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Tahani Abualteen
The Larynx
Definition: A special part of the body consists of group of cartilages which are connected to each other by connective tissue membranes & ligaments and moved by skeletal muscles Functions: o Voice production (contains vocal cords/ligaments) o Protective sphincter " "for inlet of airway to the lungs that prevents foreign body entry into lungs Location: o Extends between C4 - C6 (where it ends and trachea begins ) ** Larynx = 1/3 of pharynx ** Pharynx is located posterior to larynx and extends between base of skull C6 (where it ends and esophageous begins ) ** Pharynx has a part behind nose (nasopharynx), and a part behind mouth (oropharynx), and a part behind larynx (laryngeopharynx) Components of Larynx: Cartilages Membranes & ligaments Muscles
Cartilages :
Thyroid cartilage: o Thyroid = like a shield "" o The largest cartilage o Single large shield of hyaline cartilage (solid cartilage) o Location: felt anterior in the neck and extends on both sides of the neck o Function: it shields/protects the whole larynx behind it (especially the vocal cords, part of epiglottis, arytenoid, Corniculate & cuneiform cartilages) o Consists of: 2 Laminae: Meet in a sharp angle in the midline anteriorly to form a laryngeal prominence called "Adams apple "
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Epiglottis: o Single leaf-shaped of elastic cartilage tissue covered with a mucus membrane (more movable) o Location: above the glottis (larynx) o Function: protects laryngeal inlet upon swallowing process (upon swallowing, this cartilage closes the laryngeal inlet, to prevent food entry into larynx & trachea) o Attachments Lower edge (stalk) attached to thyroid cartilage Sides attached to arytenoid cartilages (through a quadrangular membrane "aryepiglottic membrane") ** The upper margin of this membrane is free and called the aryepigottic fold ** The lower margin of this membrane is also free and called the vestibular fold ** Cuneiform cartilages are found in the aryepigottic fold to strengthen it Upper edge is free o Related with the tongue by glossepiglottic membrane (reflection of mucous membrane from epiglottis forward to the posterior surface of the tongue ) that consists of: Median fold elevation Lateral folds elevations Vallecula depression on either side of median fold that prevents swallowing of sharp foreign bodies into esophageous
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Membranes and ligament: 2 Extrinsic (connecting cartilages of larynx to outer structures): o Thyrohyoid membrane (connects thyroid cartilage with hyoid bone) Median thyrohyoid ligament Lateral thyrohyoid ligament o Cricotracheal ligament (connects cricoid cartilage with 1 st ring of trachea) 2 Intrinsic (connecting cartilages of larynx together): o Quadrangular membrane "aryepiglottic membrane" (connects arytenoid cartilage posteriorely with epiglottis cartilage anteriorly) o Cricothyroid membrane & ligament (triangular membrane connecting cricoid cartilage with thyroid cartilage)
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Quadrangular Membrane "Aryepiglottic membrane": o Quadrangular in shape o Extends between arytenoid cartilage posteriorly & epiglottis cartilage anteriorly o Free lower Margin thickened to form vestibular fold (which is held within the vestibule of the larynx) ** The vestibular fold is a thickening of quadrangular membrane inferiorly that is located just above the vocal fold (true vocal cords) and thus sometimes mistakenly considered the vocal fold upon endoscoping the larynx from above and for this reason this fold is also called the false vocal cords which are fixed (not movable) because no muscle attaches to them o Free Upper margin folds to form Aryepiglottic fold o Cuneiform cartilage is found in the Aryepiglottic fold & serves to Strengthen it
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Structures found inside larynx: False Vocal cords: o Fixed vestibular folds inferior free margin of quadrangular membrane o Vascular & pink in color True Vocal Cords: o Mobile vocal ligaments superior free margin of Cricothyroid membrane o Avascular & white in color ** True vocal cords are whitish in comparison to false vocal cords for two reasons: 1. No blood supply (Avascular) 2. They always move and in continuous friction with air and this leads to change in epithelium from ciliated columnar epithelium (respiratory epithelium) into stratified Sequamous epithelium
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Cricothyroidotomy : An emergency incision through the skin and cricothyroid membrane to secure the airway during upper airway obstruction, when oral or nasal intubation is not possible ** Otomy = not complete ectomy just a cut in the skin between thyroid and cricoid cartilages in the cricothyroid membrane area ** In the anterior aspect of the neck, there's a very rigid area which is the thyroid cartilage , and at a certain distance from it inferiorly, there is a gap (soft area) which is the cricothyroid membrane, after which another rigid area is felt which is the arch of cricoid cartilage ** In the cricothyroid membrane there is nothing important (no arteries, nerves or even veins) so its very easy to penetrate this area to get into the airways ** Cricothyroidotomy is just an emergency incision that is NOT done routinely in the clinic
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Muscles of The Larynx: Extrinsic Muscles: o Move the whole organ of the larynx up or down during swallowing o Extrinsic muscles = hyoid related muscles mainly (supra & infra ones) ** When hyoid bone is elevated/depressed through the action of muscles attached to it, then the whole larynx will be elevated/depressed too because the hyoid bone is attached to the thyroid cartilage through the thyrohyoid membrane and so many of the hyoid movements are actually accompanied by movements of the whole organ of the larynx o Elevators: 4 Suprahyoid muscles (mylohyoid, stylohyoid, digastric and Geniohyoid) 3 pharyngeal muscles (Stylopharyngeus, Salpingopharyngeus and Palatopharyngeus) ** These muscles are known as the pharyngeal elevators and once they elevate the pharynx upon swallowing, the elevate the larynx too because the pharynx is attached to the larynx anteriorly o Depressors: 3 Infra hyoid muscles (sternohyoid, sternothyroid and omohyoid) EXCEPT thyrohyoid muscle (because it represents a connection between hyoid bone and thyroid cartilage and when this muscle contracts, it depresses the hyoid bone but doesn't depress the whole larynx)
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o Oblique arytenoid:
o Thyroepiglottic Muscle :
o Cricothyroid: Origin = anteriolateral part of cricoid cartilage Insertion = inferior margin and inferior horn of thyroid cartilage This muscle seen from lateral aspect of larynx This muscle has horizontal part (moves thyroid cartilage forward) and oblique part (moves thyroid cartilage forward downward) Action = tenses vocal cords
o Lateral cricoarytnoid: Origin = arch of cricoid cartilage Insertion = muscular process of arytenoid cartilage Action = adducts vocal cords by rotating arytenoid cartilage inside o Posterior cricoarytnoid: Origin = posterior surface of cricoid lamina Insertion = muscular process of arytenoid cartilage Action = abducts vocal cords by rotating arytenoid cartilage outside o Transverse arytenoid: Origin = one arytenoid cartilage Insertion = opposite arytenoid cartilage Action = closes posterior part of rima glottidis
Blood supply: Upper half of larynx (above vocal fold) superior laryngeal branch of superior thyroid artery (which is an anterior branch of external carotid artery) Lower half of larynx (below vocal fold) inferior laryngeal branch of the inferior thyroid artery (which is a branch of thyrocervical trunk) Nerve supply: Nerve supply to the larynx comes from the Vagus nerve (the tenth cranial nerve which descends from the skull through the jugular foramen) and as it descends it will give two nerves to the larynx
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