Laryngeal cartilages begin to ossify at 20 yrs of age

Cricoarytenoid : rotational movement and gliding movement

Muscles attached to muscular process of arytenoids : rotation movements
Thyroepiglottic ligament may contain contractile muscle
Muscle that adduct dominate over abductor by power ratio of 3:1
In newborn swelling of just 1 mm reduces laryngeal area by 60%
Airway resistance in a stenotic segment ::: according to hagen poiseulle law
Proportional to lenth of stenotic segment
Inverselt to the fourth power of radius
Glottic plane superior laryngeal nerve
Muscles that open and close receive innervations from the same nerve
Cerarocricoid muscle::variable slip from cricoid cartilage plate to inferior horn
Glottic and supraglottic blood supply:: superior thyroid
Subglottis : inferior thyroid
The calibers of both recurrent laryngeal nerves are different to compensate for difference in length
Left recurrent nerve is larger and winds around the aortic arch
While right recurrent nerve winds around the subclavian artery
Lymphatics in larynx least in the glottis plane
More lymphatics in supraglottic plane
Junctional nodes between facial vein and IJV
Subepithelial plane in glottis that contains no vessels or lymphatics: Reinkes space
Junction of larynx with trachea :: inferior border of crcoid
Epiglottis no role in preventing aspiration
Blood supply to trachea: Inferior thyroid artery
Transverse Diameter of Trachea : 13 -16mm in women 16- 20 mm in male
Trachea in adults Length is 10 13 cm
Cervical trachea 6 7 cm
Cartilage rings of trachea interconnected by annular ligaments
Epithelium of respiratory tract : endodermal in origin from laryngotrancheal groove . ventral part of foregut
Hyoid bone : 2
nd
and 3
rd
branchial arches
Laryngeal cartilages from 4
th
and 6
th
branchial arches
Except : arytenoids epiglottis and accessory cartilages : develop from mesenchyma
Nerve of 4
th
branchial arch: superior laryngeal nerve
Nerve of 6
th
branchial arch :recurrent laryngeal nerve
Laryngeal muscles arise from cell myotomes of cranial somite that migrate
In indirect laryngoscopy : Light from head lamp direct towards uvula
Angle is 45 degrees
Posterior portion of larynx best examined by patient in standing and examiner sitting
Anterior portion of larynx:::::::::opposite of above
Larynx should be examined in respiratory position
Telescopic laryngoscopy : rigid endoscope with 90 degree angle
Nasal endoscopes outer diameter : 2.7 to 6 mm
USG can be used for prelaryngeal and paralaryngeal muscle to detect whether interlaryngeal masses have
eroded through lateral skeleton
Flexible tracheoscopy under topical anesthesia Outer diameter is 2.7 to 6 mm
Abnormal weak spots in trachea on plain x ray : 2 films are taken
1
st
after forced inspiration
2
nd
after valsalva
Most frequent cause of congenital stridor :: laryngomalacia
Congenital Laryngeal cysts are saccular cyst . Develop on subglottis or laryngeal side of epiglottis. Contain
mucus.
These are removed during microlaryngoscopy
Circumscribed narrowing of trachea on expiration: Malformation of individual tracheal cartilages
Tracheomalacia: Biphasic stridor. Self limiting and remits on 12 -18 months age AS tracheal framework
becomes stable
Incomplete recanalization : glottis webs
Complete failure of recanalization : atresia
MC stenosing anomaly of larynx is Subglottic stenosis.( Not Malacia)
soft stenosis : thickened fibrous tissue
hard stenosis :malformation of cricoid cartilage
congenital subglottic stenosis tends to resolve as child grows up
ortner syndrome: anomalies of heart and blood vessels
subglottic hemangioma enlarges during crying due to engorgement. So stridor results
Isolated tracheal malformation rare and involve cervical trachea
Epiglottic malformations have no clinical significance
Croup refers to inspiratory stridor
True croup :: specific laryngitis in Diphtheria (rare now)
Croup : 6 month to 3 yrs
Croup milder course than epiglottitis
In epiglottitis : inspiratory stridor
In croup : both inspiratory and expiratory seen
High fever in epiglottitis
Muffled soft strained voice: epiglottitis
Harsh voice: croup
In Rx croup: Air humidification is important
Muffled hot potato voice: epiglottitis
Cherry red epiglottis: epiglottitis
Laryngeal manifestations in all three stages of syphilis
Hallmark of simple laryngitis hoarseness
Adult supraglottitis : epiglottitis
Laryngeal absess : typically located on epiglottis facing the tongue
Formation of sequestrated bone fragments in larynx: perichondritis
Reinkes edema operated in two stages to prevent formation of anterior synechiae
Posterior laryngitis : gastroesophagal reflux laryngitis
In this condition : most severe damage to posterior portion of larynx and post cricoid region
Interarytenoid area show garden fence appearance
Only histology will differentiate TB from glottis ca
Hammer anvil effect : contact ulcer
Paediatric larynx is less susceptible to trauma because of mobility
Chemical injury MC affect supraglottis
Acids : coagulative necrosis.. alkalis colliquative necrosis
Narrowest part of upper respiratory tract: cricoids
Intubation granuloma shows prelidiction for vocal process
Intubation is best tolerated in newborns as cricoid is flexible
Eckerbom scheme for grading severity of intubation injury
Thyrotracheopexy end to end anastomosis of thyroid cartilage with trachea
Thyrotracheopexy:: pearson
Intubation tube diameter should not exceed diameter of patient small finger
Mc benign laryngeal tumors in children papillomamultiple soft raspberry like lesions
Vocal nodules: ant 1/3
rd
and post2/3
rd

Glottis webbing : complication of repeated removal of papillomas
Hoarseness longer than 2 weeks : Laryngoscopy
Classification of laryngeal ca: UICC
Epithelized tracheostomy: eliminates creation of false passages and decreases risk of pretracheal inflammation
Coniotomy is cricothyrotomy
EMG in recurrent nerve palsy: helps to rule out arytenoids fixation and dislocation
Superior Laryngeal neuralgia: Avellis syndrome

The supraglottis derives from the midline buccopharyngeal primordium and branchial arches 3 and 4 with rich bilateral lymphatics. The
glottis, on the other hand, forms from the midline fusion of lateral structures derived from the tracheobronchial primordium and arches 4, 5,
and 6
These structures, including the conus elasticus, the quadrangular and thyrohyoid membranes, and the hyoepiglottic
ligament, act as barriers to spread of tumor (Figure 303). The thyroid and cricoid cartilages and their perichondrium are
further barriers to tumor spread. The anterior commissure tendon (Broyle's ligament) and thyroepiglottic ligaments are
not effective barriers to tumor spread, and tumors involving the anterior commissure are more likely to have direct
regional spread.
Most larynx cancers involving the subglottis are extensions of primary cancers arising in the glottis or supralglottis.

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