Larynx AKA voice box Larger in men than women (Adams apple) Connects pharynx with trachea Composed

osed of many different cartilages

Skeleton: Three single/non-paired cartilages 1. Thyroid Hyaline Fusion of lower 2/3 forms laryngeal prominence (Adams apple) May ossify ! become bone Superior border and horns attach to hyoid bone by the thyrohyoid membrane 2. Cricoid - Strong, complete ring of cartilage, may ossify - Inferior to thyroid cartilage - Connected to thyroid cartilage by the median cricothyroid ligament - Inferiorly connected to 1st tracheal ring by the cricotracheal ligament 3. Epiglottic - Leaf shaped - Inferiorly attached to thyroid lamina by the thyroepiglottic ligament Three non-paired cartilages 4. Arytenoid - Anterior: vocal process (posterior attachment for vocal ligament) - Lateral: muscular process - Superior apex: corniculate cartilage - May ossify 5. Corniculate - Attach to apex of arytenoid 6. Cuneiform - Do not attach to other cartilages 7. Others are fibrocartilage

Oblique line

Cornu=horn

Posterior View

Sagittal Section Posterior to the left, anterior to the right

Joints of the Larynx 1. Cricothyroid 2. Cricoarytenoid 3. Arytenocorniculate Boundaries of Inlet Anterior: epiglottis Lateral: aryepiglottic fold/vocal fold Posterior-inferior: mucous membrane between arytenoid cartilage, corniculate and cuneiform cartilages

Muscles Extrinsic - Attached to hyoid - Move the hyoid bone to assist in swallowing - Elevate during swallowing, depress after Intrinsic - Alter the length and tension of vocal cords - Control laryngeal inlet Function Sphincters - Inlet: swallowing - Rima glottidis: space between the vocal folds, size of space varies (i.e during coughing, sneezing etc) Phonation - Length and tension of vocal cords alters pitch - Resonates sound through pharynx, mouth and sinuses to change the quality of the sound Innervation Sensory - Above vocal cords: internal laryngeal nerve (branch of superior laryngeal nerve) - Below vocal cords: inferior laryngeal nerve (branch of recurrent laryngeal nerve) Motor - Recurrent laryngeal nerve to all intrinsic muscles except cricothyroid

Trachea Length: 9-13 cm Width: 2-2.5 cm 15-20 cartilages Semicircular rings of cartilage: posteriorly deficient Muscle posteriorly Angle of Louis: T4/T5, bifurcation into main bronchi On deep inspiration, region between C6 and the lower manubrium can lower up to 5cm Cervical and thoracic portion Blood Supply Bronchial arteries Inferior thyroid arteries Inferior thyroid veins Lymph Paratracheal nodes Deep cervical nodes Innervation Vagus nerve Sensory and secretions: recurrent laryngeal nerve Sympathetic innervation to trachealis and blood vessels

Structures in the Mediastinum 1. Thymus gland 2. Heart and pericardial sac 3. Superior vena cava 4. Brachiocephalic veins 5. Aorta Ascending Arch Descending (thoracic) 1. Trachea 2. Esophagus 3. Thoracic duct 4. Azygos venous system Hemiazygos vein Accessory hemiazygos vein 5. Vagus nerves and recurrent laryngeal nerves 6. Phrenic nerves 7. Thoracic sympathetic trunks