THE PHARYNX ,

LARYNX

N
Monday, April 10, 2023
 The Pharynx
 Funnel-shaped part of digestive system located posterior to nasal, oral cavities and
the larynx
 Its upper wider end extends from base of the skull and its lower narrow end
becomes continuous with oesophagus at lower border of cricoid cartilage (C6
vertebra level)
 Its wall is made of musculomembranous
 The wall is deficient anteriorly where its replaced by posterior nasal apertures,
oropharyngeal isthmus (opening into mouth) and laryngeal inlet
 Muscles of the pharynx
 Contains the external circular
muscles and internal longitudinal
muscles
 The 3 external curved circular
sheets of muscles overlap
posteriorly, being telescoped into
each other like 3 stacked cups
 Superior, Middle and Inferior
constrictors
 The muscles does not extend to
the base of the skull where it is
filled with pharyngo-basilar fascia
 The constrictors contract
involuntarily sequentially from
superior to inferior propelling
bolus of food into oesophagus
 Lowest fibres of inferior
constrictor is known as
cricopharyngeus muscle
 Muscles of the pharynx
 .Superior to the superior pharyngeal constrictor, the levator veli palatini,
pharyngotympanic tube, and ascending palatine artery pass through a gap between
the superior pharyngeal constrictor and the cranium. It is here that the
pharyngobasilar fascia blends with the buccopharyngeal
fascia to form, with the mucous membrane, the thin wallof the pharyngeal recess
2. A gap between the superior and middle pharyngeal constrictors forms a
passageway that allows the stylopharyngeus, glossopharyngeal nerve, and
stylohyoid ligament to pass to the internal aspect of the pharyngeal wall
3. A gap between the middle and inferior pharyngeal constrictors allows the internal
laryngeal nerve and superiorlaryngeal artery and vein to pass to the larynx.
4. A gap inferior to the inferior pharyngeal constrictor allows
the recurrent laryngeal nerve and inferior laryngeal artery
to pass superiorly into the larynx.
 The internal longitudinal layer of muscles consists of following
 Stylopharyngeus, Palatopharyngeus and Salpingopharyngeus
 These muscles elevate the larynx and shorten the pharynx during
swallowing and speaking
 The interior of the pharynx

 Interiorly, pharynx is
divided into 3 parts
 Nasopharynx,
Oropharynx and
Laryngopharynx
 The nasopharynx
functionally is not
part of the pharynx;
its purely respiratory
The interior of the pharynx (dissected
posterior part)
 Nasopharynx
 Posterior extension of nasal cavities superior to the soft palate
 Shut during swallowing by raising soft palate and drawing forward of
posterior wall of pharynx
 Consists of roof, floor, anterior, lateral & posterior
 Collection of lymphoid tissue in submucosa of superior and posterior
wall is called pharyngeal tonsil (called adenoids when enlarged)
 In the lateral wall there is tubal elevation to which in its submucosa
are the tubal tonsils

Tubal tonsils

Adenoiditis
 Oropharynx

Tonsilitis and
Tonsillectomy

 Lies behind the oral cavity; extends from soft palate to upper border of
epiglottis
 Consists of roof, floor, anterior, posterior and lateral walls
 Palatine tonsils occupies tonsilar sinus on the lateral wall
* The Palatine, Lingual, Tubal and Pharyngeal tonsils constitute the
pharyngeal tonsilar ring (waldeyer’s ring) in the superior part of pharynx
 Laryngopharynx

 Lies posterior to
the larynx
 Extends from
superior border of
epiglottis to inferior
border of cricoid
cartilage where it is
continuous with the
oesophagus
 Blood supply of the pharynx
 Arterial blood supply is derived from
 Ascending pharyngeal, Ascending palatine, Facial, Maxillary and
Lingual arteries
 Venous drainage
 Drain into pharyngeal venous plexus which drain into internal jugular v.
 Nerve supply
 Motor and sensory is from pharyngeal plexus
(formed by branches from CN IX, X and
sympathetic nerves)
 Motor fibres in the plexus is derived from cranial
part of CN XI and carried by CN X and supplies
all pharyngeal muscles except stylopharyngeus
(CN IX)
 Sensory fibres in the plexus is derived from CN
IX and supplies mucosa of all 3 parts of pharynx
 Mucosa of nasopharynx also supplied by
maxillary nerve of CN V2
 Lymphatic drainage of pharynx
 Drain directly or indirectly into deep cervical
lymph nodes
 Applied anatomy
 Tonsillitis and tonsillectomy
 Dissection and removal of palatine tonsils
from the tonsilar bed
 Adenoiditis
 Inflammation of pharyngeal tonsils (adenoids)
 Can obstruct the airway
 The Larynx
 Located in the anterior neck
at the level of bodies of C3
through C6 vertebrae
 Opens into the laryngeal part
of pharynx and is continuous
with the trachea below
 Made of cartilages, muscles,
ligaments and membranes
 Specialized organ for voice
production
 Guards the air passages e.g.
during swallowing thru
 Sphincter muscles at the inlet
that close during swallowing
 Folding back of the upper part
of epiglottis over the inlet
The Larynx
 Laryngeal skeleton
Epiglottic c

Corniculate c
Thyroid c.

Cricoid c
Arytenoid c

 Consists of 9 cartilages joined by ligaments and membranes;

and moved by muscles
 3 cartilages are single (Thyroid, Cricoid and Epiglottic)
 3 cartilages are paired (Arytenoid, Corniculate and Cuneiform)
 The epiglottis and corniculate cartilages are composed of yellow
(elastic) cartilage, the rest are composed of hyaline cartilage
Laryngeal skeleton
Laryngeal skeleton
 Thyroid cartilage

Superior
horn

Lamina

Inferior
horn

 Largest of the cartilages

 Consist of 2 lamina joined in midline in the laryngeal
prominence (V angle of Adam’s apple 120oin female & 90o in
male)
 Superior border attached to hyoid bone by thyrohoid membrane
 Posterior border of lamina has superior and inferior cornu
 Cricoid cartilage

Cricoid Cricoid
cartilage cartilage
(arch) (lamina)

 Shaped like a signet ring

 Only complete cartilaginous ring in the whole of the air passages
 Has narrow anterior arch & broad posterior lamina
 Attached to inferior margin of thyroid cartilage by median cricothyroid ligament
and to 1st tracheal ring by cricotracheal ligament
 Articulates superiorly with inferior cornu of thyroid cartilage
 Lateral parts of superior border of lamina articulates with arytenoid cartilage
 Arytenoid cartilage
 Two, small pyramidal shape
 Each has apex above and
base below
 Articulates with the lateral
parts of the superior border
of the cricoid cartilage lamina
 Has two processes
projecting from the base,
 Vocal process which give
attachment to vocal ligament
 Muscular process which give
attachment to posterior and
lateral cricoarytenoid muscles
Muscular process
 Corniculate & Cuneiform cartilages
 Corniculate cartilages
 Two small nodules
 Articulates with the apices of arytenoid cartilages
 Give attachment to the aryepiglottic folds
 Cuneiform cartilages
 Two small rod-shaped cartilages in each of the aryepiglotic folds
 Supports the aryepiglotic folds

Corniculate c
 Epiglottis
 Leaf shaped elastic cartilage
situated behind the root of the
tongue and hyoid bone and
anterior to laryngeal inlet
 Its superior broad end is free
and inferior end is connected to
thyroid cartilage by
thyroepiglottic ligament
 Its anterior surface is connected
to body of the hyoid bone by
hyoepiglottic
 Ligaments and membranes

 Thyrohyoid membrane
 Median cricothyroid
ligament
 Cricotracheal ligament
 Cricovocal membrane
 Thyroepiglottic ligament
 Hyoepiglottic ligament
 Quadrangular membrane
 Vestibular ligament
 Aryepiglottic ligament
 Laryngeal Inlet

 Borders are formed by:

 Anteriorly : Free curved
edge of the epiglottis
 Posteriorly: The arytenoid
& corniculate cartilages;
and the interarytenoid fold
 Laterally: The aryepiglottic
fold
 Cavity (interior) of the larynx
 Extends from inlet to lower border of cricoid cartilage
where it becomes continuous with trachea
 Lined by mucous membrane
 Divided into 3 parts
 Upper part (vestibule)
 Middle part (ventricle of larynx)
 Lower part (infraglottic cavity)
 Upper part (vestibule)
 Extends from the inlet to
vestibular folds
 Vestibular folds (false vocal
cords)
 Constitutes the lower
free border of
quadrangular membrane
 Extends btn epiglottis
and arytenoid cartilages
 Play no or little part in
voice production
 Middle part

 Also known as ventricle of the larynx

 Extends from the level of the vestibular folds
(false vocal cords) to the level of the vocal folds
 Vocal folds
 Also known as true vocal cords
 Contain vocal ligaments and vocalis muscle
 Extends from the lamina of thyroid cartilage anteriorly to the arytenoid
cartilage posteriorly
 The gap between vocal folds is called rima glottidis
 Source of the sound that come from the larynx
 The folds produce audible vibrations when their free margins are closely but
not tightly opposed during phonation and air is forcibly expired intermittently
 Lower part of the larynx
 Extends from the lower level of the vocal folds to
the lower border of the cricoid cartilage
 Its walls formed by the inner surface of the
cricothyroid ligament
 Phonation
 Initiated by a stream of emitted air from lower part of larynx (expired air)
 At rest (normal respiration) the vocal cords are separated
 During phonation they are held together (opposed to each other)
 The apposed vocal folds are blown apart intermittently by pressure of
expired air below them
 The frequency of emission of the air depends on the length and tension
of the vocal folds and determines the pitch
 Function of vocal folds is produce sound varying only in intensity & pitch
 Articulation depends on breaking up the sound into recognizable
consonants and vowels by the use of the tongue, teeth and lips
 Phonation
 Changes in the pitch of the voice is due to
 Variation in the tension and length of the vocal folds
 Variation in the width of the rima glottidis
 Variation in the intensity of the expiratory effort
Sex differences in the Larynx
 Testosterone hormone at puberty
 Influences the enlargement of laryngeal cavity
and strengthens the walls of the larynx
 In boys, all laryngeal cartilages enlarge
 Laryngeal prominence becomes conspicuous
in most males
 Vocal folds lengthen and thicken (this
accounts for voice changes in males)
 Muscles of the larynx
 Divided into two groups
 Extrinsic muscles – Move
larynx as a whole
 Elevators of the larynx –
digastric, stylohyoid,
mylohyoid, geniohyoid,
palatopharyngeus &
salpingopharyngeus
 Depressors of the larynx
– sternothyroid,
sternohyoid & omohyoid
 Intrinsic muscles of the larynx
 Muscles that move the laryngeal parts
making alterations in the length of the
vocal folds and in the size and shape of
rima glottidis
 Adductors muscles of vocal cords

 Close the rima glottidis

 Includes lateral cricoarytenoid and transverse
arytenoid
 Abductors muscles of vocal cords
 Opens the rima glottidis
 Include posterior cricoarytenoid muscles

Posterior
cricoarytenoid
 Sphincters of laryngeal inlet
 Closes laryngeal inlet as a protective mechanism during swallowing
 Brings the aryepiglottic folds together and pulls the arytenoid cartilages
towards the epiglottis
 Strongest reflex!
 Includes, transverse, oblique arytenoid and lateral cricoarytenoid and
aryepiglottic muscles

Aryepiglottic

Oblique arytenoid

Transverse arytenoid
 Tensors of vocal cords

Cricothyroid

 Cricothyroid muscles
 Elongate & tighten vocal ligaments hence raising the pitch of voice
 Tilt or pull the prominence or angle of the thyroid cartilage anteriorly
and inferiorly towards arch of cricoid cartilage hence increasing the
distance between thyroid prominence and arytenoid cartilages
 Relaxers of vocal cords

Vocalis

Thyroarytenoid

 Their contractions shortens the vocal folds

 Thyroarytenoid and vocalis muscles
 Nerve supply of the larynx
 Sensory nerve supply to
Superior
the mucous membrane laryngeal
 Above the vocal folds is
from internal laryngeal Internal branch
branch of superior
laryngeal nerve of Vagus
External branch
nerve
 Below the level of vocal
folds is from recurrent
laryngeal nerve
 Motor nerve supply
 To all intrinsic muscles of
the larynx is the recurrent
laryngeal nerve EXCEPT Recurrent
for the cricothyroid muscle laryngeal
which is supplied by
external laryngeal branch
 Blood supply
 Arterial supply
 Upper half of larynx is supplied by superior
laryngeal branch of superior thyroid artery
 Lower half of the larynx is supplied by inferior
laryngeal branch of the inferior thyroid artery
 Venous drainage
 The laryngeal veins accompany the laryngeal
arteries
 Lymphatic drainage
 Lymph vessels drain into the deep cervical
group of nodes
 Applied anatomy
 Injury to recurrent laryngeal nerves results
in paralysis of vocal folds hence voice is
poor
 Cancer of larynx in individuals who smoke
cigarettes or chew tobacco
 Tracheostomy
 Between 1st and 2nd tracheal rings
 Cricothyrotomy