Anatomy of the Larynx

Surg Cdr CN Jaideep Department of Anaesthesiology & Critical Care, AFMC

Embryology

Development begins from the 4th week 3rd to 6th branchial arches Upper part from 3rd & 4th - thus related to
foregut

Lower from 4th to 6th thus related to

trachea & lungs

Anatomy

Tubular organ at the top of trachea Base of tongue to lower edge of cricoid cartilage Opposite 3 6 cervical vertebrae Length: 44 mm in males, 36 mm in females

The Larynx

Guards the inlet to trachea Organ of phonation

Mainly cartilage, muscle and mucosa

Cartilages

Form the skeleton Single (unpaired) Thyroid - Cricoid - Epiglottis Paired - Arytenoid - Corniculate - Cuneiform

Ligaments

Extrinsic
Thyrohyoid Cricothyroid Cricotracheal

Intrinsic
Cricovocal Quadrangular

Intrinsic Muscles

Tensors Abductors Adductors

- Cricothyroid - Vocales - Posterior Cricoarytenoid - Lateral Cricoarytenoid - Thyroarytenoid - Interarytenoids

Vestibular (swallowing) - Aryepiglottic - Thyroepiglottic - Thyroarytenoid

Extrinsic Muscles
Primary Elevators : attached to thyroid cartilage. - Stylopharyngeus - Palatopharyngeus - Salpingopharyngeus - Thyrohyoid Secondary Elevators: attached to hyoid bone - Mylohyoid - Digastric - Stylohyoid - Geniohyoid

Blood Supply

Superior & Inferior Thyroid arteries and their corresponding veins

Nerve Supply

Sensory Innervation
Superior laryngeal (internal division) - Supraglottic mucosa - Thyroepiglottic joint - Cricoarytenoid joint - Ant subglottic mucosa - Cricothyroid joint

Superior laryngeal (external division)

Sensory Innervation
Recurrent laryngeal - Subglottic mucosa - Muscle spindles

Nerve of Galen

- Aortic arch

(communicating branch between superior and recurrent nerves)

Motor Innervation
Superior laryngeal (external division)
Cricothyroid muscle (Adductor, isotonic tensor)

Nerve of Galen (communicating branch)

Autonomic (secretory) Autonomic

Motor Innervation

Recurrent laryngeal
Thyroarytenoid muscle (Adductor, isometric tensor) Lateral cricoarytenoid muscle (Adductor) Interarytenoid muscle (Adductor) Posterior cricoarytenoid muscle (Adductor) Tracheoesophageal mucosa Tracheal smooth muscle

Longitudinal Section of Larynx showing the internal anatomy

Phonation

Applied Anatomy

The larynx is a vital organ! Knowledge of anatomic variations in adults and children essential for endotracheal intubation Surgical procedures on head & neck (esp Thyroid) can damage nerve supply

Laryngoscopy