larynx
TRANSCRIPT
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LARYNX
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• INTRODUCTION• DEVELOPMENT OF LARYNX• SKELETAL FRAMEWORK• SUBDIVISON OF LARYNX• MUSCLES• HISTOLOGY• BLOOD SUPPLY• NERVE SUPPLY• LYMPHATIC DRAINAGE• APPLIED ANATOMY
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SITUATION AND EXTENT
MEASURMENTS-
Male larynx V=44mm,T=43 mm,AP=36mm
Female larynx V=36mm,T=41 mm,AP=26mm
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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
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CARTILAGES
Paired • Arytenoid• Corniculate• Cuneiform• Cartilago triticea
Unpaired
• Thyroid• Cricoid• Epiglottis
5
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THYROID CARTILAGE
ANTERIOR ASPECT
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POSTERIOR ASPECT
LATERAL ASPECT
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EPIGLOTTIS
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CRICOID CARTILAGE
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ARYTENOID CARTILAGE
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CORNICULATE AND CUNEIFORM CARTILAGE
Corniculate cartilage of Santorini
Cunieform cartilage of Wrisberg
Cartilage Tritiate
TRITIATE CARTILAGE
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JOINTS:
Lateral View Antero-superior View
• CRICOTHYROID JOINT • CRICOARYTENOID JOINT
• ARTENOCORNICULATE JOINT
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MEMBRANES & LIGAMENTS
• Extrinsic • Thyrohyoid
• Cricotracheal
• Thyroepiglottic
• Hyoepiglottic
• Intrinsic
• Quadrangular membrane & vestibular ligament
• Cricovocal membrane & vocal ligament
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EXTRINSIC
• Thyrohyoid
• Cricothyroid
• Cricotracheal
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Sagittal section showing interior of left half of larynx
EXTRINSIC
Hyoepiglottic Ligament
Thyroepiglottic Ligament
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INTRINSIC
Sagittal section of left side of larynx showing laryngeal membranes
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Coronal section through the larynx and cranial end of trachea Posterior aspect
SUBDIVISIONS OF LARYNGEAL CAVITY
LARYNGEAL INLETARYEPIGLOTTIC FOLD
SACCULEVESTIBULAR FOLDVOCAL FOLD
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PARALUMENAL SPACES
Pre-epiglottic space
Paraglottic space
Subglottic space
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EXTRINSIC MUSCLES
Extrinsic attached to hyoid (Depressors)
– Sternothyroid– Sternohyoid– Thyrohyoid
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Extrinsic attached to thyroid (Elevators )
– Palatopharyngeus
– stylopharyngeus
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INTRINSICMuscles acting on VC
– Length and tension• Cricothyroid• Thyroarytenoids
– Abductor• Post cricoarytenoid
– Adductors• Lateral cricoarytenoid• Thyroarytenoid• Interarytenoideus
Muscles acting on epiglottis– Aryepiglotticus– Thyroepiglotticus
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CRICOTHYROID MUSCLE
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Posterior Aspect Superior Aspect
POSTERIOR CRICOARYTENOID MUSCLE
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LATERAL CRICOARYTENOID MUSCLE
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OBLIQUE ARYTENOID MUSCLE and ARYEPIGLOTTICUS
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TRANSVERSE ARYTENOID MUSCLE
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THYROARYTENOID and VOCALIS MUSCLE
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SHAPE OF RIMA GLOTTIDIS DURING DIFFERENT MOVEMENTS OF VOCAL CORDS
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DURING PHONATION DURING WHISPERING
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NERVE SUPPLY
Internal Laryngeal Nerve :
only sensory
External Laryngeal Nerve :
only motor
Recurrent Laryngeal Nerve : sensory and motor
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ARTERIAL SUPPLY
Sup Laryngeal Artery
Inferior Laryngeal Artery
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VENOUS DRAINAGE
Sup Thyroid Vein
Inf Thyroid Vein
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LYMPHATIC DRAINAGE
• Above VC upper deep cervical {anterosuperior group}
• Below VC lower deep cervical {posteroinferior group}
Upper deep cervical
Lower deep cervical
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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
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HISTOLOGY OF EPIGLOTTIS
•Epithelium•Lamina propria•cartilage
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INFANT LARYNX
• Size• Position• Cavity- funnel shaped & short• Laryngeal cartilages-softer & pliable• Epiglottis• Thyroid• Vocal cord
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APPLIED ANATOMY
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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
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LARYNGOMALACIA
• Excessive flaccidity of supraglottic larynx• OMEGA SHAPED EPIGLOTTIS
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LARYNGEAL CYST
• fluid filled smooth swelling in Supraglottic larynx
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LARYNGOCELE
Air filled dialatation of saccule
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ANTERIOR GLOTTIC WEB
•Due to incomplete recanalisation of larynx
LARYNGEAL WEB
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• SUBGLOTTIC STENOSIS
Abnormal thickening of cricoid cartilage or fibrous tissue seen below vocal cords
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Requires laryngeal mirror and head mirror
Structures seen……………
LARYNGOSCOPY-
Indirect Laryngoscopy
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Done under GA
Before endotracheal intubation
Direct Laryngoscopy
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SINGERS /SCREAMERS/CLERGYMENS NODULES
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REINKE’S EDEMA
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CLASSIFICATION OF LARYNGEAL PARALYSIS
• May be unilateral or bilateral and may involve
1. Recurrent laryngeal nerve2. Superior laryngeal nervea. External LNb. Internal LN
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LARYNGEAL OBSTRUCTION
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LARYNGOTOMY
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INFLAMMATION OF LARYNX
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MALIGNANCY OF LARYNX
• Supraglottic• Glottic• Subglottic
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