Larynx

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Larynx

  1. 1. LARYNX
  2. 2. • INTRODUCTION • DEVELOPMENT OF LARYNX • SKELETAL FRAMEWORK • SUBDIVISON OF LARYNX • MUSCLES • HISTOLOGY • BLOOD SUPPLY • NERVE SUPPLY • LYMPHATIC DRAINAGE • APPLIED ANATOMY
  3. 3. SITUATION AND EXTENT MEASURMENTS- Male larynx V=44mm,T=43 mm,AP=36mm Female larynx V=36mm,T=41 mm,AP=26mm
  4. 4. DEVELOPMENT • Laryngotracheal tube ventral wall of primitive pharynx- 28 days of development • 4th arch-thyroid,cunieform, corniculate 5th arch- cricoid 6th arch- arytenoid Epiglottis- caudal part of hypobranchial eminence Muscles- 4 & 6 arches
  5. 5. CARTILAGES Paired • Arytenoid • Corniculate • Cuneiform • Cartilago triticea Unpaired • Thyroid • Cricoid • Epiglottis 5
  6. 6. THYROID CARTILAGE ANTERIOR ASPECT
  7. 7. POSTERIOR ASPECT LATERAL ASPECT
  8. 8. EPIGLOTTIS
  9. 9. CRICOID CARTILAGE
  10. 10. ARYTENOID CARTILAGE
  11. 11. CORNICULATE AND CUNEIFORM CARTILAGE Corniculate cartilage of Santorini Cunieform cartilage of Wrisberg Cartilage Tritiate TRITIATE CARTILAGE
  12. 12. JOINTS: Lateral View Antero-superior View • CRICOTHYROID JOINT • CRICOARYTENOID JOINT • ARTENOCORNICULATE JOINT
  13. 13. MEMBRANES & LIGAMENTS • Extrinsic • Thyrohyoid • Cricotracheal • Thyroepiglottic • Hyoepiglottic • Intrinsic • Quadrangular membrane & vestibular ligament • Cricovocal membrane & vocal ligament
  14. 14. EXTRINSIC • Thyrohyoid • Cricothyroid • Cricotracheal
  15. 15. Sagittal section showing interior of left half of larynx EXTRINSIC Hyoepiglottic Ligament Thyroepiglottic Ligament
  16. 16. INTRINSIC Sagittal section of left side of larynx showing laryngeal membranes
  17. 17. Coronal section through the larynx and cranial end of trachea Posterior aspect SUBDIVISIONS OF LARYNGEAL CAVITY LARYNGEAL INLET ARYEPIGLOTTIC FOLD SACCULE VESTIBULAR FOLD VOCAL FOLD
  18. 18. PARALUMENAL SPACES Pre-epiglottic space Paraglottic space Subglottic space
  19. 19. EXTRINSIC MUSCLES Extrinsic attached to hyoid (Depressors) – Sternothyroid – Sternohyoid – Thyrohyoid
  20. 20. Extrinsic attached to thyroid (Elevators ) – Palatopharyngeus – stylopharyngeus
  21. 21. INTRINSIC Muscles acting on VC – Length and tension • Cricothyroid • Thyroarytenoids – Abductor • Post cricoarytenoid – Adductors • Lateral cricoarytenoid • Thyroarytenoid • Interarytenoideus Muscles acting on epiglottis – Aryepiglotticus – Thyroepiglotticus
  22. 22. CRICOTHYROID MUSCLE
  23. 23. Posterior Aspect Superior Aspect POSTERIOR CRICOARYTENOID MUSCLE
  24. 24. LATERAL CRICOARYTENOID MUSCLE
  25. 25. OBLIQUE ARYTENOID MUSCLE and ARYEPIGLOTTICUS
  26. 26. TRANSVERSE ARYTENOID MUSCLE
  27. 27. THYROARYTENOID and VOCALIS MUSCLE
  28. 28. SHAPE OF RIMA GLOTTIDIS DURING DIFFERENT MOVEMENTS OF VOCAL CORDS
  29. 29. DURING PHONATION DURING WHISPERING
  30. 30. NERVE SUPPLY Internal Laryngeal Nerve : only sensory External Laryngeal Nerve : only motor Recurrent Laryngeal Nerve : sensory and motor
  31. 31. ARTERIAL SUPPLY Sup Laryngeal Artery Inferior Laryngeal Artery
  32. 32. VENOUS DRAINAGE Sup Thyroid Vein Inf Thyroid Vein
  33. 33. LYMPHATIC DRAINAGE • Above VC upper deep cervical {anterosuperior group} • Below VC lower deep cervical {posteroinferior group} Upper deep cervical Lower deep cervical
  34. 34. HISTOLOGY • Histology of Supraglottis • Epithelium • Mucous glands • Rich vascularity & lymphatic • Histology of Glottis • Epithelium • Lamina propria – 3 layers • Muscle layer- vocalis • No mucous gland in free edge of vocal cord • Cartilages
  35. 35. HISTOLOGY OF EPIGLOTTIS •Epithelium •Lamina propria •cartilage
  36. 36. INFANT LARYNX • Size • Position • Cavity- funnel shaped & short • Laryngeal cartilages-softer & pliable • Epiglottis • Thyroid • Vocal cord
  37. 37. APPLIED ANATOMY
  38. 38. CONGENITAL ANOMALIES OF LARYNX :CLASSIFICATION • 1. SUPRAGLOTTIS LARYNGOMALACIA LARYNGEAL CYST CONGENITAL LARYNGOCELE 2. GLOTTIS LARYNGEAL WEB VOCAL CORD PARALYSIS 3. SUBGLOTTIS: SUBGLOTTIC STENOSIS LARYNGOTRACHEAL CLEFT
  39. 39. LARYNGOMALACIA • Excessive flaccidity of supraglottic larynx • OMEGA SHAPED EPIGLOTTIS
  40. 40. LARYNGEAL CYST • fluid filled smooth swelling in Supraglottic larynx
  41. 41. LARYNGOCELE Air filled dialatation of saccule
  42. 42. ANTERIOR GLOTTIC WEB •Due to incomplete recanalisation of larynx LARYNGEAL WEB
  43. 43. • SUBGLOTTIC STENOSIS Abnormal thickening of cricoid cartilage or fibrous tissue seen below vocal cords
  44. 44.  Requires laryngeal mirror and head mirror  Structures seen…………… LARYNGOSCOPY- Indirect Laryngoscopy
  45. 45. Done under GA Before endotracheal intubation Direct Laryngoscopy
  46. 46. SINGERS /SCREAMERS/CLERGYMENS NODULES
  47. 47. REINKE’S EDEMA
  48. 48. 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
  49. 49. LARYNGEAL OBSTRUCTION
  50. 50. LARYNGOTOMY
  51. 51. INFLAMMATION OF LARYNX
  52. 52. MALIGNANCY OF LARYNX • Supraglottic • Glottic • Subglottic

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