anatomy and physiology of the larynx beta
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Anatomy andPhysiology of the
Larynx
Dr. Supreet Singh Nayyar, AFMC
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$%&e#tives
"o dis#uss the %asi# anatomy of the larynx
"o enumerate the main fun#tions of the larynx
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Laryngeal Cartilages
Paired Arytenoid
#artilage
Corni#ulate#artilage
Cuneiform#artilage
'npaired("hyroid #artilage
Cri#oid #artilage
!piglottis
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"hyroid Cartilage
)yaline #artilage
Largest !n#loses the larynx
anteriorly andlaterally
"o alae
$ssi*#ation
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Cri#oid Cartilage
)yaline #artilage
Dire#tly %elo thethyroid #artilage
Strongest
Shape( Signet ring
Lamina + at portion
$nly #omplete annularsupport of the larynx
Arti#ulates - nferior#ornu of the thyroid#artilage
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!piglottis
Fi%roelasti##artilage
Leaf/shapedstru#ture
Petiole + small
narro portion ofthe glottis
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Arytenoid Cartilage
Mostly hyaline #artilage
Smaller in si0e
1esponsi%le for opening and #losing ofthe larynx
Shape( pyramidal
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Arytenoid Cartilage
Anterior 2o#al pro#ess /
re#eives theatta#hement ofthe mo%ile end ofea#h 2C
Lateral Mus#ular pro#ess
Arti#ulation Cri#oarytenoid
&oint
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Corni#ulate Cartilages
Fi%roelasti#
Cartilages of Santorini
Small #artilages a%ove the arytenoid and in thearyepiglotti# folds 7/
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Cuneiform Cartilages
Fir%oelasti# #artilages
Cartilages of 3ris%erg
!longated pie#es of small yello
elasti# #artilage in the aryepiglotti#folds
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"riti#eous Cartilage
Cartilago triti#ea
Small elasti# #artilage
in the lateralthyrohyoid ligament
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Laryngeal Ligaments
!xtrinsi#"hyrohyoid
mem%rane and
ligaments Cri#othyroid
mem%rane andligaments
Cri#otra#healligament
!piglottis
ntrinsi# !lasti# mem%rane
4uadrangular
mem%rane Conus elasti#us
5#ri#ovo#almem%rane6
Median #ri#othyroidligament
2o#al Ligament
"hyroepiglotti#
ligament
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!xtrinsi# Ligaments
"hyrohyoid mem%ranepier#ed on ea#h side %y(
7. Superior laryngeal vessels
8. nternal %ran#h ofsuperior laryngeal nerve
Median thyrohyoid ligament
+ thi#9ened median portion
Lateral thyrohyoid ligament
+ thi#9ened posterior%order
/ here #artilago triti#ea is
often found
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!xtrinsi# Ligaments
Cri#othyroid mem%rane and ligaments May %e pier#ed for emergen#y
tra#heotomy 5#ri#othyrotomy67/15/2012
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!xtrinsi# Ligaments
Cri#otra#heal Ligament
Atta#hes the #ri#oid #artilage to the *rst atta#hedring
!piglottis suspended in position %y mem%ranous #onne#tions
to the hyoid %one, thyroid #artilage and %ase of thetongue
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ntrinsi# Ligaments
!lasti# mem%rane Divided into upper and loer parts %y the
ventri#le of the larynx
4uadrangular mem%rane 'pper part of the elasti# mem%rane
:oundaries
!piglottis , arytenoid, #orni#ulate #artilage, false #ord Forms part of all %eteen upper pyriform
sinus and laryngeal vesti%ule
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ntrinsi# Ligaments
Conus elasti#us 5#ri#ovo#al mem%rane6 Loer part of elasti# mem%rane
Composed mainly of yello elasti# tissue
:oundaries nferior( superior %order of #ri#oid #artilage
Superoanterior( deep surfa#e of angle thyroid #artilage
Superoposterior( vo#al pro#ess of arytenoid #artilage
Median #ri#othyroid ligament + thi#9ened anteiorpart
2o#al Ligament + free upper edge
"hyroepiglotti# ligament
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Cavity of the Larynx
Divided into ;
parts( 2esti%ule 2entri#le
Su%glotti# spa#e
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Cavity of the Larynx
2esti%ule + %oundaries(
Anterior( posterior surfa#e ofepiglottis
Posterior( interval %eteenarytenoid #artilages
Lateral( inner surfa#e ofaryepiglotti# folds and uppersurfa#es of the false #ord
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Cavity of the Larynx
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Cavity of the Larynx Su%glotti# spa#e
Preepiglotti# spa#e :oundaries( Anterior( thyrohyoid mem%rane
Anteroasuperior( hyoid
Superior( valle#ula Posterior( part of the epiglottis
Lateral( hyoepiglotti# ligament
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Cavity of the Larynx
False Cords 5ventri#ular %ands6Anteriorly( angle of the thyroid #artilage
Posteriorly( %odies of the arytenoid
#artilage
"rue #ords2oi#e produ#tion
Prote#tion of loer respiratory tra#t
Anteriorly,( angle of thyroid #artilage
Posteriorly( vo#al pro#esses of the arytenoid#artilages
!n#lose vo#al ligament and a ma&or part of thevo#alis mus#le
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Laryngeal =oints
Cri#othyroid =oint :eteen inferior
#ornu of thethyroid #artilage
and fa#et on the#ri#oid #artilageat the &un#tion ofthe ar#h and
lamina"o movements(
1otation
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Laryngeal Mus#les
ntrinsi# Mus#les nterarytenoid
mus#le "ransvers
$%li>ue
Post. Cri#oarytenoidm.
Lateral#ri#oarytenoid m.
"hyroarytenoid m.
Cri#othyroid m.
!xtrinsi# Mus#les
Depressor group
!levator groupConstri#tor
mus#les
Pharyngeal
mus#les
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Depressor Origin Insertion Action
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Depressormuscles
Origin Insertion Action
Sternohyoid5C8, C;6
manu%rium of
sternum and
medial end of
#lavi#le
o%li>ue line of
the thyroid
#artilage
depresses-sta%ili
0es the hyoid
%one
"hyrohyoid5C76
oblique line of thethyroid cartilage
lower border of thehyoid bone
elevates the larynx;depresses/stabilizes
the hyoid bone
$mohyoid 5C8,C;6
superior%order ofs#apula nearthesupras#apular
not#h
inferior %orderof hyoid %one
depresses,retra#ts andsteadies thehyoid duringsalloing and
spea9ing
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Elevator Origin Insertion Action
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Elevatormuscles
Origin Insertion Action
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Elevatormuscles
Origin Insertion Action
Stylopharyngeus
5CN @6
styloidpro#ess oftemporal%one
posterior andsuperior %ordersof thyroid#artilage ithpalatopharyngeusmus#le
elevates the pharynxand larynx andexpands the sides ofthe pharynx
Salpingopharyngeus 5pharyngealplexus6
#artilaginous part of theauditorytu%e
%lends ithpalatopharyngeusmus#le
elevates the pharynxand larynx and opensthe ori*#e of theauditory tu%e duringsalloing
Palatopharyngeus
hard palateandpalatineaponeurosis
lateral all ofpharynx
tenses the soft palateand pulls the alls ofthe pharynxsuperiorly, anteriorlyand medially during
salloing
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Mus#les Controlling theLaryngeal nlet
IntrinsicMuscles
Origin Insertion Action
nterarytenoid m., o%li>ue51LN6
muscular process
of the arytenoid
cartilage
posterior surface of
the contralateral
arytenoid cartilage,
near its apex
draws arytenoid
cartilages together,
adducting the vocal
folds (closure of
glottis)
"hyroepiglotti#5!LN6
inner surface of the thyroid
cartilage near the laryngeal
prominence
lateral surface of the epiglottic
cartilage
draws the epiglottic cartilage
downward
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Mus#les Controlling Movements of the
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Mus#les Controlling Movements of the2o#al Cords
Intrinsic
Muscles
Origin Insertion Action
Cri#othyroid5!LN6
ar#h of the
#ri#oid #artilage
inferior %order of
the thyroid
#artilage
dras the thyroid
#artilage forard,
lengthening the
vo#al ligaments,
tenses vo#al #ords
"hyroarytenoid5vo#alis, LN6
inner surfa#e of
the thyroid
#artilage
lateral %order of
the arytenoid
#artilage
relaxes and
addu#ts the vo#al
folds
Lateral#ri#oarytenoid5LN6
ar#h of the
#ri#oid #artilage
mus#ular pro#ess
of the arytenoid
#artilage
Addu#ts the vo#al
#ords %y rotating
the arytenoid
#artilage
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Mus#les Controlling Movementsof the 2o#al Cords
IntrinsicMuscles
Origin Insertion Action
Posterior#ri#oarytenoid5LN6
posteriorsurfa#e of the
lamina of the
#ri#oid #artilage
mus#ular pro#essof the arytenoid
#artilage
A%du#ts the vo#al#ords %y rotating
the arytenoid
#artilage
nterarytenoidm., transverse5LN6
posteriorsurfa#e of the
arytenoid
#artilage
posterior surfa#eof the #ontralateral
arytenoid #artilage
Closes posteriorpart of rima
glottidis %y
approximating
arytenoid
#artilages
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Mu#ous Mem%rane
Strati*ed s>uamous epith.( over vo#al #ords andupper part of vesti%ule of larynx
Ciliated #olumnar epith.( remainder of the #avity
Mu#ous glands(
2entri#les and sa##uli Posterior surfa#e of epiglottis
Margins of aryepiglotti# folds
1ein9es layer of #onne#tive tissue( No glands and
no lymph vessels
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2o#al Folds
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Nerve Supply
Supplied %y 2agus nerve(
Superior laryngeal n.
nternal %ran#h 5sensory6 + areas a%ove the glottis
!xternal %ran#h 5motor and sensory6
Motor + Cri#othyroid mus#le Sensory + Anterior infraglotti# larynx at level of#ri#othyroid mem%rane
nferior 5re#urrent6 laryngeal n.
Motor + all intrinsi# laryngeal mus#les of SAM! side5ex#ept #ri#othyroid6 and interarytenoid mus#le of:$") sides
Sensory + areas %elo the glottis
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:lood Supply
'pper Larynx !xternal #arotid artery
Superior thyroidartery
Superior laryngealartery
Loer Larynx Su%#lavian artery
"hyro#ervi#al artery
nferior thyroid artery
nferior laryngealartery
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2enouos Drainage
'pper Larynx Superior laryngeal
vein
Superior thyroidvein
nternal &ugularvein
Loer Larynx nferior laryngeal
vein
nferior thyroidvein
nnominate vein
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Lymphati# Drainage
Main( Deep Cervi#al group L.N.
Supraglotti# area
B( Pedi#le Ant. !nd of aryepiglotti# fold /E
pass laterally and leave the larynx through thethyrohyoid mem%rane /E'pper deep #ervi#alnodes 5%et. Digastri# tendon and omohyoidmus#le6
8( Loer #ervi#al #hain or spinal a##essory#hain
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Lymphati# Drainage
nfraglotti# area + ; pedi#les
7. Anterior pedi#le /E #ri#othyroid mem%rane/E prelaryngeal 5Delphian6 nodes /Edeep inferior#ervi#al nodes
8. 8 Posterolateral pedi#les /E #ri#otra#healmem%rane /E paratra#heal #hain-others toinferior &ugular #hain
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P)S$L$
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:asi# Fun#tions
Prote#tion
1espiration
Phonation
Fixation of #hest Closure of glottis
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Prote#tion
A#ts as a sphin#ter Closure of the laryngeal inlet
Closure of the glottis
Cessation of respiration
Cough relfex, expulsion of se#retions andforeign %odies
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Prote#tion
; Sphin#teri# tiers of airay prote#tion(
Contra#tion of superior division of the thyroarytenoid
mus#les Contra#tion of middle thyroarytenoid *%ers
Contra#tion of inferior division of thyroarytenoid
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1espiration
Assists in regulation of gaseous ex#hange ith thelung and maintenan#e in a#id/%ase %alan#e
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Phonation in %rief
2oi#e produ#ed%y vi%ration ofthe vo#al #ords
Fundamentaltone produ#ed atthe larynx
Modi*ed %y
resonating#ham%ers of theupperaerodigestive
tra#t
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