Professional Documents
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PHYSIOLOGY OF
THE LARYNX
JULIE G. CEBRIAN, M.D., FPSO-HNS
LARYNX
voice box
sits approximately at
the level of 5th cervical
vertebrae in the adult
LARYNX
Subdivisions of larynx
Supraglottis
Glottis
Subglottis
LARYNX
Subdivisions of larynx
False vocal cords
Mucosal folds located
superior to the glottis and
are separated from the
true vocal cords by the
ventricle
LARYNX
LARYNGEAL
FRAMEWORK
A. Bone
B. Cartilages 1. unpaired
- hyoid
- thyroid
cricoid
epiglottis
2. paired
- arytenoid
corniculate
cuneiform
LARYNX
LARYNGEAL
FRAMEWORK
EPIGLOTTIS
HYOID
CORNICULATE
ARYTENOID
THYROID
CRICOID
Anterior
Posterior
LARYNX
LARYNGEAL
FRAMEWORK
EPIGLOTTIS
HYOID
CORNICULATE
ARYTENOID
THYROID
CRICOID
Lateral
Posterior
LARYNX
LARYNGEAL
FRAMEWORK
LARYNX
LARYNGEAL
FRAMEWORK
Thyroid Cartilage
Largest cartilage of the larynx.
Shield shape and acts as the anterior protective housing of the vocal
mechanism.
Has anterior attachment of the vocal folds and posterior articulation with
cricoid cartilage
LARYNX
LARYNGEAL
FRAMEWORK
Cricoid Cartilage
LARYNX
LARYNGEAL
FRAMEWORK
Epiglottis
LARYNX
LARYNGEAL
Arytenoid
Cartilage
FRAMEWORK
LARYNX
LARYNGEAL
FRAMEWORK
Corniculate
Cartilage
LARYNX
LARYNGEAL
FRAMEWORK
Cuneiform Cartilage
A pair of elongated
pieces of cartilage
placed on each side of
the aryepiglottic fold in
front of the arytenoids
cartilages.
LARYNX
LARYNGEAL
FRAMEWORK
( Supporting Structures )
A. Ligaments
LARYNX
LARYNGEAL
FRAMEWORK
( Supporting Structures )
Ligaments/Membranes
Thyrohyoid Membrane -It is a broad, fibro-elastic layer which
connects the thyroid cartilage to the hyoid bone. It facilitates the
upward movement of the larynx during deglutition.
Hyoepiglottic Ligament -It connects the epiglottis with the hyoid
bone.
Cricotracheal Ligament -It connects the cricoid with the first ring
of the trachea.
Cricothyroid Membrane -It connects the cricoid to the front parts
of the thyroid cartilage. It is mainly avascular.
Thyroepiglottic Ligament -It connects the stem of the epiglottis
with the angle of the thyroid cartilage.
LARYNX
LARYNGEAL
FRAMEWORK
( Supporting Structures )
Thyrohyoid Membrane
Hyoepiglottic Ligament
Thyroepiglottic Ligament
Cricothyroid Membrane
Cricotracheal Ligament
LARYNX
LARYNGEAL
FRAMEWORK
( Supporting Structures )
LARYNX
LARYNGEAL
musculature
A. Extrinsic Muscles
- Depressors
Elevators
B. Intrinsic Muscles
- Abductors
Adductors
Tensors
LARYNX
EXTRINSIC MUSCLES
OMOHYOID
STERNOHYOID
STERNOTHYROID
MYLOHYOID
GENIOHYOID
GENIOGLOSSUS
HYOGLOSSUS
DIGASTRIC
STYLOHYOID
* THYROHYOID *
LARYNX
INTRINSIC
MUSCLES
ABDUCTORS
Posterior
cricoarytenoid
ADDUCTORS
TENSORS
interarytenoid
Cricothyroid
(external)
Lateral cricoarytenoid
Vocalis (internal)
cricothyroid
thyroarytenoid
LARYNX
Intrinsic muscles
POSTERIOR CRICOARYTENOID
INTERARYTENOID
LATERAL CRICOARYTENOID
CRICOTHYROID
VOCALIS
THYROARYTENOID
SUPERIOR VIEW
LARYNX
Intrinsic muscles
OBLIQUE ARYTENOID
TRANSVERSE ARYTENOID
POSTERIOR
CRICOARYTENOID
OBLIQUE CRICOTHYROID
Posterior
View
TRANSVERSE
CRICOTHYROID
Lateral
View
LARYNX
INTRINSIC
MUSCLES
Posterior Cricoarytenoid
Arises from the posterior aspect of the
cricoid to the arytenoids.
Causes external rotation of the arytenoids,
which result in abduction of the cords. PCApull the cords apart.
LARYNX
ACTION OF THE posterior
cricoarytenoid muscles
LARYNX
INTRINSIC
MUSCLES
Interarytenoid
Single muscle which fills up the posterior
concave surfaces of the arytenoid
cartilages.
Aids in adduction.
LARYNX
ACTION OF THE interarytenoid
muscle
LARYNX
INTRINSIC
MUSCLES
Lateral Cricoarytenoid
Arises from the upper border of the cricoid
to the arytenoids.
Causes internal rotation of the arytenoids,
which result in adduction of the cords.
LCA-leave the cords alone.
LARYNX
ACTION OF THE lateral
cricoarytenoid muscles
LARYNX
INTRINSIC
MUSCLES
Cricothyroid Muscle
Arises from the front and lateral part of the
cricoid.
Has a triangular form and when is contracts
it causes the larynx to shift which in turn
causes cord stretch and tension.
Causes laryngospasm which is total and
profound glottic closure
LARYNX
ACTION OF THE cricothyroid
muscles
LARYNX
INTRINSIC
MUSCLES
Thyroarytenoid
Broad and thin muscle, which lies parallel with
and lateral to the vocal fold.
Helps with phonation, fine-tuning, and it relaxes
the cords
Vocalis
Lies parallel with the vocal ligament.
Also helps with phonation and fine-tuning and
works in opposition to the thyroarytenoid muscle
and tenses the cords.
LARYNX
ACTION OF THE vocalis and
thyroarytenoid muscles
LARYNX
innervation
LARYNX
innervation
Derived from the Vagus Nerve (CN-X)
LARYNX
innervation
SUPERIOR LARYNGEAL
NERVE
Internal Branch
External Branch
INFERIOR LARYNGEAL NERVE
RIGHT LATERAL
VIEW
LARYNX
innervation
The right recurrent laryngeal nerve circumflexes around the first part of the
right subclavian artery.
The left recurrent laryngeal nerve circumflexes around the aortic arch.
LARYNX
Blood supply
Superior Laryngeal Artery
supplies the internal laryngeal structures and it comes off
of the superior thyroid artery which comes from the
carotid
Inferior Laryngeal Artery
supplies the surrounding laryngeal structures and comes
off of the inferior thyroid artery which is from the
subclavian artery
Superior Thyroid Vein
joins the superior laryngeal artery which open into the
internal jugular vein
Inferior Thyroid Vein
joins the inferior laryngeal artery and opens into the
innominate vein.
LARYNX
Blood supply
Superior Thyroid Artery and Vein
Superior Laryngeal Artery and
Vein
LARYNX
LYMPHATIC DRAINAGE
SUPERIOR
upper lymph nodes of the deep cervical
chain at the level of the hyoid bone
VOCAL CORD AREA
poor lymphatic supply
INFERIOR
pretracheal nodes (Delphian node)
lower deep cervical nodes
supraclavicular nodes
superior mediastinal nodes
LARYNX
Major functions
1.
Protection of airway
2.
Respiration
3.
Phonation
other functions
1.
Valsalva maneuver
2.
LARYNX
During inspection:
INSPIRATIO
N
PHONATIO
N
LARYNX
Protection of airway
LARYNX
rESPIRATION
LARYNX
PHONATION
LARYNX
PHONATION
LARYNX
Valsalva maneuver
LARYNX
Central intrathoracic pressure
Thank you !