LARYNX

Bevy Varghese
Roll no:72
 Muscles
of larynx

extrinsic intrinsic

elevator Acting on Acting

s depressors vocal cord on
laryngea
l inlet
• Extrinsic muscles
• Connect larynx to neighbouring structures
• All are paired
• 2 types : elevators and depressors
• Elevators : primary & secondary
• Primary : attached to thyroid cartilage ,
secondary to hyoid bone
 Primary Secondary
elevators elevators

stylopharyngeus Mylohyoid(main)

Salpingopharyngeus Digastric

Palatopharyngeus Stylohyoid

thyrohyoid geniohyoid
 Sternohyoid

sternothyroid

depressor
s omohyoid
 Intrinsic muscles
• May act on vocal cord or laryngeal inlet

Lateral cricoarytenoid

adductors
Interaryteoid

Acting on Posterior
vocal cord Abductors
cricoarytenoid

tensors cricothyroid

vocalis
 Posterior cricoarytenoid
• Origin: posterior surface of cricoid lamina
• Insertion:muscular process of arytenoid
• Nerve: recurrent laryngeal
• Safety muscle of larynx
 cricothyroid
• Only muscle that lies on the external surface of larynx
• Origin : anterolateral part of arch of cricoid
• Insertion:
• lower oblique fibers …inferior cornua of thyroid cartilage
• Straight fibers ….lower border of thyroid lamina
• Nerve : external laryngeal
• Action :lengthening & tensing vocal cord
• like the ….Visor of a knight’s helmet
• Tuning fork of larynx
 vocalis
• Detatched medial part of thyroarytenoid & lie within
vocal fold

• Origin: thyroid angle & anterior part of vocal ligament

• Insertion:lateral surface of vocal process

• On contraction anterior part of vocal ligament tenses

& posterior part is relaxed….help in voice modulation
• Nerve : recurrent laryngeal
 Acting on laryngeal inlet
Closure of
Opener of laryngeal
laryngeal inlet
inlet

Thyroepiglotticus Interarytenoid
(part of (oblique part)
thyroarytenoid)

aryepiglotticus
arterial supply
• Laryngeal branches of superior & inferior
thyroid artery
• Veins accompany arteries
• Nerve supply

• Motor:all intrinsic muscles – recurrent laryngeal nerve

except cricothyroid( external laryngeal n)

• Sensory:above vocal cords-Internal laryngeal n

below vocal cords-recurrent laryngeal n
 Lymphatic drainage
• Supraglottic region: to upper deep cervical lymph
nodes
• Infraglottic region :to prelaryngeal & pretracheal
lymph nodes---lower deep cervical & mediastinal
nodes

Practically no lymphatics in vocal cords >>>>carcinoma

of this region rarely metastasize
 Cavity of larynx
• Start at laryngeal inlet
• End at lower border of cricoid cartilage
• 2 pair of folds
1)vestibular folds/ false vocal cords
• Contain vestibular ligament,few fibers of
thyroarytenoid,mucous glands
• Space between vestibular folds : rima vestibuli

2)vocal folds/true vocal cords

• Pearly white
• Contain vocal ligament,vocalis muscle & scanty subepithelial
conective tissue
• Structure of vocal cords
• Stratified squamous epithelium lines it
• Lamina propria
• superficial layer(reinke’s space)

• intermediate layer(elastic fibers)

vocal
ligament
• deep layer(collagen fibers)
• Two pair of folds divide cavity into 3 parts

• 1)Vestibule /supraglottic compartment

• 2)Ventricle /glottic compartment/sinus of larynx

• saccule: a diverticulum of mucous membrane from anterior

part of ventricle extending between vestibular folds & lamina
of thyroid cartilage. It is called oil can of larynx

• Laryngocele( internal,external)

• 3)Subglottic space
 Glottis/rima glottidis
•Elongated space
•Narrowest part of laryngeal cavity
•24 mm in men,16 mm in women
•Boundaries:
• anteriorly—thyroid cartilage
•Posteriorly:interarytenoid fold
•Laterally:Anterior 2/3rd by membraneous cords---
called phonatory glottis
• Posterior 1/3rd by vocal process of arytenoids----
called respiratory glottis
 Mucous membrane of larynx
• It is loosely attached except over the posterior surface
of epiglottis, true vocal cords , corniculate and
cuneiform cartilage
• The epithelium is ciliated columnar type except over
vocal folds & upper part of vestibule (stratified
squamous type)
• Mucous glands are present all over except on vocal
folds
• They are more on posterior surface of
epiglottis,posterior part of aryepiglottic folds,saccules
 Spaces of larynx

1) Pre epiglottic space of boyer

• bound by
• In front: upper part of thyroid cartilage & thyrohyoid
membrane
• Above: hyoepiglottic ligament
• Behind : infrahyoid epiglottis & quadrangular membrane
• Continuous with paraglottic space laterally
• Filled with fat ,areolar tissue & lymphatics
• 2)paraglottic space
• Thyroid cartilage laterally,quadrangular
membrane medially ,mucosa of pyriform
fossa posteriorly
• Growth present here present in neck
through cricothyroid space
• 3)Reinke’s space
• A potential space under the epithelium of vocal cords
with scanty subepithelial connective tissue

• Front: anterior commissure

• Behind:vocal process of arytenoid

• Edema of this space : fusiform swelling of

membraneous cords---called reinke’s edema
 laryngoscopy
• Direct------laryngoscope
• Indirect-----laryngeal mirror
• Procedure
• Structures seen

• areas missed are

• Ventricle of larynx
• Apex of pyriform fossae
• post cricoid area
• anterior commissure
Base of tongue

Valleculae

Epiglottis

Aryepiglottic folds

Piriform fossae
False vocal cords

True vocal cords

Some part of post cricoid area

 Paediatric larynx
• Positioned high in the neck
• level of glottis opposite to c3 –c4 at rest& reach c1
during swallowing

• Cricothyroid & thyrohyoid spaces are narrow---

tracheostomy

• Larynx is small & conical,subglottis the narrowest part

–paediatric endotracheal tube
• Submucous tissue are loose & easily undergo
edematous change

• 2 spurts of growth –first in 3 years of life

• Second during adolescence

• Larynx descends,finally vocal cords lying opposite

c5