DR.E.M.

MARTIN
outline
Introduction
Embryology of larynx
Morphology of larynx
Cartilage, ligaments, muscles
Nerve supply
Blood supply
Functions of the larynx
Clinical correlates
references
Introduction
Larynx is the part of the respiratory tract that lies
between the pharynx (the upper throat) and the
trachea (the windpipe) the larynx contains the vocal
cords which are responsible for the sounds we make
when we speak.
Also known as the voice box .
Embryology of the larynx
The internal lining of the larynx originates from
endoderm.
The cartilages and muscles originate from mesenchyme
of the fourth and sixth pharyngeal arches.
As a result of rapid proliferation of this mesenchyme,
the laryngeal orifice changes in appearance from a
sagittal slit to a T-shaped opening.
When mesenchyme of the two arches transforms into
the thyroid, cricoid, and arytenoid cartilages, the
characteristic adult shape of the laryngeal orifice can be
recognized.
Embryology cont..
At about the time that the cartilages are formed,
the laryngeal epithelium also proliferates rapidly,
resulting in a temporary occlusion of the lumen.
Subsequently, vacuolization and recanalization
produce a pair of lateral recesses, the laryngeal
ventricles. These recesses are bounded by folds of
tissue that differentiate into the false and true
vocal cords.
Embryology cont
 Since musculature of the larynx is derived from
mesenchyme of the fourth and sixth pharyngeal
arches, a are innervated by branches of the tenth
cranial nerve, the vagus nerve. The superior
laryngeal nerve innervates derivatives of the fourth
pharyngeal arch, and the recurrent laryngeal nerve
innervates derivatives of the sixth pharyngeal arch.
Regions & Sites of the larynx
The larynx is divided into three regions.
The supraglottis
That area above the true vocal cords
The glottis
That area at the level of the true vocal cords
The subglottis
The area below the true vocal cords.
 Sagittal section

Epiglottis Supraglottic area

Ventricular bands
Vocal folds (Glottic area)

Subglottic area
STRUCTURES
The larynx is made up of cartilages, muscles and
ligaments
Thyroid cartilage
The thyroid cartilage is the
largest of the laryngeal
cartilages.
Formed by a right and a left
lamina, which are widely
separated posteriorly, but fused
anteriorly at the midline and
subtending an angle of 90 in the
male and 120 in the female.
The prominence of the anterior
border forms the Adams apple.
Cricoid & Arytenoids
Laryngeal cartilages.
Cricoid cartilage.
The cricoid cartilage is the most inferior of the laryngeal
cartilages and completely encircles the airway
Shaped like a 'signet ring' with a broad lamina of cricoid
cartilage posterior to the airway and a much narrower
arch of cricoid cartilage circling anteriorly.
The posterior surface of the lamina of cricoid cartilage is
characterized by two shallow oval depressions separated by
a vertical ridge. The esophagus is attached to the ridge and
the depressions are for attachment of the posterior crico-
arytenoid muscles.
Cricoid cont..
The cricoid cartilage has two articular facets on each
side for articulation with other laryngeal cartilages.
one facet is on the sloping superolateral surface of the
lamina of cricoid cartilage and articulates with the
base of an arytenoid cartilage;
the other facet is on the lateral surface of the lamina of
cricoid cartilage near its base and is for articulation
with the medial surface of the inferior horn of the
thyroid cartilage.
Thyro cont
The posterior margin of each lamina of the thyroid
cartilage is elongated to form a superior horn and an
inferior horn.
the medial surface of the inferior horn has a facet for
articulation with the cricoid cartilage.
the superior horn is connected by a ligament to the
posterior end of the greater horn of the hyoid bone.
The lateral surface of each thyroid lamina is marked by a
ridge (the oblique line)
The oblique line is a site of attachment for the extrinsic
muscles of the larynx (sternothyroid, thyrohyoid, and
inferior constrictor).
Epiglottis cartilage
This is a leaf like fibro-elastic
cartilage, projecting behind the
tongue and hyoid bone.
attached by its stem to the
posterior aspect of the thyroid
cartilage.
The attachment is via the thyro-
epiglottic ligament .
The upper margin of the
epiglottis is behind the
pharyngeal part of the tongue.
Arytenoid cartilages
The two arytenoid cartilages are pyramid-shaped
cartilages
It has base of arytenoid cartilage and an apex of
arytenoid cartilage.
the base of arytenoid cartilage is concave and
articulates the superolateral surface of the lamina of
cricoid cartilage
the apex of arytenoid cartilage articulates with a
corniculate cartilage
the medial surface of each cartilage faces the other
the anterolateral surface has two depressions,
separated by a ridge, for muscle (vocalis) and ligament
(vestibular ligament) attachment.
 Arytenoid cartilages
The anterior angle of
the base of arytenoid
cartilage is elongated
into a vocal process
to which the vocal
ligament is attached.
The lateral angle is
similarly elongated
into a muscular
process for attachment
of the posterior and
lateral crico-arytenoid
muscles.
Laryngeal ligaments
Extrinsic ligaments
Thyrohyoid membrane; is a tough fibroelastic
ligament that spans between the superior margin of
the thyroid cartilage below and the hyoid bone above.
An aperture in the lateral part of the thyrohyoid
membrane on each side is for the superior laryngeal
arteries, nerves, and lymphatics.
Cricotracheal ligament; runs from the lower border
of the cricoid cartilage to the adjacent upper border of
the first tracheal cartilage.
Diagram of laryngeal ligaments
Ligaments cont
Intrinsic ligaments.
Fibro-elastic membrane
of larynx; links together
the laryngeal cartilages
and completes the
architectural framework
of the laryngeal cavity. It
is composed of two
parts-a lower
cricothyroid ligament
and an upper
quadrangular
membrane
 Each quadrangular membrane has a free upper margin
and a free lower margin.
The free lower margin is thickened to form the
vestibular ligament under the vestibular fold (false
'vocal cord') of the larynx.
Laryngeal joints
Cricothyroid joints; The joints between the inferior horns
of the thyroid cartilage and the cricoid cartilage;
synovial joint
Surrounded by a capsule and associated ligaments.
Funts; forward movement and downward rotation .
Crico-arytenoid joints between articular facets on the
superolateral surfaces of the cricoid cartilage and the bases
of the arytenoid cartilages
synovial joint
Surrounded by a capsule and associated ligaments
Funts; abduct and adduct the vocal ligaments.
Laryngel joint cont..

Crico-arytenoid joint

Cricothyroid joints
Cavity of the larynx
The central cavity of the larynx is tubular in shape and is
lined by mucosa.
The superior aperture of the cavity (laryngeal inlet).
anterior border is formed by mucosa covering the superior
margin of the epiglottis.
lateral borders are formed by mucosal folds (aryepiglottic
folds).
posterior border in the midline is formed by a mucosal fold
that forms a depression (interarytenoid notch) between
the two corniculate tubercles.
The inferior opening of the laryngeal cavity is continuous
with the lumen of the trachea.
Laryngeal cavity cont..
Three major regions.
Vestibule
Middle chamber and
Infraglottic cavity
THE MUSCLES
The larynx is made up of EXNTRINSIC and INTRINSIC
muscles.
THE EXNTRINSIC MUSCLES
A pair of
sternothyroid
muscles
Action: draws
Larynx downwards
Nerve: Ansa-
cervicalis (C2)
A pair of
thyrohyoid muscles

Action: Raises the

larynx
Nerve: Ansa
cervicalis (C1)
EXNTRINSIC MUSCLES CT.
A pair of
Stylopharyngeus
muscles
Action: Raises pharynx
and larynx
Nerve:
Glossopharyngeal
A pair of
palatopharyngeus
muscles.
Raises pharynx and tilt
larynx forwards during
swallowing. (Nerve
Glossopharyngeal)
Muscles cont.
Intrinsic muscles; adjust tension in the vocal ligaments,
open and close the rima glottis, control the inner
dimensions of the vestibule, close the rima vestibuli, and
facilitate closing of the laryngeal inlet. They do this mainly
by:
acting on the cricothyroid and crico-arytenoid joints;
adjusting the distance between the epiglottis and arytenoid
cartilages;
pulling directly on the vocal ligaments;
forcing soft tissues associated with the quadrangular
membranes and vestibular ligaments toward the midline
Laryngeal musc cont
Cricothyroid muscles
Posterior crico-arytenoid muscles
Lateral crico-arytenoid muscles
Transverse arytenoid muscle
Oblique arytenoid muscles
Vocalis
Thyro-arytenoid muscles
Nerve supply
Laryngeal vessels
Arteries; the major
blood supply to the
larynx is by the
superior (superior
thyroid branch of the
external carotid
artery)
inferior laryngeal
arteries (inferior
thyroid branch of the
thyrocervical trunk of
the subclavian artery
low in the neck)
Vessel cont..
Veins
superior laryngeal
veins drain into
superior thyroid
veins, which in turn
drain into the internal
jugular veins
inferior laryngeal
veins drain into
inferior thyroid veins,
which drain into the
left brachiocephalic
veins.
Vessel cont..
Lymphatic drainage
From the supraglottis goes to the
deep cervical lymph nodes at the
common carotid bifurcation.

From the glottis and sublottis

lymph drains into pre tracheal
and pre-laryngeal lymph node
and eventually to the lower deep
cervical lymph nodes.
Functions of the larynx
Respiration
Phonation
Swallowing
Effort closure
Clinical correlation
Tracheostomy is a procedure in which a hole is
made in the trachea and a tube is inserted to
enable ventilation.
Sites;
In the emergency situation the cricothyroid
ligament can be identified by simple palpation
and a small needle can be inserted to establish
an airway (cricothyroidectomy).
in the calm atmosphere of an operating
theater. A small transverse incision is made in
the second and third tracheal rings and a small
tracheostomy tube inserted.
Congenital malformations
Laryngomalacia; supraglottic tissues collapses into the
glottis
Congenital vocal fold immobility
Laryngeal atresia/stenosis
Congenital subglottic stenosis
Congenital web
Congenital posterior laryngeal fissure
 Laryngomalacia
Laryngeal Web
Congenital Subglottic
stenosis
Foreign bodies
Common presentation in children
Complete obstruction Death.
Incomplete obstruction cough, dyspnea, Aphonia
FB cont..
Slap on back for
children.

Heimlich maneuver
for adult.
references
Grays anatomy for students 2004.
Grays anatomy 39E 2005.
E.N.T diseases by K.B Bhargava, S.K Bhargava and T.M
shah seventh edition.
The developing of human byKeith l. moore, T.V.N
Persaud.