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LARYNX
• Introduction
• Situation & Extent
• Size
• Skeletal framework
• Subdivison of larynx
• Muscles
• Movements of vocal cord...
Introduction
• Organ of phonation
• Part of air passage
– Regulates passage of air in
inspiration and expiration
• Act as ...
Situation & Extent
• Lies in anterior midline of neck
• From root of Tongue to Trachea
• From laryngeal inlet up to
lower ...
Measurements
In Males In Females
Length 44 mm. 36 mm.
Transverse diameter 43 mm. 41 mm.
A-P diameter 36 mm 26 mm.
Circumfe...
Constitution of larynx
• 9 Cartilages:
– Connected by
• Joints
• Ligaments
• Membranes
– Moved by
• 8 Muscles(Intrinsic)
•...
Cartilages
3 Paired
• Arytenoid
• Corniculate
• Cuneiform
3 Unpaired
• Thyroid
• Cricoid
• Epiglottis
Cartilages
Thyroid
Cricoid
Epiglottis
ArytenoidCorniculate
Anterior Posterior
Cuniform
• Shield shaped, open posteriorly, angulated anteriorly
• Largest cartilage of larynx
• Protect larynx
• Provide an attach...
Thyroid Cartilage
Antero-lateral view
‘V’ shaped in cross section
Laminae
Thyroid Cartilage
Superior view
90° Male
120° female
Posterior
Anterior
Thyroid Cartilage
Anterior Border
Laryngeal
Prominence
Thyroid Notch
Posterior Borders
Superior
Cornua
Inferior
Cornua
Thyroid Cartilage
Lateral Thyro-hyoid Ligament
Crico-thyroid Joint
Cartilago Triticia
Thyroid Cartilage
Conus
Elasticus
Inferior Border
Thyroid CartilageOuter Surface
Oblique Line
Superior Thyroid Tubercle
Inferior Thyroid Tubercle
Cricoid Cartilage
• Encircle larynx below thyroid
• Thicker & Stronger than Thyroid
Cricoid Cartilage
Anterior Posterior Medial
Arch Lamina
Superiorly
Facet for
Inferior Cornu
Epiglottis
• Leaf Shaped
• Anterior wall of upper part
Epiglottis
Upper End
Lower End
Stalk
Hyo-epiglottic
Ligament
Ary-epiglottic Fold
Epiglottis
Median Glosso-
epiglottic Fold
Median Glosso-
epiglottic Fold
Arytenoid Cartilage
• Pyramidal Shaped
• On upper border
cricoid cartilage
Apex
Base
Processes of Arytenoid Cartilage
Vocal Process
Muscular
Process
Corniculate And
Cuneiform Cartilage
Corniculate cartilage
of Santorini
Cunieform cartilage
of Wrisberg
Cartilage
Tritiate
...
• Thyroid,
• Cricoid
• Base of Arytenoids
Histology of Laryngeal Cartilages:
• Hyaline Cartilage
• May ossify after 25 yrs...
Joints:
Rotatory Movements
Around Vertical Axis
Crico-thyroid Joint Crico-arytenoid Joint
Rotatory Movements
Around Transv...
MEMBRANES & LIGAMENTS
• Extrinsic
• Thyrohyoid
• Cricotracheal
• Hyoepiglottic
• Intrinsic
• Quadrangular membrane &
vesti...
EXTRINSIC Thyrohyoid Membrane
Superior Laryngeal
Vessels
Internal Laryngeal
Nerve
EXTRINSIC
Hyo-epiglottic
Ligament
Crico-Tracheal
Ligament
Intrinsic
• Part of Fibroelastic Membrane
• Lies just outside of mucous
membrane
Fibroelastic Membrane
• Divided by
Sinus of Larynx
Quadrate Membrane
Crico-vocal Membrane
Conus Elasticus
Quadrate Membrane
Arytenoid Cartilage
Epiglottis
Ary-epiglottic Ligament
(Fold)
Vestibular Ligament / Fold
(False Vocal Co...
Crico-Vocal Membrane
Arch of Cricoid Cartilage
Cricothyroid Ligament
Vocal Ligament / Fold
(True Vocal Cord)
Vocal Ligament
Middle of Angle of
Thyroid Cartilage
Vocal Process of
Arytenoioid Cartilage
True Vocal Cord
Anterior
Poster...
Laryngeal Cavity
Coronal section Posterior aspect
From Inlet of Larynx
to
Lower border of
Cricoid Cartilage
Laryngeal Inlet
Above & In Front
Upper Margin of
Epiglottis
Below & Behind
Inter-arytenoid fold
of Mucous Memb
On Each Sid...
Laryngeal Cavity
Vestibular Fold
Vocal Fold
Laryngeal Cavity
Rima Vestibuli
Rima Glottidis
Anterior
Posterior
Rima Glottidis
Anterior 3/5th
Inter-membraneous Part
Posterior 2/5th
Inter-cartilageous Part
Laryngeal Cavity
Supraglottic Part / Vestibule
Above Vestibule
Glottic Part / Sinus / Ventricle
Between Vestibular & Vocal...
Sinus / Ventricle of Larynx
Vestibular Fold
Sinus Of Morgagni
Lamina of Thyroid Cartilage
Saccule Of Larynx
Mucous Glands
...
Extrinsic Muscles
Extrinsic attached to hyoid
(Depressors)
– Sternothyroid
– Sternohyoid
– Thyrohyoid
Extrinsic attached to thyroid
(Elevators )
– Palatopharyngeus
– Stylopharyngeus
Intrinsic
Muscles acting on Vocal Cords:
– Length and tension
• Cricothyroid
• Thyroarytenoids
– Abductor
• Post cricoaryt...
Have 2 fiber types
• Oblique
• Vertical
Action: lengthens and tenses VF
Cricothyroid
Antero-Lat
Action:
Abduction of Vocal Cord
Posterior Cricoarytenoid
Post.
Action:
Adduction of Vocal Cord
Lateral Cricoarytenoid
Lat, Thyroid lamina removed
Action:
Close Laryngeal Inlet
Oblique Arytenoid
Ary-epiglotticus
Post.
Action:
Adduction
Transverse Arytenoid
Only Unpaired
Post.
Action:
Relax Vocal Cords
ThyroArytenoid
Thyro-epiglotticus
Action:
Open Laryngeal Inlet
Post-lat, Thyroid lamina removed
Action:
Relax Vocal Cords
ThyroArytenoid
Vocalis
Post.
Action Abduction of Vocal CodsAdduction of Vocal Cods
Vocal Process
Muscular Process Post.
Action
Posterior Cricoarytenoid MuscleLateral cricoarytenoid muscle
Ant.
Post.
Abduction of Vocal CodsAdduction of Vocal C...
Ant.
Post.
Action
Thyroarytenoid & Vocalis
Relaxation of Vocal Cods
Action Rotate Thyroid ForwardTensioning of Vocal Cods
Crico-thyroid Jt Med Crico-thyroid Muscle
Shape Of Rima Glottidis During Different
Movements Of Vocal Cords
Resting Condition During Forced Inspiration
Post. Post.
During Phonation During Whispering
Post. Post.
NERVE SUPPLY
Internal Laryngeal Nerve :
Only sensory – Above VC
External Laryngeal Nerve :
Only motor - Cricothyroid
Recur...
Blood Supply
Sup Laryngeal
Sup Thyroid
Inf Laryngeal
Inf Thyroid
Lymphatic Drainage
• Above VC upper
deep cervical =
anterosuperior
group
• Below VC lower
deep cervical =
posteroinferior
...
Applied Anatomy
 Requires laryngeal mirror and
head mirror
 Structures seen……………
Laryngoscopy-
Indirect Laryngoscopy
Done under GA
Before endotracheal
intubation
Direct Laryngoscopy
Singers / Screamers/ Clergymens
Nodules / Teacher’s Nodule
Reinke’s Edema
Classification Of Laryngeal Paralysis
• May be unilateral or
bilateral and may involve
1. Recurrent laryngeal nerve
2. Sup...
RLN Paralysis
• Moderate trauma produces only abductor
paralysis.
• Severe injury or section of nerve produces
both abduct...
Unilateral Abductor Paralysis
 Paralysis of recurrent laryngeal nerve.
 Vocal cord lies in median or paramedian position...
Laryngeal Obstruction
• Produce severe protective
cough reflex
• If Internal laryngeal nerve
is damaged
• Break reflex arc...
Laryngotomy
Inflammation Of Larynx
• Produce Hoarseness of Voice
Malignancy Of Larynx
• Supraglottic
• Glottic
• Subglottic
Larynx Anatomy
Larynx Anatomy
Larynx Anatomy
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Larynx Anatomy

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Anatomy of Larynx

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Larynx Anatomy

  1. 1. LARYNX
  2. 2. • Introduction • Situation & Extent • Size • Skeletal framework • Subdivison of larynx • Muscles • Movements of vocal cords • Histology • Blood supply • Nerve supply • Lymphatic drainage • Applied anatomy Objectives
  3. 3. Introduction • Organ of phonation • Part of air passage – Regulates passage of air in inspiration and expiration • Act as Sphincter at Inlet of Lower Respiratory Tract • Upper Respiratory tract?
  4. 4. Situation & Extent • Lies in anterior midline of neck • From root of Tongue to Trachea • From laryngeal inlet up to lower border of cricoid cartilage • Opp to C3 to C6 vertebrae in men • Slightly higher in female & children
  5. 5. Measurements In Males In Females Length 44 mm. 36 mm. Transverse diameter 43 mm. 41 mm. A-P diameter 36 mm 26 mm. Circumference 136 mm. 112 mm. Until puberty there is little difference b/w male & female larynx. After puberty:- Male larynx undergoes considerable increase; thyroid cartilage becomes prominent – Adam’s Apple
  6. 6. Constitution of larynx • 9 Cartilages: – Connected by • Joints • Ligaments • Membranes – Moved by • 8 Muscles(Intrinsic) • Cavity – Mucous membrane
  7. 7. Cartilages 3 Paired • Arytenoid • Corniculate • Cuneiform 3 Unpaired • Thyroid • Cricoid • Epiglottis
  8. 8. Cartilages Thyroid Cricoid Epiglottis ArytenoidCorniculate Anterior Posterior Cuniform
  9. 9. • Shield shaped, open posteriorly, angulated anteriorly • Largest cartilage of larynx • Protect larynx • Provide an attachment to vocal cords Thyroid Cartilage
  10. 10. Thyroid Cartilage Antero-lateral view ‘V’ shaped in cross section Laminae
  11. 11. Thyroid Cartilage Superior view 90° Male 120° female Posterior Anterior
  12. 12. Thyroid Cartilage Anterior Border Laryngeal Prominence Thyroid Notch Posterior Borders Superior Cornua Inferior Cornua
  13. 13. Thyroid Cartilage Lateral Thyro-hyoid Ligament Crico-thyroid Joint Cartilago Triticia
  14. 14. Thyroid Cartilage Conus Elasticus Inferior Border
  15. 15. Thyroid CartilageOuter Surface Oblique Line Superior Thyroid Tubercle Inferior Thyroid Tubercle
  16. 16. Cricoid Cartilage • Encircle larynx below thyroid • Thicker & Stronger than Thyroid
  17. 17. Cricoid Cartilage Anterior Posterior Medial Arch Lamina Superiorly Facet for Inferior Cornu
  18. 18. Epiglottis • Leaf Shaped • Anterior wall of upper part
  19. 19. Epiglottis Upper End Lower End Stalk Hyo-epiglottic Ligament
  20. 20. Ary-epiglottic Fold Epiglottis Median Glosso- epiglottic Fold Median Glosso- epiglottic Fold
  21. 21. Arytenoid Cartilage • Pyramidal Shaped • On upper border cricoid cartilage Apex Base
  22. 22. Processes of Arytenoid Cartilage Vocal Process Muscular Process
  23. 23. Corniculate And Cuneiform Cartilage Corniculate cartilage of Santorini Cunieform cartilage of Wrisberg Cartilage Tritiate Tritiate Cartilage
  24. 24. • Thyroid, • Cricoid • Base of Arytenoids Histology of Laryngeal Cartilages: • Hyaline Cartilage • May ossify after 25 yrs of age • Epiglottis, • Corniculate, • Cuneiform • Processes of Arytenoid • Elastic • They do not ossify
  25. 25. Joints: Rotatory Movements Around Vertical Axis Crico-thyroid Joint Crico-arytenoid Joint Rotatory Movements Around Transverse Axis Synoial
  26. 26. MEMBRANES & LIGAMENTS • Extrinsic • Thyrohyoid • Cricotracheal • Hyoepiglottic • Intrinsic • Quadrangular membrane & vestibular ligament • Crico-vocal membrane & vocal ligament
  27. 27. EXTRINSIC Thyrohyoid Membrane Superior Laryngeal Vessels Internal Laryngeal Nerve
  28. 28. EXTRINSIC Hyo-epiglottic Ligament Crico-Tracheal Ligament
  29. 29. Intrinsic • Part of Fibroelastic Membrane • Lies just outside of mucous membrane
  30. 30. Fibroelastic Membrane • Divided by Sinus of Larynx Quadrate Membrane Crico-vocal Membrane Conus Elasticus
  31. 31. Quadrate Membrane Arytenoid Cartilage Epiglottis Ary-epiglottic Ligament (Fold) Vestibular Ligament / Fold (False Vocal Cord)
  32. 32. Crico-Vocal Membrane Arch of Cricoid Cartilage Cricothyroid Ligament Vocal Ligament / Fold (True Vocal Cord)
  33. 33. Vocal Ligament Middle of Angle of Thyroid Cartilage Vocal Process of Arytenoioid Cartilage True Vocal Cord Anterior Posterior
  34. 34. Laryngeal Cavity Coronal section Posterior aspect From Inlet of Larynx to Lower border of Cricoid Cartilage
  35. 35. Laryngeal Inlet Above & In Front Upper Margin of Epiglottis Below & Behind Inter-arytenoid fold of Mucous Memb On Each Side Ary-epiglottic Fold Closure by apposition of Ary-epiglottic Fold
  36. 36. Laryngeal Cavity Vestibular Fold Vocal Fold
  37. 37. Laryngeal Cavity Rima Vestibuli Rima Glottidis
  38. 38. Anterior Posterior Rima Glottidis Anterior 3/5th Inter-membraneous Part Posterior 2/5th Inter-cartilageous Part
  39. 39. Laryngeal Cavity Supraglottic Part / Vestibule Above Vestibule Glottic Part / Sinus / Ventricle Between Vestibular & Vocal Folds Infraglottic Part Below Vestibule
  40. 40. Sinus / Ventricle of Larynx Vestibular Fold Sinus Of Morgagni Lamina of Thyroid Cartilage Saccule Of Larynx Mucous Glands Lubrication of Vocal Cords
  41. 41. Extrinsic Muscles Extrinsic attached to hyoid (Depressors) – Sternothyroid – Sternohyoid – Thyrohyoid
  42. 42. Extrinsic attached to thyroid (Elevators ) – Palatopharyngeus – Stylopharyngeus
  43. 43. Intrinsic Muscles acting on Vocal Cords: – Length and tension • Cricothyroid • Thyroarytenoids – Abductor • Post cricoarytenoid – Adductors • Lateral cricoarytenoid • Thyroarytenoid • Interarytenoideus / Transverse Muscles acting on epiglottis: – Aryepiglotticus – Thyroepiglotticus
  44. 44. Have 2 fiber types • Oblique • Vertical Action: lengthens and tenses VF Cricothyroid Antero-Lat
  45. 45. Action: Abduction of Vocal Cord Posterior Cricoarytenoid Post.
  46. 46. Action: Adduction of Vocal Cord Lateral Cricoarytenoid Lat, Thyroid lamina removed
  47. 47. Action: Close Laryngeal Inlet Oblique Arytenoid Ary-epiglotticus Post.
  48. 48. Action: Adduction Transverse Arytenoid Only Unpaired Post.
  49. 49. Action: Relax Vocal Cords ThyroArytenoid Thyro-epiglotticus Action: Open Laryngeal Inlet Post-lat, Thyroid lamina removed
  50. 50. Action: Relax Vocal Cords ThyroArytenoid Vocalis Post.
  51. 51. Action Abduction of Vocal CodsAdduction of Vocal Cods Vocal Process Muscular Process Post.
  52. 52. Action Posterior Cricoarytenoid MuscleLateral cricoarytenoid muscle Ant. Post. Abduction of Vocal CodsAdduction of Vocal Cods
  53. 53. Ant. Post. Action Thyroarytenoid & Vocalis Relaxation of Vocal Cods
  54. 54. Action Rotate Thyroid ForwardTensioning of Vocal Cods Crico-thyroid Jt Med Crico-thyroid Muscle
  55. 55. Shape Of Rima Glottidis During Different Movements Of Vocal Cords Resting Condition During Forced Inspiration Post. Post.
  56. 56. During Phonation During Whispering Post. Post.
  57. 57. NERVE SUPPLY Internal Laryngeal Nerve : Only sensory – Above VC External Laryngeal Nerve : Only motor - Cricothyroid Recurrent Laryngeal Nerve : Sensory – Below VC Motor – All other muscles
  58. 58. Blood Supply Sup Laryngeal Sup Thyroid Inf Laryngeal Inf Thyroid
  59. 59. Lymphatic Drainage • Above VC upper deep cervical = anterosuperior group • Below VC lower deep cervical = posteroinferior group Upper deep cervical Lower deep cervical
  60. 60. Applied Anatomy
  61. 61.  Requires laryngeal mirror and head mirror  Structures seen…………… Laryngoscopy- Indirect Laryngoscopy
  62. 62. Done under GA Before endotracheal intubation Direct Laryngoscopy
  63. 63. Singers / Screamers/ Clergymens Nodules / Teacher’s Nodule
  64. 64. Reinke’s Edema
  65. 65. Classification Of Laryngeal Paralysis • May be unilateral or bilateral and may involve 1. Recurrent laryngeal nerve 2. Superior laryngeal nerve a. External LN b. Internal LN
  66. 66. RLN Paralysis • Moderate trauma produces only abductor paralysis. • Severe injury or section of nerve produces both abductor and adductor paralysis. • Vocal cords lies in cadaveric position – Bet Abducted & Adducted position • Phonation is completely lost • Semon's law: Progressive moderate lesion – Abductor: first to paralyzed & last to recover
  67. 67. Unilateral Abductor Paralysis  Paralysis of recurrent laryngeal nerve.  Vocal cord lies in median or paramedian position, doesn’t move on deep inspiration.  Initial hoarseness.  No regurgitation.  Vocal cord compensation occurs leading to improvement of voice.
  68. 68. Laryngeal Obstruction • Produce severe protective cough reflex • If Internal laryngeal nerve is damaged • Break reflex arc • Allow entry of foreign body • Obstructiom
  69. 69. Laryngotomy
  70. 70. Inflammation Of Larynx • Produce Hoarseness of Voice
  71. 71. Malignancy Of Larynx • Supraglottic • Glottic • Subglottic

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