ANATOMY OF LARYNX

KINJAL CHAHAL(723)
 INTRODUCTION
• The larynx lies in front of hypopharynx opposite
the 3rd -6th cervical vertebrae.
• It moves vertically and in anteroposterior
direction during swallowing and phonation .
• It can also be passively moved from side to side
producing a characteristic grating sensation
called laryngeal crepitus
• In an adult ,the larynx ends at the lower border
of C6 vertebra
 LARYNGEAL CARTILAGES
• Larynx has 3 unpaired and 3 paired cartilages .
• UNPAIRED : THYROID , CRICOID,EPIGLOTTIS.
• PAIRED: ARYTENOID,
CORNICULATE,CUNEIFORM
 THYROID
• It is the largest of all .its two alae meet anteriorly
forming an angle of 90 degrees in males and 120
degrees in females
• Vocal cords are attached to the middle of thyroid
angle
• Most of the laryngeal forgein bodies are arrested
above the vocal cords i.e. above the middle of
thyroid cartilage and an effective airway can be
provided by piercing the cricothyroid memberane
-cricothyrotomy
 CRICOID
• It is the only cartilage forming a complete
ring.
• Its posterior part is extended to form a lamina
while anteriorly it is narrow forming an ARCH
 EPIGLOTTIS
• It is a leaf like ,yellow,elastic cartilage forming anterior
wall of laryngeal inlet
• It is attached to the body of hyoid bone by hyoepiglottic
ligament which divides it into suprahyoid and infrahyoid
epiglottis
• Anterior surface of epiglottis is separated from thyrohyoid
memberane and upper part of thyroid cartilage by a
potential space filled with fat –preepiglottic space
• The space may be invaded in CA of supraglottic larynx or
the base of tongue
 ARYTENOID CARTILAGES
• Pyramidal in shape
• Base- articulate with cricoid cartilage
• Muscular process- attached to intrinsic
laryngeal muscles
• Vocal process- attached to vocal cord
• Apex- supports corniculate cartilage
 CORNICULATE CARTILAGES
• Eeach articulate with apex of arytenoid cartilage
CUNEIFORM CARTILAGE
Each is rod shaped ,situated in aryepiglottic fold
Thyroid, crecoid and most of arytenoid cartilages are
hyaline and undergo ossification which begins at 25
years in thyroid ,little later in crecoid &arytenoids,
completed at 65 years
• Epiglottis , corniculate , cuneiform and tip of arytenoid
are fibroelastic
 LARYNGEAL JOINTS
• CRICOARYTENOID JOINT –Synovial joint, formed between
base of arytenoid & a facet ,on upper border of cricoid
lamina
• MOVEMENTS-1) Rotatory-arytenoid cartilage moves
around a vertical axis,abducting or adducting vocal cord
• 2)Gliding movement-one arytenoid glides away or towards
the other,closing or opening the posterior peart of glottis
• CRICOTHYROID JOINT-Synovial joint , formed by inferior
cornu of thyroid cartilage with a facet on crecoid
 LARYNGEAL MEMBRANES
• 1)E
• XTRINSIC MEMBRANES-
THYROHYOID- Connects thyroid cartilage to hyoid bone ,peirced by superior laryngeal vessels & internal
laryngeal nerve
CRICOTHYROID-Connects thyroid cartilage to cricoid
CRICOTRACHEAL-connects cricoid to first tracheal ring
2)INTRINSIC MEMBRANES-
CRICOVOCAL –Triangular fibroelastic membrane ,upper border free and forms vocal ligaments ,lower
border attached to crecoid, from its lower attachment membrane moves upwards and medially & with its fellow
on opposite side forms conus elsticus where subglottic forgein bodies get impacted
QUADRANGULAR - lies deep to mucosa of aryepiglottic folds ,streches between epiglottic and arytenoid
cartilages, lower border forms vestibular ligament which lies in false vocal vocal cord.
 MUSCLES OF LARYNX
• TWO TYPES:-
• INTRINSIC attach laryngeal cartilages to each other.
• EXTRINSIC:-attach larynx to surrounding structures
• INTRINSIC-act on vocal cords or laryngeal inlet
• Acting on vocal cords-abductors-posterior cricoarytenoid
adductors-lateral cricoarytenoid,interarytenoid,thr
yroaryteniod
tensors-cricothyroid vocalis.
• Acting on larngeal inlet
openers of laryngeal inlet-thyroepiglottic.
closers of laryngeal inlet-interaryteniod,aryepiglottic
 Contd.
• EXTRINSIC-connect larynx to neighbouring
structures,divided into depressors &elevators of larynx
• Elevators-primary-act directly,attached to thyroid
cartilage.stylopharyngeus,salpingopharyngeus,palatopha
ryngeus,thyrohyoid.secondary-act indirectly attached to
hyoid bone-mylohyoid,digastric,stylohyoid,geniohyoid
• Depressors-sternohyoid,sternothyroid,omohyoid
 CAVITY OF LARYNX
• Starts at larnygeal inlet-communicates with pharynx,ends at lower
border of cricoid cartilage.two pairs of folds-
vestibular&vocal,divide the cavity into 3 parts-
vestibule,ventricle,subglottic space
• INLET OF LARYNX-oblique opening bounded anteriorly-free margin
of epiglottis,on sides-aryepiglottic folds,posteriorly-interarytenoid
• VESTIBULE-extends from laryngeal inlet to vestibular folds,anterior
wall-posterior surface of epiglottis,sides-aryepiglottic
folds,posterior-mucuos membrane of arytenoids.
• VENTRICLE(SINUS OF LARYNX)-deep elliptical space between
vestibular&vocal cords,when abnormally enlarged &distended
forms-laryngocele.
 Contd.
• SUBGLOTTIC SPACE(INFRAGLOTTIC LARYNX)-extends from
vocal cords to lower border of cricoid cartilage
• VESTIBULAR FOLDS(FALSE VOCAL CORDS)-each of the two
is a fold of mucous membrane extending anteroposteriorly
across laryngeal cavity containing vestibularligament,fibres
of thyoarytenoideus&mucous glands.
• VOCAL FOLDS(TRUE VOCAL CORDS)-two pearly white
sharp bands extending from middle of thyroid angle to
vocal processes of arytenoids.each vocal cord has vocal
ligament i.e.true upper edge of cricovocal membrane.
• GLOTTIS(RIMA GLOTTIDIS)-elongated space-narrowest
part of laryngeal cavity,24mm-men,16mm-
women.bounded anteriorly_vocal cords,vocal
processes.posteriorly-base of arytenoids.
MUCOUS MEMBRANES OF LARYNX
• Lines the larynx except over-posterior surface
of epiglottis,true vocal
cords,corniculate&cuneiform cartilages
• EPITHELIUM-ciliated columnar,stratified
squamous type over vocal cords&upper part
of vestibule.mucous glands- distributed all
over the mucous lining except in vocal folds.
 LYMPHATIC DRAINAGE
• SUPRAGLOTTIC LARYNX-above vocal cords-lymphatics
piercing thyrohyoid membrane go to upper deep cervical
nodes.
• INFRAGLOTTIC LARYNX-below vocal cords-lymphatics
piercing the cricothyroid membrane go to pretracheal&
prelaryngeal nodes& then to lower deep
cervical&mediastinal nodes.some vessels pierce
cricotracheal membrane& drain into lower deep cervical
nodes.
• There are practically no lymphatics in vocal cords,hence
CA of this site rarely shows lymphatic metastases.
 NERVE SUPPLY
• MOTOR-all the muscles which move the vocal
cord-recurrent laryngeal nerve except
cricothyroid muscle_external laryngeal
nerve(branch of superior laryngeal nerve)
• SENSORY-above vocal cords-internal laryngeal
nerve(branch of superior laryngeal)below
vocal cords-recurrent laryngeal nerve.
 Contd.
• RECURRENT LARYNGEAL NERVE-RIGHT-arises from vagus at the
level if subclavian artery, hooks around it,ascends between
trachea &oesophagus.LEFT-arises from vagus in mediastinum-
at the level of arch of aorta, loops around it&ascends in to the
neck in the tracheo-oesophageal groove. The left recurrent
laryngeal nerve has a much longer course & is more prone to
paralysis
• SUPERIOR LARYNGEAL NERVE-arises from inferior ganglion of
vagus,descends behind external carotid artery, divides in to
external& internal branches at the level of hyoid bone.external
branch supplies-cricothyroid,internal branch supplies- larynx
&hypopharynx.
 SPACES OF LARYNX

• PRE-EPIGLOTTIC SPACE OF BOYER-bounded

front- upper part of thyroid cartilage&thyrohyoid membrane.
above-hyoepiglottic ligament
• behind-epiglottis&quadrangular membrane
Contains-fat,areolar tissue,lymphatics.
• PARAGLOTTIC SPACE-bounded
laterally-thyroid cartilage
inferomedially-conus elasticus
• medially-ventricle&quadrangular membrane
• Continuous with pre-epiglottic space.
• REINKE’S SPACE-bounded
above& below-arcuate lines
front-anterior commisure
behind_vocal process of arytenoid
Odema of this space causes fusiform swelling of membraneous cords-reinke”s odema