Anatomy of larynx
larynx • A cartilaginous structure present in front of C3-C6 • About 5cm in long in adults • Shorter and higher in women and children • Moves on deglutition(*) • Primary function is sphincteric in nature • Organ of phonation • The typical male voice develops only at puberty
Skeleton of larynx •
Thyroid cartilage,cricoid cartilage and epiglottis (unpaired cartilages)
•Arytenoids,corniculates and cuneiforms(paired)
Thyroid cartilage
Front view
Side view
Thyroid angle (laryngeal prominence)
• 900 in males • 1200 in females
Cricoid cartilage
Posterior view
Side view
epiglottis
Membranes and ligaments
arytenoids
False vocal cords (vestibular folds) • Lower borders of quadrangular membrane(vestibular ligament) • Present above and lateral to the true vocal cords • Pinkish in appearance • (vascular)
F
F
True vocal cords • Upper borders of conus elasticus • Involved in phonation • Pearly white in appearance • Present below and medial to false vocal cords
Conus elasticus • Crico-thyro-arytenoid ligament • Its free upper border is the fibrous ligament of the true vocal cord
Cavity of larynx • Divided into 3 parts by these vocal cords • 1.vestibule • 2.sinus (ventricle) • 3.infraglottic cavity
Rima glottidis(glottis) • Space between the two vocal cords(true vocal cords) • Directly concerned with voice production • Rima vestibuli is the space between the false vocal cords
Saccule of larynx • Extension from sinus • Secretes mucus to keep the vocal cords lubricated.
Intrinsic muscles • These help in • opening and closing the glottis , • altering the length and tension of the vocal cords and • closing the inlet. • All are supplied by recurrent laryngeal nerve except cricothyroid(supplied by external laryngeal nerve)
Inlet of larynx
A
• Opens superiorly into laryngopharynx • Oblique • leads to vestibule of larynx
P
Muscles of inlet • oblique arytenoids, transverse arytenoid and aryepiglottic muscles • close the inlet during swallowing
Bending of epiglottis (during deglutition)
Tensor of the vocal cord • Cricothyroid muscle is the “tensor of the vocal cord” • The only intrinsic muscle placed externally • Tilts “the thyroid cartilage forwards” and the arytenoids backwards” • so that vocal cords become longer
Cricothyroid in action
Muscles of the vocal cords • Posterior crico arytenoid(5 in the pic) is • The ONLY ABDUCTOR of the vocal cords and keeps the airway open • (life saving muscle!!)
The abductor in action
Superior view
Muscles closing the glottis (adductors) Lateral cricoarytenoid muscles
Relaxers of the vocal cords Main relaxers are Thyro arytenoid muscles A part of this muscle is called “vocalis”
Movements of vocal cords
During speech(adducted)
During breathing(abducted)
stemband[1].avi
Apex should be anterior
Office view
Operating view
Blood supply and nerve supply of larynx • true Vocal cords are reference points • Up to the cords supplied by superior laryngeal artery(br.of superior thyroid) • Below the cords supplied by inferior laryngeal artery
•Up to the cords sensory nerve is • internal laryngeal nerve(of X) (1in fig) •Below the cords, sensory nerve is • the Recurrent laryngeal nerve(of X)(3in fig) 1 2 ? 3
laryngoscopy A
P
Vocal cord paralysis
Injury to recurrent laryngeal nerve causes paralysis of the ipsilateral cord(same side) Usually the left rec.laryngeal.nerve is affected(?) So the left cord is paralyzed
SEMON’S LAW • In recurrent laryngeal nerve injury the abductor is the first to paralyze and last to recover.
summary
cu cor
From behind(mucosa intact)
Mucosa removed
Trachea
Trachea • Wide,fibrocartilaginous tube beginning at C6 • Lies anterior to esophagus and in the superior mediastinum inclines to the right side. • and ends by dividing into right and left principal bronchi at the level of sternal angle.
Tracheal rings(15-20)
carina
The carina is the upwardly directed ridge seen internally at the bifurcation and is a landmark during bronchoscopy
relations
Right bronchus is directly in line with trachea
Bronchial tree
Applied anatomy • tracheostomy • Tracheo bronchial lymph nodes and carina • (lung’s lymphatic drainage)
1.Can you see the tracheal shadow and principal bronchi? 2.Male or female?
http://anatomy.med.umich.edu/surface/cardinal/cardinal.html
Check for all surface anatomy and eye movements