HEAD & NECK

Lecture #21, 5/4 Subject: The Larynx; cartilages of the larynx, membranes and ligaments of the larynx, and the vocal cords. --------------------------------------------------------------------------------------------------------------------------

The Larynx:A special part of the body consists of group of cartilages which are connected
to each other by membranes and ligaments and moved by muscles. Two organs in the neck the anterior one known as the larynx, and the one behind it the pharynx the difference that the larynx is one third of the pharynx; the pharynx extends from C4 to C6 vertebrae, at the level of C6 the beginning of the trachea. While the pharynx extends from the base of the skull behind the nasal cavity all the way until the level of C6 then the pharynx become esophagus. - Functions: Voice production and Protective sphincter for inlet of airway to the lungs. Components of Larynx: >Cartilages >Membranes and ligaments >Muscles

Cartilages of the larynx:

The larynx consists of six groups of cartilage; three singular and three paired:

1. Thyroid cartilage: Largest one, anterior in the neck. Thyroid is something like a shield; because it's the largest one and extends on both sides of the neck and its main function is to shield the whole part of the larynx behind it (mainly the vocal cords), providingprotection. Consists of two laminae meet in the midline anteriorly, they form a sharp angle it's called Adams apple or laryngeal prominence. On the lateral side of each thyroid cartilage you will see a line that going obliquely, linear elevation but it is in an oblique direction, this elevation we call it the Oblique Line of thyroid cartilage. The oblique line very important landmark on the thyroid cartilage; because we have some muscles attached there (2 infrahyoid muscles: sternothyroid and thyrohyoid) but there is another one attached to it from posterior which is the inferior constrictor muscle of the pharynx. So the attachments in the oblique line are sternothyroid, thyrohyoid, and the inferior constrictor of the pharynx. You have to know that the thyroid cartilage is not closed; just going anterolaterally, and posteriorly it's open. 2. Cricoid cartilage:"krikoeides" (Greek, ring-shaped) located below of the thyroid cartilage. Small ring of hyaline cartilage,that's made anteriorly of a narrow arch (cricoid arch), posteriorly more wide become like alamina, in this lamina you'll see that there is an arytenoid cartilages resting.

3. Epiglottis: most elastic located above the larynx (glottis old name of the larynx), considered as a very important structure; because its main function is to protect the laryngeal inlet during the swallowing process. A leaf-shaped of elastic cartilage tissue covered with a mucous membrane, it's attached inferiorly through its stalk to the thyroid cartilage Upper is a freemargin. On the sides there is a membrane that connects the epiglottis back with the arytenoid cartilages (quadrangular membrane).

The upper margin of this membrane (quadrangular membrane) which is forms like a fold, two layers between the epiglottis and arytenoid; this fold is known as Aryepigottic fold connects posteriorly the arytenoid and anteriorly to the epiglottis Tostrengthen in this fold inside it you will find the cuneiform cartilage, that's why you have the cuneiform; when you add the cuneiform to this membrane inside it will become more strength.

On the other hand there are three smaller but paired cartilages: 4. Arytenoid Cartilage: looks like a pitcher (pyramidal in shape), in the posterior part of the larynx, resting on the lamina of cricoid cartilage. Very important one because to this cartilage you will have the vocal cords attached. Pyramidal in shape: have a base on the lamina of cricoid and apex where the corniculate cartilage is resting, and two processes: - Anterior process: more sharp, is called the Vocal process of arytenoid cartilage; vocal cords are attached here and they extend from this vocal processes until thyroid cartilage. - Lateral process: wider because muscles are attached here; so they call it the Muscular process, there are two main muscles (posterior and lateral cricoarytenoid muscles) Once the lateral contract the arytenoid moves inside and is closes the vocal cords. And once the posterior contract it will rotate the arytenoid and is opens the vocal cords.

5. Corniculate cartilages: above the arytenoid another smaller one, looks like small horns we call it corniculate. 6. Cuneiform Cartilages: like a wedge (triangular), and those are located within a membrane to strengthen this membrane (aryepiglottic fold), we call them cuneiform Cartilages.

Membranes and ligament:four membranes; two extrinsic and two intrinsic

Extrinsic membranes: One connects the thyroid up with hyoid bone, the thyrohyoid membrane. The other one connects the cricoid cartilage to the fist ring of the trachea, cricotracheal ligament. The thyrohyoid membrane: this connects the upper margin of the thyroid to the hyoid bone. In the midline it is thickened to form the median thyrohyoid ligament. The membrane is

pierced on each side by the superior laryngeal vessels, and internal laryngeal nerve, a branch of the superior laryngeal nerve. Intrinsic membranes: -Quadrangular membrane: extends between the epiglottis and the arytenoid cartilages, its upper margin is free and folds to form the aryepiglottic fold. Its thickened inferior margin forms the vestibular ligament, and the vestibular ligaments form the inferior of the vestibular folds, in other words those which we know them as false vocal cords, false because when you look in an endoscope it's possible to err and think it's the true vocal cords. - Cricothyroid membrane and ligament: the lower margin as attached to the upper border of the cricoid cartilage. The superior margin of the ligament, instead of being attached to the thyroid cartilage, ascends on the medial surface of the thyroid cartilage. Its upper free margin composed almost entirely elastic tissue, forms the important vocal ligament on each side. The vocal ligaments form interior of the vocal folds (vocal cords).Theanterior end of each vocal ligament is attached to the thyroid cartilage, and the posterior end is attached to the vocal process of the arytenoid cartilage. The movements of the vocal folds depend on the movements of the arytenoid cartilages, which rotate and slide up and down on the sloping shoulder of the superior border of the cricoid cartilage

Vocal fold (vocal cord): The vocal fold is a mobile fold on each side of the larynx and is concerned with voice production. It is formed by mucous membrane covering the vocal ligament and is avascular and white in color. The vocal folds moves with respiration and its white color is easily seen when viewed with a laryngoscope. The gap between the vocal folds is called the rimaglottidis or glottis. The glottis is bounded in front by the vocal folds and behind by the medial surface of the arytenoid cartilages. Laryngoscopy and Vocal Cords in action - False Vocal cords: Fixed vestibular folds (inferior free margin of quadrangular membrane) vascular and pink in color - True Vocal Cords: Mobile vocal ligaments (superior free margin of cricothyroid membrane) Avascular and white in color; no blood supply, and the continuous friction with the air leads to change in the epithelium to become stratified squamous epithelium. - Rima Vestibularis: it is the space between the two vestibular folds, usually fixed - Rima Glottidis: the space or the gap between the two true vocal cords, change by opening and closing the vocal cords during the voice production - Sinus of Larynx: a small recess extended from lateral sides of the larynx between vestibular folds above and the vocal cords below.

The End

'''' To all my beloved colleagues, sorry for all the mistakes Id done. '''' For all U_NAN students here and there.<3 " "