Unit 5: Anatomy and physiology

of Larynx

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 Introduction
• What is this sound? What is Voice?

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• Voice is sound created by voice box present
in neck along with assistance from structures
in throat & mouth.

• Unit 5: Study the anatomy & physiology and

diseases of the larynx.

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 Anatomy & Physiology of larynx
• Larynx, commonly called VOICE BOX
• Located in front, in the middle of the
neck.
• Perched on the top of the trachea
(windpipe).

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 Location
• The position of the larynx in the neck varies
with age, gender, head position and
swallowing.
• The length of larynx is about 44 mm in an
adult male and 36 mm in an adult female.

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Biological functions
• Protection of the airway
• Building intra-thoracic pressure for excretion
and carrying out strenuous physical activities

Non biological functions

• Speech
• Singing

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 Anatomy of larynx
• Made of a bone, cartilages, muscles,
membranes and joints.
• Hyoid bone supports larynx.

Front View

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 Hyoid (Bone)
• U shaped single bone present above the thyroid cartilage.

•It is suspended from the tips of

Styloid processes of the Temporal
bones by Stylo-hyoid ligament.
• It is not connected to any other bone directly.
• Hyoid bone is supported by many muscles & it can make
variety of movements.

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 Hyoid (Bone)

• Hyoid has 3 parts: a body and 2 pairs of horns.

• The 2 pairs of horns attach the Hyoid bone to

the Thyroid cartilage.

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 NOTE: ligament vs. cartilage vs.
tendon
• Ligament: Fibrous tissue that connects bones to other
bones.
• Cartilage: Stiff yet flexible connective tissue found in
many areas in the body, including the joints between
bones. It is not as hard and rigid as bone but is stiffer and
less flexible than muscle.
• Tendon: Tough band of fibrous connective tissue that
usually connects muscle to bone and is capable of
withstanding tension. Tendons are similar to ligaments

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 Cartilages
• 3 unpaired & 3 paired cartilages in larynx.
Cartilage Number Location
Epiglottis single Behind the hyoid bone and base of the
tongue
Thyroid single Front of the neck in the midline
Cricoid single Above the trachea; below thyroid cartilage
Arytenoids paired Rests on the back surface of cricoid
cartilage
Corniculates paired Rests on the arytenoid cartilages
Cuneiform paired Embedded in aryepiglottic folds

List of cartilages & location in larynx

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 Epiglottis (Cartilage)
• It is leaf shaped cartilage.
• Attached to upper, inner
surface of Thyroid.
• It attaches to Arytenoids at
the back by the
Quadrilateral membrane.
• The upper margins are
formed by the Aryepiglottic
folds.
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 Epiglottis (Cartilage)
• Fn: Protects the wind pipe/ airway by deflecting
food, water, saliva into trachea.
• It is open during breathing and closed during
swallowing.

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 Thyroid (Cartilage)
• Biggest cartilage in larynx present
in front & sides.
• Protects voice box in the front.
• 2 laminas (quadrangular plates of
cartilage-1 on right side & 1 on
left side)
• Laminas join at midline to form
the thyroid prominence (Adam’s
apple in men) - Felt or seen on
surface of the neck in most men.
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 Thyroid (Cartilage)
• 2 big horn-like structures (greater
horns) to attach to the hyoid bone.
• 2 small horns (lesser horns) to
attachment with Cricoid cartilage.
• Lesser horns attach Thyroid to Cricoid
through the Cricothyroid ligament &
Cricothyroid (CT) joints. CT joints are
important for changing the pitch.

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 Cricoid (Cartilage)
• It forms base of larynx .
• Attached to thyroid above through
Cricothyroid ligament, Cricothyroid joints
& trachea below by Cricotracheal
ligament.
• Ring shaped cartilage
• Front surface is thin, narrow (called Arch)
& back surface (known as Lamina) is
broad, thick and wide. Arytenoids are
present on the lamina of Cricoid
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 Arytenoids (Cartilage)
• These are paired, pyramid shaped
cartilages present on upper
margins of lamina of Cricoid
cartilage.
• Each Arytenoid has a base, an
apex & 3 surfaces.
• Vocal process present on the
medial surface is an important
structure, because they form the
posterior 1/3rd of true vocal folds.
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 Arytenoids (Cartilage)
• Arytenoids are attached to the
Thyroid in the front by Vestibular
and Vocal ligaments.
• They are attached to Cricoid
through the Cricoarytenoid
ligaments & joints.
• These ligaments & joints are
important for the opening &
closing of vocal folds.
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 Corniculates & Cuneiform
• Corniculates: Small, paired, nodular structures
perched on apex of each arytenoids.
• They may be 2 or even absent sometimes.

• Cuneiform: Small, paired, rod like structures

present above the Corniculates.
• Present in a few individuals

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 Joints/ ligaments of larynx
• Cartilages are connected to each other with the
help of joints, muscles and membranes.

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Joints/ ligaments Connects Action
Cricothyroid Thyroid to Helps in changing the pitch of
ligament and joints Cricoid voice

Cricoarytenoid joints Cricoid to Important for opening and

and ligaments Arytenoid closing of vocal folds

Vestibular ligaments Arytenoids Helps in changing the pitch of

to Thyroid voice

Vocal ligaments Arytenoids Helps in changing the pitch of

to Thyroid voice

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 Anatomy of vocal folds
• The important structures responsible for
producing voice (sound) are the vocal folds.
• There are 2 sets of vocal folds: Ventricular
folds and True vocal folds.
• Their main function is protection of the lower
airway.

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 Ventricular folds/ False Vocal
Folds
• They are pink in color & thick bands of mucous
membranes with very few muscles, blood
vessels & nerves.
• They start (originate) from the thyroid & attach
(insert) to the arytenoids cartilages at the back
through the Ventricular ligaments.
• They are not suited for voice production as
they are bulky and do not have many muscles,
blood vessels and nerves.
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 True Vocal Folds/ Vocal folds
• They are present just beneath the Ventricular
folds.
• They originate from the Thyroid cartilage, in the
front and insert into the Arytenoid cartilages at
the back through the Vocal ligaments.
• The true vocal folds are light pink in color but on
laryngoscopy appear glossy white but the color
changes in clinical conditions.
• The space between the true vocal folds is called
the Glottis.
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 True Vocal Folds/ Vocal folds
• VFs are made of mucous membranes, ligaments &
muscles. ( blood vessels & nerve fibers)
• Under microscope, 5 different layers can be identified:
1.Epithelium
2.Superficial layer of Lamina propria (Reinke’s space)
3.Intermediate layer of Lamina propria
4.Deep layer of Lamina propria
5.Vocalis muscle

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True Vocal Folds/ Vocal folds

Front view

Cross-section
view

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 True Vocal Folds/ Vocal folds
• Epithelium is the surface or the "skin" of the
larynx and it is continuous with the lining of
mouth, pharynx and trachea.
• Lamina propria has 3 distinct layers, each with
a different consistency. The Intermediate
layer and Deep layer of Lamina Propria forms
the Vocal ligament.

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 True Vocal Folds/ Vocal folds
• Superficial layer - a jelly-like substance, close
to the surface
• Intermediate layer - an elastic, fibrous
substance, like rubber bands
• Deep layer - a thread-like collagenous fiber
layer
• Vocalis muscle is the main body of the vocal
fold and very stiff.

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• BLOOD SUPPLY TO LARYNX
 Blood supply to Larynx
• Blood supply is derived from laryngeal branches of
superior & inferior thyroid arteries and
cricothyroid branch of the superior thyroid artery.
• (i) Superior thyroid artery arises from the external
carotoid artery
• (ii) Inferior thyroid artery arises from thyrocervical
trunk of the first part of the subclavian artery.

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 Blood supply to Larynx (Contd.)
• On the left side, the
thoracic duct is an
important relation to the
commencement of
inferior thyroid artery. It
lies in front of either the
artery or the thyrocervical
trunk, crossing them from
medial to lateral side.
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 Superior Laryngeal Artery
• The superior laryngeal artery arises
from the superior thyroid artery. It
passes deep to the thyrohyoid
muscle and together with the
internal branch of the superior
laryngeal nerve, pierces the
thyrohyoid membrane to supply the
muscles and mucous membrane of
the larynx and to anastomose with
branches of its opposite side & with
those of the inferior laryngeal artery.

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 Inferior Thyroid Arteries
• The latter arises from the inferior
thyroid artery at the level of the
lower border of the thyroid
gland and ascends on the
trachea, together with the
recurrent laryngeal nerve. It
enters the larynx beneath the
lower border of the interior
constrictor muscle and supplies
the muscles and mucous
membrane.

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 Cricothyroid Artery
• The cricothyroid artery
passes from the superior
thyroid artery, across the
upper part of the
cricothyroid ligament and
anastomose with the branch
of the opposite side.

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 Veins
• The veins leaving the larynx
accompany the arteries. The
superior vessels enter the
internal jugular vein by way of
the superior thyroid or facial
vein the inferior vessels drain
by way of the inferior thyroid
vein into the brachiocephalic
veins. Some venous drainage
from the larynx is by way of the
middle thyroid vein into the
internal jugular vein. 40
 Lymphatic drainage
• The part of the larynx above the vocal folds is
drained by vessels which accompany the superior
laryngeal vein, pierce the thyrohyoid membrane
and empty into the upper deep cervical lymph
nodes whereas the zone below the vocal folds
drains, together with the inferior vein, into the
lower part of the deep cervical chain often through
the prelaryngeal and pretracheal nodes.

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 Membranes of larynx
Laryngeal membranes Location

Mucous membrane (Ciliated Columnar Present in the entire larynx

Epithelium)

Cricovocal membrane (Conus Originates from Cricoid cartilage

Elasticus) and connects the Cricoid, Thyroid,
and Arytenoid cartilages together.
Inserts into the true vocal folds

Quadrangular membrane Connects Epiglottis and Thyroid to

the Arytenoid cartilages at the
back

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