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  • 02-04-2011
  • 02-04-2011
  • 02-04-2011
  • Transcript

    • 1. LARYNX02--04--2011 1
    • 2. INTRODUCTION Respiratory organ modified to produce sound Synonym: Voice box,organ of phonation Anterior midline of upper neck infront of laryngopharynx Extent:upper border of epiglottis to lower border of cricoid. Lies:infront of C3-C6 Male larynxV=44mm,T=43 mm,AP=36mm02--04--2011 2
    • 3. 02--04--2011 3
    • 4. FUNCTIONS Phonation Respiration Protection Deglutition02--04--2011 4
    • 5. DEVELOPMENT• Laryngotracheal groove (caudal end of ventral wallof primitive pharynx- 28 days of development)02--04--2011 5
    • 6. DEVELOPMENT02--04--2011 6
    • 7. • Epithelium & glands--endodermal lining• Laryngeal cartilages-from mesenchyme ie derived from neural crest cells• 4th arch-thyroid,cunieform,corniculate• 5th arch-cricoid• 6th arch-arytenoid• 2 and 3 arch –hyoid bone• Epiglottis- caudal part of hypobranchial eminence• Muscles- 4 & 6 arches(Cricothyroid, Extrinsic=4th)• Muscle cells-myotomes of cranial somites02--04--2011 7
    • 8. SKELETON OF LARYNX Cartilages Joints Membranes & ligaments Muscles02--04--2011 8
    • 9. CARTILAGES Paired Unpaired• Arytenoid • Thyroid• Corniculate • Cricoid• Cunieform • Epiglottis• Cartilago triticea02--04--2011 9
    • 10. 02--04--2011 10
    • 11. THYROID CARTILAGE02--04--2011 11
    • 12. Cricoid cartilage02--04--2011 12
    • 13. Epiglottis02--04--2011 13
    • 14. Arytenoid cartilage Cunieform cartilage of Wrisberg Corniculate cartilage of Santorini02--04--2011 14
    • 15. • Hyaline cartilages: Thyroid, Cricoid, basal part& muscular process of Arytenoid• Elastic fibrocartilage: Epiglottis,Corniculate,Cunieform,apices & vocal process of Arytenoids02--04--2011 15
    • 16. JOINTS:• Cricothyroid joint - Between inferior horn of thyroid and cricoid - Synovial hinge - Rocking movements{ Transverse axis}02--04--2011 16
    • 17. • Cricoarytenoid joint – Plane synovial – Movements: • Sliding • Rotatory• Arytenocorniculate02--04--2011 17
    • 18. 02--04--2011 18
    • 19. MEMBRANES & LIGAMENTS Extrinsic Intrinsic• Thyrohyoid • Quadrangular membrane & vestibular ligament• Cricothyroid• Cricotracheal • Cricovocal membrane &• Thyroepiglottic vocal ligament• Hyoepiglottic02--04--2011 19
    • 20. Extrinsic 02--04--2011 20
    • 21. Extrinsic02--04--2011 21
    • 22. Intrinsic-Quadrate membran eBoundaries: – Sup : aryepiglottic folds – Ant : lat margin of epiglottis – Post : arytenoid and corniculate cartilage – Inf : free called as vestibular fold – Covered by mucous membrane to Form “False vocal folds”02--04--2011 22
    • 23. 02--04--2011 23
    • 24. Cricothyroid ligament – Median cricothyroid lig : • Thickened membrane • Pass from upper border of cricoid to lower border of thyroid – Lateral cricothyroid lig : (cricovocal membrane) • Attachments – Project up from arch of cricoid to » Anteriorly : Jn of thyroid lamina » Posteriorly: vocal pr of arytenoid – Cricovocal memb free b/t ant & post attachment is thick – Form CV ligament, when covered with mucous memb : form true Vocal cordsConus elasticus : commonly includes all parts of the lig or just the anterior part of VC02--04--2011 24
    • 25. 02--04--2011 25
    • 26. Intrinsic02--04--2011 26
    • 27. 02--04--2011 27
    • 28. Extrinsic• Attached to hyoid, thyroid• Depressors – infrahyoid• Elevators as belowExtrinsic attached to hyoid – Geniohyoid – Mylohyoid – Digastric, ant and post belly – Stylohyoid – ThyrohyoidExtrinsic attached to thyroid – Palatopharyngeus – Salpingopharyngeus – stylopharyngeus02--04--2011 28
    • 29. Intrinsic• Acts on VC• Acts on epiglottisMuscles acting on VC – Length and tension • Cricothyroid • Thyroarytenoids – Abductor • Post cricoarytenoid – Adductors • Lateral cricoarytenoid • Thyroarytenoid • InterarytenoideusMuscles acting on epiglottis – Aryepiglotticus – Thyroepiglotticus02--04--2011 29
    • 30. MUSCLES OF LARYNX Extrinsic Intrinsic02--04--2011 30
    • 31. Extrinsic02--04--2011 31
    • 32. Intrinsic02--04--2011 32
    • 33. 02--04--2011 33
    • 34. 02--04--2011 34
    • 35. 02--04--2011 35
    • 36. 02--04--2011 36
    • 37. INTRINSIC MUSCLE OF LARYNX02--04--2011 37
    • 38. EXCEPTIONS• Cricothyroid -> only muscle lying on outer aspect of larynx• Transverse arytenoid-> only intrinsic muscle of larynx which is unpaired• All intrinsic muscles adduct vocal cords except post cricoarytenoid02--04--2011 38
    • 39. SUBDIVISIONS OF LARYNGEAL CAVITY02--04--2011 39
    • 40. inlet – Boundaries • Ant : epiglottis • Post : arytenoid cart • Sides : aryepiglottic foldsVestibule – Space b/t inlet & vestibular folds – Laterally : quadrate membrane – Ant : epiglottis – Lower : Rima of vestibuleFalse vocal cords – Vestibular folds – Rima vestibuli (b/t vestibular folds02--04--2011 40
    • 41. True vocal cords – Formed by upper free border of cricovocal lig – Rima glottidis (glottis) • Gap b/t true vocal cords • Parts : – Intermembranous : ant 60%, bounded each side with vocal fold – Intercartilaginous : Post 40%, bounded each side with vocal pr and base of arytenoid cartVentricle (laryngeal sinus) – Space b/t False and true VC with deep horizontal groove in lateral wall – Opening at ant end : Saccule of larynx – Covered with mucous membrane – Extend up for few mm b/t thyroid lamina and vestibular fold 02--04--2011 41
    • 42. HISTOLOGY OF LARYNX02--04--2011 42
    • 43. SHAPE OF RIMA GLOTTIDIS DURING DIFFERENT MOVEMENTS OF VOCAL CORDS02--04--2011 43
    • 44. 02--04--2011 44
    • 45. 02--04--2011 45
    • 46. NERVE SUPPLY ILN : only sensory ELN : only motor RLN : sensory and motor02--04--2011 46
    • 47. ARTERIAL SUPPLYSup LaryngealArtery Inferior Laryngeal Artery 02--04--2011 47
    • 48. VENOUS DRAINAGE Sup Thyroid Vein Inf Thyroid Vein02--04--2011 48
    • 49. LYMPHATIC DRAINAGE• Above VC upper deep cervical {anterosuperior group}• Below VC lower deep cervical {posteroinferior group}02--04--2011 49
    • 50. Crux Above VC Below VCArterial supply Sup laryngeal art Inf laryngeal artVenous drainage Sup thyroid Vein Inf thyroid VeinLymph drainage Upper Deep Lower deep cervical LN cervical LNNerve supply Sensory: ILN Sensory: RLN 02--04--2011 50
    • 51. MECHANISM OF PHONATION02--04--2011 51
    • 52. 02--04--2011 52
    • 53. 02--04--2011 53
    • 54. APPLIED ANATOM Y02--04--2011 54
    • 55. LARYNGOSCOPY- Indirect laryngoscopy  Requires laryngeal mirror and head mirror  Structures seen…………… 02--04--2011 55
    • 56. Direct laryngoscopyDone under GA“Sniff position”Macintosh LaryngoscopeBefore orotracheal/endotracheal intubation02--04--2011 56
    • 57. Cricothyrotomy • Emergency airway establishment • Cricothyroid ligament opened • Transverse incision,pocketknife • Converted to standard tracheotomy soon to prevent laryngeal stenosis02--04--2011 57
    • 58. Consequences of thyroidectomy on larynx02--04--2011 58
    • 59. HEIMLICH MANEUVER• Foreign body in laryngeal cavity• Choking,asphyxia02--04--2011 59
    • 60. MALFORMATIONS OF LARYNX• Laryngomalacia: – Supraglottic structures(epiglottis,arytenoid cartilages) abnormally soft & pliable Collapse inwards during inspiration – S/S: feeding difficulty,stridor from birth,louder in supine position – Diagnosis: laryngoscopy-”Omega shaped” epiglottis – Treatment: • Resolve by 2 yrs • Temporary tracheostomy02--04--2011 60
    • 61. • Others – Congenital laryngeal cyst – Congenital laryngocele – Congenital Subglottic stenosis – Congenital vocal cord paralysis – Subglottic hemangioma02--04--2011 61
    • 62. SINGERS /SCREAMERS/CLERGYMENS NODULES02--04--2011 62
    • 63. LARYNGOCELEIncreased air pressure in laryngeal sinusTrumpet players,glass blowers,weight liftersSaccule dilates to produce air filled cystic swelling External Internal02--04--2011 63
    • 64. NEUROGENIC DISORDERS OF LARYNX Recurrent laryngeal nerve paralysis  Unilateral : 02--04--2011 64
    • 65.  Bilateral02--04--2011 65
    • 66. Superior laryngeal nerve paralysis02--04--2011 66
    • 67. SIMON’S LAW02--04--2011 67
    • 68. 02--04--2011 68
    • 69. Infectious & inflammatory diseases of larynx02--04--2011 69
    • 70. Reinke’s edema02--04--2011 70
    • 71. TUMOURS OF LARYNX02--04--2011 71
    • 72. 02--04--2011 72
    • 73. Thank you02--04--2011 73