ANATOMY OF THE LARYNX AND PHARYNX

Dr. J. Ahenkorah
Anatomy Dept., UGMS

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 Learning Objectives
By the end of the lecture, you should be able to:

Describe the walls of the pharynx and their

anatomical relations.

Describe the anatomical framework of

larynx

List the intrinsic and extrinsic muscles of the

larynx , blood supply and innervation.

Clinical correlations

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  The Larynx is an air passage, a
sphincter and an organ of phonation. It
extends from the tongue to the trachea.

 The pharynx - musculo/membranous or

fibromuscular tube that forms a
transition space between the respiratory
tract, the oral cavity and the digestive
tracts.

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 THE PHARYNX

• It is deficient anteriorly and so communicates

with the
– NASAL CAVITY
– ORAL CAVITY
– LARYNX

 It is attached above to the base of the skull and

continue down with the oesophagus.
It is about 12-14cm long

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 FUNCTIONS OF THE PHARYNX
• RESPIRATORY
• DEGLUTITION (swallowing)
• PROTECTIVE
– REFLEX MECHANISM
• PREVENT FOOD FROM ENTERING NASAL CAVITY
• PREVENT FOOD FROM ENTERING LARYNX

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 PARTS OF PHARYNX
• NASO-PHARYNX (BEHIND NOSE)
– FROM ROOF TO PALATE
– 1ST CERVICAL VERTEBRA

• ORO-PHARYNX (BEHIND MOUTH)

– FROM PALATE TO THE 2ND AND 3RD CERVICAL VERTEBRAE

• LARYNGO-PHARYNX (BEHIND LARYNX)

– FROM 3RD TO 6TH CERVICAL VERTEBRAE

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Pharynx - Sensory

Nasal
Regions cavity
Palat
• Nasopharynx e V-2
Oral cavity

IX
• Oropharynx

• Laryngopharynx Hyoid
X

Thyroid
cartilage
NOTE: The lining mucosa of the pharynx is continuous
with that lining the Pharyngotympanic tubes, nasal
cavity , mouth and larynx.
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 RELATIONS OF THE NASO PHARYNX
-It lies above the soft palate and behind the posterior nares, which also
allow free respiratory passage between the nasal cavities and the
nasopharynx.
BOUNDARIES:
ROOF
– SPHENOID
– NASO-PHARYNGEAL/PHARYNGEAL TONSIL (Adenoid)
 At birth it grows rapidly largest at 5yrs but involutes and atrophy by 8-10yrs.
Explains the frequency of nasal breathing problems & incidence of
adenoidectomy in preschool children.
• POSTERIOR
– MUCOUS MEMBRANE-
– PHARYNGO-BASILAR FASCIA-a rigid membrane fill the gap
– SUPERIOR CONSTRICTOR
– BUCO-PHARYNGEAL MEMBRANE

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 Torus tubarius

Bucco-pharyngeal
membrane
vallencula

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 Stylopharyngeus, palatopharyngeus & salpingopharyngeus are
supplementary muscles of the pharynx
Pharyngobasilar fascia- a submucosal fibrous thickening that holds the
nasopharynx permanently open for breathing.
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 Pharynx - Motor
Pharyngeal constrictors
Innervation Superior
• Vagus nerve (CN X)

Buccinator
Superior Middle

Hyoid bone

Thyroid cartilage Inferior

In swallowing, the Soft palate
Inferior
closes the oropharyngeal
Thyroid
isthmus cartilage

Thyroid
gland

Inhaling Swallowing Esophagus

 CON’T OF NASO PHARYNX
• LATERAL WALLS
– OPENING OF PHARYNGO-TYMPANIC TUBE
– THE TUBAL ELEVATION (a prominent rounded ridge)
• LEVATOR VELI PALATINI
• NOTE ALSO TENSOR VELI PALATINI
– SALPINGO-PHARYNGEUS
• FLOOR
– SOFT PALATE (ANT. NASOPHARYNX)
– COMMUNICATION WITH ORO-PHARYNX

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Salphingopharyngeal fold (muscle under mucous
membrane)
Pharyngeal recess ( fossa of Rosenmüller)
Pharyngeal
10/04/2024 tonsil (adenoids) in children
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 CON’T OF NASO PHARYNX
• ANTERIOR WALL
– COMMUNICATES WITH NASAL CAVITY
• THE CHOANAE
• MIDDLE AND INFERIOR CONCHAE
• NERVE SUPPLY
– PHARYNGEAL PLEXUS
– PHARYNGEAL BRANCH OF MAXILLARY NERVE
• MUCOSA – RESPIRATORY

NOTE: All the boundaries of the nasopharynx are rigid

except the floor, which can be raised or lowered by the
soft palate
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 ORO PHARYNX
• SOFT PALATE TO EPIGLOTTIS
• COMMUNICATES WITH ORAL CAVITY
• 2ND & 3RD CERVICAL VERTEBRAE
• PALATO-GLOSSAL ARCH (anterior fold)
• PALATO-PHARYNGEAL ARCH (posterior fold)
• POSTERIOR 1/3 OF TONGUE
• THE PALATINE TONSIL
• TONSILLAR FOSSA
• LINGUAL TONSIL

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 PALATOGLOSSUS

PALATOPHARYNGEUS

Lingual tonsil
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 Palate
Levator veli palatini m. (CN X)
Tensor veli palatine m. (CN V-3)
Hard palate Soft
palat
e
Palatoglossus m (CNXI)
Palatopharyngeus m (CNXI)
via pharyngeal plexus
Posterior view;
Coronal Section

Medial view; Sagittal Section

Uvula Palatoglossal arch

Palatine tonsils
Palatopharyngeal arch
(Pilars of the fauces)
 CON’T OF ORO PHARYNX
• PALATINE TONSIL
– TONSILLAR CAPSULE
– PARA-TONSILAR VEINS
– BLOOD SUPPLY
• TONSILLAR BRANCH OF FACIAL
• ASCENDING PALATINE ARTERY
– NERVE SUPPLY
• MAXILLARY
• GLOSSOPHARYNGEAL

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Taken from GRAY’S ANATOMY 40TH ED
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 SALPHINGOPHARYNGEUS

TONSILLECTOMY-Surgical removal to
prevent recurrent acute tonsillitis
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 WALDERYER’S RING
A circumpharyngeal ring of mucosa-associated
lymphoid tissue (MALT) that surrounds the
openings into the digestive and respiratory tracts.
WHY?
•ANTEROINFERIORLY = LINGUAL TONSIL

•LATERALLY = PALATINE & TUBAL TONSILS

•POSTEROSUPERIORLY = PHARYNGEAL TONSIL with

other smaller ones.
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 LARYNGO PHARYNX
• FROM UPPER BORDER OF EPIGLOTTIS TO THE LOWER
BORDER OF CRICOID CARTILAGE
• C6 VERTEBRA
• INFERIORLY
– CONTINUOUS WITH OESOPHAGUS
• ANTERIOR
– LARYNGEAL OPENING (aditus or laryngeal inlet)

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 LARYNGO PHARYNX CON’T
PIRIFORM RECESS/FOSSA:
It lies on each side of the laryngeal
inlet
Bounded :
Medially by aryepiglotic fold.
Laterally by the thyroid cartilage &
thyrohyoid membrane (here
branches of the internal laryngeal
nerve & vessels lie beneath its
mucous membrane).
Posteriorly by the inferior
pharyngeal constrictor muscles.

Clinically important : FISH

BONE
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  The pharyngeal reflex or gag reflex is a reflex contraction
of the back of the throat, evoked by touching the soft palate .
It prevents something from entering the throat except as
part of normal swallowing and helps prevent choking.
 The afferent limb of the reflex is supplied by the
glossopharyngeal nerve (cranial nerve IX), which inputs to
the nucleus solitarius and the spinal trigeminal nucleus and
the efferent limb is supplied vagus nerve (cranial nerve X)
from the nucleus ambiguus.
NOTE: Intermittent
pharyngeal obstruction may cause
snoring, and complete obstruction may cause APNOEA
which may lead to arousal and sleep disturbance.

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NOTE: The pharyngeal
branch of the vagus supplies
all the muscles of the
pharynx EXCLUDING
STYLOPHARYNGEUS which is
supplied by the
glossopharyngeal nerve and
of the soft palate EXCLUDING
TENSOR VELI PALATINI.

STYLOGLOSSUS is supplied
by Hypoglossal nerve

Note that when the lips and

jaws are apart, swallowing is
difficult!!!
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 THE LARYNX

 It projects ventrally between the great vessels

of the neck covered anteriorly by skin, fasciae and
the hyoid depressor muscles.
The larynx is mobile on deglutition
(swallowing), respiration (breathing), and
phonation (voice production).
Act as a protective sphincter for air passages.

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  Since the larynx is to remain open to help in
respiration it is designed in such a way that
cartilages are present and these cartilages are
moved by muscles.
The principal biological function of the larynx is to
act as a sphincter controlling the entry of foreign
bodies into the air ways and regulate airflow during
ventilation
The larynx is opened widely during ventilation
and closed tightly during swallowing, defecation or
parturition

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 LARYNX - POSITION
• FROM TONGUE
• CONNECTED TO HYOID BONE
ABOVE, TO TRACEA BELOW
• FROM C3 to C6 CERVICAL
VERTEBRAE
• COMMUNICATES WITH
LARYNGO-PHARYNX ABOVE
• COMMUNICATES WITH
TRACHEA BELOW

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 LARYNX CON’T
The larynx consists of four (4)basic anatomic
components:

• Mucosal lining/membrane
• Cartilaginous skeleton,
• Ligaments & fibrous membranes
•Skeletal muscles-Intrinsic & extrinsic muscles

Note: until puberty, male & female larynx are similar

in size
•Male thyroid cartilage increase in size until 40yrs

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Laryngeal Cartilages
• Unpaired Cartilages
– Epiglottis
– Thyroid
– Cricoid
• Paired Cartilages
– Arytenoid: located on the sup. Border of
the lamina of the cricoid
– Corniculate
– Cuneiform
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 ANTEROLATERAL VIEW POSTERIOR VIEW

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 EPIGLOTTIS
Leaf-like elastic fibrocartilage
• Attached to thyroid cartilage
• Median glossoepiglottic
fold.
• Lateral glossoepiglottic
folds.
• Vallecula-depression on each side
of median fold.

Though the epiglottis is not essential in

respiration, phonation or swallowing, it
diverts food and liquids away from the
laryngeal inlet.

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 THYROID CARTILAGE
The largest of the laryngeal
cartilages. It is connected to
the hyoid bone above and
cricoid below.
• 2 Laminae
• 2 pair of Horns
• Oblique line
• Superior thyroid
notch
The laryngeal prominence
(Adam’s apple) is most distinct
in men
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 CRICOID CARTILAGE

•Shaped like a signet ring

• Has a Lamina posteriorly
• Has an arch
The only laryngeal cartilage that forms a complete ring around
the air passages.ai
Congenital malformation may occur resulting in severe narrowing of
the airway (SUBGLOTTIC STENOSIS)
Acquired subglottic stenosis more common due to trauma & scaring
from prolonged endotracheal intubation of babies on ICU
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ARYTENOID CARTILAGE

• Pyramidal in shape, a base and apex

• Has a vocal process
• Has a Muscular process

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CORNICULATE CARTILAGE

•Two conical nodules of elastic fibrocartilage that

articulates with the apices of the arytenoids
•They lie in the posterior parts of the aryepiglottic
mucosal folds
The cuneiform are 2 small club-like nodules
anterosuperior to the DR.
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corniculate
J. AHENKORAH cartilages 41
  JOINTS

• CRICOTHYROID- SYNOVIAL, THE RECURRENT LARYNGEAL

NERVE LIES IMMEDIATELY BEHIND THIS JOINT

• CRICOARYTENOID -SYNOVIAL, ROTATORY & LATERAL

GLIDINGING MOVEMENTS

 NOTE SYNOVIAL JNT INFECTIONS

Calcification of cartilages

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 LIGAMENTS & MEMBRANES
•Extrinsic – thyrohyoid membrane, cricotracheal, hypoepiglottic and thyroepiglottic
ligaments.
•Intrinsic- quadrangular membrane & cricothyroid ligament

 Thyrohyoid membrane

Has a thick median part

& a thinner lateral part
which is pierced by the sup.
Laryngeal vessels &
internal laryngeal nerves

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Fibroelastic Membrane
• Deep to mucous membrane of larynx
• 2 Parts:
Upper part – Quadrangular Membrane
Lower part – Cricothyroid lig/Cricovocal
Membrane.
- Conus Elasticus

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Quadrangular Membrane.
Between arytenoid
cartilage and Epiglottis
• Lower border forms the
vestibular folds
•Conus elasticus
Lies deep to the thyroid
lamina cartilages. Thyro--
arytenoid muscle lie
between them.
• Upper border forms Note the laryngeal sinus leading
into the larygeal saccule.
vocal ligaments
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 LARYNGEAL CAVITY
• FROM INLET TO CRICO-TRACHEAL
• 3 PARTS
– UPPER (LARYNGEAL VESTIBULE)
• FROM INLET TO VESTIBULAR FOLDS
– MIDDLE (LARYNGEAL SINUS)
• BETWEEN VOCAL AND VESTIBULAR FOLDS
– LOWER
• FROM VOCAL FOLDS TO LOWER BORDER OF
CRICOID

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 Vocal folds
2 parts
• Vocal ligaments
• Vocal Process
Rima Glottidis/Glottis
• Space between
Vocal folds

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A saggital diameter of about 23mm in adult males and
17mm in adult females

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 LARYNGEAL MUSCLES
EXTRINSIC
INFRAHYOID STRAP MUSCLES
STERNOHYOID
TYROHYOID
STERNOTHYROID
INFERIOR CONSTRICTOR MUSCLE
Elevator muscles of the pharynx eg., stylopharyngeus &
palatopharyngeus

INTRINSIC
CRICOTYROID, POST. & LAT. CRICOARYTENOID, TRANSVERSE
& OBLIQUE ARYTENOID, ARYEPIGLOTTICUS, THYROARYTENOID,
VOCALIS, THYROEPIGLOTTICUS
 ALL but the transverse (INTER)arytenoid are paired.
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 INTRINSIC MUSCLES OF LARYNX
 Posterior cricoarytenoid-Abduction of vocal
ligaments
Lateral cricoarytenoid- Adduction of vocal
ligaments
Transverse arytenoid-Adduction
Oblique arytenoid -Adduction
 Thyroarytenoids-shortens and relax vocal ligament (pitch)- Adduct
Cricothyroid- lengthens and affects tension in the
vocal folds.
Aryepiglottic muscle-close the laryngeal inlet
Thyroepiglottic muscles-opens the inlet
 Vocalis muscles- medial fibers of thyroarytenoid increase
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tension within vocal fold
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 Musculature

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 The greater the length of the cord, the deeper the
pitch of the voice eg. Adult males

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 Extrinsic muscles of the larynx
Laryngeal elevators (suprahyoid muscles)
Digastric
Stylohyoid
Mylohyoid
Geniohyoid
Thyropharyngeus

Laryngeal depressors (Infrahyoid muscles)

Sternohyoid
Sternothyroid
Thyrohyoid

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 The intrinsic muscles are concerned with
the movements of the laryngeal parts,
making alterations in the length and tension
of the vocal folds and in the size and shape of
the rima glottidis in voice production.
 All intrinsic muscles of the larynx are
supplied by the recurrent laryngeal nerve, a
branch of the vagus nerve (CN X) EXCEPT the
CRICOTHYROID muscle, which is supplied by
the EXTERNAL LARYNGEAL NERVE.

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BLOOD SUPPLY OF THE LARYNX
•The superior and inferior laryngeal arteries supply the larynx.
They are branches of the superior and inferior thyroid arteries
respectively.
•The superior laryngeal artery runs with the internal branch of the
superior laryngeal nerve which lie above it. It passes through the
thyrohyoid membrane, and then branches to supply the internal
surface of the larynx. Note that the close relationship of the
external laryngeal nerve & the superior thyroid artery puts it in
danger during thyroid lobectomy.
•The inferior laryngeal artery is smaller and runs with the
recurrent laryngeal nerve (inferior laryngeal nerve) and supplies
the mucous membrane and muscles of the inferior aspect of the
larynx.

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 Unilateral complete palsy of the recurrent laryngeal nerve is more
common on the left side because the nerve is longer on that side –
hoarse voice!!! Even worse when it is bilateral damage

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  Sensory innervation above the vocal folds is
by the INTERNAL LARYNGEAL NERVE (branch of
superior laryngeal branch of vagus).

The sensory innervation of the mucous

membrane below the vocal folds is by the
RECURRENT LARYNGEAL

Conventionally, the internal laryngeal nerve is

sensory, the external laryngeal is motor and the
recurrent laryngeal nerve is mixed.

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 Laryngeal Nerves

Sup. Laryngeal
• Internal
• External

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  Thevocal cords are responsible for making
sound through their vibration, they are what
becomes inflamed in laryngitis.

 The vibration of the vocal cords is responsible

for the pitch of the voice. Being inflamed, they
vibrate more slowly causing a lower pitch

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 LARYNGEAL LYMPHATICS
• TWO GROUPS
– ABOVE THE VOCAL CORDS
– BELOW THE VOCAL CORDS
• THOSE ABOVE THE VOCAL CORDS
– TRAVEL WITH SUPERIOR THYROID ARTERY
• TO DEEP CERVICAL LYMPH NODES
• THOSE BELOW VOCAL CORDS
– TRAVEL WITH INFERIOR THYROID ARTERY
• TO DEEP CERVICAL LYMPH NODES

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 CLINICAL INTERESTS
• DAMAGE TO INTERNAL LARYNGEAL
– ANAESTHESIA TO INLET
– INHALATION OF FOOD
– LOSS OF COUGH REFLEX
• LARYNGEAL CANCER-Laryngectomy ; Electrolarynx
• NERVE DAMAGE
– RECURRENT LARYNGEAL
– EXTERNAL LARYNGEAL
• INTUBATION
• TRACHEOSTOMY vrs TRACHEOTOMY?

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 THANK-YOU
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