing of the median thyrohyoid fold in G as compared with H and the
drawing in of the skin above and below the thyroid cartilage in G. F
(Figs. 3 .7G, H, [, J are overleaf on pages 58 and 59. )
Whisper

57 EFFORT CLOSUR E
- -- - · _· : • . ! . • .. -~-.,; ·.--_:.·:::.. _ ._.:._ • __ __ :_ __ : : :: .• • • :· . . • ·: • •. - · · • • . • .· . • . . ..

1cm
1cm

LARYNGEAL BIOMECHANICS 58
. ~ - . . .

1 cm

59 EFFORT CLOSURE
. -· . .. : . . .. - - -- ·.-· - -~::: . . . .:. - _; .. -- . . . . •:• . . :- . . ·-. .... •'-. ,• .. ·.- .• . . . . . . . . - -

Inspiration

hyoe piglottic li gament A

epi glottis

. Y ~ - -- - thyrohyoid ligament
a
epi glottic t ubercle
y,.;.;,;.;.::.,;;,..,...._ _ __ _ th yro epiglotti c
ligament

Inspiration Elfort Closure

B C C TH

Occlusive Forces
Ex pirat ion Elf ort

Fig. 3.8 M edi an th yroh yoid fo ld compression. Diagrams based o n
lateral ra diographs taken during end-inspiration (A ), end-expirati on
(B), and effort closure (C) . Th e presence of cirumscribing elasti c li ga-
ments in th e median thyrohyoid fold, symbo lized in the diagrams as
coil springs, ensures that the fold behaves as a tension spring when
E
the fold is stretched in in spi ra ti on (A ) and as a compression spring
wh en th e fold is compressed in effo rt closure (C ). In both cases, the
fo ld recoils elastically to th e reference end-expiratory confi guratio n
(B) when the deformin g force ceases to act.

LARYNGEAL BIOMECHAN ICS 60

 Inspiration

,nt A B

thyroid
ament Fig. 3.9 Laryngeal occlusion. Left, posteroanterior
arytenoid
projection; right, lateral projection. A, B, inspira-
Jlottic LCA tion; C, D, E, F, effort closure. Arrows represent
muscle action. In inspiration posterior and latera l
cricoarytenoid muscle activity (PCA, LCA) stabi-
lizes the cricoarytenoid joint. In effort closure
arytenoideus muscle activity (A ) srabi lizes the cri-
coarytenoid joint by locking the adducted aryte-
Effort Closure noids to the cricoid; thyroarytenoid (TA), vocal (V),
D and cricothyroid (CT) muscle activity stabi lizes the
C TH cricothyroid joint. The cartilages are thus temporar-
ily converted into an arytenocricothyroid unit that
is approximated to the hyoid bone by the thyro-
hyoid muscles (TH). The median thyrohyoid fold is
thereby forced against the top of the vestibular
folds which have been adducted and also stiffened
by the thyroarytenoid muscle activity, just as the
vocal folds are stiffened by the vocal muscle activ-
ity. E and F, the forces on sorne of the apposed sur-
faces in the closed la rynx.
CT
Occlusive Forces

E F
:rn (A) and as a compression spring
effort closure (C). ln both cases, the
·erence end-expiratory configuration
~ases to act.

61 EFFORT CLOSURE
.. . . ....· ,.• '.,. .. . .. .. . . .. ;,· .. . . •·: .. .. . .... . ,• ,• . . . .. . . . . . . .ß

A B C

1 \ I
I\ - I
öl
D

Fig. 3.10 Effect of effort closure on body mechanics. Schematic ex-

planation of the stabi lizing effects of effort closure on body posture
with larynx open, arms unloaded (A), larynx open, arms loaded (B), Fig. 3.11 T runcal forces in effort closure.
and lary nx closed, arms loaded (C, D). When the larynx is open even are schematized as boxes hinged at the spi
a li ght load demands a bracing effort of the muscles to resist col- and postaxial muscles whose contraction 1
lapse of th e ehest. With the larynx closed a heavier load can be sup- the cages. Effort closure of the la rynx ens1
ported. Effort closure of the larynx helps to stabilize the posture of the thorax, facilitates imm obilization of th
the trunk and so increases the efficiency of forcible effort by the
limbs. lt appea rs to be a specialization of primates.

LAR YNGEAL B IOMECHAN ICS 62

-~ . ··•· ..
A B
Fig. 3.11 Truncal forces in effort closure. The thorax and abdomen
are schematized as boxes hinged at the spine and braced by preaxial
and postaxial muscles whose contraction pressurizes the contents of
the cages. Effort closure of the larynx ensures retention of the air in
the thorax, facilitates immobilization of th e cages at a variety of vol-
63
. .
C
umes, and converts th e trunk into a pillar that gives efficient purchase
to efforts by the limbs. The centra l nervous control mech ani sm au to-
matically couples a given stabilizing effort by the trunk muscles and
an eq uivalent closing effort by the larynx.
EFFORT CLOSURE
 4
Phonatory Folding
Three principal conditions must be fulfilled in transforming
the larynx from the respiratory mode to the tone production,
or phonatory, mode: (1) the mobile, posterior ends of the
/ vocal ligaments must be immobilized; (2) the vocal ligaments
Y\ must be rendered tense; and (3) air must flow between the lig-
aments. The first two conditions render the vocal folds capa-
ble of vibration. (The vibratory motion of the vocal folds is
cyclic but not sinusoidal, as the phases of medial and lateral
motion are of unequal duration.) The third supplies the en-
ergy for the vibration.
The first condition is attained by adduction and apposition
of the arytenoid cartilages in the median line (figs. 4.lA-D,
4.2, and 4.3), thereby folding the vocal folds (fig. 4.4). Simul-
taneously, the second condition is achieved by elongation of
the vocal ligaments. Only then does air flow begin (the third
condition) driven by the muscles of expiration and resisted by
the variable stiffness of the glottic muscles (fig. 4. lD). Return
to the respiratory mode is accomplished by elastic recoil of
springs stressed during phonation (figs. 4. lA' -D', 4.2) .
Physics of Phonation
Many analogies have been proposed for the way the larynx
generates the pressure variations appreciated as sound. Unfor-
65
tunately, comparisons with musical instruments or simula-
tions by electrical models are of limited help in understanding
the mode of operation of the actual living machinery in respi-
ratory conduction, effort closure, and swallow closure. The
biophysical model ideally should reproduce the elements of all
the observed behaviors.
In the case of the acoustic wave generator, there must be a
source of energy and an energizable oscillator constructed
from elements of the glottic apparatus. Together, these must
regulate the fundamental frequency (pitch) and the intensity
(loudness) of the oscillations.
In the human larynx the conversion to a sound generator
mode from the ventilatory conductance mode involves three
coordinated sets of activities.
1. Formation of an oscillatory system by immobilization of
the posterior attachment of the oscillator folds. The anterior
attachment is permanently immobilized by insertion to the
thyroid cartilage. The posterior immobilization is of course
achieved by adduction of the arytenoid vocal processes to the
median line.
2. Adjustment of the fundamental frequency of oscillation
by regulation of the tension of the vocal folds . Different
means establish the requisite tension in the ligamentous and
muscular parts of the fold as follows: (a) Tensile stress in the
 ' . .· " ,. - . . . . . .• .. . .. . ..
vocal ligament is determined externally, by contraction of the
cricothyroid muscle. This distracts the ends of the ligament
and affects simultaneously the passive tension, length, and
mass distribution of the ligament, as weil as the vocal muscle.
The relaxed vocal muscle, being much more compliant than
the vocal ligament, would be much less tense. (b) Tensile
, stress in the vocal muscle is regulated actively by the muscle's
own contraction. Topreserve the targeted tension of the vocal
ligament, active contraction of the vocal muscle must be
balanced by a supplementary contraction of the cricothyroid
muscle. lt is weil established that cricothyroid muscle activity
is always paralleled by activity of the vocal muscle. Our
model interprets the concurrent activities as, in part, agonist-
antagonist contractions stabilizing the movements at the cri-
cothyroid articulation and, hence, the tension of the liga-
ments.
3. Energizing of the oscillator by power transfer at the
glottis. The myoelastic aerodynamic theory of phonation (van
den Berg, 1958) accounts for the oscillatory motion of the
vocal folds as follows: Pressure energy from the compressed
subglottic air is transferred to the vocal folds and forces them
apart; in this process, potential energy of air compression is
converted to kinetic energy of fold motion.
The oscillatory motion of the vocal fold is determined by
three physical properties: inertia (or mass), elasticity (of stiff-
ness), and resistance. Energy overcomes the inertia and pro-
duces a displacement; elasticity restores the initial position;
inertia causes an overshoot; elasticity brings the overshoot to
a stop and reverses the motion; and so on, until the energy is
dissipated. Energy is dissipated partly as heat due to internal
and external frictional resistance and partly in the form of
acoustic pressures communicated to the air and, eventually,
the eardrum. The myoelastic-aerodynamic theory of phona-
tion, as originally formulated, regards the vocal fold as an in-
tegral mechanical unit and does not attribute distinctive roles
to the vocal ligament and vocal muscle. The present model
states that such a distinction is necessary to accommodate
LARYNGEAL BIOMECHANICS
.... . . .- . . . . . - ,
data that have accrued since the myoelastic-aerodynamic the-
ory was formulated (see Fink, 1975, for discussion).
The rate of energy transfer (power transfer) determines the
amplitude of oscillation and intensity of sound pressure and,
hence, the intensity of the perceived tone. The power transfer
is regulated by (1) the thoracic expiratory air flow V and (2)
the glottal resistance Re, that is, by the factors that determine
the subglottic pressure P.:
Ps = V x Re.
The power is given by the product of Ps and V:
Power = Ps X V.
The glottal resistance depends in part on the stiffness or elas-
tic flexibility of the tissues of the glottis and, therefore, varies
with the tension of the vocal muscle. Thus, according to the
model, the frequency-determining contraction of the tensor
apparatus (vocal muscles and cricothyroid muscles) can be
complemented by resistance-determining contraction of the
same muscles. If appropriately balanced, the supplemental
contractions of these muscles will not alter the tension of the
vocal ligaments. lt follows that the higher the frequency, that
is, the greater the tensor contraction of the vocal and crico-
thyroid muscles, the less the reserve in these muscles for glot-
tic resistance control. At very high pitch no reserve exists, and
intensity regulation (power transfer) then becomes completely
dependent on the activity of the expiratory muscles of the
trunk. lt is these muscles that control V in equation (1). This
is in accordance with the experimental evidence (Fink, 1975).
In summary, the model postulates that the tension of the
vocal ligament primarily determines the fundamental fre-
quency of the glottal oscillation and that the tension of the
vocal muscle primarily determines the magnitude of the glot-
tal resistance and hence (in part) the power transfer at the
glottis, or the sound intensity.
lt follows from these postulates that the work of the crico-
thyroid muscle will be the sum of two elements: (1) work to
render the vocal ligaments tense, which determines the funda-
L
66
mental frequency of the glottic tone
the tension of the vocal muscle, whic'
de activity from unloading the li ga
that th e glottal resistance is also dete
resistance due to tension of th e vocal
due to tension of the vocal muscle (
increases, the relative role of the latte
of the ligaments, that is, at high pitc
ment may be assumed to dominate.
(1)
servations of Isshiki (1964) who f0t
phonation, voice intensity (soun d p
tional to the log of the glottal resis
(2)
pitched phonation, the voice intensi
glottal resistance. Of course, as state
voice inte?sity (power transfer) cad
changing V, the expiratory airflo w. l
Biomechanical Sc
In the formation of the osci ll atory
chanical details are of note.
1. Subluxation. The adduction o f t
line apposition is an active continuat
chanically coupled, in parallel slide
However, the total distance slid excee,
on the cricoid facet, so that the last p,
involves subluxation at th e cricoary1
4.2) . Somewhat paradoxically, sublu:
of contact between the arytenoid an d
centrates the normal force produ ced 6
cle on a smaller area and so increases t
at the joint surface (fig. 4.2 ).
2. Elastic restitution. The respirato1
is safeguarded by the elastic corniculat
tic tissue of cricoarytenoid capsul e. T
by the adductor subluxation (fig. 4. 1 ),
e the myoelastic-aerodynamic the-
nk, 1975, for discussion) .
er (power transfer) determines the
d intensity of sound pressure and,
)erceived tone. The power transfer
acic exp iratory air flow V and (2)
at is, by the factors that determin e
(1)
= V x Rc-
product of Ps and V:
'f = Ps X V. (2)
:ids in part on the stiffness or elas-
of the glottis and, therefore, varies
:al muscle. Thus, according to the
·mining contraction of the tensor
and cricothyroid muscles) can be
:e-determining contraction of the
ately balanced, the supplemental
les will not alter the tension of the
that the higher the frequency, that
:mtraction of the vocal and crico-
e reserve in these muscles for glot-
ry high pitch no reserve exists, and
transfer) then becomes completely
of the expiratory muscles of the
iat control V in equation (1). This
i:perimental evidence (Fink, 1975 ).
•ostulates that the tension of the
determines the fundamental fre-
lation and that the tension of the
:rmines th e magnitude of the glot-
n part) the power transfer at the
ity.
;tulates that the work of the crico-
sum of two elements: (1 ) work to
:ense, which determin es the fund a-
mental frequency of the glottic tone, and (2) work to balance
the tension of the vocal muscle, which prevents the vocal mus-
cle activity from unloading the ligaments. lt further follows
that the glottal resistance is also determined by two elements:
resistance due to tension of the vocal ligaments and resistan ce
due to tension of the vocal muscle (M. vocalis). As the former
increases, the relative role of the latter lessens. At high tension
of the ligaments, that is, at high pitch, the tension of the liga-
ment may be assumed to dominate. This accords with the ob-
servations of Isshiki (1964) who found that, in low-pitched
phon ation, voice intensity (sound pressure level) is propor-
tional to the log of the glottal resistance, whereas in high-
pitched phonation, the voice intensity is independent of the
glottal resistance. Of course, as stated in equation (1) above,
voice intensity (power transfer) can always be varied by
changing V, the expiratory airflow.
Biomechanical Setting
In the formation of the oscillatory system, several biome-
chanical details are of note.
1. Subluxation. The adduction of the arytenoids into mid-
line apposition is an active continuation of the passive, me-
chanically coupled, in parallel slide seen during exp iration.
However, the total distance slid exceeds the distance available
on the cricoid facet, so that the last part of the adductor slide
involves subluxation at the cricoarytenoid articulation (fig.
4.2). Somewhat paradoxically, subluxation reduces the area
of contact between the arytenoid and cricoid facets but con-
centrates the normal force produ ced by the arytenoideus mu s-
cle on a smaller area an d so increases the pressure and friction
at the joint surface (fig. 4.2).
2. Elastic restitution. The respiratory patency of the glottis
is safeguarded by the elastic corniculate cartil age and the elas-
tic tissue of cricoarytenoid capsule. These springs are loaded
by the adductor subluxation (fig. 4 .1), and their recoil restores
67
the patency of the glottis as soon as the adductor contraction
of the interarytenoid muscle ceases.
3. Cricoid-arytenoid locking. This useful by-product of
sliding adduction of the arytenoid is a consequence of the ge-
ometry of the cricoarytenoid joint. When firmly apposed, the
two arytenoids form a triangular pyramid whose base rests at
two corners on the cricoid facets. Because the axis of the cri-
coid facet is directed obliquely upward, backward, and in-
ward, the force that slides the arytenoids together simulta-
neously forces them against the cricoid. In effect, it clamps the
three cartilages together so that they then perform as a single
beam or lever (fig. 4.3), hereafter referred to as the "aryteno-
cricoid unit." The result is to stabilize and immobilize the ap-
posed vocal processes of the adducted arytenoids at relatively
little energy cost. As noted above, subluxation somewhat
paradoxically increases the solidity of the clamping.
4 . Paramedian axis of oscillation. The adducted vocal fold
tends to be bowed outward by interstitial elastic fibers; the in-
fluence of these elastic fibers becomes apparent in the curving
medial borders of the adducted folds prior to the onset of os-
cillation at low frequencies. The concavity (fig. 4.1 ) ensures
that air flow will starr the oscillation in the medial direction,
in accordance with the Bernoulli principle. ,,. Thus the concav-
ity may be regarded as an adaptation for increased efficiency
of phonation since the axis of oscillation is then paramedian
rather than median and the energy of lateral displacement is
correspondingly less.
Plication of the laryngeal folds resembles plication of a bel-
lows. Folding is manifest as an increased angularity of the fo ld
surfaces; unfolding, the opposite (fig. 4.4 ). By analogy, pho-
natory adduction of the vocal folds, inasmuch as it involves
••- The Bernoulli princip lc specifies that flo w energy is parririon ed into po-
tential energy (pressure) and kinetic energy (velocity) . lf the tota l energy is
constant, acceleration of stream lined flow at a co nstriction implies a ga in in
kinetic energy a nd a corresponding loss of potenti a l energy. T he loss of po-
tential energy is detected as a dynamic fa ll in pressure a t the glottic constric-
tion, w hi ch then tends to constrict forrher.
PHONATORY FOLDING
. . " ...,.. . . . •'· . . . ....... -· ·
an increased angularity of their medial surfaces, implies in-
creased folding of the vocal folds. Decreased angularity, on
the contrary, denotes unfolding.
The adduction of the vocal folds only partially adducts and
folds the vestibular folds because the vestibular ligaments are
attached to the arytenoid more laterally than the vocal liga-
ments and the vestibular folds themselves are braced outward
by the cuneiform cartilages (fig. 3.5). When a rise in pitch
elongates the vocal and aryepiglottic folds and renders them
thinner, it further sharpens their folding. In the anteropos-
terior tomographic outlines of fig. 4.4, the transition from a
less folded configuration in inspiration to a more folded con-
dition in phonation is readily apparent.
In unilateral paralysis, all the muscles attached to an aryte-
noid cartilage, except the interarytenoid muscle, which
bridges the midline and has a double nerve supply, are para-
lyzed. The posture of the affected cartilage is then determined
by passive forces. Mechanical coupling continues to operate
on the unparalyzed side, so that the airway is not seriously
compromised. The interarytenoid muscle still functions and is
able to appose the two arytenoids, albeit imperfectly because
one of the arytenoids is sagging (fig. 4.3G,H), so that adduc-
tor clamping of the cartilages to the cricoid is impaired and
the voice is apt to be weakened, even though increased sub-
luxation of the healthy cartilage may enable its vocal process
to cross the median line and touch the paralyzed one.
In bilateral recurrent nerve paralysis both arytenoids are
without active postural support, and the mechanical coupling
system is disabled. Passive forces rock the arytenoids forward,
the vocal processes sag and become convergent, and the rima
glottidis becomes narrowed. Inspiratory flow now produces
an exaggerated dynamic pressure drop at the rima (Bernoulli
effect). This adducts the vocal folds and gives rise to life-,
threatening airway obstruction.
LARYNGEAL BIOMECHANICS
. . . . . . -"'
Tensor Mechanism
Regulation of vocal ligament tension is the primary means
of controlling pitch and is achieved by the distraction of the
ends of the ligament. The anterior end of the ligament is fixed
to the back of the angular (isthmal) region of the thyroid car-
tilage, and the posterior end is attached to the vocal process of
the arytenoid. Functionally, because the adducted arytenoids
are clamped to the cricoid the adducted vocal processes be-
come part of a right-angled lever, the arytenocricoid unit.
Thus the mechanism distracting the ends of the ligament can
be viewed as a mechanism that regulates the distance between
the thyroid cartilage isthmus and the vocal processes of the
arytenocricoid unit. One may therefore diagram it as a tensor
system consisting of two levers, the right-angled lever of the
arytenocricoid unit and the linear vocal lever of the thyroid
cartilage, the latter roughly bisecting the right angle and
pivoting at the cricothyroid joint (see fig. 4.10).
r The vocal ligament spans the superior angle between the
\ two levers. The length and tension of the ligament is regulated
\ by two mutually antagonistic muscles: the cricothyroid
1-" muscle, whose fibers span the inferior angle between the two
l levers, and the vocal muscle, which is roughly parallel to the
· vocal ligament. The cricothyroid muscle usually has two
parts: a nearly vertical straight part (pars recta) and a nearly
horizontal oblique part (pars obliqua) (fig. 4.5). Because of
the direction of its fibers, the pars recta is apt to rotate the
levers at the cricothyroid joint and thereby elongate the vocal
ligament and render it tense. The pars obliqua, on the other
hand, is more apt to translocate the levers at the joint, al-
though the effects on the vocal ligament will be the same. Th e
_other muscle is the vocal muscle, and since it is roughly paral-
' lel to the ligament, it a~ts as an antagonist to both parts of the
cricothyroid muscle, thereby stabilizing the position of the
levers and the length (and tension) of the vocal ligament im-
posed by the cricothyroid muscle. Before considering the per-
formance of the three muscular divisions further, a survey of
the observed behavior of the levers in tone production is nec-
68
essary. That behavior has been mu ch
ple, Sonninen, 1956) and is here out].I
previously unpublished.
Figure 4.6 demon strates that the v
the cricothyroid visor angle narrows a
ries of tones of rising pitch (128 , 256,
joining diagrams demonstrate th;:,r th
panied by prominent downward rotat
translation of the thyroid cartilage. Th
teristic of rone production by untrain
Figure 4. 7 presents a simil ar set of ~
untrained male subject, but in th is case
by rotating the cricoid cartilage up to t
motion is minimal even with the 512
as a whole is depressed with high freq
elevated, as is more usual.
Figures 4.8 and 4.9 portray the beha
anism with intonation in a train ed SOJ
tenor. In fig. 4.8 extension of the voca
largely by forward translation of the th
to the cricoid, with only 6 degrees of r
inclination of the cartilages changes ha1
440 Hz or less, and elongation of the '
predominantly the result of cricothyroi
is added at the 512 Hz tone but is lirr
both trained subjects, the tran slation c
takes place in a downward and forwarc
portant implications for the mechanic!
To summarize, it appears from data
1
are representative that within a certain
larynx can regulate the tension of the ,
distinct mechanisms, rotation and trar
first is used preferentially by people wit
I the second is cultivated by trained pro
Figure 4.11 schematizes the two n
composed of a fixed and a mobile Jever
sequent section, the external supports
do not affect the vocal operations tha
 ,..
r Mechanism
ment tension is the primary means
achieved by the distraction of the
rnterior end of the ligarnent is fixed
(isthmal ) region of the thyroid car-
d is attached to the vocal process of
1 because the adducted arytenoids
1'the adducted vocal processes be-
led Jever, the arytenocricoid unit.
1cting the ends of the ligament can
that regulates the distance between
ms and the vocal processes of the
1ay therefore diagram it as a tensor
evers, the right-angled lever of the
e linear vocal lever of the thyroid
1ly bisecting the right angle and
d joint (see fig. 4.10).
ns the superior angle between the
tension of the ligament is regulated
mistic muscles: the cricothyroid
the inferior angle between the two
Je, which is roughly parallel to the
::>thyroid muscle usually has two
light part (pars recta) and a nearly
•ars obliqua) (fig. 4.5). Because of
the pars recta is apt to rotate the
::iint and thereby elongate the vocal
se. The pars obliqua, on the other
1slocate the levers at the joint, al-
ocal ligament will be the same. The
~g_e, and since it is roughly paral-
LS an antagonist to both parts of the
~by stabilizing the position of the
tension) of the vocal ligament im-
muscle. Before considering the per-
:cular divisions further, a survey of
he levers in tone production is nec-
.. . .. - -.
essary. That behavior has been rnuch studied (see, for exarn-
ple, Sonninen, 1956) and is here outlined in figs. 4.6 to 4.9,
previously unpublished.
Figure 4.6 demonstrates that the vocal folds lengthen and
the cricothyroid visor angle narrows as the sub ject hums a se-
ries of tones of rising pitch (128, 256, and 512 Hz). The ad-
joining diagrarns dernonstrate th;,t these changes are accom-
panied by prominent downward rotation but minor forward
transl ation of the thyroid cartilage. This is apparently charac-
teristic of rone production by untrained voices.
Figure 4. 7 presents a similar set of observations in another
untrain ed male subject, but in this case, elongation is achieved
by rotating the cricoid cartilage up to the thyroid. Translatory
motion is minimal even with the 512 Hz tone, and the larynx
as a whole is depressed with high frequency tones instead of
elevated, as is rnore usual.
Figures 4.8 and 4.9 portray the behavior of the Jever mech-
anisrn with intonation in a trained soprano and in a trained
tenor. In fig. 4.8 extension of the vocal ligaments is achieved
largely by forward translation of the thyroid cartilage relative
to the cricoid, with only 6 degrees of rotation. In fig. 4.9 the
inclination of the cartilages changes hardly at all with tones of
440 Hz or less, and elongation of the vocal ligament is again
predominantly the result of cricothyroid translation. Rotation
is added at the 512 Hz tone but is limited to 11 degrees. In
both trained subjects, the translation of the thyroid cartilage
takes place in a downward and forward direction; this has im-
portant implications for the mechanics of voice training.
To summarize, it appears from data of which figs. 4.6-4.9
are representative that within a certain tonal range the human
larynx can regulate the tension of the vocal ligaments by two
distinct mechanisms, rotation and translation (fig. 4.10); the
first is used preferentially by people with untrained voices and
the second is cultivated by trained professional singers.
Figure 4.11 schematizes the two rnechanisms as models
composed of a fixed and a mobile Jever. As discussed in a sub-
sequent section, the external supports of the levers probably
do not affect the vocal operations that are under considera-
69
. . . .. . . . .. . .. . .
tion here. Such extrinsic muscles join the thyroid cartilage to
extralaryngeal structures and move the larynx up and down
in the course of voicing, but, according to our model, this re-
lates to the production of vowel formants (fig. 4.12) rather
than to the regulation of the fundamental frequency. The ary-
tenocricoid unit is arbitrarily chosen as the fixed or reference
lever, and the vocal Jever of the thyroid cartilage, as the mo-
bile lever. Although the living system is three-dimensional, it
is bilaterally symmetrical and a lateral projection suffices for
the analysis.
The forces that move and stabi lize the vocal lever relative to
the arytenocricoid unit include (1) the forces produced by
M. vocalis, M. cricothyroideus pars obliqua, and M. crico-
thyroideus pars recta and (2) the reactions at each end of the
vocal Jever, that is, in the vocal ligaments and the cricothyroid
articular ligaments. The Stresses in the ligaments are in reac-
tion to the stresses in the vocal Jever produced by forces of
group (1). Figure 4.11A and B contrast the positions of the
vocal lever in rotational and translational extension of
the vocal ligaments. Note that the initial and final lengths
of the vocal ligaments in both diagrams are the same but that
the extension by translation requires more energy than does
the extension by rotation. For, while the reaction in the vocal
ligaments (represented by the long coil) is, by definition, the
sarne in both behaviors, the reaction in the cricothyroid artic-
ular ligament, and therefore the force that elicits it, is greater
in the translational mode. In brief, it takes more wörk to
stretch the ligaments of the Jever to pattern B than to pat-
tern A.
Voice Training
What is the point of the extra energy investment in transla-
tional extension made by our operatic singers (figs. 4.8 and
4.9) and those of Sonninen? To answer this question a closer
consideration of the translatory excursion in fig. 4.9 is neces-
PHONATORY FOLDING
.. . ' . · '--- .. -- · -".· -
.;;• . .· _;_.:. __ :_:
sa ry. In the living larynx the translation of the thyroid lever
does no t take place directly forward as represented in fig.
4.1 lB, but rather in a downward and forward direction as in
figs. 4.8 and 4.9. The real displacement can be considered to
result from two simultaneous or successive rotations: (1) rota-
tion of the upper end of the thyroid vocal Jever around the
cricoid pivot at the lower end and (2) reverse rotation of the
lower end of the Jever around the upper end. Thus the element
in the work of extension by translation is additive to the work
of extension by rotation (fig. 4.llB).
To find out whether the extra work of translation is a waste
of energy on the part of the trained singer, we will examine
the force systems involved, aided by fig. 4.13A,B. The forces
to be analyzed are generated by the vocal muscle, the pars
recta, and the pars obligua of the cricothyroid muscle, and the
reactions in the vocal ligament and the cricothyroid capsular
ligamen ts. The vocal ligament reaction has the same value in
translational and rotational intonation of a given tone. Like-
wise, the pars recta tension is the same in translational and
rotational intonation, since, as we have just seen, the transla-
tional displacement when present is additive to the rotational.
To simplify, we represent the combined forces in the vocal lig-
ament and vocal muscle by their resultant V and the com-
bined forces of the cricothyroid muscle pars obligua and pars
recta by their resultant C. Resolving V and C into axial and
normal components VA, VN, CA, Cv, we obtain the free-body
diagram of rotational eguilibrium (fig. 4.13A).
At eguilibrium the following conditions prevail: (1) axial
reaction RA is egual and opposite to the sum of the axial
forces CA and VA, (2 ) the couple-momen ts CN · a, VN · b
about the cricothyroid joint J are egual and opposite, and (3)
the normal reaction RN is egual and opposite to the sum of CN
and VN.
In the free-body diagram of translational eguilib rium (fig.
4 .13B) for the same tone as fig. 4.13A, we use the same set of
symbols, primed. Since the translational force is additional to
LARYN GEAL BIOMECHANICS
·--: .. . .. . ..... .... • ..- . - .• .. . . . . - ~
the rotational fo rce, the forces and force components in the
translational d iagram must be !arger than the corresponding
ones in the rotational diagram-hence, the conclusion that in-
tonation by translation reguires more work from both the
vocal muscle and the cricothyroid muscle than does the corre-
sponding intonation by rotation.
We can now answer the guestion concerning the benefit to
the trained singer. A person who regulates vocal ligament ten-
sion by translating the thyroid cartilage relative to the cricoid
exercises the vocal and cricothyroid muscles more extensively
or more intensively, or both, than a person who regulates the
tension by rotation at the cricothyroid joint. If o ther things
are egual, a trained singer will develop a greater hypertrophy
of the exercised muscles than the untrained, leading to the fol-
lowing conseguences: (1) As documented in high-speed mo-
tion pictures (Farnsworth, 1940) hypertrophy of the vocal
muscle reduces both the mean size and duration of the open
phase in a glottic cycle and, thus, tends to economize airflow.
(2) Hypertrophy of the vocal muscle increases the glottic resis-
tance and the peak subglottic pressure attainable during
phonation and, hence, the acoustic power output (see egua-
tions 1 and 2 above); in some subjects divergence of the inner
border of the arytenoids posterior to the vocal processes (fig.
3 .3) is very conspicuous at laryngoscopy. This gap offers a po-
tential bypass for some of the wasteful escape of air during
phonation, w hich was noted by Cavagna and Margaria
(1965), but would probably close with hypertrophy of the
neighboring vocal muscle. (3) Differential hypertrophy of the
vocal muscle may enable the vocal fold to acguire an acousti-
cally more efficient contour (see fig. 4 .15). (4) Translational
extension of the cricothyroid articular ligaments presumably
elicits additional proprioceptive feedback information that
could increase the sensitivity and accuracy of positioning for a
given intonation.
Thus, accordi ng to the model, voice training would p artly
con sist of learning to control tone by cricothyroid translation
combined with cricothyroid rotation . The by-products, crico-
70
rhyroid and vocal muscular hypertro~
listed benefits to vocal efficiency. ,:-
From X-ray film s (figs. 4 .6 to 4.9) ~
sional voice training involves differel
rwo parts of the cricothyroid muscle (~
qua) . The inference lends new interest 1
ability of the muscle (G öppert, 1937).
human cricothyroid muscle may prese~
sheet, or in two full y distinct parts, ,
state. Acco rding to our model, the uj
mutability of the state of division of th
means that there is an inheren t, presen l
geal limitation on the trainability of a i
-according to our model-the laryn~
divided cricothyroid muscle wou ld be
in attempting differential translation a;
Mathematical M<
Mathematical models of the acoust
great value in exploring the effect of i
do not necessarily explain how the a<
effected in the body. That a model I
sponses similar to those of the hum ar
that it generates them in the same wa:
The ability of birds to produce astoni
iles of human utterances with a dissirr
vocal folds at all is evidence enough th
be produced in more ways than one. B
ing the rel ation of actual biological
forces and displacements (Gans, 1974)
.._ In classical experiments on excised larynges
subglottic pressure produced not only a rise in lo
of the sound . At low ton es this is predicted in o
subglottic pressure unopposed by vocal muscli
vocal ligaments and th erefore increase th eir teil'
 - -~· ·-·---·
,rces and force components in the
- be ]arger than the corresponding
am-hence, the conclusion that in-
quires more work from both the
hyroid muscle than does the corre-
:ation.
question concerning the benefit to
l who regulates vocal ligament ten-
oid cartilage relative to the cricoid
othyroid muscles more extensively
1, than a p erson who regulates the
cricothyroid joint. If other things
will develop a greater hypertrophy
m the untrained , leading to the fol-
\s docurnented in high-speed rno-
1940) hypertrophy of the vocal
ean size and duration of the open
, thus, tends to econornize airflow.
11 rnuscle increases the glottic resis-
lottic pressure attainable during
acoustic power output (see equa-
ne subjects divergence of the inner
)sterior to the vocal processes (fig.
aryngoscopy. This gap offers a po-
the wasteful escape of air during
Jted by Cavagna and Margaria
,ly close with hypertroph y of the
(3 ) Differential hypertrophy of the
1e vocal fold to acquire an acousti-
r (see fig. 4.15). (4) Translational
,id articular ligarnents presurnably
eptive feedback information that
y and accuracy of positioning for a
1odel, voice training would partly
ol tone by cricothyroid translation
1 rotation. The by-products, crico-
. .
thyroid and vocal muscular hypertrophy, lead to the above-
listed benefits to vocal efficiency. ,,.
From X-ray filrns (figs. 4.6 to 4.9 ) we inferred that profes-
sional voice training involves differential regulation of the
two parts of the cricothyroid muscle (pars recta and pars obli-
qua). The inference lends new interest to the well-known vari-
ability of the muscle (Göppert, 1937). Göppert states that the
human cricothyroid muscle rnay present as a single, undivided
sheet, or in two fully distinct parts, or in any intermediate
state. According to our rnodel, the unpredictability and im-
mutability of the state of division of these muscles in a person
means that there is an inherent, presently unpredictable laryn-
geal limitation on the trainability of a person's voice because
-according to our rnodel-the larynx of people with an un-
divided cricothyroid muscle would be structurally disfavored
in attempting differential translation at the cricothyroid joint.
Mathematical Models
Mathematical models of the acoustic generator, though of
great value in exploring the effect of individual adjustments,
do not necessarily explain how the adjustrnents are actually
effected in the body. That a rnodel possesses frequency re-
sponses similar to those of the human voice does not assure
that it generates them in the same way as the human larynx.
The ability of birds to produce astonishingly faithful facsim-
iles of human utterances with a dissimilar vocal tract and no
vocal folds at all is evidence enough that natural vocables can
be produced in more ways than one. Biomechanics, by expos-
ing the relation of actual biological behavior to physical
forces and displacernents (Gans, 1974), lays the indispensable
··- In classical experiments on excised larynges (Müller, 1842), a rise in the
subglottic pressure produced not only a rise i □ loudn ess but also a rise i □ pitch
of the sound. At low tones this is predicted in our model beca use increase in
subglottic pressure unopposed by vocal muscle tension must elongate the
voca l ligaments and therefore i □ crease their tension.
71
. . . . . .. ---·--
observational foundation on which realistic mathematical
modeling must build.
Unfortunately, available mathematical rnodels, even the
brilliant, innovative ones of lshizaka and Matsudaira (1968)
and Titze (1973, 1974), still lack the sophistication requisite
for our biomechanical model of the glottis and larynx. These
mathematical models describe vocal fold motion in terms of
an upper and a lower set of elastic coupled masses, in Titze's
model the mucosa and the combined ligament and muscle
masses. To us, however, the important experimental evidence
of Isshiki (1964) indicates that the tension of the vocal liga-
ment and the tension of the vocal rnuscle vary independently
over at least the lower part of the fundamental tone range;
consequently, a rnathematical description that treats the liga-
mentous and rnuscular masses as one is probably oversimpli-
fied. Moreover, the mathematical models fail to make explicit
provision for intensity regulation at the glottis, for vocal
training, and for a paramedian axis of oscillation at low fre-
quencies and damping by the vestibular folds with certain
tones of high intensity. Thus, further refinement of the mathe-
matical analysis appears necessary to cope with the objective
biomechanical model; exciting advances along these lines are
being made by Titze (1976).
Mechanics of the Laryngeal Sinus
The laryngeal sinus (formerly called the "ventricle") is an
anteroposterior gutter separating the vocal and vestibular
folds. Anteriorly, an upward recess called the "laryngeal sac-
cule" opens into it. The sinus is necessary to the efficient func-
tioning of the larynx as a folding system. lt gapes widely dur-
ing respiratory unfolding of the system, becomes occluded
during folding closure of the larynx, and, during phonatory
folding, prevents or reduces damping of the vocal fold oscilla-
tion by the vestibular fold.
PHONATORY FOLDING
 During one phase of a phonatory oscillation, the vocal folds
are forced upward and outward by the air pressure (not
directly laterally as the foreshortened view from above might
suggest). The amplitude of the displacement varies inversely
with the tension of the vocal ligaments and directly with the
subglottic pressure. On the amplitude depends the sound in-
tensity, since intensity varies with the square of the amplitude.
With sounds of low frequency and high intensity there thus
exists a considerable likelihood that the vibrating fold will hit
and be damped by the vestibular fold, with a corresponding
loss of efficiency in sound production. The mechanics of the
quadrangular membrane, which supports the vestibular fold ,
provides insurance against such an eventuality.
The quadrangular membrane extends from the edge of the
aryepiglottic fold, where the aryepiglottic muscle adh eres to
it, to the lower edge of the vestibular fold, where it borders on
the sinus and is thickened to form the vestibular ligament. At
the upper projection into the pharynx, the free edge of the
aryepiglottic fold is rounded and concave during respiration
but stands up as a prominent ridge visible both through the
laryngoscope andin X-ray pictures (fig. 4.12) when the aryte-
noids are adducted. The ridge extends from the adducted cu-
neiform tubercle to the lateral margin of the epiglottis and is
in evidence whether elongated in phonation (figs. 4.8,
4.12) or shortened in laryngeal closure (fig. 3.5); on the other
hand, it is effaced when the arytenoids are unadducted, as in
whispering or in inspiration. The aryepiglottic muscle under-
lying the ridge is a forward prolongation of the oblique aryte-
noid muscle fibers that are part of the arytenoid adductor,
and, doubtless, contraction of the muscle is partly responsible
for the formation of the ridge. Since formation of the ridge
must increase the upward tension in the quadrangular mem-
brane, the aryepiglottic muscular contraction will indirectly
tend to elevate the vestibular fold and ligament and keep the
sinus open. Thanks in part to this effect, tonal phonation can
take place even when the laryngeal cavity is shortened verti-
cally to the same extent as in laryngeal closure (fig. 4.12A).
The effect is strikingly conspicuous when the hyoid bone and
LARYNGEAL BIOMECHANICS
thyroid cartilage are widely distracted, as in the utterance [u]
(fig. 4.12B).
The aryepiglottic muscles have been reputed to assist in
folding the epiglottis downward in swallow. However, in the
living body their direction is unfavorable, since the fibers ap-
proach the margin of the epiglottic cartilage very obliquely
(fig. 1.5).
The saccular extension of the sinus, whose lubricating func-
tion was noted in chapter 1, also constitutes a plane of sliding
for the most anterior part of the vestibular and aryepiglottic
folds. lt reduces the viscous resistance to changes in shape of
the vestibular fold and in effect provides a ready-made plane
of shear (fig. 3.5).
Speech
Vowels are produced by acoustically energizing t~e vocl11
tract atthe level o[ the l~yn; with a periodic e-;_citation while
keeping the vo°Zal tract relatively open or unco~tricted (Mini-
- fie, 1973 ). The amplitudes of the various harmonic energies
from the glottal sound source will be selectively modified by
the vocal tract resonators in order to shape the distinctive
vowel sounds. Consonant sounds, on the other hand, are pro-
duced with the vocal tract partially or completely occluded.
The location of the sound source during consonant produc-
tion may be laryngeal, supralaryngeal, or both. In the produc-
tion of the voiceless consonants [p], [t], and [s], rapid fluctua-
tion (0.05 second) in glottic aperture occurs.
lt is sometimes contended that once the vocal membranes
have begun to vibrate nothing else of importance takes place
in the larynx (Lessac, 1960, p. 11). Others count the larynx
among the important resonators of the voice (Adler, 1965,
p. 39). According to W . T. Bartholomew (1942), experiments
have proved that the particular overtone that gives a voice its
"ring"-an overtone of an approximate frequency of
2,800 Hz for male and 3,200 Hz for female voices-origi-
72
nates in a small resonator, which h/
larynx" (the supraglottic cavity of r~
The resonances within the vocal tq
mined by the three-dimensional geo ~
rube and, as a first appro~imation , \
glottis ro the pomt o_f rna1or vocal tl
dius of the constnctton at that poir
index at the open end (S tevens and J
Three principal form ants are cu
though six or more resonances ma
The first formant, Fi, is the reson
largest cavity, which is usually poster
tion and in such cases includes the 1
!arges, the frequency of the first fon
ond formant, F2 , is the resonance
Formant F3 is usually determined byl
along the vocal tract. The larynx is i
with an increase in fund amental freq
dence on the subject is hard to find.
ume of the vocal tract are, howev er,
of the larynx in vowel producti on.
In the outlines of fig. 4.12 the extn
the sinus with [u] contrasts with the n
although the anteroposterior length •
same in both. At the upper aditus the
of the aryepiglottic fold is mu ch gr,
parent that there is a marked differe
size of the supraglottic cavity in the t
[a] the upper orifice of the supraglot
more constricted than with [u]. The
the two configurations very likely cc
the characteristic formant patterns of
sounds.
This last observation casts an int(
evolutionary history of peripheral spe
production exploits th e vertical mol:
tfiis mobility is undoubtedly a functi
thebasicranium to the hyoid bone arn
1
- .
~ly distracted, as in the utterance [u]
des have been reputed to assist in
mward in swallow. However, in the
n is unfavorable, since the fibers ap-
e epiglottic cartilage very obliquely
of the sinu s, whose lubricating func-
. 1, also constitutes a plane of sliding
·t of the vestibu lar and aryepiglottic
ms resistance to changes in shape of
effect provides a ready-made plane
Speech
by acoustically _e_E_e~izing_!_~ voSll
ynx with a periodic excitation while
la!i_vely open or uncon,stricted (Mini-
es of the various harmonic energies
rnrce will be selectively modified by
rs in order to shape the distinctive
t sounds, on the other hand, are pro-
et partially or completely occluded.
d source during consonant produc-
)ralaryngeal, or both. In the produc-
)nants [p], [t], and [s], rapid fluctua-
ttic aperture occurs.
ded that once the vocal membranes
thing eise of importance takes place
60, p. 11). Others count the larynx
,onators of the voice (Adler, 1965,
-. Bartholomew (1942), experim ents
·icular overtone that gives a voice its
,f an approximate frequency of
3,200 Hz for female voices-origi-
·-·-- -
nates in a sma ll resonator, which he calls the "collar of the
larynx" (the supraglottic cavity of the larynx).
The resonances within the vocal tract (formants) are deter-
mined by the three-dimensional geometry of the entire vocal
tube and, as a first approximation, by the distance from the
glottis to the point of major vocal tract constriction, the ra-
dius of the constriction at that point, and the conductivity
index at the open end (Stevens and House, 1955).
Three principal formants are customarily identified, al-
though six or more resonances may occur simultaneou sly.
The first formant, Fi, is the resonance determined by the
largest cavity, which is usually posterior to the major constric-
tion and in such cases includes the larynx. As this cavity en -
larges, the frequency of the first formant decreases. The sec-
ond formant, F2 , is the resonance of the smaller cavity.
Formant F3 is usually determined by interactions of volumes
along the vocal tract. The larynx is often said to be elevated
with an in crease in fundamental frequency, but objective evi-
dence on the subject is hard to find. The length and the vol-
ume of the vocal tract are, however, affected by the position
of the larynx in vowel production.
In the outlines of fig. 4.12 th e extreme vertical dilatation of
the sinus with [u] contrasts with the minor dilatation with [a],
although the anteroposterior length of the sinus is about the
same in both. At the upper aditus the length of the free border
of the aryepiglottic fold is much greater with [u]. lt is ap-
parent that there is a marked difference between the volume
size of the supraglottic cavity in the two cases, and that with
[a] the upper orifice of the supraglottic cavity must be much
more constricted than with [u]. The different resonances of
the two configurations very likely contribute significantly to
the characteristic formant patterns of each of these particular
sounds.
This last observation casts an interesting sidelight on the
evolutionary history of peripheral speech mechanisms. Vowel
production exploits the vertical mobility of the larynx, and
this mobility is undoubtedly a function of the distance from
the basicranium to the hyoid bone and from th~ hyoid bone to
73
. . . ... . . . . ---·--·
!_he larynx. lt is well established that these distances are
greater in man than in apes, and !arger in the great apes than
in monkeys (Jordan, 1960). The existence of such generic dif-
ferences suggests that the marked laryngeal mobility exploited
in the range of the vowel sounds of speech may have been an
irnportant factor in the speciation of Homo sapiens. A similar
idea has been proposed on somewhat questionable grounds
by Lieberman and Crelin (1971). An interesting account of
supra laryngeal factors in formant production by singers is
given by Sundberg (1977).
Whisper Folding
Other animals do not whisper. Should we wri te that off as a
deficiency of the nonhuman brain, or is there more to it than
that? ls there a laryngeal mechanism that enables humans to
whisper, and is it lacking in other species? At what age are
children first able to whisper? Such questions give an unex-
pected importance to the mechanics of this peculiarly human
activity. The configuration assumed by the larynx in whis-
pering has often been described as partial adduction of the
vocal cords. In our model, however, the available evidence in-
dicates that whispering involves a distinctive pattern of laryn-
geal folding (figs. 3.7F, 4.14 ).
The lateral radiographs of fig. 4.14 show that ":hisper fold--
ing includes partial approximation of the thyroid cartilage to
the hyoidbone, with partial folding of the median thyrohyoid
fold, parti~I narrowing of the laryngeal sinus, and partial ap-
proximation of the vestibular folds, all secondary to the
thyroid-hyoid approximation. The presence of adduction of
tne arytenoids, which would have a similar effect on the ves-
tibular folds, is excluded because the density of the shadows
at the ievel of the vocal folds is about the same as in the con -
trol films of expiration. S~ the glottis is open. The radiographs
also show that in whispering, unlike vibratory phonation, the
cricothyroid visor angle remains as fully open as in respira-
PHONATORY FOLDING
+ • ·'- ..; ·-· .-;•- • • • • • •
tion. Correspondingly, the length of the vocal fold in whis-
pering must be less than in phonation (fig. 3.5).
Radiography thus suggests that the whispering conforma-
tion of the larynx is produced mainly by muscle activity that
approximates the thyroid cartilage and hyoid bone, that is, by
extrinsic muscles of the larynx. This is consistent with the
electromyographic data from intrinsic muscles obtained by
Faaborg-Andersen (1957, pp. 70 - 71), who observed a much
lower level of activity (although higher than the resting activ-
ity) in the cricothyroid and vocal muscles with whispering
than with speaking.
The laryngoscopic view of whispering, reproduced in fig.
3.5A, contains additional evidence. lt confirms that the ves-
tibular folds are partly adducted, since these are about the
same distance apart as in phonation (compare fig. 3.5B), but
without adduction of the vocal folds or arytenoid cartilages.
This is a critical point. The arytenoid cartilages remain in the
eupneic expiratory position, that is, unadducted and down-
turned, as suggested by the radiographs of fig. 4.14. Thus the
data from all three available sources, all independent of each
other, are compatible with the proposed model, namely, that
whispering involves a type of laryngeal folding characterized
by partial folding of the vestibular folds brought about by
partial thyroid-hyoid approximation, which is equivalent to
saying there is also some folding of the median thyrohyoid
fold. On the other band, the interarytenoid and vocal folds re-
main unfolded. lt is interesting that in bilateral paralysis of
the recurrent laryngeal nerves, where the extrinsic muscles are
intact but the intrinsic muscles, except for the cricothyroid,
are out of commission, a patient attempting to phonate pro-
duces a whisper. Radiography shows that the attempt by the
patient is accompanied by thyroid-hyoid approximation. The
nerve supply of the approximator muscles is of course intact.
Partial approximation of the thyroid cartilage and hyoid bone
with whispering can readily be detected in a presumably nor-
mal person by placing a fingertip in the notch just above the
prominence of the larynx.
Thus, whispering frequently requires partial folding of the
LARYNGEAL BIOMECHANICS
• • • • • -
median thyrohyoid fold and secondary partial folding of the hyoid muscles. Such synchronou
aryepiglottic and vestibular folds, produced by thyroid-hyoid prevail during thyroid-hyoid app
approximation. The questions asked at the beginning of this However, for this to affec t the ten
section can then be answered quite succinctly. Other animals there would have to be a corresp
do not whisper not only because they lack the needed cerebral arytenocricoid unit, pulling the lat
equipment but also in part because they lack the necessary la- source for such a counterforce exis
ryngeal equipment: they either lack a median thyrohyoid fold
altogether, or, as in the chimpanzee, they have too little clear-
ance between the hyoid bone and thyroid cartilage to allow
the necessary extent of partial folding.
Extrinsic Muscles and Phonation: Frame Function
Although their role in whispering has been generally disre-
garded, two other phonatory functions have been accorded to
the extrinsic muscles that move the larynx (fig. 4.15): (1) eleva-
tion or depression of the larynx to modify the supraglottic
resonance cavities and influence the related speech formants.
About this there is no disagreement (fig. 4.12), and (2) ele-
vation of the larynx to facilitate the generation of high-
pitched tones. The participation of extrinsic laryngeal muscu-
lature in the regulation of the length and tension of the vocal
folds has been termed the external frame function of these
muscles. lt is a highly controversial subject, rieb in anecdote
and theory but not in objective documentation. The balance
of competent professional opinion seems to be that upward
movement of the larynx is a sign of incorrect voice habit chat
easily ruins the voice (Sonninen, 1956). How such elevation
influences pitch is not clear. According to the present model, it
would have to facilitate either rotation or translation (gliding)
at the cricothyroid joint. Our model does state that if the ele-
vation approximates the thyroid cartilage to the hyoid bone it
will partially close the supraglottic laryngeal cavity and pro-
duce an undesirable "covered" voice habit. The model also
predicts a forward translatory force on the thyroid cartilage
by synchronous contnction of the thyrohyoid and sterno-
74
 hyoid muscles. Such synchronous contraction is known to cians have sought one in the cricopharyngeal muscle.
1d secondary partial folding of the prevail during thyroid-hyoid approximation (see fig. 2.15). Sonninen (1968) pointed out that the orientation of the
r folds, produced by thyroid-hyoid However, for this to affect the tension of the vocal ligaments, frame function muscles varies with the degree of extension or
ons asked at the beginning of this there would have to be a corresponding counterforce on the flexion of the neck, so that an effort producing a rise in pitch
·ed quite succinctly. Other animals arytenocricoid unit, pulling the latter backward. No plausible in one attitude would be ineffective in doing so in the reverse
cause they Jack the needed cerebral source for such a counterforce exists, although some theoreti- attitude of the neck.
because they Jack the necessary la-
ther Jack a median thyrohyoid fold
mpanzee, they have too little clear-
)ne and thyroid cartilage to allow
·tial folding.

Phonation: Frame Function

hispering has been generally disre-
ry functions have been accorded to
ove the larynx (fig. 4.15): (1) eleva-
larynx to modify the supraglottic
.1ence the related speech formants.
agreement (fig. 4.12), and (2) ele-
facilitate the generation of high-
ation of extrinsic laryngeal muscu-
:he length and tension of the vocal
external frame function of these
:roversial subject, rich in anecdote
ctive documentation. The balance
opinion seems to be that upward
a sign of incorrect voice habit that
o.inen, 1956). How such elevation
According to the present model, it
1er rotation or translation (gliding)
ur model does state that if the ele-
yroid cartilage to the hyoid bone it
raglottic laryngeal cavity and pro-
red" voice habit. The model also
ory force on the thyroid cartilage
in of the thyrohyoid and sterno-

75 PHONATORY FOLDING
 Vestibular fol Vocal fold

A'

s'

dnd right
orniculate
A tubercle

Rima glottidis C'

o'

LARYNGEAL BIOMECHANICS 76
 Vocal fold

A'

s'
Fig. 4.1 Phonatory closure of glottis. Bell Telephone cinemato-
graphic sequence showing the activation phase of the glottic sound
generator, photographed at 16 frames per second. A, B, C, D, en-
largements from alternate frames. The phonatory adduction of the
vocal fo lds is initiated by medial sliding of the arytenoids; the vocal
processes remain parallel. Contact between the vocal processes (C ) is
preceded by compression of the corn icu late tubercles (B ). The subja-
Aryepig lottic fold C' cent cornicu late cartilages are strained by apposition (A ' -D ' ) and en-
ergize the reopening of the resp iratory passage. The jugal ligament
sometimes portrayed as a Y-shaped stru cture binding the corn icu-
lates to the back of the cricoid cartil age, may assist in preserving the
functional orientation of the corniculates for spring action.

o'

77 PHONATORY FOLDING
Fig. 4.2 Arytenoid subluxation. Diagrar--
matic posterior view of adducted arytenoid
carti lages in apposition. The posterior part
of the articular processes has been removed
to show the slope of the articular facets. Be- A
cause the total in parallel sliding excursion facet of
cricoid
of the arytenoid is langer than the di stan ce
avai lab le on the cricoid facet, apposition of
the arytenoid cartil ages has to be completed
with a certain amoun t of sub luxation in
which, as indicated in A, the most medi al Adduc ted
p art of the arytenoid facet is unsupp o rted
by the cricoid. Somewhat paradox icall y,
this increases the pressure (force per unit
area) of the arytenoid facet against the cri-
coid facet because the adductor force F is
appli ed to a smaller area than if th ere were
no sublu xation; it may actually increase the
stability of apposition becau se the friction is
proportional to the normal force F,v
(C) rather th an to the area o f contact. Elastic
strai n induced in the cricoary teno id capsule Geometry
of Locking
by subluxa tion (B ) furnish es energy for au-
tomatic lateral recoil at the bottom of th e
arytenoid , when the add uctor force sup-
plied by th e arytenoid muscle (C) ceases. As
noted in fig. 4. 1, apposition of the aryte- Fig. 4.3 Imm obilization o f apposed ar:
no ids bends the corniculate cartilages cricoarytenoid articulation is oblique!;
against each o ther so that when the add uc- coronal, and sagittal plan es in thi s diag1
tor muscle fibers relax the arytenoids are res ult, the add uctor contraction of th,
forced apart at th e top by th e elastic recoi l clamps or locks the arytenoids to each
of the cornicu lates. The model postu lates Rocking is precluded by th e gcometry o
that this delicate reco il mechani sm operates Expiration Adduction ward rocking cannot take pl ace because
effectively only when the posture of the ary- noids to diverge upward, o utward, and
tenoids is maintained upright during add uc- cesses to diverge upward , outward, an
tion by the activity of th e cricoarytenoid Fo rward rocking is excluded because i·
muscles.

LARYNGEAL BIOMECH AN ICS 78

1

. ., . - ---· --·---- . . . ·,. .. . . . ··-- -·-.

facet of
cricoid

Adducted Expiration Inspiration Inspiration ii

Geometry Expiration Expiration Adducted

of Locking

Fig. 4.3 lmmobilization of apposed arytenoids. The lang axis of the
cricoarytenoid articulation is obliquely oriented to the horizontal,
coronal, and sagittal planes in this diagrammatic anterior view. As a
result, the adductor contraction of the arytenoid rnuscle virtually
clarnps or locks the arytenoids to each other and to the cricoid (A ).
Rocking is precluded by the geometry of the adducted systern. Back-
Adduction ward rocking cannot take place because thi s wou ld require the aryte-
noids to diverge upward, outward, and backward an d the vocal pro-
cesses to diverge upward, outward, and latera lly (D and fig. 2. 7).
Forward rocking is excluded because it would drive the two vocal
processes into each other (fig. 4.3 E). Unilateral paralysis (C) of the
cricoarytenoid muscles allows the paralyzed arytenoid to sag and im-
pairs locking with the other arytenoid even if the latter is sub luxated
across the midline (H ). Bilateral paralysis (F ) abolishes the postural
stability of both arytenoids and prevents the executi on of mechani-
ca lly coupled abduction in parallel. lnspira tory fall in pressure, re in-
forced by the Bernoulli effect, is then unopposed and tends to suck
the vocal folds together. Serious respiratory obstruction is only too
likely to develop.

79 PHONATOR Y FOLD ING


A B
Inspiration Expiration
Fig. 4.4 Phonatory folding. Anteroposterior tornographic tracings
frorn subj ect 4 (a thirty-two-year-old male) du ring inspiration (A ),
expiration (B), and phonating [ee] (C). Unfolding (A) and fo lding
(C) are in evidence at the internal surfaces, relative to the reference
configurati on of expiration (B). In phonation, elongation of the la-
LARYNGEAL BIOMECHANI CS
Fig. 4.5 Tensor mechanisms of vocal fol
vocal ligament tension effected by cricot
vocal ligament tension effected by cricoth
regards the cricothyroid muscl e as the ten
muscl e as the tensor of the rest of the voc
known ways of increasing the tension of
sliding or translation (C) at the cricoth
which each is called on are indeterminate.
predominates in untrained voices, wherca
in trained singers. As already noted, the 111
vestibular ing the tension of the vocal ligaments als
fold
and aryepiglottic folds. In contrast, active
does not of itself affect the other fold s.
distin ct groups of fibers, termed pars ob/i
entations to the airway axis. The pars rcct;
the cricothyroid joint (B )-its fi bers beini
arm from the isthmus of the thyroid cartil;
tion. On the other hand, the pars obliqua 1
its fibers, will in addition have a tendency t1
consequence is elongation and increase in
with elongation but minor passive increa
bring the muscular part of the vocal fold tc
requires contractile activity of the vocal n
anced by additional cricothyroid muscul a
vocal ligarnent by the M. vocalis contracti<
muscle is an increase in stiffness, and a con
tion of the vocal fold by the pressure of ex
C
traction of the vocal muscle facili tates a ris
in the energy of vibration and intensity of
Phonation [EE] muscle can thus function as a fin e control c
balanced by a corresponding excess in the
the pitch. Balanced excess, applied to ad,
ryngeal fo lds with rising pitch makes thern thinner in cross section reinforces glottic resistance in th e closed :
and rnay be classified as increased fo lding of the vocal folds. For ex- cricothyroid and vocal muscles du ring eff
ampl e, in fig. 4.1 A-D, the aryepiglottic folds come to stand out in- the crico thyroid angle is unaltered. Rise i
creasingly sharply as phonatory adduction proceeds. Stretch the vocal ligaments and to produce
tone produced. This, too, must be allowed
of these muscles.
80

vestibular
fold
1ation [EE]
makes them thinner in cross section
ed fo lding of the vocal folds. For ex-
:piglottic folds come to stand out in-
. adduction proceeds.
Fig. 4.5 Tensor mechanisms of vocal fold. A, reference condition; B, increase in
vocal ligament tension effected by cricothyroid articular rotation; C, increase in
A
vocal ligament tension effected by cricothyroid articular subluxation. The model
regards the cricothyroid muscle as the tensor of the vocal ligament and the vocal
muscle as the tensor of the rest of the vocal fold. The diagrams illustrate the two
known ways of increasing the tension of the vocal ligaments: rotation (B) and
sliding or translation (C) at the cricothyroid joint. The circumstances under
which each is called on are indeterminate. Figures 4.6 to 4.9 suggest that rotation
predominates in untrained voices, whereas translation becomes highly developed
in trained singers. As already noted, the mechanism is so constructed that increas- M. cricothyroid
( pars recta)
ing the tension of the vocal ligaments also increases the tension of the vestibular
and aryepiglottic folds. In contrast, active increase in tension of the vocal muscle
(pars obliqua)
does not of itself affect the other folds. The cricothyroid muscle comprises two
distinct groups of fibers, termed pars obliqua and pars recta because of their ori-
entations to the airway axis. The pars recta is well situated to produce rotation at
the cricothyroid joint (B)-its fibers being almost perpendicular to the rotation B
arm from the isthmus of the thyroid cartilage to the axis of cricothyroid articula-
tion . On the other hand, the pars obliqua (C), because of the oblique direction of
its fibers, will in addition have a tendency to subluxate the joint. In either case, the
consequence is elongation and increase in tension of the vocal ligament, together
with elongation but minor passive increase in tension of the vocal muscle. To
bring the muscular part of the vocal fold to the same tension as the vocal ligament
requires contractile activity of the vocal muscle. Such activity must then be bal-
anced by additional cricothyroid muscular activity to prevent shortening of the
vocal ligament by the M. vocalis contraction. Inherent in contraction of the vocal
muscle is an increase in stiffness, and a consequent increase in resistance to deflec-
tion of the vocal fold by the pressure of expiratory air flow. In other words, con-
traction of the vocal muscle faci litates a rise in subglottic pressure and an increase
in the energy of vibration and intensity of sound. Excess contraction of the vocal
muscle can thus function as a fine control of vocal intensity, provided the excess is C
balanced by a corresponding excess in the cricothyroid muscle so as not to alter
the pitch. Balanced excess, applied to adducted but slack vocal ligaments, also
reinforces glottic resistance in the closed larynx and explains the activity of the
cricothyroid and vocal muscles during effort and swallow closure, even though
the cricothyroid angle is unaltered. Rise in subglottic pressure of itself tends to
Stretch the vocal ligaments and to produce an unintentional rise in the pitch of the
tone produced. This, too, must be allowed for by a singer in adjusting the activity
of these muscles.
81 PHONATORY FOLDING
 End Expiration
A

c------- --E
B
Fig. 4. 6 Cricothyroid pitch control, untrain ed subject. column
1, radiographi c outlines aligned at the cricoid cartilage to show
the phonatory changes in an untrained thirty-five-year-old male.
(subj ect 5). Upper row, reference conditio n in end expiration . 128 Hz
Co lumn 2, the inclination of th e cricoid and thyroid cartilages to
each other. The lines are drawn fr om the posterosuperior to the
anteroinferior extremities of the shadow of the cricoid cartilage
(A, B) and from the inferior horn to the lower end of the isthmus
of the thyroid cartilage (C, D ). In column 3 the interrupted line --E
C- E is the reference line. lt joins th e thyroid inferior horn (C) to c~,
E
th e isthmal attachment of the vocal folds (E) and shows the refer-
ence eupneic end-expiratory condition of th e vocal Jever arm of
th e th yro id cartilage (fig. 4.10). Ro tation of th e vocal lever arm
is indicated by E'. Because the orientation of the cricoid cartilage
was fixed, the diagrams in the lower rows, when the subject Expiration 256
was humming tones of pitch 128, 256, and 512 Hz respectively, 256 Hz
demonstrate that the increase in vocal fold length and tension
was achieved preponderantly by cricothyroid rotation and rela-
A
tively little by subluxation (sliding or translation). In this sub-
ject the cricothyroid rotation was effected chiefly by rotating the --E
th yroid down toward the cricoid . The change in the cricothyroid
visor angl e from 64 degrees in expira tio n to 32 degrees in intoning
C --=-:::::::-- D
C
512 H z, covers a range of 32 degrees. Note the outline of the la- ------- E'
ryngeal sinu s and observe its increased width with phonation, in- B
dicati ve of increased support of the vestibular fold from above. D E
The model attrib utes thi s in part to the aryepiglottic muscle (fig.
1.5 ). 512 Hz

A~
c - ~ - - -- E

B
--------E' G H

LARYNGEAL BIOMECHANICS 82
Expiration
A

c------- --E

Fig. 4. 7 Cricothyroid pitch control, un-

128 Hz trained subj ect. Radiographie tracings
a ligned at the vertebrae in an untrained
forry-two-year-old male. ln this subject in-
tonation of high-pitched tones was accom-
--E pan ied by descent of the larynx and, in con-
trast to fig. 4.6 where the thyroid rotated on
C~E' the cricoid, change in vocal ligament length
was effected principally by rotating the cri-
coid on the thyroid. The lengtb of tbe vocal
and vestibular ligaments at 512 Hz is
greater than at 25 6 Hz. Tbe aryepiglottic
Expiration 256 Hz 512 Hz
free border is also longer, but tbe cricotby-
256 Hz roid visor angle is smaller. Tbe orientations
of tbe cricoid and tbyroid cartilages (de-
A fined in fi g. 4.6) are shown in the middle

~
row. Tbe bottom row shows the orientation
--E of the vocal lever arm of the thyroid carti-
c-~
E'
C
D

B
~ lage in expiration (interrupted lin eA-B) and
the changed orientation at 256 and 512 Hz
(A'B', A"B"). Tbe visor angle rneasures 34
degrees in expiration and 9 degrees during
D E F
512 Hz intonation, a change of 25 degrees.
512 Hz

c-~' ·~ .,B ~B
A

A''
A'\
'\

E'

G
B
H
"
B B

83 PHONATORY FOLDING
 B
11
C~ ? . s r.1.

J
~ (

il
(
:~D B
c------ -- E

/
1cm

Expiration
1cm

Fig. 4.8 Cricothyroid pitch control, trained subject. Radiographie
outl ines from a forty-two-year-old female trained soprano, sub-
ject 6, at expiration (A, B) and intonation (C, D ) of [F] (386 Hz) .
Key to line drawings as in fig. 4.6. Intonation is accompanied by
elevation of the larynx toward the hyoid bone, with only 5-degree
rotation of the thyroid cartilage toward the cricoid at the cricothy-
roid joint but with conspicuous forward translation of the thyroid.
The thyroid-hyoid approxi mation has caused parti al folding of the
median th yro hyoid fo ld, but forward transl ation of the thyroid
cartilage reduces the encroachment on the vestibule. The lines CE,
CE ' demonstrate that in this subject translation at the cricothyroid
joint was the main mechan ism of increasing the length and tension
of the vocal ligament.

LAR YNGEAL B IOMECHAN ICS 84

 D

__ .E E'
A~
C-~

Intonation 386 Hz
1cm

1.as caused partial fo lding of the

vard translation of the thyroid
: on the vestibule. The lines CE,
:t translation at the cricothyroid
ncreasing th e length and tension

85 PHONATORY FOLDING
 Expiration
384 Hz
Fig. 4.9 Cricothyroid pitch control,
trained subject. Column 1, radiographic
o utlines from a forty-eight-year-old trained
tenor, subj ect 7. Co lumns 2 and 3 as in fig.
4. 6. The lines in column 2 demon strate rela-
tively little change in the angle of open ing of E
the cricothyroid visor over the range of fre-
quencies studied: the angle measures 49 de-
grees in expiration and 38 degrees in 512
Hz intonation, a total range of rota tion
of 11 degrees. Below 512 Hz, increased A~O
c---- -- -- ----E
tension of the vocal fold was achieved pre- 128 Hz
440 Hz
dominantly by forward translati on (sublux-
B
ation) of the thyroid on th e cricoid , mani-
fested by the advance of the inferi or corn u
of the thyroid across the tracheal shadow.
In column 3 the interrupted line shows the
orientation of the vocal lever arm of the
thyroid cartil age in expiration; the solid
line demonstrates restricted rotation and
marked forward and downward translation
of the lever arm at frequ encies up to 440
H z. Rotation became conspicuous only at
the hi ghest frequency in this series, 512 Hz.
256 Hz
The laryngeal sinus is narrow in expiration 512 Hz
but becomes wider and more conspicuous
in low-intensity, low-frequency tones, such
as 128 Hz. At higher intensity the vibratory
excursion of the vocal fold encroaches
markedly on the sinus, but the risk of
damping of the vibration by the vestibular
fo ld in the upper margin of the sinus is re-
duced through the intervention of the ary-
epiglottic muscle mechanism for lifting the
vestibular fo ld.
/

LARYNGEAL BIOMECHANICS 86
 •• • •• • • • •• : • -~-~---·---· - • •;• •• -•. . ,•,.•,• • •• ; ..... !, -··· ·- ••• : -··· • • --; • -• • --· - -~>;~----- •. . . •:.+•

384 Hz

--E
c-- ~ -- - E'

----E
-o c---- -- ---
440 Hz
3

C ~
--E
-----~
---::----

512 Hz

__.E

·---::::---
c --..::::.----- ---- ----
---=.::::-:.....------

87 PHONATORY FOLDING
 A
arytenocricoid
lever
B C
Fig. 4.10 Cricothyroid tensor biomechanics. The tensor system of
the vocal folds is depicted as a dual-Jever device. The fixed lever or
supporting base represents the adducted arytenoids locked to the cri-
coid cartilage (see fig. 4.3); the mobile lever, the lower part of the
thyroid cartilage (A and B ). The thyroid cartilage lever can be further
LARYNGEAL BIOMECHANICS
A Rot ation
vocal lever
M. cricothyroideus
(pars recta)
pars ob liqua
Fig. 4.11 Cricothyroid tenso r biomecha
schematized as a bar bridging the interval between the isthmal at-
·ing the method of analysis of fig. 4.10, th<
tachment of the vocal ligament and cricothyroid articular ligaments
defined in fig. 4.5 can be di agrammed. lt
(C). The three intrinsic muscle bundles that regulate the system are
the cricothyroid articul ati on (A) deman
marked by arrowheads : (1) M. vocalis; (2) M. cricothyroideus pars
shortening of the pars recta than of the p,
recta, and (3) M. cricothyroideus pars obliqua.
roid muscle. The tenso r contracti on o
elongates the vocal ligament and the voca
tion, however, can be obtained by transl,
88
 A Rotation B Translation

~ ,ocal le,e,

M. cricothyroideus
(pars recta)

he interval between the isthmal at-
md cricothyroid articular ligaments
•undles that regu late the system are
1
ocalis; (2) M. cricothyroideus pars
s pars obliqua.
Fig. 4.11 Cricothyroid tensor biomechanics (continued). By apply-
ing the method of analysis of fig. 4.10, the two types of tensor action
defined in fig. 4.5 can be diagrammed. lt is apparent that rotation at
the cricothyroid articulation (A) dem ands proportionately greater
shortening of the pars recta than of the pars obliqua of the cricothy-
roid muscle. The tensor contraction of the cricothyroid muscle
elongates the vocal ligament and the vocal muscle. The same elonga-
tion, however, can be obtained by translation (subluxation, gliding)
of the thyroid cartilage relative to th e cricoid, as indicated in B, but
this dem ands a relatively uniform shortening in the two parts of the
cricothyroid muscle, as weil as additional work, since the muscle now
also has to elongate the cricothyroid articular ligaments. Preferential
use of the second or translatory rnechanisrn is likely to lead to hyper-
trophy of at least two of the three muscle bundles concerned : the
vocal muscle and the pars obliqu a of the cricothyroid muscle.

89 PHONATORY FOLDING
A B

J
C

j
J
J
J( /
I
1cm

Fig. 4.12 Laryngeal formants. Lateral radiographic tracings of la-
ryngeal region during utterances [a] (A and C ) and [u] (B and D) . The
modification of glottis-generated acoustic vibrations in articulated
speech occurs mainly in the supralaryngeal vocal tract. However,
some modulation also takes pl ace in the larynx between the glottis
and the aryepiglottic rim, in the zone termed the collar of the larynx
by Vennard (1967) . In these tracings, the elevation of the larynx to-
ward the hyoid bone with [a] is as great as in effort closure (fig. 3.1 ),
but the vestibule remains open with [a] because cricothyroid rotation
maintains the separation of the arytenoid cartilages from the median
[a]
thyrohyoid fold. The larynx is elevated with [a] and depressed with
[u], where the thyroid-hyoid distance is similar to that of deep in-
spiration (fig. 2.3 ). The greater enlargement of rhe sinus with [u] is
explained by the descent of the larynx and craniocaudal tension in
the quadrangular membrane. The craniocaudal and anteroposterior
dimensions of the laryngeal cavity in [a] and [u] are extremes. Lesser
differences occur with other vowels. If laryngeal positioning for tone
production (fig. 4.8) conflicts with laryngeal positioning related to
vowel formants, blurring of the vocal message is likely to occur.

LARYNGEAL BIOMECHANI CS 90
 •• • • ••• •'' • •--------r---~ •- ~•• •; • ,,-• ,•,_:1..,• • • :• ~ ,:,•--••-• 'l • •-• • • • •• < • •,- • • • ;- :;---: - -~----••- • • • ••• : •,,:+ ••
•I . . c·

~
D

J l
C

j hyoid bone
J
J vestibule
)
J J
J( 1
I I
J
-(
sinus

/
(
[a)
'ated with [a] and depressed with
nce is similar to that of deep in-
largement of the sinus with [u] is
rynx and craniocaudal tension in
craniocaudal and anteroposterior [u]
n [a] and [u] are extremes. Lesser
:. lf laryngeal positioning for tone
L laryngeal positioning related to

cal message is likely to occur.

91 PHONATORY FOLDIN G
Fig. 4.13 Free-body diagrams of thyroid
cartilage in intonation. In these diagrams
the forces exerted by the pars recta and pars median - - - --+--- ---J
thyrohyoid fold
obliqua of the cricothyroid muscle are re-
placed by a single vector C, as are the reac-
thyroid - - - - - " < - '
tion in the vocal ligament and the force cartilage
exerted by the vocal muscle, which may be
Rotation cricoid - - ------'
combined as vector V. Each of these vec-
carti lage
tors is resolved into a normal component
CN, VN and an axial component CA, VA.
Shearing strains are omitted. The sum of the
vocal and cricothyroid axial vectors gives Con trol
the axial reaction RA necessary for equili- V'N
brium. The normal reaction R,v balances the
net translational action of C,v and V,v, and B
the turning moment aCN, produced by C,v,
is balanced by the turning moment bV ,v pro-
duced by VN. The two diagrams illustrate
the same tonal pitch and intensity, pro-
duced by rotation (upper diagram) and by
translation (lower diagram) at the crico-
thyroid joint. The greater magnitude of the
force vectors in the translational mode is R'A
in accordance with the analysis of fig. 4.11.

Eu pnea

B
C'N
Translation

LARYNGEAL BIOMECHANICS 92
 Fig. 4.14 Whispering. Tracings of lateral
radiographs of two adu lts studied by Ar-
dran and Kemp (1967). In the present fig-
ure, comparison of the control configura-
tion (left) with whispering (righ t ) shows
that whispering emails approximation of
the th yroid carti lage and hyoid bone, partial
median
thyrohyoid fold folding of the median thyrohyoid fold, par-
tial effacement of the laryngeal sinus, and
thyroid ---~.,.\ laryngeal opacification due to narrowing of the cavity
cartilage sinus directly above the sinus. The opacification
cricoid - - - - - - 1 implies partial approxima tion of the vestib-
cartilage ular fo!ds. T he cricothyroid visor angle re-
Whispering [ee] mains unchanged, indicating that the vocal
(Ventricle Closed) folds were relaxed, and a rectilinear portion
is lacking in the aryepiglottic margin, indi-
Control cating absence of active adduction of the ar-
V'N
ytenoids or of contraction by the M. aryepi-
glotticus. T he Bell Telephone photograph
B of whisper described in fig. 3.5A shows lax
aryepiglottic
margin vocal folds, unadducted arytenoids, and
partial closure of the vestibular folds. These
rather limited data suggest that whispering
arytenoid
cartilage is performed with partial closure of the lar-
ynx as a result of thyroid-hyoid approxima-
tion produced by extrinsic muscles, without
the intervention of the intrinsic muscles.
The combination resembles quite closely
Attempted the conditions in attempted phonation by
Whispering
persons with bilateral recurrent laryngeal
nerve paralysis and produces approximately
~ Eupnea
the same sound.
C'

93 PHONATORY FOLDING
 A

Fig. 4.15 Extern al fram e function. Extrinsic muscles, sketched on

an anteroposterio r tomographic tracing of a trained tenor's larynx .
A, anterio r muscles; B, posterio r muscles. Th e extrinsic muscles of
the larynx fun ction in part as suspensory muscles that add transitory
stresses to the background support contributed by the ligamentou s
suspensory system. They regul ate the vertical position of the larynx
in the performance of its va rious behavio rs, including formant activ-
ity. Some authors (see Z enker and Zenker, 1960 ; Sonninen, 1968 )
have p roposed, in addition, that the strap muscles also assist in regu-
lating the tension of the vocal folds. The possibility arises because the
attachments of th ese muscles to th e th yroid ca rtilage theoreticall y
tomographic
causes th em to generate a turning moment about the cricothyroid ar- o utl ine
ticulatio n. The experimental evidence, ho wever, is scanty and incon- of a irway
clusive. The extrinsic muscles are not weil situated to affect the crico-
thyroid visor an gle since, except for the cricopharyngeus, they are all
attach ed on one side of the visor, whereas muscu lar stabilization of
the oth er side namely, the cricoid cartilage, is lacking. The actio n of
the cri copharyngeus on the cricoid ca rtil age is un certain. The ability
of the extrinsic muscles to generate a moment abo ut the cricothyroid
joint is additionall y suspect because of the location of th e joint,
which is close to if not on the transverse axis of ba lance of the cricoid
cartilage. Thus, a vocal tensor effect by extrinsi c muscles may be an
anomaly rather th an anormal element of tonal mechanics. Ho wever,
-
the attachment of extrinsic muscles to the obliqu e line does enable
them, acting bilaterally, to generate a bending moment about the
isthmus of the th yroid carti lage th at wo uld ten d to in crease o r de-
crease th e transverse diameter of th e cavity intern al to the laminae
(see figs. 2. 15, 5.7) . T here is some evidence that such effects do occur
(Fink, 1974). T he outline of th e laryngeal airway in trained voices is
streamli ned below and above the rima glottidi s, suggesting an ap-
proxim ately exponential curvature of the intern a l surface. Such a
curvatu re would favor th e transmission of sound energy un selectively
over a wide range of frequencies.
sternoth yroid

LARYNGEA L BIOMECHAN ICS 94

 A B

)n. Extrinsic muscles, sketched on

racing of a trained tenor's larynx.
muscles. The extrinsic muscles of
,ensory muscles that add transitory
,rt contributed by the ligamentous
the vertical position of the larynx
Jeh aviors, including formant activ- digastric
,d Zenker, 1960; Sonninen, 1968 ) muscle d igastric
he strap muscles also assist in regu- (posterior belly} (posterior belly)
s. The possibility arises because the
the thyroid ca rtilage theoretically tomographic stylohyoid
moment about the cricothyroid ar- outline muscle
:nce, however, is scanty and incon- of airway
not weil situated to affect the crico-
or th e cricophary ngeus, they a re all
, whereas muscul ar stabilization of
cartilage, is lacking. The action of omohyoid
d cartilage is uncertain. The ability
inferior
:e a moment about the cricothyroid constrictor
ause of the location of th e joint,
sverse axis of balance of the cricoid
:ect by extrinsic muscles may be an
ment of tonal mechanics. However,
:!es to the oblique lin e does enable
rate a bending moment abo ut the
that would tend to increase or de-
: the cavity interna l to the laminae
: evidence that such effects do occur
aryngeal airway in trained voices is
e rima glottidis, suggesting an ap-
\;
1
1re of the interna l surface. Such a
ission of sound energy unselectively
sternothyro id

95 PHONATORY FOLDING
 The mechanical act of swallowin g i
in forcing food into the gut and in b
lungs. The barrier has to be dou bly se
pressure-as high as 600 mm Hg
bolus in its travel down the pharynx (
human larynx closed in swallow has t
pressures from above that may be mor
the peak pressures that ch all enge it J
closed in effort. Special p rotective mea:
ably manifested as additional folding.
With the lesser degree of foldin g tha
closure, the main events are (1 ) appo
cartilages and vocal fold s, (2) appositio
tilages and vestibular fold s, and (3) apr
roid cartilage and hyoid bone, with ii
glottic folds and apposition of the mec
the lower part of the adducted vestibu
Although these events completely an
lower reaches of the laryngeal passage,
the entrance into which a puddle of
thence fall into the depths when th e lar
ventive additional steps are norm ally U
sure: (1) An elastic lid, the epiglottis, i
entrance. This diminishes the size and
of the pit. (2) A final hyperel evation
against the lid clears any stray bolus o
,1 • • •• ,· ·---------~---- - · . · -!• ,.-· • ,. ,• : • . ,, ___ ' :1 ..... •• • • • - • -· ·--~- - -~----·- • • • ..+ ··

5
Swallowing
The mechanical act of swallowing is vital to existence both Epiglottic Folding
in forcing food into the gut and in barring its access to the
The rnechanism whereby the epiglottis is downfolded has
lungs. The barrier has to be doubly secure because of the high
long been one of the minor mysteries of deglutitional me-
pressure-as high as 600 mm Hg-that is applied to the
chanics. A push from the back of the tongue, a push by the
bolus in its travel down the pharynx (Dodds et al., 1975). The
squeezed bolus, a pull by the aryepiglottic muscles-all have
human larynx closed in swallow has to be able to withstand
been invoked, but not always convincingly. Cinematography
pressures from above that may be more than twice as high as
has shown that the presence of a bolus is not essential and
the peak pressures that challenge it from below when it is
that the epiglottis may start folding down ahead of any obvi-
closed in effort. Special protective measures are taken, expect-
ous push from the back of the tongue. Anatomically, the ary-
ably manifested as additional folding.
epiglottic muscles seem too flimsy, attached too far down, and
With the lesser degree of folding that pervails during effort
directed too obliquely to exert much leverage on the epiglot-
closure, the main events are (1) apposition of the arytenoid
tis; they are certainly not effective in this respect during effort
cartilages and vocal folds, (2) apposition of the cuneiform car-
closure and phonation. Indeed, the slight recurvature of the
tilages and vestibular folds, and (3) approximation of the thy-
edges of the adult epiglottis seems expressly shaped to hinder
roid cartilage and hyoid hone, with infolding of the aryepi-
such an eventuality. An additional factor contributing to
glottic folds and apposition of the median thyrohyoid fold to
downfolding, which can be illustrated by a simple paper
the lower part of the adducted vestibular folds.
model, emerges from a reexamination of the data in the
Although these events cornpletely and herrnetically seal the
published accounts of Ramsey and co-workers (1955) and
lower reaches of the laryngeal passage, they still leave a pit at
Saunders, Davis, and Miller (1951), as weil as from cineradio-
the entrance into which a puddle of bolus can collect and
graphic studies of six subjects by Fink and Martin (1977).
thence fall into the depths when the larynx reopens. Two pre-
ventive additional steps are normally taken with swallow clo- 1. Passage of the bolus through the laryngeal pharnyx in-
sure: (1) An elastic lid, the epiglottis, is downfolded over the volves vigorous upward movement of the larynx, trachea, la-
entrance. This dirninishes the size and likelihood of invasion ryngeal pharynx, hypopharynx, and esophagus. The upward
of the pit. (2) A final hyperelevation of the closed larynx climb of these structures is led by an upward and forward
against the lid clears any stray bolus out of the pit. movement of the hyoid bone (figs. 5.lA,B and 5.2A,B).

97
 2. The larynx starts up later but climbs faster than the
hyoid bone (fig. 5.2C).
3. The air space in the larynx shrinks as the larynx rises
(fig. 5 .2C).
4. The epiglottis may start folding backward before any
bolus reaches the fauces; it continues folding apparently in re-
sponse to further upward and forward movement of the lar-
ynx (figs. 5.lC,D and 5.20).
5. At its peak, thyroid cartilage-hyoid bone approximation
is more extreme, and forward motion of the hyoid more
marked, than with effort closure.
6. Descent and backward motion of the hyoid bone pre-
cedes descent and reopening of the larynx and unfolding of
the epiglottic cartilage (fig. 5.2E- G).
At the peak of the excursions of the hyoid bone and larynx,
forward translation of the hyoid bone, combined with ex-
treme thyroid-hyoid approximation, causes extreme forward
tension on the hyoepiglottic ligament, notably at the attach -
ment of the ligament to the margins of the epiglottic tubercle
(figs. 1.3, 5.3A-G, and fig. 5.3H from Tucker, 1971). Sec-
ondary to the extreme thyroid-hyoid approximation, the
compression of the median thyrohyoid fold makes the epi-
glottic tubercle bulge backward transversely as well as cranio-
caudally.
Figures 5.1 and 5.2 indicate that the force that causes epi-
glottic folding is effective when (1) the hyoid bone is hyperele-
vated and pulled forward; (2) the hyoepiglottic ligament is
extremely elongated and tense; and (3) the tissue below the
ligament is compressed and bulging back under pressure.
Under such conditions the margin of the epiglottic tubercle is
subjected to strong tension from the attachment of the hyoepi-
glottic ligament (fig. 5 .3F) and the center of the tubercle to
strong pressure from the compression of the median thyro-
hyoid fold (fig. 5.3B, E).
Three structural features now assume enhanced signifi-
cance: (1) the epiglottis proper arches transversely with con-
LARYNGEAL BIOMECHANICS
cavity backward, (2) the epiglottic tubercle arches trans-
versely (and vertically) with convexity backward, and (3) the
junctional zone or groove between the epiglottis proper and
the epiglottic tubercle gives attachment anteriorly to the hyo-
epiglottic ligament. Because of (2) and (3 ), compression of the
median thyrohyoid fold forces the epiglottic tubercle to bulge
backward. When this happens the left and right halves of the
groove at the top of the tubercle are rotated toward each
other (fig. 5 .4); the vertex of the groove acts as the axis of ro-
tation. Each half-groove is then moving downward, medially,
and forward, generating a conical surface whose formation
is facilitated by the arched epiglottis proper. As a result, the
epiglottis is drawn down backward into a conoid shape. Just
at this time the hypercompression of the median thyrohyoid
fold is also tilting the stem of the epiglottic cartilage in the
same direction (Saunders, Davis, and Miller 1951), enabling
the downfolded epiglottis to conform closely to the top and
back of the arytenoid contour.
The suggested mechanism may supplement or even sup-
plant the reputed action of the aryepiglottic muscles in pro-
ducing the downfolding (see chapter 3 ). Since the com-
pression of the median thyrohyoid fold is elastic, the sug-
gested formation of the conoid is itself elastic; thus the folded
epiglottis can automatically spring back to its unfolded shape
when the compression ceases.
A simple paper model of the proposed mechanism is set up
in a few seconds, following the directions in fig. 5.4.
Geometrically, a cone is formed by the rotation of a genera-
tor line, the generatrix. The generator moves along a circular
directrix while passing through a fixed point, the vertex, that
lies on the perpendicular axis of the directrix. In the unfolded
paper cone of figs. 5 .4 and 5 .5, a and b are generators; the
vertex is at the center of the circle. In the unfolded epiglottic
cartilage (fig. 5.4A), the vertex is at the apex of the epiglottic
tubercle, and the generators are formed by the groove on ei-
ther side of the apex. During deglutitional downfolding, the
epiglottic cartilage undergoes a conoidal transition, seen in
98
figs. 5.4D and 5.7A,B. Pressure by the
the paper causes the paper epiglottic tu
paper epiglottis to fold down behind i
According to this model, downfoldi
swallowing is caused by rotation of t
the center of the rotation is at the vert
bercle. The rotation of the apical groov
tis into a conoidal surface is a consequ
the median thyrohyoid fold anterior to
Compression of the fold, caused by thy
tion, increases the backward bulge of
both in the sagittal and horizontal pla
the two half grooves toward each oth
observing a cough, the bulge is notic
backward prominence of epiglottic
caused by the thyroid-hyoid approxim
(fig. 3.40) . The complete downfolding
able to greater compression of the md
1
and to tilting of the epiglottic tubercle m
zontal with hyperelevation of the larynx
An elementary qualitative understanci
of forces in the downfolded epiglottis i
paper cone model. For this analysis an,
parallel to the directrix can be consid<
bent into a circle by the bending mon
shows a segment of such a strip; th e cen
strip is at the axis of the cone.
The neutral surface within the strip, •
Stress and strain, is bent into an arc of r
has a moment of inertia I around the r
tion of the bending moment M, which
force producing the bending, to the r
given by M = EI/ p where E is the mod1
material (Popov, 1968). Although the
not an isotropic material and a simple
would not describe its behavior, th e eq
fining the ideal from which the real cas
 ~i
piglottic tubercle arches trans-
:onvexity backward, and (3) the
tween the epiglottis proper and
ttachment anteriorly to the hyo-
.f (2) and (3 ), compression of the
s the epiglottic tubercle to bulge
s the left and right halves of the
Jercle are rotated toward each
:he groove acts as the axis of ro-
~n moving downward, medially,
)nical surface whose formation
Jiglottis proper. As a result, the
:<ward into a conoid shape. Just
ssion of the median thyrohyoid
,f the epiglottic cartilage in the
vis, and Miller 1951), enabling
conform closely to the top and
r.
may supplement or even sup-
1e aryepiglottic muscles in pro-
e chapter 3 ). Since the com-
)hyoid fold is elastic, the sug-
1 is itself elastic; thus the folded
Jring back to its unfolded shape
=proposed mechanism is set up
1e directions in fig. 5 .4.
ned by the rotation of a genera-
~nerator moves along a circular
h a fixed point, the vertex, that
Jf the directrix. In the unfolded
.5, a and b are generators; the
ircle. In the unfolded epiglottic
: is at the apex of the epiglottic
re formed by the groove on ei-
deglutitional downfolding, the
a conoidal transition, seen in
• • •• • - • • • • ------- ----:---
figs. 5.4D and 5.7A,B. Pressure by the fingers on the edges of
the paper causes the paper epiglottic tubercle to bulge and the
paper epiglottis to fold down behind it (fig. 5.4E).
According to this model, downfolding of the epiglottis in
swallowing is caused by rotation of the apical grooves, and
the center of the rotation is at the vertex of the epiglottic tu-
bercle. The rotation of the apical groove that folds the epiglot-
tis into a conoidal surface is a consequence of compression of
the median thyrohyoid fold anterior to the epiglottic tubercle.
Compression of the fold, caused by thyroid-hyoid approxima-
tion, increases the backward bulge of the epiglottic tubercle,
both in the sagittal and horizontal planes. The bulge rotates
the two half grooves toward each other. To laryngoscopists
observing a cough, the bulge is noticeable as an increased
backward prominence of epiglottic tubercle (fig. 5.5B,C)
caused by the thyroid-hyoid approximation of effort closure
(fig. 3.4D) . The complete downfolding of swallow is account-
able to greater compression of the median thyrohyoid fold
and to tilting of the epiglottic tubercle more nearly to the hori-
zontal with hyperelevation of the larynx (figs. 5 .3E and 5.4G).
An elementary qualitative understanding of the equilibrium
of forces in the downfolded epiglottis is obtainable from the
paper cone model. For this analysis any circular strip of cone
parallel to the directrix can be considered a deflected beam
bent into a circle by the bending moments M. Figure 5 .5D
shows a segment of such a strip; the center of curvature of the
strip is at the axis of the cone.
The neutral surface within the strip, where fibers are free of
stress and strain, is bent into an arc of radius p, and the beam
has a moment of inertia J around the neutral axis. The rela-
tion of the bending moment M, which is proportional to the
force producing the bending, to the radius of curvature is
given by M = EI/ p where E is the modulus of elasticity of the
material (Popov, 1968). Although the epiglottic cartilage is
not an isotropic material and a simple equation of this type
would not describe its behavior, the equation is useful in de-
fining the ideal from which the real case departs.
• -· •-! ;--···. ·,. •• : - !. -·-··· •• •,. • •••••• ., • • --- ·- ·-·-- · --·- • · · . :• • •t;
Note that in the folded paper epiglottis, as in the living
folded epiglottic cartilage, elastic strain energy of tension and
compression is stored in the course of deformation and ener-
gizes the unfolding as soon as the pressure is released.
Although the paper model may explain how the epiglottis
folds over and springs back elastically in swallow, it does not
explain why, in the body, the epiglottis folds very little in ef-
fort closure. One difference between the model and the real
thing is that in the body the hyoepiglottic and thyroepiglottic
ligaments yield to the compression of the median thyrohyoid
fold more readily than the epiglottic tubercle. The latter seems
to bulge appreciably only after the thyroepiglottic ligament
has been stretched to the limit. Presumably the critical degree
of pressure is only barely attained in effort closure but is con-
siderably exceeded in the course of swallow closure.
The operation of the hypothesized mechanism of epiglottic
downfolding is contingent on craniocaudal shortening of the
median thyrohyoid fold . In other words, it is contingent on
the thyroid cartilage isthmus being positioned considerably
caudal to the body of the hyoid hone during eupnea. The re-
quired relation exists in the human adult but not in the infant,
where, on the contrary, the cartilage and the hone usually
overlap. In the great apes the thyroid cartilage isthmus ad-
joins the body of the hyoid bone; in monkeys the two gen-
erally overlap but are separated by a median air sac; and in
nonprimate mammals there is a hyoepiglottic muscle instead
of a ligament, and a median thyrohyoid fold does not develop
at all.
Unfortunately, the comparative biomechanics of epiglottic
folding is presently unknown. However, we have noted that
in the orangutan and also in the dog the introduction of a di-
rect laryngoscope into the mouth of a lightly anesthetized ani-
mal often reveals the epiglottis tobe lying retrovelarly, that is,
in the nasal pharynx behind the soft palate. If the laryngo-
scopic exposure triggers a swallowing reflex, the larynx as-
cends cranially, the vallecular base of the epiglottis impacts
the free edge of the soft palate, and pressure from the palate
99 SWALLOWING
seems to flip the epiglottis over backward to cover the ad-
ducted arytenoids. A high cervical, retrovelar station of the
epiglottis is also characteristic of cercopithecoid and ceboid
monkeys, felids, and ungulates (Negus, 1962). In these taxa
it correlates with the absence of a developed median thyro-
hyoid fold but the presence of a hyoepiglottic muscle. In
quadrupeds this muscle, which is lacking in man, may lift the
epiglottis and prevent it from obstructing the open larynx.
Although the human epiglottic inversion requires an as-
cending excursion of the larynx just as in other mammals, the
human mechanism allows the elevation to stop short of the
soft palate, enabling the larynx to maintain a low cervical po-
sition without the risk of deglutitional invasion. In chapter 4,
we saw that this position and the associated development of
the median thyrohyoid fold may also be interpreted as a spe-
cialization for vowel production, that is, for speech. We have
also seen how changes in the median thyrohyoid fold are in-
volved in effort closure (chapter 3) andin th e enlargement of
the larynx with inspiration (chapter 2). The conclusion inevi-
tably follows that the median thyrohyoid fold is a develop-
ment of the human larynx adaptive to all of the four main
types of human laryngeal behavior.
Vestibular Stripping
During the swallowing of a radioopaque liquid bolus, bolus
material is often seen to penetrate under the downfolded epi-
glottis into the declivity of the vestibule. Figure 5 .6 illustrates
this condition. The figure is taken from a cinematographic se-
quence in which the invading bolus was cleared away by a
transient hyperelevation of the larynx preceding laryngeal de-
scent and reopening. With repetitive swallowing of a draught
of liquid the hyperelevation and clearing were seen to occur
only with the final swallow. Evidently, the hyperelevation
produces excess folding that forces the median thyrohyoid
fold back against the full length of the adducted vestibular
LARYNGEAL BIOMECHANICS
folds and cuneiform cartilages and squeezes the stray bolus
teriorly against the posterior wall
back into the hypopharynx.
squeezes it transversely between the
The radiographic motion pictures show that swallowed liq-
cartilage. The tran sverse narrowing m
uid regularly gains access to the vestibular entrance without
by the elevators of the larynx, includi
eliciting a cough, so regularly as to suggest that the cough re-
geus, for with thyroid-hyoid approxi
flex is temporarily inhibited or that the sensitive mucosa has
clined superior horn of the thyroid c
been withdrawn into the interior out of reach of the Stimulus
cornu major of the hyoid bone an
(or both). Fibers of the thyroepiglottic muscle are known to
What this amounts to is th at the extr ·
sweep up from their origin near the ligamentous confluence at
slight narrowing of the thyroid ang
the back of the thyroid cartilaginous isthmus into the aryepi-
folding of the thyro id cartilage at th
glottic fold and end in the mucosa . Such fibers seem weil situ-
reinforces the folding of the soft rissue
ated to produce the suspected mucosal inversion (fig. 1.5).
Galen inferred something of the sort
The multiplicity of devices that safe
against deglutitional invasion requi red
Thyroid Cartilage Folding history. Chance genetic modification
tional security evidently enhan ce th e
The security of laryngeal closure during deglutition is fur-
tion. Although there may seem to be a
ther enhanced by the mechanics of the inferior constrictor
tion, this redundancy may be no grd
muscle and the thyroid cartilage (fig. 5.7). Anatomically, the
redundancy of renal or hepatic tissu e,
inferior constrictor muscle of the pharynx is the thickest of
constitutes a reserve availabl e in extr
the three constrictors and consists of two parts, thyropharyn-
when lacking, may cause the organi
geal and cricopharyngeal. The former arises principally from
exposed to such extremes and thus be d,
the oblique line of the lamina of the thyroid cartilage and
from the surface of the lamina behind this line; the latter,
from the side of the cricoid cartilage posterior to the crico-
thyroid muscle. The fibers from the oblique line spread up-
ward and backward, sweep around the posterior border of
the lamina, and then incline upward and medially to meet
those of the other side in the median fibrous raphe at the back
of the pharynx. The cricopharyngeus fibers , however, follow
a roughly horizontal course and merge with the circular fibers
of the esophagus.
The position of the pharyngeal space enclosed by the in-
ferior constrictor muscles is outlined by swallowed bolus in
the anteroposterior cineradiographs of fig. 5. 7. Successive
frames show that the space becomes slightly narrowed from
side to side as the bolus descends. lt appears that the inferior
constrictor muscle not only squeezes the bolus anteropos-
100
 ~s and squeezes the stray bolus
terio rly against the posterior wall of the larynx but also Similarly, the ability of the human organism to survive surgical
squeezes it transversely between the laminae of the thyro id mutil ation of the deglutitional apparatus should not be taken
ictures show that swallowed liq-
cartilage. The transverse narrowing may be indirectly ass isted to imply that the excised part is unnecessary.
the vestibular entrance without
by th e elevators of the larynx, including the M. stylopharyn-
as to suggest that the cough re-
geus, for w ith thyroid-hyoid approximation the medially in- A final advantage of our model is that it opens the way to a
)r that the sensitive mucosa has
clined superior horn of the thyroid cartilage may contact the unified biomechanical analysis of the infant and the ad ult
rior out of reach of the stimulus
cornu rnajor of the hyoid bone and become bent inward. larynges.
>epiglottic muscle are known to
What this amounts to is that the extrinsic rnuscles produce a At birth the epiglottis proper is typically hood-shaped; it is
ar the ligamentous confluence at
slight narrowing of the thyroid angle, equivalent to slight also more nearly horizontal than in later years. In addition,
aginous isthmus into the aryepi-
folding of the thyroid cartilage at th e isthmus, and that this the prominence of the newborn's thyroid cartilage is adjacent
lcosa. Such fibers seem well situ-
reinforces the folding of the soft tissues proceeding internally. to or even overlapped by th e body of the hyoid bone. These
d mucosal inversion (fig. 1.5).
Galen inferred something of the sort 1800 years ago. characteristics contrast with the relatively flat and more
The multiplicity of devices that safeguards the lower airway nearly vertical epiglottis and the marked thyroid-hyoid sepa-
against deglutitional invasion required a lengthy evolutionary ration found in the adult. lt is interesting that the infantile
rtilage Polding hi story. Chance genetic modifications that add to degluti- triad reappears transiently in th e ad ult in the course of a nor-
tional securi ty evidently enhance the likelihood of reproduc- mal swallow, when the larynx ascends and the epiglottis
:losure during deglutition is fur-
tion. Although there may seem to be a redundancy of protec- arches from side to side as it folds over (fig. 5. 7). This suggests
anics of the inferior constrictor
tion, this redundancy may be no greater than the apparent th at the elements of the infantile triad compose a partial, pro-
lage (fig. 5.7). Anatomically, the
redundancy of renal or hepatic tissue. The margin of safety tective folding closure of th e larynx, built-in at birth but re-
>f the pharynx is the thickest of
constitutes a reserve availabl e in extreme situations, which, versibly unfolded by differential growth as the median thyro-
nsists of two parts, thyropharyn-
when lacking, may cause the organism to succumb when hyoid fold mechanism develops and the larynx descends with
1e former arises principally from
exposed to such extremes and thus be deprived of descendants. maturation.
ina of the thyroid cartilage and
1ina behind this line; the latter,
cartilage posterior to the crico-
:rom the oblique line spread up-
around the posterior border of
e upward and medially to meet
median fibrous raphe at the back
taryngeus fibers, however, follow
and merge with the circular fibers

yngeal space enclosed by the in-

; outlined by swallowed bolus in
iiographs of fig. 5.7. Successive
becomes slightly narrowed from
cends. lt appears that the inferior
y squeezes the bolus anteropos-

101 SWALLOWING
 Fig. 5 .1 Deglutitional plication. Tracings
from prints of a cineradiographic film .
A B (For th e ori ginal photographs, see Ardran
and Kemp, 1967. Th e exact timing of the
pictures was not stated.) These more recent
mandible
data reconfirm those of Saunders, Davis,
and Miller (1951 ) and of Ramsey and c<x;
workers (1955 ; fig. 5.1). A , Before swallow
the airway is open and the intralaryngeal
border of the medi an thyroh yoid fold
sharply defin ed. B , The apex of the bolus
is descending over th e back of the tongue.
The hyoid bone has been elevated toward
the mandible and is being drawn for wa rd,
and the thyroid cartilage is approaching
the hyoid bone. The laryngeal airway is
thyroid no longer clearly defined and has begun
cartilage to close. The epiglottis is still unfolded. C,
The upward excursions of the hyoid bone
and thyroid cartilage have increased . The
laryngeal cavity is completely obliterated.
D The epiglottis is folded down, and the
bolus has spilled over it. D , Descent of
the hyoid bone has begun, but the approxi-
mation of the thyroid cartilage to the hyoid
bone is even more pronounced ; the epi-
glottis is still folded back.
In summary, with minor variations, the
sequence in fig. 5 .2 is also o bserved in this
and other studies (Sa unders, Davi s, and

l Miller, 1951 ). The mechanism of epiglotti c

folding deducible from th e evidence impli-
cates several facto rs, including press ure by

\
an advancing bolus, thru st fr om the to ngue,
and, possibly to a minor degree, tension
in th e a ryepiglotti c muscle. In additio n,
the anatomical dynamics of th e medi an
throhyoid fold itself gua rantees degluti-
tio nal epiglotti c downfo lding and post-
deglutition al recoi l.

103 SWALLO WIN G


Fig. 5.2 Deglutiti ona l plication (continu ed). The speed and com-
plexity of the laryngea l phase of deglutiti on precludes effective X-ray
ana lysis. T he data are borrowed from a cineradi ographi c stud y by
Ramsey and colleagues (1955) that confirmed and extended the
work of Saunders, Davis, and M iller (1951 ). In motion pictures of
deglutition, a succession of four major changes in the conditi on of
the laryngeal passage regul a rl y occurs: (1) the air passage closes; (2)
the entrance is covered by the epiglottis ; (3) any residue at th e en-
trance is cleared before reopening; (4 ) the entrance is uncovered and
the passage restored . The movement of the bolus downward out of
the oral pharynx began at time zero, elapsed time in tenths of a sec-
ond being displayed on the di a l.
A, The bolus is anterior to fa uci al pi ll ars. Note th e level of the la-
ryngeal sinus and its distance from the hyoid bone (elapsed time, 0
seconds ). B, Th e bolus approaching the valleculae. The hyoid bone is
beginning to move upward and forw ard away from the epiglotti s. C,
The head of the bolus li es on the epiglottis. The hyoid bone has
ascended furth er and advanced away fro m the epigl ottis which has
begun to fo ld backward; the larynx has been further elevated toward
the hyoid bone and is cl osing, and the laryngeal sinus is becoming
smaller (elapsed time, 0.2 second). D, The bolus now distends the la-
ryn geal pharynx, and th e hyoid bone's upward and forward move-
ments are at their peak. T he laryngohyoid distance is at a minimum,
the hypoepiglottic di stance maximal, the sinu s is ob li terated, and the
larynx closed. The epiglottic folding is complete, weil ahead of the
Stripping wave (arrow) moving down th e posterior wall of the phar-
ynx (elapsed time, 0.3 5 second). E, Descent of the hyoid bon e has
just begun, but the hypoepiglottic distance has not decreased and the
epiglottis is still fold ed back. The larynx is sti ll close to the hyoid
bone and has not yet reopened (elapsed time 0.8 second). F, The
LARYNGEAL BIOMECHANlCS
A
hyoid bone is dropping down away from the man dib le and backward
toward the epiglotti s and vertebrae; the larynx is dropping away epiglo ttis
from the hyoid bone and is reopening, and the epiglottis is un fo ldin g
(elapsed time 0.8 second). G, The resting stage of the ph aryn x and
laryn x has been reestablished (elapsed time 1.0 second ). C)
In summary, the sequence demonstrates fun ctional steps 1, 2, and 4
as mentio ned above. Step 3 is discu ssed in fi g. 5 .6. The present se-
quence shows that in th e course of a swallow, laryngeal closure is led E
by movement of the hyoid bone; the hyoid bone is drawn upward
and forward , the larynx is drawn toward the hyoid bone and closes,
and the epiglottis fo lds down backward . The recovery sequence is
agai n led by th e hyoid bone; the larynx then begins to descend and
reopen, and the epiglotti s starts to unfold . The main differen ce be-
tween the events of swallow closure and those of effort closure is
that, in swallow, the hyoid bon e is drawn forward and hyperelevated
and the epiglottis is downfolded back, whereas in effort closure, they epi glot·
are not. Otherwise, the two closures are quite similar. It seems, then ,
that the fo rward and upward motion of the hyoid bone may be a
condition necessary for epiglottic backfolding, while the reverse
movement of the hyoid may be a conditio n for initiating epiglo tti c
unfolding. H, !, ]; altern ate frames from an unpublished cineradio-
graphic study (by Fink and Charles F. Rohrmann ) photograph ed at
16 frames per second. In H th e larynx is closed and liquid bolus is
already enterin g the esoph agus, but thyroid-hyoid approximation as
weil as hyoid bone elevation are incomplete and the epiglottis is still
unfolded. In J thyroid-hyoid approximation has increased, the hyoid
is moving forw ard and upward, and the epiglottis is beginning to
fold. In] the process has gone further and epiglottic folding is almost
complete.
104
 A B C D

.y from rh e mandible and backward

,rae; rhe larynx is dropping away epiglottis
(!jepigloltis \ \
ning, and ehe epiglottis is unfolding
e resti ng stage of the pharynx and
1psed time 1.0 second ). C)
,nstrates functional steps 1, 2, and 4
scussed in fig. 5.6. Th e present se-
f a swa llow, laryngeal closure is led E F G
; the hyoid bone is drawn upward
toward th e hyoid bone and closes,
.ckward. The recovery sequence is
larynx then begins to descend and
:o unfold. The main difference be-
sure and those of effort closure is
, drawn forward and hyperelevated
ack, whereas in effort closure, they
epiglottis
res are quite similar. lt seems, then,
Jtion of the hyoid bon e may be a
ic backfolding, while the reverse
1 condition for initi atin g epiglottic
f'T;
es from an unpublished cineradio-
es F. Rohrmann ) photographed at
v
arynx is closed and liquid bolus is
ut thyroid-hyoid approximation as
ncomplete and the epigl ottis is still
oximation has increased, the hyoid
and the epiglottis is beginning to
:her and epiglottic folding is almost

j

A B
Fig. 5.3 H yoepiglottic ligament. O utlines o f median th yrohyoid
fo ld in swall ow, to show the behavior of the hyoepiglottic ligament.
A, B, enlargements from figs. 5. l A and 5.l C respecti vely. C, D, E,
tracings from lateral radiograph s of subject 1. Th e hyoepiglotti c liga-
ment has been sketched in . F, a coronal secti on (X 4 ), stain ed fo r
elastic tissue, th ro ugh th e lary nx of a fo rty-four-year-old male
(Tu cker, 1971); the plane passes through the upper part of the epi-
glottic tubercle (labeled "epiglo ttis") and th e anterio r third of the
LAR YN G EAL B IOMECH AN ICS
ep iglottic
F
cartilage
hyoepiglottic
ligament
vocal ligament (labeled " Reinke's space") . A -E clari fy that when the
epigl otti s is folded backward it fold s at the top of the epiglottic tuber-
cle, at th e attachment of the hyoepiglotti c ligament to the front of th e
epiglotti c cartilage. G, the attachment of the ligament to the base of
the epigl ottis and to the lateral margin of the epigl ottic tubercle. H,
dry swallow. The epiglottis is downfo lded. Extreme advance and
elevation of th e hyoid bone has placed a maximal strain o n the hyo-
epiglotti c ligament.
106
 C E ~

Expiration Effort Swallow

G
- - - ep iglottic
F
carti lage
GLOSSO-EPIGLO TT IC
FO LD

HYO-E PI G LO TTIC

t
, space" ). A-E clarify th at when the
lds at the top of th e epiglottic tu ber-
piglottic ligament to the front of the
ment of the ligament to th e base of
nargin of th e epiglottic tubercle. H ,
fownfo lded. Extreme advance and
)!aced a maximal strain on the hyo-

107 SWALLOW ING

 A C

0 0
b
•
Fig. 5.4 Paper model of epiglottic fo lding. The biomechanical prin-
ciple underlying our model of epiglottic folding is that of transform-
ing a plane surface into a conoidal surface. The first stage of the
ZZ'
model is simply a paper disk (A), slit along the radius. The disk is D
transformed into a cone (B), by overlapping the edges OZ, OZ ', of
the cut-the greater the overl ap, the steeper the cone. If one now
snips away the overlapping edges, the remainder when flattened con- F
stitutes a sector of a circle (C). To re-form the cone one rotates the

~
edges of the sector toward each other in three dimensions. This ac-
tion fo lds the flat paper into a cone with a vertex angle of x degrees. B
, /
(The angle of fo ldi ng is 180 - x degrees.) The second stage of the ,,
model is a paper rectangle (D) inscribed with the said sector. By V i
'
l
1
a b ' 1
creasing the paper along the radii a and b of the sector, we obtain a ' 1
'' ''
working model of the epiglottic cartilage. The paper above the A B 1

generatrix
creases represents the epiglottis; the paper below the creases, the epi- ~ .
glottic tubercle; and the creases themselves, the transition zone or !.
groove between the convexity of the epiglottic tubercle below and
concavity of the epiglo ttis proper above. Hold the rectangular paper
at the edges between the thumb and middle finger below the creases d irectrix
with the concavity of the creases facing away from the hand (as
shown in E). Pressure by the thumb and middle fingertips, repre-
senting tension in the hyoepiglottic ligament, makes the creases ro-
tate toward each other; the tubercle below the creases then bulges
bactward, and the epiglottis folds down behind it, assuming a co-
noid'shape. The same effect is produced with pressure by the tip of the
index finger in the concavity of the epiglottic tubercle, which simu-
lates the effect ,o f compression of the median thyrohyoid fold. The mation caused by compression of the median thyrohyoid fold in
concavity of the epiglottis accentuates increasingly as the downfold- thyroid-hyoid approximation. At a critical degree of compression,
ing proceeds. Experiment demonstrates that the more acute the angle however, presumably barely reached in the compression of effort clo-
between the creases, the sharper the concavity of the downfolded epi-
glottis (F). lt is also found that the creases need not extend all the
way out to the margins of the epiglottis (G). Thus a transversely nar-
row epiglottic tubercle is quite adequate to downfolding a broad epi-
glottis. The real epiglottic tubercle differs in that it can also bend lon-
sure but surpassed in swallow closure, the extensibility of the liga-
ments is exhausted and the epiglottic tubercle apparently bulges
enough to make the epiglottis fold over. As in the paper model,
downfolding may be expected to accentuate the transverse curvature
of the epiglottis, leading to a snug fit with the bulging posterior sur-
I\
gitudinally, whereas the model only bends transversely. Moreover, in face of the adducted arytenoid mass. The folding and subsequent
the rea l case one has to reckon with the hyoepiglottic and thyroepi- elastic unfolding can be expressed in terms of the relation of strain-
glottic ligaments. These ligaments are much more extensible than curvature to moment-curvature in the elastic deflection of a beam, as
the epiglottic cartilage and accommodate much of the initial defor- shown in fig. 5 .5.

LARYNGEAL BIOMECHANICS 108

 C

E
I
a
•

~
!.

V
a b ' ''
'
' ''
A B . ;--'- - -==- G
~ -·

) . '

he median thyrohyoid fold in

critical degree of compression,
in the compression of effort clo-
·e, the extensibility of the liga-
tic tubercle apparen tly bulges
over. As in the paper model,
·ntuate the transverse curvature
with the bulging posterior sur-
,' .
I\
;, The fo ldi ng and subsequent
terms of the relation of strain-
. elastic deflection of a beam, as

109 SWALLOWING
 vertex
A 8 C
a,..... ),,
,.....,h / generatrix

~ A

----
'
'

elastic curve
D E

/ ~ bending
~ moment

epiglottis

radius of elastic curvature

of downfolded epiglottis 8 C

Fig. 5 .5 Forces in epiglottic folding. A, B, C, contour of vertex of
epiglottic tubercle observed in a laryngeal mirror during a cough
(from th e Bell Telephone motion picture); D, elastic curve of down-
folded epiglotti s; E, anteroposterior silhouette of downfolding epi-
glottis in a twenty-seven-year-old male swallowing a liquid radio-
opaque bolus (from a 16-mm cineradiograph). Note the similarity to
fig. 5.7A from Ramsey and co-workers (1955). In the paper model
the bending stresses in the cone are produced by the rotation of the
creases around the median axis of the tubercle: the epiglottis, being arytenoid mass ·
inextensible, is pulled into a conoidal shape whose ba sal diameter di -
minishes pari passu with the rotation. The deformation is elastic and
reverses automatically when the force generating the reactive stress
ceases.

LARYNGEAL BIOMECHANICS 110

rtex
I,,'-b,</ generat ri x
w
>) ~
' A
' is of sufficiently liquid consistency. During
' repetitive swall owing, liquid may even
·e produced by the rotation of the
the tubercle: the epiglottis, being
lal shape whose basal diameter di-
on. The defonnation is elastic and
xce generating the reactive stress
Fig. 5.6 Vestibular stripping. A, lateral
radiographic outline of an opaque liquid
bolus in the laryngeal vestibule during re-
petitive swallowing (traced from fig. 7B in
Ramsey et al., 1955). The vestibule is often
incompletel y closed early in a swallow
and may be infiltrated by bolus if the latter
find its way into the laryngeal sinus.
When projected, the cineradiographi c film
clearly demonstrates that toward the end
of a swallow sequence any liquid in th e
vestibule is forced out before the larynx
reopens. lt is expelled by means of a mino r
add itional hyperelevation of the larynx
against th e epiglottis. This stripping action
was noted by Ramsey and colleagues
(1955 ), who suggested that the laryngea l
sphincters are undergoing a stripping wave
from below upward, as originally concluded
by Pressman (1942 ). Though a Stripping
wave in laryngeal muscles is no t excluded,
the stripping effect can be more simply
epiglott is explained as an additional hyperelevati on
of the arytenoid mass accompanying hyper-
compression of the median thyrohyoid fo ld
B C against adducted vestibular folds (B, C, D ).
lt is produced by a surge in th yrohyoid
muscle activity. Electromyographi c evi-
dence shows th at activity in th is muscle in
man do es indeed reach a peak just before
the reo pen ing swall ow phase and th en
diminishes abruptly.
arytenoid mass ·
111 SWALLOWING
 ~wnfolding
epiglottis

Ele
C

Galileo concluded that a body tends

Fig. 5.7 Approximation of the thyroid larninae. A , B, anteropos-
terior views of passage of liquid barium mixture through the laryn- at rest, and when moving uniformly in
tinue that uniform velocity indefini tely.

r
geal pharynx, looking obliquely downward and backward in a fifty-
• )
' ►
seven-year-old male. (Traced from cinefluorographic photographs,
fig. l, Ramsey et al., 1955.) A, The lateral walls of tbe oral pharynx
"inertia." Whenever a body changes f

\ larnlaa(\ stant velocity in a straight line, a fo rce Ü

I
I\

,,
,
,,
A
1
1
1

\
\
of thyroid
cart1lage

1
1
1
\,
,,
\ 1
1
I
1
and the posterior faucial pillars (white arrows), which are contract-
ing on the tail of a bolus. The laryngeal pharynx is moderately dis-
tended, and a stream of fluid has passed cauda ll y over the epiglottis
and laryngeal entrance. Black arrows point to bulges of the pharyn-
geal lumen at the upper rnargins of the thyroid laminae. B, the
pharyngeal lumen, which has been obliterated down to the base of
the inverted epiglottis (black arows) where a small amount of fluid
the first law of Newton (and Galileo):
a state of rest or uniform motion in a s
compelled to change that state by forc,
Acceleration (a) is the rate of change
uniform or variable. Retardation may 1:
"I

I
I \
\ \ acceleration. Since acceleration has dir,
I has accumulated on the undersurface. C, the posterior muscular wall
1

.' '
\
B'
I \
I \
" of the pharynx covering the lam in ae of the thyroid cartilage, redrawn
nitude, it is a vector quantity. M omen
A'
' \
1
\ from Grant (1972 ). The drawing is a ligned with A ' and B' at th e
the quantity of matter or mass (m ) of ~
upper margins of the thyroid laminae. A' and B' define the angle be- (v). Newton's second law of motion st
tween the margins of the bolus in A and B and indicate the angle be- rate of change of momentum is proport
tween the laminae of th e thyroid cartilage (angle of flare). The angl e force, and takes place in the direction
decreases from A to B as the bolus descends. The changing angle is lows that force is measured by the rate
explicable as an effect of contraction of the inferior constrictor mus-
turn : F = d(mv)/dt = m (dv / dt) = ma
cle, which tends to approximate the laminae of th e thyroid cartilage
while propelling the bolus into tbe esophagus. The bending of tb e force that gives a mass of one gram an a
laminae of the thyroid cartilage rn ay be construed as a limited addi- timeter per second per second. A gran
tional folding that reinforces the closure of the larynx during passage force that gives a 1 gm mass an acce
of a bolus. Attachment to the ob lique line maximizes this effect of the mately 980 cm per second per secc
inferior constrictor muscle. weight = g dynes.
LARYNGEAL BIOMECHA ICS 112

:hyroid laminae. A, B, anteropos-
iarium mixture through the laryn-
ownward and backward in a fifty-
m cinefluorographic photographs,
1e lateral wall s of the oral pharynx
,vhite arrows), which are contract-
·yngeal pharynx is moderately dis-
passed caudally over the epiglottis
Jws point to bulges of the pharyn-
.s of the thyroid laminae. B, the
n obliterated down to the base of
vs) where a small amount of fluid
ace. C, the posterior muscular wall
3e of the thyroid cartilage, redrawn
; is aligned with A' and B' a t the
nae. A' and B' define the angle be-
A and B and indicate the angle be-
:a rtilage (angle of flare ). The angle
JS descends. The changing angle is
1011 of the inferior constrictor mus-
he lamina e of th e thyroid cartilage
he esophagus. The bending of the
iay be constru ed as a limited addi-
losure of th e_larynx during passage
:iue lin e ma xurnzes this effect of th e
6
Eletnents of Biotnechanics
Galileo concluded that a body tends to remain at rest when
at rest, and when moving uniformly in a straight line, to con-
tinue that uniform velocity indefinitely. This property is called
"inertia." Whenever a body changes from rest or from con-
stant velocity in a straight line, a force is the cause, as stated in
the first law of Newton (and Galileo): "Every body remains in
a state of rest or uniform motion in a straight line unless it is
compelled to change that state by force acting on it."
Acceleration (a) is the rate of change of velocity and may be
uniform or variable. Retardation may be regarded as negative
acceleration. Since acceleration has direction as weil as mag-
nitude, it is a vector quantity. Momentum is the product of
the quantity of matter or mass (m) of a body and its velocity
(v). Newton's second law of motion states that "the time (t)
rate of change of momentum is proportional to the impressed
force, and takes place in the direction of that force." lt fol-
lows that force is measured by the rate of change of momen-
tum: F = d(mv)/dt = m(dv/dt) = ma. A dyne is the unit of
force that gives a mass of one gram an acceleration of one cen-
timeter per second per second. A gram weight is the unit of
force that gives a 1 gm mass an acceleration g of approxi-
mately 980 cm per second per second. Therefore, 1 gm
weight = g dynes.
113
Graphical Representation of Forces
Quantities like force and velocity, which involve both mag-
nitude and direction, are called "vector quantities." Any vec-
tor can be represented by an artow . The effect of a force de-
pends on its line of action and its point of application. A force
applied to a rigid body may be regarded as acting anywhere
along its line of action. The components of a force are the ef-
fective values of a force in directions other than that of the
force itself. The component in any direction making an angle
0 with that of the force vector Fis equal to F cos 0. The com-
ponents of F in mutually perpendicular directions are called
the "rectangular components" of F in these two directions.
Any force may be replaced by its rectangular components.
Sets of forces which lie in the same plane are coplanar. Sets of
forces with the same point of application are concurrent.
Any two forces meeting at a point can be replaced by a sin-
gle resultant force. In a diagram of the forces, the resultant is
obtained by completing the parallelogram and drawing the di-
agonal that passes through the meeting point (fi g. 6.1). If the
resultant of all forces acting at a point is zero, the point and
the forces are in equilibrium. Any set of coplanar, concurrent
forces can be replaced by a single force whose effect is the
same as that of the given forces and is called their "resultant."
The torque, or moment, of a force about an axis is the
product of the force and the force arm, or moment arm of
force, about the axis. The moment arm is the perpendicular
distance from the axis of rotation to the li11e of action of the
force (fig. 6.2). The algebraic sum of the moments of a11y two
forces is equal to the moment of their resulta11t. The algebraic
sum of the moments, about any point, of any 11umber of co-
planar forces in equilibrium is zero. A moment has a sense,
clockwise or cou11terclockwise (positive or negative).
The forces 011 a body often reduce to two forces of equal
magnitude and opposite direction, having lines of action that
are parallel. Such a pair of forces is called a "couple" (fig.
6.3). Any set of copla11ar, nonconcurrent forces can always be
degenerated to a si11gle couple a11d a single force.
The only effect of a couple is to produce a twisting action.
The twisting actio11 of a couple is measured qua11titatively by
the mome11t of the couple, also called the "couple-moment"
or "torque." The couple-moment equals the product of one of
the forces composing the couple times the perpendicular dis-
ta11ce between the forces.
In fig. 4.12, RN a11d the algebraic sum of V N and CN consti-
tute a couple. The couple-moment RN · a is clockwise. In the
same figure, VN and the differe11ce of CN and V N also consti-
tute a couple. The couple-moment V N • (b - a) is equal and
opposite to that of RN · a.
The first co11ditio11 of equilibrium is stated as follows: two
or more forces co11curre11t at a poi11t are in equilibrium if their
resultant is zero. Expressed in symbols: 1Fx = 0, lF11 = 0,
where the subscripts x and y indicate mutually perpendicular
reference axes in the place of actio11 of the forces. lt follows
that two or more coplanar forces are in equilibrium if the sum
of their compone11ts, taken along two mutually perpendicular
axes, 1s zero.
The second co11ditio11 of equilibrium is that the algebraic
sum of all torques acti11g upon a body in equilibrium about an
axis is zero: lM = 0. The conditio11s of equilibrium express
relatio11s among the forces acting on a body in equilibrium.
LARYNGEAL BIOMECHANICS
B D
A C
Fig. 6.1 Parallelogram of forces. Forces are vector quantities. Th e
vector sum of forces AB and AC is AD.
F,
Fig. 6.2 Moment of a force. OA, moment arm of force F, about
axis O; OB, moment arm of force F 2 about axis O; F 1 X OA: mo-
ment of the force F1 about O; F 2 X OB: moment of the force F2
about 0.
F Friction occurs when a solid obj ect i
0 and is called "frictional force. " Wh en
F left acts on the block, and an equal fo
Fig. 6.3 Couples. F, F, two parallel forces equal in magnitude but
opposite in direction constitute a couple. The only effect of a coupl e
is to produce rotation . The moment of the couple is independent of
the position of O and is equal to F x e.
114
To represent these, a sketch of the str
made and the forces exerted on it are
represents a free-bod y diagram of the
The weight of a body is the resulta
of attraction of the earth 011 the partic
sulta11t of the weights of all the elemen
through a certain fixed point in the bo
gravity."
Newton derived a third law from
between colliding bodies: "Action and
opposite." Whenever one body exerts
second always exerts on the first a f
magnitude, opposite in direction , and
tion. This principle applies primarily tc
pressure by a weight on a table is equ~
table on the weight. The action-reacti<
on different bodies.
Work is clone by a force when it disp
W clone by the force while it displ aces
the product of the displacemen t d and
force in the direction of the displaceme
is the ability to do work. An erg is the
whe11 a force of one dyne is exerted on
displaced one centimeter in the direct
the force continues to act. In brief, an e
Power is the rate of doing work. P<
time= W/t.
zontal surface, and a constant force is J
motion at a constant speed. This force i
the resistance provided by irregulariti
to right along the surface of th e table,
the table. Frictional force at a joint is f
mal force between the articular surf:
pressing the two surfaces together. lt
the normal force and, to a good apprc
 D To represent these, a sketch of the structure at equilibrium is
made and the forces exerted on it are shown. The sketch then
represents a free-body diagram of the isolated structure.
The weight of a body is the resultant of the parallel forces
of attraction of the earth on the particles of the body. The re-
sultant of the weights of all the elements of a rigid body passes
C
through a certain fixed point in the body called the "center of
gravity."
Forces are vector quantities. The Newton derived a third law from experiments on impact
, AD. between colliding bodies: "Action and reaction are equal and
opposite." Whenever one body exerts a force on another, the
second always exerts on the first a force which is equal in
magnitude, opposite in direction, and has the same line of ac-
tion. This principle applies primarily to two bodies in contact:
pressure by a weight on a table is equal to the pressure of the
table on the weight. The action-reaction pair necessarily acts
on different bodies.
Work is clone by a force when it displaces a body. The work
W clone by the force while it displaces the body is defined as
the product of the displacement d and the component of the
force in the direction of the displacement: W = F · d. Energy
, moment arm of force F 1 about is the ability to do work. An erg is the amount of work clone
F2 about axis O; F 1 X OA: ma-
when a force of one dyne is exerted on a body and the body is
x OB: moment of the force F2
displaced one centimeter in the direction of that force while
the force continues to act. In brief, an erg is a dyne centimeter.
Power is the rate of doing work. Power = work per unit
time= W /t.
F Friction occurs when a solid object is pushed across a hori-
zontal surface, and a constant force is required to maintain its
motion at a constant speed. This force is required to overcome
the resistance provided by irregularities in the two surfaces
and is called "frictional force." When a block slides from left
to right along the surface of the table, a frictional force to the
F
left acts on the block, and an equal force to the right acts on
el forces equal in magnitude but the table. Frictional force at a joint is proportional to the nor-
•uple. Tbe only effect of a couple mal force between the articular surfaces, that is, the force
t of the couple is indepcndent of pressing the two surfaces together. lt acts at right angles to
X f.
the normal force and, to a good approximation, is independ-
115
ent of the area of the surface of contact. lt depends on the na-
ture of the surfaces, as weil as their state of roughness and
wetness. "Normal" here indicates a direction at right angles
to the tangential surface. If the force of limiting friction is
denoted by F and the normal reaction by R, then F = Rµ,
where µ, is the coefficient of friction.
When a body rotates, it is said to have angular velocity.
Angular acceleration a is the rate of increase of angular veloc-
ity. Moment of inertia I depends on the mass and its distance
from the axis of rotation. lt is equal to the integral sum of
the elements of mass multiplied by the square of their distances
r from that axis: I = Lmr 2 • In a body pivoted about a fixed
axis the sum of external torques M is equal to the moment
of inertia times the angular acceleration.
Load is a general term referring to any force that is applied
to a solid object. Forces can always be broken down into a
perpendicular, or normal, component and a horizontal com-
ponent. Perpendicular force is classified as compression when
it makes an object shorter in the direction of the applied force
and as tension when it makes an object longer. Force applied
parallel to a surface is called "shear." Force that resu!ts from
transmission of a load is called "stress." Stress is simply load
per unit area: S = P/ A, where S equals stress, P, load, and A,
area. When a load is applied to an object, deformation, or
strain, results. Tensile strain is the amount of stretch under
e
load per unit length of the unstretched body: e = /L, where e
equals strain, e, total amount of stretch, and L, original total
length.
The compressive strain of a body in compression is the ratio
of the decrease in length to the original length.
When a load or stress is applied to a spring, the spring is
stretched an amount x, the spring gains elastic potential en-
ergy Ee = ½kx 2 ; k is a constant of proportionality called the
"force constant" of the spring. The spring's ability to return
completely to its original size and shape when the load is re-
moved is called "elasticity." The ratio of the stress to the
strain is called the "modulus," or "coefficient of elasticity," or
"Young's modulus." Stress/ strain = constant = E =
ELEMENTS OF BIOMECHANICS

N
E lar components. One component is a meshwork of collag-
E
----
~
0)
C/J
C/J
~
U)
10 20 30
Elongation(%)
St ress-strain curve of wet
elastic cart i lage (Yamada , 1970)
Young's modulus. Modulus is a coefficient or number that
expresses the degree to which a substance possesses some
property. E describes the elastic stiffness of a material as
such; its inverse is called the "elastic flexibility."
A shearing strain is a condition in or deformation of an
elastic body that tends to produce a parallel sliding motion of
the body's planes. If a heavy book, such as a medical text, is
placed on the table and the upper cover is forced sideways, th e
leaves all move over their neighbors from top to bottom. The
shearing motion of the leaves is produced by lateral forces,
and the shearing strain is defined as the amount of lateral dis-
placement per unit thickness or height. In trigonometric
term s, the shearing strain is defined as th e tangent of the angle
<p. In materials where <p is small , tan <p is very nearly equal to
<p (in radians). The ratio of the shearing stress to the corre-
sponding shearing strain is called the "shear modulus" of a
material. lt is also called the "mod ulus of rigidity" or the
"torsion modulus."
Strength is the capacity of a passive material to resist force
without breakage or permanent deformation. In active ma-
terials such as muscle, strength is the capacity to support a
load by virtue of the capacity to shorten.
LARYNGEAL BIOMECHANICS
Biomechanics
Cartilage is a composite material, consisting of two dissimi-
enous or, in some cases, elastic fibers. The other component is
a glycoprotein. Collagenous fibers are flexible at low loads
and become increasingly stiff (resistant to elongation) as the
load increases. Because of its heterogeneity, one cannot speak
of an elasticity modulus of cartilage, but one may measure,
instead, its force-deformation (stress-strain) characteristics
(Yamada, 1970), and note the slope of the plot at various
points.
To comprehend the whole we have to divide it into parts:
In biomechanics the subdivisions are made in pursuit of a
dual objective: (1) The subsystem shall be restricted to in-
clude only those living interrelationships being studied.
(2) The subsystem must be reducible to a model amenable to
quantitative analysis.
In terms of the mechanics of solids, the laryngeal cartilages
at equilibrium are members in which external loads cause in-
ternal stresses of four types : an axial force, a shear force, a
bending moment, and a torque, or twisting moment.
Axial force. This component tends to elongate the
member.
Shear force. These components tend to shear one part
of the member relative to the adjacent part.
Twisting moment. This component is responsibl e for
the twisting of th e member about its axis.
Bending moment. These components cause the mem-
ber to bend.
Shear forces and twisting moments within the laryngeal
cartilages are here assumed to be of negligibl e magnitude in
relation to external forces and moments on the laryngeal car-
tilages. For convenience, these are resolved into tangential
and normal components.
116
llllCS

11, consisting of two dissimi-

t is a meshwork of collag-
•ers. The other component is
rs are flexible at low loads
,istant to elongation) as the
rogeneity, one cannot speak
age, but one may measure, GLOSSARIES
,tress-strain) characteristics
lope of the plot at various
REFERENCES
have to divide it into parts:
s are made in pursuit of a
n shall be restricted to in- INDEX
:lationships being studied.
ble to a model amenable to

lids, the laryngeal cartilages

,ich external loads cause in-
1xial force, a shear force, a
,r twisting moment.
tends to elongate the

ts tend to shear one part

: adjacent part.
onent is responsible for
bout its axis.
mnents cause the mem-

nents within the laryngeal

of negligible magnitude in
ments on the laryngeal car-
re resolved into tangential
 Glossary of Anatomical Terms
These de-{initions assume the correctn ess of the mechanical
coupling model of laryngeal biomechanics.
Abduction in divergence The later phase of inspiratory
opening of the glottis, during which mechanical coupling
rocks the arytenoids backward, carrying the tips of the
vocal process upwards and outwards. The return expi-
ratory excursion is energized by elastic recoil.
Abduction in parallel The earlier phase of inspiratory open-
ing of the glottis, during which the medial surfaces of the
vocal processes of the arytenoids remain parallel or
slightly convergent. During this phase mechanical cou-
pling slides the arytenoids laterally. The return expira-
tory excursion is energized by elastic recoil.
Adduction of arytenoids Active apposition of the arytenoid
cartilages by the M. arytenoideus, usually starting from
the reference end-expiratory position.
Aditus The entrance of the larynx, particularly the space be-
tween the aryepiglottic folds.
Aerodynamic pressure drop The fall in potential energy that
is reciprocal to the increase in kinetic energy occasioned
by flow through a constriction.
Angle of flare Upward divergence of the laminae of the thy-
roid cartilage. The angle tends to be diminished during
passage of swallowed bolus past the larynx.
119
Ansa cervicalis The nerve loop formed by the union of th e
descending branch of the hypoglossal nerve (which con-
tains only fibers from C 1 ) and the lower root of the ansa
from C2 and C3 • lt supplies the sternohyoid and sterno-
thyroid muscles. The thyrohyoid muscle is supplied by a
branch of the hypoglossal nerve containing fibers derived
from its communication with Ci.
Articular process Synonym: muscular process of the aryte-
noid cartilage.
Aryepiglottic fold Paired uppermost part of the lateral la-
ryngeal wall and entrance, supported internally by the
quadrangular membrane.
Aryepiglottic muscle Forward continuation of the oblique
arytenoid muscle. lt ends at the margin of the epiglottis
and braces the free border of the aryepiglottic fold.
Arytenocricoid unit The integral mechanical unit or Jever
formed by the adducted arytenoid cartilages locked to
each other and to the cricoid cartilage.
Arytenoid cartilage Paired, pyramidal hyaline cartilage sus-
pended from the epiglottis and supported on the cricoid
cartilage, to which the paired laryngeal folds are attached
and whose lateral movement regulates the size of the
glottis.
Ceratocricoid ligament Paired elastic bands that strengthen
the cricothyroid joint.
Check ligament A noncapsular band that restrains a specific Cricothyroid ligament Median and lateral elastic bands that folds in effort closure. The u
movement between joint surfaces. For example, the pos- respectively suspend the anterior arch of the cricoid from folds back over the top of the a
terior cricoarytenoid liga ment restra ins the lateral slide the isthmus of the thyro id cartilage and the side of th e closure.
of the ary tenoid at th e cricoarytenoid joint. cricoid from the thyroid inferior horn. The lateral liga- Epiglottic tubercle The con vex int
Corniculate cartilage Paired hornlets of elastic fibrocarti- ments are also known as the ceratocricoid ligaments and the epiglottic cartilage that
lage that project posteromedially from the top of th e a ry- regulate movement at the cricothyroid joint. top of the adducted vestibula
Cricothyroid muscle Fan-shaped muscle whose fibers di - larynx.
tenoids and function as shock absorbers and reopening
springs for the adducted arytenoids . verge upwards and backwards from the anterolateral Epiglottis The upper, pharyngeal
surface of th e cricoid to the inferior border and horn of glottic cartilage.
Corniculate tubercle Mucosa-covered projection of the cor-
niculate cartilage, situated posteriorly at the entrance of the thyroid cartilage. The straight part of the muscle is External frame function Partial co
the larynx. anterior, the oblique part posterior. lt is the tensor of the ation by extrinsic mu scles. Th .
Cornu major The greater horn of the hyoid bon e; a long vocal ligament. non is unclear.
backward projection from the body of the hyoid bone Cricovocal membrane Elastic sheet that connects the vocal Extrinsic muscle A muscl e that joi
forming the side of the hyoid arch. ligament to the upper border of the cricoid cartilage and tralaryngeal structure.
Cornu minor The lesser horn of the hyoid bone ; a short up- supports the muscle of the vocal fold. Fold A continu ous double layer
ward proj ection at the junction of the body and cornu Cuneiform cartilage Paired rod of elastic fibrocartilage this book th e meaning of the ·
major of the bone. lt gives attachment to the stylohyoid bound to the anterolateral aspect of the arytenoid. lts clude the entire mechanical sub1
ligament. lower end is forced medially in laryngeal closure, but at layer and the enfolded tissue a~
other times, it retains the vestibular and aryepiglottic Folding lncreased angularity of thJ
Cricoarytenoid joint Articulation at which the arytenoid
geal fold. I
cartilage slides or rocks on the posterolateral corner of folds to the side of the open cavity.
the cricoid ring. Cuneiform tubercle Mucosa-covered projection of the top Folding confluence The region aro
fluence on which th e medi an th
Cricoarytenoid ligament A paired stout triangular band that of the cuneiform cartilage, anterolateral to the cornicu-
joins the back of the cricoid cartilage to the medial edge late tubercle. aryepiglottic, vestibular, an d vc
Formant Any of several frequency
of the base of the arytenoid cartilage. lt checks the latera l Digastric muscle Two-bellied muscle whose intermediate
intensity in a sound spectru m, '
inspiratory excursion of the arytenoid cartilage. tendon slides in a cuff attached to the side of the hyoid
the characteristic quality of a v
Cricoid cartilage A ring of hyaline cartilage at the base of bone and slings the hyoid from the chin and mastoid
Gesture A motion of the body or
the suspensory mechanical system of the larynx. notch, thus preserving mobility without sacrificing sus-
Glottic closure The configuration c
Cricopharyngeal muscle The lower part of the inferior con- pensory support.
tained during phonatory adduc
strictor muscle. lts fib ers spread backwards and medially Effort closure Hermetic closure of the larynx that facilitates
from the side of the cricoid cartilage and are inserted into tilages.
pressurization and stabilization of the thorax and abd o-
Glottic spasm Rhythmical, in vo
the median posterior raphe (seam) of th e pharynx. ln- men for supportive or expulsive efforts.
glottis, accompanied by "music
feriorly, its fibers are continuous with the circular layer Elastic recoil The passive return of laryngeal folds to their
of the esophagus. tory stridor.
reference end-expiratory configuration.
Glottis The region of the laryngea
Cricothyroid joint Articulation at which the cricoid ring is Epiglottic cartilage A leaf-shaped elastic fibrocartil age at the
suspended from the inferior horn of th e thyroid cartilage; vocal fold s.
front of the laryngeal entrance; the lower part, or petiole
Hyoepiglottic ligament The stron i
the joint allows rotatory and transl atory (gliding) motion (leaf-stem), bea rs the epiglottic tubercle, a swelling that
the back of the arch of the hyoi
between the cartilages. presses against the adducted aryepiglottic and vestibular

GLOSSARY OF ANATOM ICAL TERMS 120


and lateral elastic bands that
:erior arch of the cricoid from
cartilage and the side of the
ferior horn. The lateral liga-
e ce ratocricoid ligaments and
ricothyroid joint.
ed muscle whose fibers di-
ards from the anterolateral
: inferior border and horn of
traight part of the muscle is
,sterior. lt is the tensor of the
.heet that connects the vocal
r of the cricoid cartilage and
,ocal fold.
)d of elastic fibrocartilage
aspect of the arytenoid. Its
, in laryngeal closure, but at
vestibular and aryepiglottic
cavity.
vered projection of the top
mterolateral to the cornicu-
muscle whose intermediate
hed to the side of the hyoid
from the chin and mastoid
lity without sacrificing sus-
of the larynx that facilitates
on of the thorax and abdo-
,ive efforts.
1 of laryngeal folds to their
1figuration.
:i elastic fibrocartilage at the
e; the lower part, or petiole
tic tubercle, a swelling that
aryepiglottic and vestibular
folds in effort closure. The upper part, the epiglottis,
folds back over the top of the adducted folds in swallow
closure.
Epiglottic tubercle The convex intralaryngeal projection of
the epiglottic cartilage that presses back against the
top of the adducted vestibular folds in closure of the
larynx.
Epiglottis The upper, pharyngeal or leaflike part of the epi-
glottic cartilage.
External frame function Partial control of the pitch of phon-
ation by extrinsic muscles. The extent of the phenome-
non is unclear.
Extrinsic muscle A muscle that joins the larynx to some ex-
tralaryngeal structure.
Fold A continuous double layer of mucous membrane. In
this book the meaning of the term is broadened to in-
clude the entire mechanical subunit formed by the double
layer and the enfolded tissue at the base of the fold .
Folding Increased angularity of the inner surface of a laryn-
geal fold.
Folding confluence The region around the ligamentous con-
fluence on which the median thyrohyoid fold and paired
aryepiglottic, vestibular, and vocal folds converge.
Formant Any of several frequency regions of relatively great
intensity in a sound spectrum, which together determine
the characteristic quality of a vowel sound.
Gesture A motion of the body or body parts.
Glottic closure The configuration of the laryngeal cavity ob-
tained during phonatory adduction of the arytenoid car-
tilages.
Glottic spasm Rhythmical, in voluntary closure of the
glottis, accompanied by "musical" inspiratory or expira-
tory stridor.
Glottis The region of the laryngeal cavity at the level of the
vocal folds.
Hyoepiglottic ligament The strong elastic sheet that unites
the back of the arch of the hyoid bone to the front of the
121
epiglottic cartilage between the epiglottis and epiglottic
tubercl e.
Hyoid hone The anteromedian arch of bone, suspen ded by
ligaments and muscles from the cranium and mandible,
that supports the tongue and from which the larynx is
suspended.
Hypopharynx A functional subdivision of the pharynx situ-
ated below and posterior to the inlet of the larynx.
Inferior constrictor muscle Paired extrinsic muscle that
sweeps round the back of the pharynx from one oblique
line to the other. The united muscles tend to pull the lam-
in ae of the thyroid cartilage in ward and upward as they
propel a bolus downward .
lnterarytenoid fold The mucosa and muscle joining the two
arytenoid cartilages. One of the eight mechanical sub-
units th at make up the fold system of th e larynx.
lntrinsic muscle A mu scle that moves one p art of the larynx
relative to another part of the larynx.
Isthmus A narrow part conn ecting two !arger parts. In the
larynx, the anteromedian junction of the diverging pl ates
or lamin ae of the thyroid cartilage.
Lamina A plate. Specifically, the roughly quadrilateral plate
of the thyroid cartilage th at joins its fellow anteriorly to
form the isthmus. The term is also applied to the broad
posterior part of the cricoid ring.
Laryngospasm Synonym: laryngeal spasm. An ill-defined
term that ought to signify persistent involuntary effort
closure of the larynx but has often been used loosely as a
synonym for glottic spasm. Prevents respiratory ex-
change and is therefore generally silent.
Larynx The part of the respiratory tract between the trachea
and the pharynx. lt is composed mainly of cartilages and
folds that regulate the size of the air passage.
Lateral cricoarytenoid muscle Arises from the upper border
of the arch of the cricoid cartil age and courses obliquely
upward and backward to the front of the muscular pro-
cess of the arytenoid cartilage. Classically considered to
GLOSSARY OF ANATOMICAL TERMS
 close the glottis. The mechanical coupling hypothesis as- Oblique line Latin: linea obliqua. A shallow ridge at which that supplies the in nervation 0
cribes to it a posture-maintaining function during aryte- certain extrinsic muscles are attached to the outside of of the larynx except the cricot
noid sliding, complementary to that of the posterior cri- the lamina of the thyroid cartilage. The ridge is strategi- sory innervation of the muco
coarytenoid muscle. cally located to facilitate auxiliary bending (folding and level of the vocal ligament.
Ligamentous confluence Region of the back of the isthmus unfolding) of the thyroid cartilage. Reference configuration The confi
of the thyroid cartilage where the thyroepiglottic liga- Palatopharyngeal muscle Extrinsic muscle that extends folds at the end of eupneic ex
ment and the paired vestibular and vocal ligaments con- from the palate to the posterior border of the thyroid folding and unfolding forces ar
verge. cartilage, rnerging with and acting like the stylo- librium.
Locking The functional clamping of the arytenoids to each pharyngeus. Rima glottidis Cleft of the glottis.
other and to the cricoid cartilage that results frorn the ad- Paramedian axis of vibration A curved outward bowing of peromedial borders of the voc
ductor action of the arytenoideus rnuscle. the vocal ligament preceding the onset of vibration at low Rocking The curvilinear excursion1
Lower horn (cornu inferior) Projection from the lower pos- fundamental frequencies, caused by adduction of the facet across the cricoid articula~
terior corner of the lamina of the thyroid cartilage; it ar- posterior end of the ligament. is at the outer end of the latteq
ticulates with the side of the cricoid ring at the crico- Petiole The lower part of the epiglottic cartilage. In botany, and forward in expiration.
thyroid joint. the stalk by which a leaf is attached to a stem. Rotation Relative motion of the ~
Mechanical coupling The postulated rnode of conversion of Pharynx The muscular funnel through which air and food lages on the cricothyroid interai
the vertical momentum of the larynx to roughly trans- pass respectively from the nose and mouth to the larynx the cricothyroid muscle in one q
verse momentum of the arytenoid cartilages that leads to and esophagus. coil in the other.
respiratory variations in the configuration of the laryn- Piriform recess Compartment of the hypopharynx lateral to Saccule An upwa rd recess of the •
geal cavity. the arytenoid cartilage. lt facilitates the movements of mits lubricant mucus from vesl
Median thyrohyoid fold Mucosa-lined mechanical subunit the cartilage. face of the vocal fold.
formed by the epiglottis, the epiglottic tubercle, and the Posterior cricoarytenoid muscle Converges upward and lat- Sinus laryngis, or ventricle The lar
ligament-enclosed fatty tissue anterior to the latter. erally from the back of the cricoid cartilage to the pos- that intervenes between the vo,
Muscular process Synonym: articular process. Posterolat- terolateral muscular process of the arytenoid cartilage. Sternohyoid muscle An accessory
eral projection from the base of the arytenoid cartilage Classically it is considered to separate the vocal folds, but pulls the body of the hyoid tov.
that bears the articular facet on its undersurface and the timing of its electrical activity is more consistent with facilitating descent of the lary;
gives attachment to the posterior and lateral cricoaryte- a postural stabilizing action on the arytenoid during the airway at the back of the tongt
noid muscles. sliding phases of abduction and adduction. Sternothyroid muscle An extrinsic
Myoelastic-aerodynamic theory of phonation The theory Posture A position or attitude of the body or bodily parts. of its attachments to the sternu,
that air flow between vocal ligaments rendered tense by Prominentia laryngis The prominent forward projection to draw the thyroid cartilage ca
muscular contraction generates the audible oscillations formed by the convergence of the upper margins of the outward, and cause internal lar
of the vocal folds. laminae of the thyroid cartilages colloquially called Stylohyoid ligament Paired elastic
Oblique arytenoid muscle Crosses from the back of the Adam's apple. hyoid bone at the cornu minor
muscular (or articular) process of one arytenoid cartilage Quadrangular membrane A paired quadrilateral elastic of the base of the skull.
to the apex of the opposite cartilage. Some of its fibers sheet that suspends the arytenoid cartilage from the mar- Styloid process Paired spear-like pr
are prolonged forward into the aryepiglottic fold where gin of the epiglottic cartilage and supports the aryepiglot- the skull from which th e hyoid
they constitute the aryepiglottic muscle. The muscles tic and vestibular folds. stylohyoid ligament and musclf
form a truss of support for the adducted arytenoids. Recurrent laryngeal nerve The branch of the vagus nerve Stylopharyngeal muscle An extrins

GLOSSAR Y OF ANATOM ICAL TERMS 122

1a. A shallow ridge at which
~ attached to the outside of
rtilage. The ridge is strategi-
xiliary bending (folding and
rtilage.
insic muscle that extends
:erior border of the thyroid
nd acting like the stylo-
. curved outward bowing of
the onset of vibration at low
rnsed by adduction of the
t.
,iglottic cartilage. In botany,
lttached to a stem.
hrough which air and food
)Se and mouth to the larynx
f the hypopharynx lateral to
acilitates the movements of
Converges upward and lat-
cricoid cartilage to the pos-
of the arytenoid cartilage.
separate the vocal fo lds, but
ivity is more consistent with
on the arytenoid during the
md adduction.
,f the body or bodily parts.
ninent forward projection
)f the upper margins of the
rtilages colloquially called
aired quadrilateral elastic
1oid cartilage from the mar-
and supports the aryepiglot-
branch of the vagus nerve
that supplies the innervation of all the intrinsic muscles
of the larynx except the cricothyroid, as weil as the sen-
sory innervation of the mucous membrane below the
level of the vocal ligament.
Reference configuration The configuration of the laryngeal
folds at the end of eupneic expiration, when the elastic
folding and unfolding forces are postulated to be in equi-
librium.
Rima glottidis Cleft of the glottis. The space between the su-
peromedial borders of the vocal folds.
Rocking The curvilinear excursion of the arytenoid articular
facet across the cricoid articular facet when the arytenoid
is at the outer end of the latter; backward in inspiration
and forward in expiration.
Rotation Relative motion of the cricoid and thyroid carti-
lages on the cricothyroid interarticular axis, governed by
the cricothyroid muscle in one direction and by elastic re-
coil in the other.
Saccule An upward recess of the sinus laryngis that trans-
mits lubricant mucus from vestibular glands to the sur-
face of the vocal fold.
Sinus laryngis, or ventricle The laryngeal sinus is the gutter
that intervenes between the vocal and vestibular folds.
Sternohyoid muscle An accessory respiratory muscle that
pulls the body of the hyoid toward the sternum, thereby
facilitating descent of the larynx and straightening the
airway at the back of the tongue.
Sternothyroid muscle An extrinsic muscle, which, because
of its attachments to the sternum and oblique line, tends
to draw the thyroid cartilage caudally, bend the laminae
outward, and cause internal laryngeal unfolding.
Stylohyoid ligament Paired elastic band that suspends the
hyoid bone at the cornu minor from the styloid process
of the base of the skull.
Styloid process Paired spear-like projection from the base of
the skull from which the hyoid bone is suspended by the
stylohyoid ligament and muscle.
Stylopharyngeal muscle An extrinsic muscle, which elevates
123
the larynx because of its attachments to the styloid pro-
cess and posterior border of the thyroid cartilage.
Subglottic Below the level of the glottis.
Subluxation A partial separation of articular surfaces by
sliding, encountered at the cricoarytenoid and cnco-
thyroid joints.
Superior laryngeal nerve The branch of the vagus nerve
whose external subdivision supplies the cricothyroid
muscle. The internal subdivision supplies sensory fibers
to both surfaces of the epiglottis, the aryepiglottic fold,
and the interior of the larynx down to the level of the
vocal folds.
Thyroarytenoid muscle, external division Arises from the
back lower half of the isthmal region and from the crico-
thyroid ligament and loops laterally and upward tobe in-
serted into the anterolateral surface of the arytenoid car-
tilage. Contraction straightens the fibers of the loop and
forces the tissues medial to the loop into apposition. lt is,
thus, the adductor of the vestibular fold.
Thyroepiglottic ligament A median elastic band that binds
the stem of the epiglottic cartilage to the thyroid
cartilage at the ligamentous confluence behind the
isthmus.
Thyroepiglottic muscle Fibers of the thyroarytenoid muscle
that are continued upward into the aryepiglottic fold,
where some of them end. Others end at the epiglottis.
The former may serve to infold the entrance mucosa of
the larynx during laryngeal closure.
Thyrohyoid ligaments Median and lateral elastic bands that
respectively suspend the prominence of the thyroid carti-
lage from the body of the hyoid bone and the tip of the
thyroid superior horn from the cornu major of the hyoid
bone.
Thyrohyoid membrane A continuous thin elastic sheet sus-
pending the thyroid cartilage from the hyoid bone,
strengthened posterolaterally and anteriorly by the
thyrohyoid ligaments.
Thyroid cartilage The prominent cartilage at the front of the
GLOSSARY OF ANATOMICAL TERMS
 larynx on which seven of the eight laryngeal folds con- Vestibule The region of the laryngeal cavity between the
verge. vestibular folds. The term is often extended to include the
Trachea The tube that carries air from the larynx to the space between the aryepiglottic folds.
lungs. Visor angle, or the cricothyroid angle The angle formed by
Translation Sliding movement between the facets of the cri- the upper rim of the cricoid cartilage and the lower bor-
cothyroid joint that alters the tension of the vocal liga- der of the thyroid lamina; it narrows during phonation
ments. Contrasts with rotation. but is otherwise invariant.
Transverse arytenoid muscle The adductor muscle of the
arytenoids. lt runs horizontally from the back of one ary-
Vocal fold Paired mucosa-covered shelf of muscle supported
by the cricovocal membrane and vocal ligament, and sep-
Glo
tenoid cartilage to the other. arated from the vestibular fold by the laryngeal sinus.
Triticea cartilage The nodule of hyaline cartilage often pres- Vocal lever of the thyroid cartilage The idealized lever ex-
ent in each lateral thyrohyoid ligament. Its presence tending from the attachment of the vocal ligament at the Acceleration The rate of change
renders overextension of the middle of the ligament isthmus of the thyroid cartilage, back along the lamina time.
unlikely. and down the inferior horn of the cartilage to the crico- Aerodynamic pressure drop Th e fc
Upper horn (cornu superior) Projection from the upper thyroid articular ligament. is reciprocal to the in crease in .
posterior corner of the lamina, by which the thyroid car- Vocal ligament Elastic thickening at the upper margin of the by flow through a constriction l
tilage is suspended from the tip of the hyoid cornu major cricovocal membranes; extends from the tip of the vocal Bernoulli effect Manifestation at t
by a ligament, the lateral thyrohyoid ligament. process of the arytenoid cartilage to the ligamentous con- principle, which states that
Ventricle The sinus laryngis. fluence at the back of the isthmus. pressure is least where the velc
Vestibular fold Paired arythyroid continuation of the ary- Vocal muscle The medial part of the thyroarytenoid muscle that the total energy is constan
epiglottic fold, thickened by mucous glands and by the in the substance of the vocal fold. Its contraction regu- Compression Diminution of size l
vestibular ligament in its lower border. lates the tension of the nonligamentous part of the vocal Couple Two forces of equal magn
Vestibular ligament Elastic thickening in the lower free fold . posite directions of action, ca1
border of the quadrangular membrane; extends from the Vocal process Stubby anteromedial projection from the base but not translation.
root of the vocal process, above the vocal ligament, to the of the arytenoid cartilage to which the vocal ligament is Couple-moment, or moment of a eo
back of the isthmal region of the thyroid cartilage. attached. of a force couple, mea sured by
tude of one force of the couple :
tance between th e two forces.
Directrix The fixed curve traverse
erating a cone or a cy linder.
Elasticity The ability to recover frc
returning to an initial form fol
Energy The capacity to do work:
system is capable of doing in
state to a specified reference st
Force A vector quantity that tenc
the direction of its app li cation.

GLOSSARY OF ANATOMICAL TERMS 124

aryngeal cavity between the
often extended to include the
)ttic folds.
angle The angle formed by
cartilage and the lower bor-
it narrows during phonation

red shelf of muscle supported

: and vocal ligament, and sep-
:old by the laryngeal sinus.
lage The idealized Jever ex-
t of the vocal ligament at the
ilage, back along the lamina
of the cartilage to the crico-
ng at the upper margin of the
,nds from the tip of the vocal
:ilage to the ligamentous con-
;thmus.
of the thyroarytenoid muscle
Glossary of Physical Tertns
Acceleration The rate of change of velocity with respect to
time.
Aerodynamic pressure drop The fall in potential energy that
is reciprocal to the increase in kinetic energy occasioned
by flow through a constriction.
Bernoulli effect Manifestation at the glottis of the Bernoulli
principle, which states that along a streamline the
pressure is least where the velocity is greatest, provided
that the total energy is constant.
Generatrix A straight line that generates a surface by mov-
ing in a specified fashion. The generatrix of a right circu-
lar cone moves along a circular directrix and passes
through a fixed point, the vertex, lying on the perpendic-
ular axis of the directrix.
Geometry of a cone.
vertex
1

al fold. Its contraction regu- Compression Diminution of size under pressure.

1
generatrix
1
igamentous part of the vocal Couple Two forces of equal magnitude and parallel but op- 1

~dial projection from the base

) which the vocal ligament is
posite directions of action, capable of causing rotation
but not translation.
Couple-moment, or moment of a couple The twisting action
--,---
1

of a force couple, measured by the product of the magni- directrix

tude of one force of the couple and the perpendicular dis-
tance between the two forces.
Directrix The fixed curve traversed by a generatrix in gen-
erating a cone or a cylinder.
Elasticity The ability to recover from strain. The property of
returning to an initial form following deforrnation.
Energy The capacity to do work: the work that a physical
systern is capable of doing in changing from its actual
state to a specified reference state.
Force A vector quantity that tends to accelerate a body in
the direction of its application.
axis [
Kinetic energy Energy associated with motion.
Lever A bar pivoted on a fixed hinge or fulcrum arranged so
that a force applied at one part of the bar can overcome a
resistance elsewhere.
Mass The quantity of matter a body contains, measured by
the inertia or resistance of the body to linear acceleration .
Modulus A coefficient that indicates the relation between
amount of physical-effect and arnount of force producing
it, and expresses the degree to which a substance pos-
sesses some property.

125
Moment The product of a quantity, usually a force, and its
moment arm or perpendicular distance from a reference
point.
Moment of inertia The rotational equivalent of mass. Thus,
the resistance of a body to angular acceleration.
Momentum The product of the mass of a body and its ve-
locity.
Normal Perpendicular to.
Oscillation Variation between alternate extremes, with ade-
finable period.
Posture A position or attitude of the body or body parts.
Potential energy Energy associated with position.
Power The rate at which work is done.
Pressure Force applied over a surface measured as the force
per unit area.
Resistance Opposition to flow.
Rigidity The ratio of shearing stress to shearing strain.
Casually called stiffness.
Shearing strain A condition in or deformation of an elastic
G LOSSAR Y OF PHYS ICAL T ERMS
body caused by forces; an opposite but parallel sliding
motion of the body's planes.
Stiffness See Young's modulus, rigidity.
Strain A deformation produced by stress.
Stress An applied force that tends to strain or deform a
body.
Tensile strength The stress needed to pul! a material asunder
by breaking all the bonds between the atoms along the
line of fracture.
Tensile stress A stress tending to produce elongation.
Tension See tensile stress.
Vector A quantity specified by a magnitude and a direction .
Vibration A rapid linear motion of an elastic solid about an
equilibrium position .
Work The product of a displacement and the component of
force in the direction of the displacement.
Young's modulus The stress that would in theory produce
elastic doubling of the length of a specimen (if the speci-
men did not break first). Symbol: E. Synonym: stiffness.
Units: force / unit area .
126
Adler, K. 1965. T he art of accompa11~
neapolis: University of Minnesot
Ardran, G. M., and Kemp, F. H. 196i
larynx in the epiglottis and closu
Radio!. 40:372-38 9.
Bartholomew, W. T. 1942. Acoustic:
Prentice-Hall.
Bertin, E. J. 1745. Sur le nouveau s:
Hague.
Best, C. H., and Taylor, N. B. 1973.
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Cavagna, G. A. , and M argaria, R. l'.
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Descartes, R., 1637. D iscours de la 11
Dodds, W. J., Hogan, W . J., Lydon, S
J. ]., and Arndorfee, R. C. 1975. <
geal motor function in normal b
Physiol. 39 :492 - 496.
Faaborg-Andersen, K. 1957. Electrorn
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Farnswo rth, D. W . 1940. H igh speed
hum an voca l cords. Bell Lab. Re,
 opposite but parallel sliding
:s.
;, rigidity.
·d by stress.
tends to strain or deform a
ded to pull a material asunder
between the atoms along the
to produce elongation.
a magnitude and a direction.
m of an elastic solid about an
:ement and the component of
~ displacernent.
hat would in theory produce
th of a specimen (if the speci-
'rnbol : E. Synonym: stiffness.
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129 REFEREN CES


Abdomin al wa ll mu scles, in effort closure, 46
Abduction of a rytenoids, 15 - 17, Fig. 2.5
Abdu ctor fo rces, Fig. 2.5
Acceleration, 113
Adam's apple, 16; in effort closure, 46
Adam 's curse, 45
Aditus, 4
Angle, cricoth yro id : in effort closure, 46; in-
vari ance in respirati on, 2
Angul a r velocity, 115
Apposition : in effort closure and phonati on,
Fig. 3.3; of a rytenoids, 6, Fig. 4.3
Arteries of larynx, 7
Articul ar facets, cu rva ture, 17, Figs. 2.6, 2.16
Aryepiglotti c fo ld, 1, 4, Fig. 1.2
Aryepiglotti c muscle, 4, Fig. l.4; in effort clo-
sure, 45, Fig. 3.5; in phonation, 72
Aryepiglotti c ridge, 45, 75, Figs. 3.5, 4.8 , 4.12,
4.13
Arytenocri coid leve r, 68
Arytenocricoid unit, 67-68, Fig. 4.1 0
Arytenoid ca rtilage, 1, 3, Fig. 1.1
Arytenoid mu scle, Fig. l .4; oblique fi bers, 6
Aryteno ids: abduction, 15- 17, Fig. 2.5; abduc-
tor rrajecrory, 19, Fig. 2.13; apposition, 6,
Fig. 4.3 ; cl amped to cricoid, 46; couplin g
fo rces, Fig. 2.16 ; divergence, 15; immobiliza-
tion , Fig. 4.3; stabilizati on, 16, Fig. 2. 6; sub-
luxation, 67, Figs. 4.1, 4.2
Axial fo rce, l 16
Axis : of balance, 3; of oscillation , 67, Fig. 4.1
Index
Bending, of th yroid lamina, 2 Co rnicul ate cartilage, 1, 3
Bending moment, 11 6 Co ugh, 48 , Fig. 3.5
Bernoulli prin ciple, 67 Coup de gla tte, Fig. 3.5
Blood supply, 7 Couple, 2, 114
Body mechani cs, in effort closure, Figs. 3.10, Couple-moment, 114, Fig. 6.3
3.11 Coupling force: aryten oid, Fig. 2.16; tracheal ,
19, Fig. 2. 13
Ca rtilage: arytenoid, l; biomechani cs, 116; Cricoarytenoid joint, 2, 3, Fig. 1. 1; in respira-
cornicul ate, 1, 3; crico id, 1, 2; cuneiform, 1, tion, Fig. 2.5 ; normal force at, 18
4 ; elastic, 1; epiglottic, 1, 3; hyaline, 1, Fig. Cricoarytenoid mu scles, 6, Fig. 1.4; fu nctio n,
1. 1; thyroid, 1, 2, 20. See also individual 6; in respiration, 17; tendin ous insertion, 7
names of cartil age C ri coid, face t for arytenoid, orientati on, 19- 20
Cavity of larynx, respiratory enlargement, 18, Cri coid-arytenoid locking, 67
Figs. 2.5, 2.7, 2. 8 Cri coid ca rtilage, 1-3, Fig. 1. 1
Center of gravity, 11 5 Cri coid ring, taper, 3
Check ligaments, 18 Cri copharyngeal ligam ent, 5
Childbirth, 48 Cri copha ryngeus fibers, 100
Cineradi ography of swallow, 97, 100, Figs. 5.1, Cricothyroid: pitch control, Figs. 4. 6 to 4.9;
5.2, 5.6, 5. 7 subluxa ti on, 2; tenso r biomechani cs, Figs.
Closure of glotti s: against in spiration, 47, Fig. 4.10, 4.11
3.7; phonatory, Fig. 4.1 Cri coth yroid angle: in effo rt closure, 46; in-
Coefficient: of elasti city, 115; of frictio n, 115 va riance in respiration, 2
Collar of larynx, 73 Cri cothyro id joint, 2 ; in effort closure, 46 ; ro-
Compression, 115; of median th yrohyoid fo ld, tation and translocatio n at, 68
Fig. 3.8 Cricothyro id ligament, 2, Fig. 1.3
Co mpressive strain, 115 Cricothyro id muscle, 6, Fig. 1.4; in effo rt clo-
Cone, geometry, 98, Figs. 5.4, 5.5 sure, 46; parts, 68; work, 66 - 67
Conoid, of downfolded epiglottis, 98 Cri covocal memb rane, 4, Fig. 1.3
Conoid al transition, 98, Figs. 5.4, 5.7 Cuneiform cartil age, 1; fu nction, 4
Consonants, 72 Curse of Adam, 45
Convergence, ligamentous, 2 Curvature of facets, 17, Figs. 2.6, 2.16
13 1
Defecation, 48
Deglutitional plication, Figs. 5.1, 5.2
Digastric muscle, Fig. 1.4; pulley, 5
Effort: expul sive, 48; supportive, 48
Effort cl osure: abdominal wall muscles 46·
compared wich phonatory closure, 47; e:o lu-
tion, 48 ; postural effect, 48 , Figs. 3.10, 3.11;
skeletal supports of larynx, Figs. 3 .1, 3. 7;
truncal forces , Fig. 3.11
Effort folding, Figs. 3.1, 3.2, 3.4 ; anteropos-
terior radiographs, Fig. 3.6; lateral radio-
graphs, Fig. 3.6; stages, 45
Elastic behavio r, in respiration, 19, Figs. 2.10,
2.11, 2.12
Elasti c cartil age, 1
Elastic elements, groups, 19, Figs. 2.10, 2.11 ,
2.12
Elasti c fl exibi lity, 116
Elastic membranes, Fig. 1.3; in respiration, 17-
18
Elasti c recoil: cranial view, Fig. 2.12; in expi ra-
ti on, 19; lateral view, Fig. 2.10; of vocal lig-
ament, 2; posterior view, Fig. 2.11
Elasti c restitution, 67, Fig. 4.1
Elasti city of vocal fold, 66
Electromyography, of arytenoid muscle, 20; of
posterior cricoarytenoid, 17
Elevator muscles of larynx, 101
End -expiration, eupneic, 18
Energy, 115
Entrance of laryngeal cavity, 4
Epiglottic ca rtil age, 1, 3
Epiglotti c downfolding in animals, 99-100
Epi glottic fo lding, 3, 97; forces, Fig. 5 .5;
models, 98 , Figs. 5.4, 5.5
Epi glottic groove, 98
Epiglottic tubercle, 3; in swa llow, 98 - 99; ver-
tex, 98, Fig. 5.4
Epiglottis, 3; folding in swallow, 98 , Figs. 5.1,
5.2
Equilibrium, conditions of, 114
Evoluti on: of effort closure, 48; of respiratory
rhythm, 18
Expiration, normal end, 1
Expulsive effort, 48
Extern al frame function, 74, Fig. 4.15
Extern al thyroarytenoid mu scle, Fig. 1.4
INDEX
Extrinsic forces , respiracory, Figs. 2.14, 2. 15
Extrinsic muscles, 21; nerve suppl y, 7
Facets, curvature, 17, Figs. 2.6, 2. 16
Flare, of thyroid lamin ae, 2
Fold: aryepiglottic, 1, 4 ; interarytenoid , 4, 5 ;
laryngeal, 3; med ian thyrohyoid, 2, 4, 5 ; of
larynx, Fig. 1.2; vestibular 1 2 4· vocal 1
2, 4. See also individual n~m~s ~f fo lds ' '
Folding, 1; cranial view, Fig. 3.5; definition,
15 ; effort, radiographs, Fig. 3.6; grades, Fig.
3.5; in effort closu re, 45, Fig. 3.4; in whis-
pering, 73-74, Fig. 4.15; of epiglotti s, 3, 97;
of thyroid carti lage, in swallow, 100, Fig.
5.7; phon atory, Fig. 4.4; system, 3
Force: graphi c representation, 113; shearing, in
effort closure, 4 7
Force constant of spring, 11 5
Force couple, 114, Fig. 6.3
Force vector, 113, Fig. 6.1
Forces: in epiglottic fo lding, Fig. 5 .5; of aryte-
noid coupling, Fig. 2.16; of mechanical cou-
pling, Fig. 2.13; on arytenoid, respiratory,
20, Fig. 2.16; o n vocal lever, 69, Fig. 4.11;
respiratory, Figs. 2.14, 2.15; truncal, Fig.
3. 11
Formants, 69, 73, Fig. 4 .12
Frame fun ction, external , 74, Fig. 4.15
Framework, anatomi ca l, 1
Free body diagram: arytenoid cartilage, in res-
piration, Fig. 2.16; thyro id ca rtilage, in into-
nation, Fig. 4. 13
Frequency, regulati on of, 65
Friction, 115
Glands, muco us, 4
Glottal resistance, 66- 67
Glottic resistan ce, 70
Glottis: closure, 47, Figs. 3.7, 4.1; triangular,
in birds, 18
Golgi tendon o rgan, 6
Hyaline cartilage, 1, Fig. 1.1
Hyoepiglottic ligament, in swall ow, 98, Fig. 5.3
Hyoid bone, 1, Figs. 1.1, l.4; hyperelevation in
swallow, 98, Figs. 5.1 , 5.2; in effo rt closure,
46, Fig. 3.7; in inspi ration, 16; rnotion in
swallow, 97, Figs. 5.1, 5.2; suspension , 5
132
lnertial moment, 3
Infant larynx, 101
Inferior constri ctor rnuscle, in swall ow, 100 -
101 , Fig. 5.7
Inspiration: 16, Figs. 2.1 eo 2.4; laryngeal clo-
su re aga inst, 47, Fig. 3.7; latera l view, Fig.
2.3; posterior view, Figs. 2.4, 2.5; twisting
couple in, 2
ln spiratory unfolding: cranial view, Fig. 2.7;
lateral view, Fig. 2.8; posterior view, Fig. 2.5
Inrerarytenoid fold, 4 - 5, Fig. 1.2
Interna! stress, 116
Intonati on forces, on th yroid ca rtil age, Fig.
4.13
lnrrinsic mu scles, Fig. 1.4; nerve suppl y, 7
Joint, cricoarytenoid , 2, 3, 18, Figs. 1.1, 2.5
Lamina of thyroid cartilage, flare, 2
Laryngeal closure, against inspiration, 47, Fig.
3.7
Laryngeal folds: definition, 3, 4; funcrional
gro ups, 4 ; in effort closure, Fig. 3.4
Laryngeal formants, Fig. 4.12
Laryngeal occlusion, Fig. 3 .9
Laryngeal paralysis, 68
Laryngeal prominence, 2, 47 - 48 ; in effort cl o-
sure, 46
Laryngeal resonance, 72
Laryngeal sinus, mechanics, 71
Laryngeal springs, function, 1
Larynx: motion in swall ow, 97, Figs. 5.1, 5.2;
prominence, 2; suspension from hyoid, 1
Lateral cri coarytenoid muscle, Fig. 1.4
Levers, 68; behavior in phonati on, 69, Figs. 4.6
to 4.9; of chyroid cartilage, 2; scherne of, 69,
Fig. 4.11
Ligament: cricoph aryngeal, 5; hyoepiglotti c, in
swall ow, 98, Fig. 5.3; median cri coch yroid,
2; posterior cricoa rytenoid , 18 ; stylohyoid,
5 ; thyroepiglottic, 2, 47; vestibular, 2; vocal ,
2, 4
Ligamentous convergence, 2, 4
Liga mcntous suspension, main and subsid ia ry,
6 Muscle, thyroarytenoid, 4, Fig. 3.3
Ligaments, Fig. 1.3; check action 18· elastic 2
17 - 18; suspenso ry, 1 ' ' ' '
Linea ob liqu a, 2
Load , 115
Lockin g, cricoid-arytenoid, 67
Lubrication, articu lar, 17
Lyrnph atics, 7
Mandible, 1
Margin of safety, in swallow cl osure 100
Math ematical model s, 7·1 '
Mechanical co upling, 16; forces, 13, l 9 fi .
2.9, 2.13 ' gs.
M ed ian cricoth yroid li gamcnr, 2, Fig. 1.3
Median thyrohyoid fold , 4, Fi g. 1.2; as tensi o,
and compression sp.ring, 5; comprcssion, Fig
3.8 ; evolunon, 48; 111 effort closurc 46 47
Fig. 3.7; in swallow, 98 , 99, Fig. 5 \ s~ruc'.
ture, 5
Membrane, cri covocal, 4
M embrane, quadrangul ar, 4 - 5; in rcspiration
16 - 17 '
Membranes, elastic, Fig. l .3 ; in rcspi ra ti on
17 - 18 . ' 1
M1srnatch of amcular curvature, 17, Fi gs. 2.6,
2. 16
Modulus, 115; of rigidity, 11 6; Young's, 115
M~menr: of cricoid carti lage, 3; of force, 11 4,
F1g. 6.2; of inertia, 115
Momentum, 113
Mucous glands, 4
Muscle, aryepiglotti c, 4; in effort closure 45
Fi ~3 .5 , ,
Mu scle, arytenoid, 6; in respiration, 20
Mu scle, cricoarytenoid , 6; tendinou s inscrtion,
7
Muscle, cricothyroid: direction of fibc rs 2· cf-
fect of contracti on 6· in effort cl osur~ 46
Muscle, inferior con;tri~tor, in swa ll ow, '100-
101 , Fig. 5.7
Muscle, lateral cricoarytenoid , 6
Muscle, oblique arytenoid, 6, Fig. 1.4
Muscle, posterior cricoarytenoid : fun ction, 6;
in respiration, 17
Muscle, sternohyoid, 21
Muscle, sternoth yroid : action, 20 - 21 , Figs.
2.14, 2.15; in inspirati on, 20
M uscle, sty lopharyngeus, 101
Muscle, th yroep iglottic, 4 ; in swall ow, l0 0
Muscle, th yrohyoid, 21; in effo rt cl osure, 45
Muscle, voca l, 6; in effort closure, 46
Muscle spindle, 6
1ent, 3
(, 101
.t rictor mu scle, in swa ll ow, 100-
; .7
t6, Figs. 2.1 ro 2.4; laryngeal clo-
st, 47, Fig. 3.7; lateral vi ew , Fig.
rior view, Figs. 2.4, 2.5; rwistmg
z Mechanica l co upling, 16; forces, 13, 19, Figs.
; nfolding: cra ni al view, Fig. 2.7;
~ , Fig. 2.8; posreri o r view, F1g. 2.5
jd fold, 4 - 5, Fig. 1.2
ss, 116
rces, o n th yroid cartil age, Fig.
0 3.8; evolutio n, 48; in effort closure, 46, 47,
scles, Fig. 1.4; nerve suppl y, 7
rytenoid , 2, 3, 18, Figs. 1.1, 2.5
0 yroid ca rtilage, fl are, 2
0 sure, against in spiratio n, 47, Fig.
Jids: defi nition , 3, 4 ; functional
; in effo rt closure, Fig. 3.4
Jrrnants, Fig. 4.12
cclusion, Fig. 3.9
aral ysis, 68
rominence, 2, 47- 48 ; in effort clo-
~sonance, 72
.nus, mechanics, 71
Jrings, function, 1
tion in swallow, 97, Figs. 5.1, 5.2;
ce, 2; suspension from byoid, 1
Jarytenoid muscle, Fig. 1..4
behavior in phonati o n, 69, Figs. 4.6
· thyroid ca rtil age, 2; scheme of, 69,
ricopharyngea l, 5; hyoepiglottic, in
98, Fi g. 5.3; median cri coth yroid,
or cricoarytenoid, 18; stylohyoid,
piglottic, 2, 47; vestibular, 2; vocal,
s co nvergen ce, 2, 4
s suspension, main and subsidiary,
Fig. 1.3; check action, 18; elasti c, 2,
Uspensory, 1
~a, 2
Lockin g, cri coid- arytenoid, 67
Lubrication, a rti cu lar, 17
Lymphatics, 7
Mandible, 1
Margin of safety, in swa ll ow closure, 100
Mathematical model s, 71
2.9, 2.13
Median cri coth yroid liga ment, 2, Fig. 1.3
Median tbyrohyoid fold, 4, Fig. 1.2; as tension
and compress io n spring, 5; compression, Fig.
Fig. 3.7; in swa ll ow, 98, 99, Fi g. 5.3; stru c-
ture, 5
Membrane, cri covoca l, 4
Membrane, qu ad ra ngul ar, 4 - 5; in respiration,
16-1 7
Membrane s, elastic, Fig. 1.3; in resp iration,
17-18
Mismatcb o f a rti cul ar curva ture, 17, Figs. 2.6,
2.16
Modulus, ll5; of rigidity, 11 6; Young's, 115
Moment: of cri coid ca rtil age, 3; of force, 114,
Fig. 6.2; of inertia, 115
Momentum, 113
Mucous glands, 4
Muscle, aryepiglottic, 4 ; in effo rt closure, 45,
Fig. 3.5
Muscle, arytenoid, 6; in respiration, 20
Muscle, cricoarytenoid, 6; tendinous insertion,
7
Muscle, cricothyroid : direction of fibers, 2; ef-
fect of contraction, 6; in effort closure, 46
Muscle, inferi o r constrictor, in swa llow, 100-
101, Fig. 5.7
Muscle, lateral cricoary tenoid, 6
M uscle, obliqu e arytenoid, 6, Fig. 1.4
Muscle, posterior cricoarytenoid: function, 6;
in respiration, 17
Muscle, sternohyoid, 21
Muscle, sternothyroid: action, 20-21, Figs.
2.14, 2.15; in in sp irati on, 20
Muscle, stylopharyngeus, 101
Muscle, th yroarytenoid , 4, Fig. 3.3
Muscle, th yroepiglotti c, 4; in swallow, 100
Muscle, th yro hyoid, 21; in effort closure, 45
Muscle, vocal, 6; in effort closure, 46
Muscle spindl e, 6
Muscles, abdominal, in effort closure, 46
Muscles, cxtrin sic, 6, 21
Muscles, intrinsic, 6
Myoelastic aerody nami c theory, 66
N erve supply , motor and sensory, 7
Ob li que line, 2, 20; mu scles, in effort closure,
47
Oscill ation: mo tion , 66; phonatory, 72; system,
65
Ossifi catio n, 20
Paralysis, bilateral and un il ateral , 68
Paramedian axis, 67, Fig. 4.1
Pars obliqu a, 68, Fig. 4.5
Pars recta, 68
Phary ngeal pressure, 97
Phona ti on: biomechanical mod el, 66; closure o f
glottis, Fig. 4 .1; conditions for, 65; cra ni al
view, Fig. 3.5; physics, 65; th eory of mecha-
ni sm, 66
Phonatory closure, compared with effort clo-
sure, 47
Phonatory folding, 67-68, Fig. 4.4
Phonatory oscillation, 72
Pitch cont rol, Figs. 4.6 to 4.9
Pl icatio n, 15, Fig. 3.2; deglutiti onal, Figs. 5. 1,
5.2; ph onatory, 67
Posterior cricoarytenoid muscl e, Fig. 1.4; in
respi ration, 17
Postural reflex, 6
Postural role, of effort closure, 48
Power transfer, 66
Pressure, subglottic, 66
Prominence of larynx, 2
Prom inenti a laryngis, 16, Fig. 2.5; in effo rt clo-
sure, 47
Quadrangu lar membrane, 4-5, Fig. 1.3; boun-
daries, 4; function, 5; in phonation, 72; in
resp iration, 16-17; respiratory Stresses, 19,
Fig. 2.13
Radiograph, lateral , end eupneic expiration,
Fig. 2.2
Rad iographi e tracing, anteroposterior: deep in -
spiration, Fig. 2.4; end eupneic expirati on,
Fig. 2.11; phonation, Fig. 4.4; swallow, Fig.
5.7
Radiographie tracing, latera l: deep inspiration,
Fig. 2.3; effort closure, Figs. 3.6, 3.7; end
eupneic expiration, Fig. 2.2; fo rmants, Fig.
4.12; ph onati on, Figs. 4.6 to 4.9; swallow ,
Fig. 5.6; whispering, Fig. 4.14
Recoi l, elastic, of li gament, 2
Reference conditi on, 18
Reflex, postura l and Stretch, 6
Regu lation o f frequency, 65
Resistance : glottal, 66 ; of voca l fold, 66
Resonato rs, voca l, 72
Respiratory cycl e, 16
Respiratory forces , extrin sic, Figs. 2.14, 2.15
Respiratory rh ythm, evoluti on, 18
Resultant force, 113, Fig. 6.1
Ridge, aryepiglotti c, 45, 72, Figs. 3.5, 4.8 ,
4.12, 4.13
Rima glottidis, 4 ; five sided, 15
Rotation, at cricoth yroid joint, 68
Saccule, 4
Safeguards, multipli city, 101
Shear, 115
Shear force, 116
Shear modulu s, 116
Shearing force, in effort closure, 4 7
Shearing strain, 1.16
Sinus laryngis, 4
Sinus of larynx, 4; in inspi ration, 17, Fig. 2.8;
mechani es, 71
Sinus of Morgagni, 4
Skeletal supports, effort closure, Fig. 3.1
Skull, suspension from, 1
SI ide track, 3
Sliding ph ase, 17
Speech, 72
Springs, laryngeal, 1
Stabilization of a rytenoids, Fig. 2.6
Sternohyoid m uscle, 21
Sternothyroid mu scl e, 21; action, 20-21, Fi gs.
2.14, 2.15; in inspiration, 20
Strain, 11 5
Strength, of material, 116
Stress, 115; intern al, 116
Stretch reflex, 6
Stripping, vestibul ar, in swa llow, 100, Fig. 5.6

133 INDEX
Stylohyoid ligament, 5, Fig. 1.4; in inspiration,
16, Fig. 2.1
Stylopharyngeus muscle, 101
Subglottic pressure, 66, 70; in effort closure,
46, Fig. 3.7
Subluxation: arytenoid, 67, Figs. 4.1, 4 .2; cri-
cothyroid, 2
Superior horn: in effort closure, 47, Fig. 3.1; in
swallow closure, Fig. 5.7
Supportive effort, 48
Suspensory ligaments, 1
Suspensory supports: in inspiration, lateral
view, Fig. 2.3; lateral view, Fig. 2.2; pos-
terior view, Figs. 2.4, 2.5
Suspensory system, 1, 5; elastic, 2; in respira-
tion, 16, Figs. 2.1 to 2.4; of hyoid, Fig. 1.4;
principal, 5; subsidiary, 5
Swallow: motion of hyoid bone, 97-99, Figs.
5.1, 5.2; motion of larynx, 97-99, Figs. 5.1,
5.2; pharyngeal pressure, 97. See also Cin-
eradiography
Swallow folding, 97
Swimming, glottis in, 21
Tension, 115; of vocal ligament and muscle,
66; tracheal, 20, Fig. 2.16
Tensor biomechanics, Figs. 4 .10, 4.11
Tensor mechanism, 68, Fig. 4.5
Thyroarytenoid muscle, 4, Fig. 3.3
Thyroepiglottic ligament, 2; in effort closure,
47
Thyroepiglottic muscle, 4; in swallow, 100
Thyrohyoid air sac, 48
INDEX
Thyrohyoid muscle, 21 ; in effort closure, 45,
46, Fig. 3.7
Thyroid cartilage, 1, Fig. 1.1; angle, 2; angular-
ity, 20; articular facet, 2; bending of lamina,
2; cornua, 2; effect of ossification, 21 ; flare
of lamina, 2, 20; folding in swallow, 100,
Fig. 5.7; in effort closure, 46, F,g. 3.7; in res-
piration, 20 ; inferior horn, 1; isthmus, 1, 2;
lamina, 1; lever, 2; oblique line, 2; shield
function , 1; structure, 1; wishbone lever, 2
Thyroid-hyoid approximation: in effort closure,
46; in swallow, 98
Thyroid laminae: approximation, in swallow,
Fig. 5.7; flare, 2
Torque, 114; rocking, 20, Fig. 2.16
Trachea: inspiratory descent, 16; suspended, 1
Tracheal tension, 20, Fig. 2.16
Trained voice, forces on vocal lever, 70, Fig.
4.13
Training, mechanical consequences, 70
Translocation, at cricothyroid joint, 68
T runcal forces, in effort closure, Fig. 3 .11
Tubercle, of epiglottic cartilage, 3
Twisting moment, 116
Unfolding, 1; inspiratory, Figs. 2.5, 2.7, 2.8;
respiratory, 18
Urination, 48
Ventricle, 4
Vestibular fold, 1, 4, Fig. 1.2
Vestibular ligament, 2, Fig. 1.3; check action,
18
134
Vestibular stripping, 100, Fig. 5.6
Vestibule, 4
Visor angle, 2
Vocal fold , 1, Fig. 1.2; adduction , 68; elastic-
ity, 66 ; inertia, 66; resistance, 66; source of
oscillation of, 66; structure, 4; tensor mecha-
nism, Fig. 4.5
Vocal lever, 68; forces on, 69, Fig. 4.11
Vocal ligament, 4, Fig. 1.3; check action, 18;
elastic recoil, 2
Vocal ligament tension, 2, 66; regulation by ro-
tation and translation, 69, Fig. 4.10
Vocal muscle, 6; effect of contraction, 66; hy-
pertrophy, 70; in effort closure, 46; regula-
tion of ligament tension by, 68; stabilizer ac-
tion, 68; tension, 66
Vocal process, of arytenoid, in respiration, 17
Voice, trained, forces on vocal lever, 70, Fig.
4.13
Voice training, 69
Vorniting, 48
Vowel formants, 69, Fig. 4.12
Vowel sounds, 72
Weeping Iubrication, 17
Whisper, cranial view, Fig. 3.5
Whisper folding, 73 - 74, Figs. 3.7, 4.14
Whispering, radiographs, Fig. 4.14
Wishbone, thyroid, 2
Work, 115
Young's modulus, 115