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Larynx
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- 2. • INTRODUCTION • DEVELOPMENTOF LARYNX • SKELETAL FRAMEWORK • SUBDIVISON OF LARYNX • MUSCLES • HISTOLOGY • BLOOD SUPPLY • NERVE SUPPLY • LYMPHATIC DRAINAGE • APPLIED ANATOMY
- 3. SITUATION AND EXTENT MEASURMENTS- Malelarynx V=44mm,T=43 mm,AP=36mm Female larynx V=36mm,T=41 mm,AP=26mm
- 4. DEVELOPMENT • Laryngotracheal tube ventralwall 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. CARTILAGES Paired • Arytenoid • Corniculate •Cuneiform • Cartilago triticea Unpaired • Thyroid • Cricoid • Epiglottis 5
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- 11. CORNICULATE AND CUNEIFORM CARTILAGE Corniculatecartilage of Santorini Cunieform cartilage of Wrisberg Cartilage Tritiate TRITIATE CARTILAGE
- 12. JOINTS: Lateral View Antero-superiorView • CRICOTHYROID JOINT • CRICOARYTENOID JOINT • ARTENOCORNICULATE JOINT
- 13. MEMBRANES & LIGAMENTS •Extrinsic • Thyrohyoid • Cricotracheal • Thyroepiglottic • Hyoepiglottic • Intrinsic • Quadrangular membrane & vestibular ligament • Cricovocal membrane & vocal ligament
- 14. EXTRINSIC • Thyrohyoid • Cricothyroid •Cricotracheal
- 15. Sagittal section showinginterior of left half of larynx EXTRINSIC Hyoepiglottic Ligament Thyroepiglottic Ligament
- 16. INTRINSIC Sagittal section ofleft side of larynx showing laryngeal membranes
- 17. Coronal section throughthe larynx and cranial end of trachea Posterior aspect SUBDIVISIONS OF LARYNGEAL CAVITY LARYNGEAL INLET ARYEPIGLOTTIC FOLD SACCULE VESTIBULAR FOLD VOCAL FOLD
- 18. PARALUMENAL SPACES Pre-epiglottic space Paraglotticspace Subglottic space
- 19. EXTRINSIC MUSCLES Extrinsic attachedto hyoid (Depressors) – Sternothyroid – Sternohyoid – Thyrohyoid
- 20. Extrinsic attached tothyroid (Elevators ) – Palatopharyngeus – stylopharyngeus
- 21. INTRINSIC Muscles acting onVC – Length and tension • Cricothyroid • Thyroarytenoids – Abductor • Post cricoarytenoid – Adductors • Lateral cricoarytenoid • Thyroarytenoid • Interarytenoideus Muscles acting on epiglottis – Aryepiglotticus – Thyroepiglotticus
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- 23. Posterior Aspect SuperiorAspect POSTERIOR CRICOARYTENOID MUSCLE
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- 25. OBLIQUE ARYTENOID MUSCLEand ARYEPIGLOTTICUS
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- 28. SHAPE OF RIMAGLOTTIDIS DURING DIFFERENT MOVEMENTS OF VOCAL CORDS
- 29. DURING PHONATION DURINGWHISPERING
- 30. NERVE SUPPLY Internal Laryngeal Nerve: only sensory External Laryngeal Nerve : only motor Recurrent Laryngeal Nerve : sensory and motor
- 31. ARTERIAL SUPPLY Sup LaryngealArtery Inferior Laryngeal Artery
- 32. VENOUS DRAINAGE Sup ThyroidVein Inf Thyroid Vein
- 33. LYMPHATIC DRAINAGE • AboveVC upper deep cervical {anterosuperior group} • Below VC lower deep cervical {posteroinferior group} Upper deep cervical Lower deep cervical
- 34. HISTOLOGY • Histology ofSupraglottis • 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. HISTOLOGY OF EPIGLOTTIS •Epithelium •Laminapropria •cartilage
- 36. INFANT LARYNX • Size •Position • Cavity- funnel shaped & short • Laryngeal cartilages-softer & pliable • Epiglottis • Thyroid • Vocal cord
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- 38. CONGENITAL ANOMALIES OFLARYNX :CLASSIFICATION • 1. SUPRAGLOTTIS LARYNGOMALACIA LARYNGEAL CYST CONGENITAL LARYNGOCELE 2. GLOTTIS LARYNGEAL WEB VOCAL CORD PARALYSIS 3. SUBGLOTTIS: SUBGLOTTIC STENOSIS LARYNGOTRACHEAL CLEFT
- 39. LARYNGOMALACIA • Excessive flaccidityof supraglottic larynx • OMEGA SHAPED EPIGLOTTIS
- 40. LARYNGEAL CYST • fluidfilled smooth swelling in Supraglottic larynx
- 41. LARYNGOCELE Air filled dialatationof saccule
- 42. ANTERIOR GLOTTIC WEB •Due toincomplete recanalisation of larynx LARYNGEAL WEB
- 43. • SUBGLOTTIC STENOSIS Abnormalthickening of cricoid cartilage or fibrous tissue seen below vocal cords
- 44. Requires laryngealmirror and head mirror Structures seen…………… LARYNGOSCOPY- Indirect Laryngoscopy
- 45. Done under GA Beforeendotracheal intubation Direct Laryngoscopy
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- 48. CLASSIFICATION OF LARYNGEALPARALYSIS • May be unilateral or bilateral and may involve 1. Recurrent laryngeal nerve 2. Superior laryngeal nerve a. External LN b. Internal LN
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- 52. MALIGNANCY OF LARYNX •Supraglottic • Glottic • Subglottic