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LARYNX

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INTRODUCTION
Respiratory organ modified to produce sound
Synonym: Voice box,organ of phonation
Anterior midline of upper neck infront of
laryngopharynx
Extent:upper border of epiglottis to lower
border of cricoid.
Lies:infront of C3-C6
Male larynxV=44mm,T=43 mm,AP=36mm

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FUNCTIONS
Phonation
Respiration
Protection
Deglutition

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DEVELOPMENT
Laryngotracheal

groove (caudal end of ventral wall


of primitive pharynx- 28 days of development)

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DEVELOPMENT

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Epithelium & glands--endodermal lining


Laryngeal cartilages-from mesenchyme ie derived
from neural crest cells
4th arch-thyroid,cunieform,corniculate
5th arch-cricoid
6th arch-arytenoid
2 and 3 arch hyoid bone
Epiglottis- caudal part of hypobranchial eminence
Muscles- 4 & 6 arches(Cricothyroid, Extrinsic=4th)
Muscle cells-myotomes of cranial somites
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SKELETON OF LARYNX
Cartilages
Joints
Membranes & ligaments
Muscles
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CARTILAGES
Paired
Arytenoid

Unpaired
Thyroid

Corniculate

Cricoid

Cunieform

Epiglottis

Cartilago triticea
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THYROID CARTILAGE

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Cricoid
cartilage

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Epiglottis

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Arytenoid cartilage

Cunieform cartilage of Wrisberg


Corniculate cartilage of Santorini

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Hyaline cartilages:
Thyroid, Cricoid, basal part& muscular
process of Arytenoid
Elastic fibrocartilage:
Epiglottis,Corniculate,Cunieform,apices &
vocal process of Arytenoids

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JOINTS:

Cricothyroid joint
- Between inferior horn of thyroid and cricoid
- Synovial hinge
- Rocking movements{
Transverse
axis}
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Cricoarytenoid joint
Plane synovial
Movements:
Sliding
Rotatory

Arytenocorniculate
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MEMBRANES & LIGAMENTS


Extrinsic
Thyrohyoid
Cricothyroid

Intrinsic
Quadrangular membrane
& vestibular ligament

Cricotracheal
Thyroepiglottic

Cricovocal membrane &


vocal ligament

Hyoepiglottic
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Extrinsic

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Extrinsic

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Intrinsic-Quadrate membrane
Boundaries:
Sup : aryepiglottic folds
Ant : lat margin of epiglottis
Post : arytenoid and corniculate
cartilage
Inf : free called as vestibular fold
Covered by mucous membrane to Form
False vocal folds
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Cricothyroid ligament

Median cricothyroid lig :


Thickened membrane
Pass from upper border of cricoid to lower border of thyroid

Lateral cricothyroid lig : (cricovocal membrane)

Attachments
Project up from arch of cricoid to
Anteriorly : Jn of thyroid lamina
Posteriorly: vocal pr of arytenoid
Cricovocal memb free b/t ant & post attachment is
thick
Form CV ligament, when covered with mucous
memb : form true Vocal cords
Conus elasticus : commonly includes all parts of the lig or just the anterior part of
VC
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Intrinsic

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Extrinsic

Attached to hyoid, thyroid


Depressors infrahyoid
Elevators as below

Extrinsic attached to hyoid

Geniohyoid
Mylohyoid
Digastric, ant and post belly
Stylohyoid
Thyrohyoid

Extrinsic attached to thyroid

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Palatopharyngeus
Salpingopharyngeus
stylopharyngeus
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Intrinsic
Acts on VC
Acts on epiglottis

Muscles 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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MUSCLES OF LARYNX
Extrinsic

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Intrinsic

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Extrinsic

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Intrinsic

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INTRINSIC MUSCLE OF LARYNX

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EXCEPTIONS
Cricothyroid -> only muscle lying on outer
aspect of larynx
Transverse arytenoid-> only intrinsic
muscle of larynx which is unpaired
All intrinsic muscles adduct vocal cords
except post cricoarytenoid
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SUBDIVISIONS OF LARYNGEAL
CAVITY

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inlet
Boundaries
Ant : epiglottis
Post : arytenoid cart
Sides : aryepiglottic folds

Vestibule
Space b/t inlet & vestibular folds
Laterally : quadrate membrane
Ant : epiglottis
Lower : Rima of vestibule

False vocal cords


Vestibular folds
Rima vestibuli (b/t vestibular folds
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True vocal cords


Formed by upper free border of cricovocal lig
Rima glottidis (glottis)
Gap b/t true vocal cords
Parts :
Intermembranous : ant 60%, bounded each side with vocal fold
Intercartilaginous : Post 40%, bounded each side with vocal pr
and base of arytenoid cart

Ventricle (laryngeal sinus)


Space b/t False and true VC with deep horizontal
groove in lateral wall
Opening at ant end : Saccule of larynx
Covered with mucous membrane
Extend up for few mm b/t thyroid lamina and
vestibular fold
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HISTOLOGY OF LARYNX

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SHAPE OF RIMA GLOTTIDIS DURING DIFFERENT


MOVEMENTS OF VOCAL CORDS

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NERVE SUPPLY

ILN : only
sensory
ELN : only
motor
RLN : 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}

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Crux
Above VC
Arterial supply

Below VC

Sup laryngeal art Inf laryngeal art

Venous drainage Sup thyroid Vein

Inf thyroid Vein

Lymph drainage

Upper Deep
cervical LN

Lower deep
cervical LN

Nerve supply

Sensory: ILN

Sensory: RLN

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MECHANISM OF PHONATION

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APPLIED
ANATOMY
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LARYNGOSCOPY-

Indirect laryngoscopy

Requires laryngeal mirror and


head mirror
Structures seen

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Done under GA
Sniff position
Macintosh Laryngoscope
Before orotracheal/
endotracheal intubation

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Direct laryngoscopy

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Cricothyrotomy
Emergency airway
establishment
Cricothyroid ligament
opened
Transverse
incision,pocketknife
Converted to standard
tracheotomy soon to
prevent laryngeal
stenosis
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Consequences of thyroidectomy on
larynx

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HEIMLICH MANEUVER
Foreign body in laryngeal cavity
Choking,asphyxia

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MALFORMATIONS OF LARYNX
Laryngomalacia:
Supraglottic structures(epiglottis,arytenoid
cartilages) abnormally soft & pliable Collapse
inwards during inspiration
S/S: feeding difficulty,stridor from birth,louder in
supine position
Diagnosis: laryngoscopy-Omega shaped
epiglottis
Treatment:
Resolve by 2 yrs
Temporary tracheostomy
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Others
Congenital laryngeal cyst
Congenital laryngocele
Congenital Subglottic stenosis
Congenital vocal cord paralysis
Subglottic hemangioma

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SINGERS /SCREAMERS/CLERGYMENS
NODULES

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LARYNGOCELE
Increased air pressure in laryngeal sinus
Trumpet players,glass blowers,weight lifters
Saccule dilates to produce air filled cystic swelling
External

Internal

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NEUROGENIC DISORDERS OF LARYNX


Recurrent laryngeal nerve paralysis
Unilateral :

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Bilateral

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Superior laryngeal nerve paralysis

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SIMONS LAW

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Infectious & inflammatory


diseases of larynx

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Reinkes edema

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TUMOURS OF LARYNX

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Thank you
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