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LARYNX
• Larynx is the upper expanded part of the lower respiratory tract, which is modified
for producing voice, hence it is also called voice box/organ of phonation.
• Acts as a sphincter for the lower respiratory tract- protects trachea and respiratory
tract from entry of foreign material (most important) function

Location and Extent

• Location: Anterior midline structure
• Extension in adults: From the root of the tongue to the trachea; 3rd - 6th cervical
vertebrae. However, in children and females it lies at a little higher level.
• Length:
o Males- 44mm
o Females-36mm

Laryngeal Skeleton
• Larynx is composed of nine cartilages, of which three are unpaired and three are
paired. The principal cartilages of the larynx are, cricoid, thyroid, and two arytenoids
1. Unpaired cartilages: The unpaired cartilages are large and comprise: (CET)
(a) Thyroid
(b) Cricoid
(c) Epiglottis
2. Paired cartilages: The paired cartilages are small and comprise: (ACC cement)
(a) Arytenoid
(b) Corniculate (of Santorini)
(c) Cuneiform (of wrisberg)
• Trititial Cartilages are sometimes present making paired 11.
• The thyroid, cricoid and base of arytenoid cartilages are hyaline cartilages, rest all
the cartilages are elastic cartilages. Epiglottic cartilage is fibroelastic cartilage.

Thyroid cartilage
• Shield like (wedge) shape; Is the largest laryngeal cartilage; Commonly called
“Adam’s apple.”
• In the male, the laminae of thyroid cartilage meet at an angle of 90°, whereas in the
female the angle is 120°→ more prominent larynx in the male.
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Attachments of Thyroid Cartilage

Superiorly Inferiorly
Thyrohyoid membrane and ligament. Cricoid cartilage at inferior cornua
Greater cornua of hyoid bone at the tips. Cricothyroid ligament at the inferior
border of lamina
Cricothyroideus muscle: at the inferior
margin of the lamina
Inner surface Outer surface (anteriorly)
Ventricular bands Omohyoid
Thyroepiglottic ligament Sternothyroid
Vocal ligaments via the Broyles' Inferior constrictor muscles
ligament. They all attach along the oblique line
Thyroarytenoid muscles (major
adductors and tensors of the vocal fold).

Epiglottic Cartilage
• Leaf shaped; Situated posterior to the root of the tongue and the hyoid and anterior
to the laryngeal inlet.
• Tapered inferior end→ called the stalk of epiglottis.
• Multiple perforations allow free access of lymphatics. This space is also known as
Boyer’s space.

Arytenoid Cartilage
• They articulate with the lateral parts of the upper border of cricoid lamina.
• Pyramidal in shape.
• Presents two processes—muscular and vocal.
o The muscular process projects laterally and backwards whereas the vocal
process is directed forwards.
• The base of arytenoid cartilage articulates with the upper border of cricoid cartilage.
• The base is prolonged anteriorly to form the vocal process.
• The apex is curved posteromedially and articulates with the corniculate cartilage.

Joints of the Larynx

Cricothyroid joint
• Between the cricoid and thyroid cartilages.
• Is a plane synovial joint - permits two types of movements, viz.
1. Rotatory movement
2. Gliding movement.

Cricoarytenoid joint
• Present between the arytenoid and cricoid cartilage.
• This joint permits two types of movements, viz.
1. Rotatory movement, allows abducting or adducting the vocal cords.
2. Gliding movement, - allows closing or opening the posterior part of glottis.

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Arytenocorniculate joint
• It is a synovial joint between the arytenoid and corniculate cartilages. It is of no
functional significance.

Extrinsic ligaments of larynx

• Thyrohyoid membrane
• Fibro-elastic ligament; Connects the superior margin of the thyroid cartilage
inferiorly and the hyoid bone superiorly.
• Pierced by superior laryngeal artery, the internal branch of the superior laryngeal
nerve and lymphatics.
• Posterior borders are thickened to form the lateral thyrohyoid ligaments while
the thickened anterior section forms the median thyrohyoid ligament.
• May occasionally enclose a small cartilage (triticeal cartilage).
• Hyo-epiglottic ligament
• Cricotracheal ligament

Intrinsic ligaments of larynx

• Fibro-elastic membrane of the larynx
• Links together the laryngeal cartilages and completes the architectural
framework of the laryngeal cavity.
• Composed of two parts:
▪ Lower cricothyroid ligament
▪ Upper quadrangular membrane.
• Cricothyroid ligament (cricovocal membrane; Cricothyroid membrane)
• Attaches to the arch of cricoid cartilage inferiorly
• It extends superiorly to end in a free upper margin within the space enclosed by
the thyroid cartilage.
• On each side, this upper free margin attaches anteriorly to the thyroid cartilage,
and posteriorly to the vocal processes of the arytenoids cartilages thus forming
the vocal ligament, which is under the vocal fold (true vocal cord) of the larynx.
• Quadrangular membrane
• On each side it runs between the epiglottis and arytenoid cartilage.
• It is also attached to the corniculate cartilage.

Laryngeal Cavity
• Extends from inlet of larynx, to the lower border of
the cricoid cartilage, where it is continuous with the
lumen of the trachea.
• The anterior wall of laryngeal cavity is longer than
the posterior wall.
• Laryngeal inlet is obliquely placed, sloping
downwards and backwards. It opens into the
laryngopharynx.

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Boundaries
• Anterior: Epiglottis.
• Posterior: Inter-arytenoid fold of the mucous membrane.
• Lateral (on each side): Aryepiglottic fold of the mucous membrane.
❖ The upper folds are produced by vestibular ligament and called vestibular folds
or false vocal cords. The space between vestibular folds is called rima vestibuli.
❖ The lower folds are produced by the vocal ligaments and vocalis muscle, and
called vocal folds or true vocal cords. The space between the right and left vocal
folds is called rima glottidis, the narrowest part of the laryngeal cavity.

Mucous Membrane of Larynx

• Larynx is lined by pseudostratified ciliated columnar epithelium except at the
following areas where we find Stratified squamous epithelium:
o Anterior surface of larynx
o Upper half of posterior surface of epiglottis
o Vocal folds.
• Saccule: known as the Oil can of Larynx

Muscles of Larynx
1. Intrinsic Laryngeal muscles - Move the laryngeal components
2. Extrinsic Laryngeal muscles - Move the larynx as a whole

Infrahyoid muscles: sternohyoid muscle, omohyoid muscle,

Extrinsic sternothyroid muscle, thyrohyoid muscle
muscles Suprahyoid muscles: stylohyoid muscle, digastric muscle, mylohyoid
muscle, geniohyoid muscle
Adductors: lateral cricoarytenoid muscle, transverse arytenoid muscle
Abductors: posterior cricoarytenoid muscle
Intrinsic Sphincters: transverse arytenoid muscle, oblique arytenoid muscle,
muscles aryepiglottic muscle
Tensors: cricothyroid muscle
Muscles that relax vocal cords: thyroarytenoid muscle, vocalis muscle
Action Muscles involved
Muscles which open glottis (abductors of vocal cord) Posterior cricoarytenoids
Muscles which close the glottis (adductors of vocal • Lateral cricoarytenoids
cord) • Transverse arytenoids,
(TLC) • Thyroarytenoids
Muscles which tense the vocal cord (CT) Cricothyroids
Muscles which relax the vocal cord • Thyroarytenoids
• Vocalis
Muscles which open the inlet of larynx Thyroepiglotticus
Muscles which close the inlet of larynx • Aryepiglotticus
• Oblique arytenoids

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Blood Supply and Lymphatic Drainage of Larynx

Arterial Supply:
- Superior + Inferior laryngeal artery
- Cricothyroid artery
Nerve Supply:
- Internal + External laryngeal nerve
- Recurrent laryngeal nerve
Veins of Larynx
- Superior + Inferior laryngeal vein
Lymphatic Drainage
- Superior + Inferior deep cervical lymph nodes

Injury to Laryngeal Nerves

Recurrent laryngeal nerve paralysis
- Moderate trauma produces only abductor paralysis
- Severe injury cause both adductor and abductor paralysis
- Phonation is completely lost
- Semon’s law: Progressive moderate lesion,
: Abductor – First to paralyze, last to recover.
➢ Unilateral injury to RLN causes Hoarseness of voice
➢ B/L paralysis of RLN causes stridor- it is a medical emergency as the vocal cords
come in cadaveric position leading to complete closure of airway- immediate
intubation is required to save the patient.

Superior Laryngeal Nerve Paralysis

• Causes loss of timbre of voice- a voice that is monotonous in character because
cricothyroid muscle is paralyzed.