Anatomy of larynx

larynx
A cartilaginous structure present in front of C3-C6 About 5cm in long in adults Shorter and higher in women and children Moves on deglutition(*) Primary function is sphincteric in nature Organ of phonation The typical male voice develops only at puberty

Skeleton of larynx
Thyroid cartilage,cricoid cartilage and epiglottis (unpaired cartilages)

Arytenoids,corniculates and cuneiforms(paired)

Thyroid cartilage

Front view

Side view

Thyroid Cartilage
Consist of 2 laminae of hyaline cartilage meeting in the midline in the prominent V angle of Adams Apple Posterior border of each lamina is drawn upward by Superior Cornu and downward by Inferior Cornu

Thyroid angle (laryngeal prominence)

900 in males 1200 in females

Cricoid cartilage

Posterior view

Side view

Cricoid Cartilage
Formed from a complete ring of hyaline cartilage Shape like a signet ring Lies below the thyroid cartilage It has a narrow Anterior arch and broad posterior lamina

epiglottis

Epiglottis
Leaf shaped elastic cartilage situated at root of the tongue

Membranes and ligaments

Thyroid Membrane Cricotracheal Ligament Cricothyroid Ligament Cricothyroid Ligament Vocal Ligament Hyoepiglottic Ligament Thyroepiglottic Ligament

arytenoids Corniculate

Arytenoid Cartilage
Located at upper border of cricoid cartilage

False vocal cords (vestibular folds)

Lower borders of quadrangular membrane(vestibular ligament) Present above and lateral to the true vocal cords Pinkish in appearance (vascular)

True vocal cords

Upper borders of conus elasticus Involved in phonation Pearly white in appearance Present below and medial to false vocal cords

Conus elasticus
Crico-thyro-arytenoid ligament Its free upper border is the fibrous ligament of the true vocal cord

Cavity of larynx
Divided into 3 parts by these vocal cords 1.vestibule 2.sinus (ventricle) 3.infraglottic cavity

Rima glottidis(glottis)
Space between the two vocal cords(true vocal cords) Directly concerned with voice production Rima vestibuli is the space between the false vocal cords

Saccule of larynx
Extension from sinus Secretes mucus to keep the vocal cords lubricated.

Intrinsic muscles
These help in opening and closing the glottis , altering the length and tension of the vocal cords and closing the inlet. All are supplied by recurrent laryngeal nerve except cricothyroid(supplied by external laryngeal nerve)

Inlet of larynx
Opens superiorly into laryngopharynx leads to vestibule of larynx

Muscles of inlet
oblique arytenoids, transverse arytenoid and aryepiglottic muscles close the inlet during swallowing

Bending of epiglottis (during deglutition)

Tensor of the vocal cord

Cricothyroid muscle is the tensor of the vocal cord The only intrinsic muscle placed externally Tilts the thyroid cartilage forwards and the arytenoids backwards so that vocal cords become longer

Cricothyroid in action

Muscles of the vocal cords

Posterior crico arytenoid(5 in the pic) is The ONLY ABDUCTOR of the vocal cords and keeps the airway open (life saving muscle!!)

The abductor in action

Superior view

Muscles closing the glottis (adductors)

Lateral cricoarytenoid muscles

Relaxers of the vocal cords

Main relaxers are Thyro arytenoid muscles A part of this muscle is called vocalis

Movements of vocal cords

During speech(adducted)

During breathing(abducted)

During speech production there is intermitted release of expired air between the adducted vocal fold results in their vibration and produces sound

Frequency or pitch of voice is determined by changes in the length and tension of vocal ligament

During Singing it requires more prolong release of the expired air between the adducted vocal cord

Blood supply and nerve supply of larynx

true Vocal cords are reference points Up to the cords supplied by superior laryngeal artery(br.of superior thyroid) Below the cords supplied by inferior laryngeal artery

Up to the cords, sensory nerve is internal laryngeal nerve(of X) (1in fig) Below the cords, sensory nerve is

the Recurrent laryngeal nerve(of X)(2in fig)

laryngoscopy
A

Vocal cord paralysis

Injury to recurrent laryngeal nerve causes paralysis of the ipsilateral cord(same side) Usually the left rec.laryngeal.nerve is affected(?) So the left cord is paralyzed

SEMONS LAW
In recurrent laryngeal nerve injury the abductor is the first to paralyze and last to recover.

summary

From behind(mucosa intact)

Mucosa removed