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Larynx anatomy and physiology
- 1. ANATOMY & PHYSIOLOGYOF LARYNX BRIG ANWAR UL HAQ ENT SPECIALIST
- 2. Laryngeal cartilages Laryngeal Membranes Laryngealmuscles function 3 Subdivisions of larynx Nerve supply of larynx Functions of larynx CONTENTS
- 4. Anatomy of larynx Rigidskeleton cartilages, muscles ligaments membranes Extension from hyoid bone above to cricoid cartilage below Opposite to C3 to C6 Laryngeal crepitus: Normally present Absent in post-cricoid carcinoma
- 5. Laryngeal cartilages 3 unpaired 3paired cartilages • Unpaired: 1.Thyroid 2.Cricoid 3.Epiglottis • Paired: 1.Arytenoid 2.Cuneiform ( Wrisberg) 3.Corniculate (Santorini)
- 6. Histological types oflaryngeal cartilages (1)Elastic: (little or no calcification) Epiglottis Corniculate Cuneiform Apex of arytenoid (2)Hyaline (calcify as age advances) Thyroid Cricoid Remaining arytenoid Ossification Begins by 25 yrs Completed by 60 yrs
- 7. 1. Thyrohyoid membrane: 2.Cricothyroid membrane: cricothyroidotomy done though this membrane • Cricoid cartilage: only rigid & complete ring among the cartilages forming larynx and trachea
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- 10. Laryngeal Membranes (I). Extrinsicmembranes: 1.Thyrohyoid membrane 2.Cricothyroid membrane 3.Cricotracheal membrane (II).Intrinsic membranes: 1.Cricovocal membrane forms vocal ligament 1.Quadrangular membrane forms the vestibular ligament
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- 15. Pediatric Larynx Vs Adult larynx 1.Subglottis is the narrowest part – may cause stridor easily 2. Loose submucosal tissues (swell up easily) may cause croup 3. Positioned high (C3-C4) 4. Soft cartilages collapse easily- Laryngomalacia
- 16. Subdivisions of Larynx A.Supraglottis: laryngeal inlet to apex of ventricle B. Glottis: apex of ventricle to 1cm below C. Subglottis: lower glottis border to lower cricoid
- 17. Sub Sites A. Supraglottis: 1.Epiglottis 2.AE fold 3. False Vocal Cords 4. Ventricle B.Glottis: 1.True Vocal Cords 2. Anterior commissure 3. Posterior commissure C. Subglottis
- 18. Intrinsic Muscles A. Actingon vocal cords 1. Abduction Posterior crico-arytenoid Adduction Lateral crico-arytenoid Transverse arytenoid (inter-arytenoid) Thyro-arytenoid 2. Tension + lengthening Cricothyroid 3. Relaxation + shortening Vocalis ( internal part of thyroarytenoid)
- 19. B. Acting onlaryngeal inlet Opener Thyro-epiglottic (part of thyroarytenoid) Closer Inter-arytenoid (oblique part) Ary-Epiglottic (Posterior oblique part of inter-arytenoid)
- 20. Extrinsic laryngeal muscles •Elevatorsof larynx Primary elevators Stylo-pharyngeus Salpingo-pharyngeus Palato-pharyngeus Digastric Secondary elevators Mylohyoid Stylohyoid Geniohyoid •Depressors of larynx ( strap muscles of the neck) •Sternohyoid ,Sternothyroid , thyrohyoid ,Omohyoid
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- 26. MucousMembrane 1.Stratified squamous epithelium 2.Pseudostratifiedciliated columnar (respiratory) epithelium
- 27. Nerve Supply •Superior LaryngealNerve ( SLN): • Internal: • Sensory supply to supraglottis & glottis • External: • Motor supply to cricothyroid muscle •Recurrent Laryngeal Nerve(RLN): • Sensory supply to subglottis • Motor supply to all intrinsic muscles except cricothyroid
- 28. Blood Supply Arterial supply: •Laryngealbranch of superior & inferior thyroid artery •Venous drainage: • Superior thyroid vein internal jugular vein • Inferior thyroid vein innominate vein
- 29. Lymphatic Drainage Supraglottis: Upper deepcervical nodes Subglottis: Pretracheal lower deep cervical nodes Glottis: has no lymphatics
- 30. Functions of Larynx 1.Protectionof lower airway: Primary function (i)Closure of larynx: Three tier mechanism (ii)Cough reflex 2.Phonation (voice production): Secondary function 3.Respiration 4.Chest fixation by glottic closure: Coughing Micturition Defecation
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