Mayur Ingale

INTRODUCTION

4 ,5 Larynx is situated infront of

th

th

vertebra. Consists of framework of Cartilages connected by ligaments & membranes and is held in position by Intrinsic & Extrinsic musculature. Higher in women & Children. At puberty, Anteroposterior diameter of larynx in males increases.

& 6th Cervical

Embryological Development
Age 3 Weeks 5th Week 7th Week 12th Week

Development

Development of epiglottis takes place. Thyroid cartilage & Cricoid cartilage appear. Chondrification of these 2 cartilages. Development & Chondrification of Arytenoid and Corniculate take place. Chondrification of epiglottis occurs. Development of Cuneiform cartilage occurs.

20th Week 28th Week

Age & Ossification of Laryngeal Skeleton

Hyoid Thyroid

Starts at birth; Completes by 2 years. Starts at 20-22 years at inferior margin & extends posteriorly in Thyroid each alae. Superior margin never ossifies. Starts at 25-30 years. Starts at 25-30 Years.

Cricoid Arytenoids

Laryngeal cartilages
Larynx has 3 Unpaired & 3 Paired Cartilages : Unpaired : Thyroid, cricoid & Epiglottis. Paired : Arytenoid, Corniculate & Cuneiform.

Thyroid Cartilage

It is the Largest of all.

Its 2 alae meet at midline Thyroid Notch, forming an angle of 90 in males and 120 in females. Vocal cords are attached to the middle of the thyroid angle. Superior Cornu : Long, narrow, curves upwards backwards & medially. Inferior Cornu : Shorter, thicker, curves downwards & medially, oval articular facet.

Attachments

Inner Aspect : Smooth, Mucosa covered. There is attachment of thyroepiglottic, vestibular & vocal ligaments, thyroarytenoid, thyroepiglottic & Vocalis muscle. Superior Border : Thyrohyoid Ligament. Inferior Border : Cricothyroid Ligament.

Cricoid Cartilage

a complete It is the only cartilage forming

cartilagenous ring. Its posterior part is expanded to form a Lamina while anteriorly it is narrow forming an arch. There is articular facet for inferior cornu at the junction of arch and lamina. Articular facets for arytenoids on lamina. Verticular ridge on midline for attachment of longitudinal muscles of oesophagus.

Epiglottis

cartilage forming It is a leaf like, yellow elastic

anterior wall of laryngeal inlet. It is attached to the body of hyoid bone by hypoepiglottic ligament which divides it into suprahyoid & infrahyoid epiglottis. A stalk like process (petiole) of epiglottis attaches the epiglottis to thyroid angle. Anterior surface of epiglottis is seperated from thyrohyoid membrane & upper part of thyroid cartilage by a potential space- pre-epiglottic space ( Fat filled space).

EPIGLOTTIS

Arytenoid Cartilage
They are paired. Each arytenoid cartilage is pyramidal in shape. It has a base which articulates with cricoid cartilage; a Muscular process directed laterally to give attachment to intrinsic laryngeal muscles; a Vocal process directed anteriorly giving attachment to vocal cord; and an apex which supports the corniculate cartilage.

Corniculate Cartilage (Santorini)

They are Paired. They are small, conical, Elastic fibrocartilage. Each articulates with the apex of arytenoid cartilage.

Cuneiform Cartilage (wrisberg)

They are rod shaped. Each is situated in aryepiglottic fold infront of corniculate cartilage and provides passive supports to the fold.

ossification

cartilages are Thyroid, Cricoid & arytenoid

Hyaline cartilages ; whereas Epiglottis, corniculate & cuneiform are Fibroelastic nature. Hyaline cartilages can undergo ossification; it begins at age of 25 years in thyroid, a little later at cricoid and arytenoids & is complete by 65 years of age.

Laryngeal Joints :

: 1) Cricoarytenoid Joint
It is a synovial joint surrounded by capsular ligament. It is formedbetween the base of arytenoid and a facet, on the upper border of cricoid lamina. 2 types of movement occur : Rotatory & Gliding.


2) Cricothyroid Joint : It is also a synovial joint. Each is formed by the inferior cornu of thyroid cartilage with the facet on the cricoid cartilage.

Laryngeal Membranes
These are :

A] Extrinsic Membranes. B] Intrinsic Membranes.

Extrinsic Membranes :

1) Thyrohyoid Membrane : Connects thyroid cartilage to hyoid bone. It is pierced by superior laryngeal nerve & internal laryngeal nerve. 2) Cricothyroid Membrane : Connects thyroid cartilage to cricoid cartilage. 3) Cricotracheal membrane : Connects lower border of cricoid cartilage to the first tracheal ring.

Intrinsic membrane :

: 1) Cricovocal Membrane
It is a triangualar fibroelastic membrane. Its upper border is free & stretches between middle of thyroid angle to the vocal process of arytenoids & forms the vocal ligament. Its lower border attaches to the arch of cricoid cartilage.

 : 2) Quadrangular Membrane
It lies deep to aryepiglottic folds & is not well defined. It stretches between the epiglottic & arytenoid cartilages. Its lower border forms the vestibular ligament which lies in the false cord.

Muscles Of Larynx
These are of 2 Types :

1] Intrinsic Muscles. 2] Extrinsic Muscles.

Intrinsic Muscles :

: A) Acting on Vocal cords

Abductors : Posterior cricoarytenoid. Adductors : 1) Lateral cricoarytenoid.
Tensors :

2) Interarytenoid. 3) Thyroarytenoid. 1) Cricothyroid. 2) Vocalis.

B) Acting on Laryngeal Inlet : Openers of laryngeal inlet: Thyroepiglottic. Closers of laryngeal inlet: 1) Interarytenoid. 2) Aryepiglottic.

Extrinsic Muscles :

act directly as they A] Elevators : Primary elevators

are attached to thyroid cartilage and include Stylopharyngeus, Salpingopharyingeus, Palatopharyngeus & Thyrohyoid. Secondary elevators act indirectly as they are attached to hyoid bone and include Mylohyoid, Digastric, Stylohyoid & Geniohyoid. B] Depressors : 1) Sternohyoid. 2) Sternothyroid. 3) Omohyoid.

Cavity of Larynx :

Laryngeal cavity starts at laryngeal inlet where it communicates with pharynx & ends at lower border of cricoid cartilage where it is continuous with the lumen of trachea. Divided by vestibular & vocal folds into 3 compartments : 1)Superior vestibule. 2)Ventricle/sinus of the larynx. 3)Subglottic space.


1) Vestibule : Extends from laryngeal inlet to vestibular folds. Its anterior wall is formed by posterior surface of epiglottis; Sides by ariepiglottic folds & Posterior wall by mucous membrane over the anterior surface of arytenoids.

 : 2) Ventricle (sinus of larynx)

It is a deep elliptical space between vestibular & vocal folds, also extending a short distance above & lateral to vestibular fold. The saccule is a diverticulum of mucous membrane which starts from anterior part of the ventricular cavity & extends upwards between vestibular folds & lamina of thyroid cartilage.

3) Subglottic Space : It extends from vocal cords to lower border of cricoid cartilage.

Mucous membranes of Larynx :

Closely attached over the posterior surface of the epiglottis, corniculate, cuneiform & vocal ligament. Epithelium ciliated columnar except over vocal cord & upper part of the vestibule where it is stratified squamous epithelium. Numerous mucous glands except at the vocal folds ( mucous from saccule ). Few taste buds on posterior surface of epiglottis and Aryepiglottic fold.

Spaces of Larynx :

of Boyer) : Pre-epiglottic space (Space

Anterior thyrohyoid ligament & hyoid Posterior epiglottis Superior hyoepiglottic ligament Lateral continuous with paraglottic space. Para-glottic space: Lateral thyroid cartilage Medial conus elasticus & quadrangular membrane Posterior mucosa of pyriform fossa.

Reinkes Space : Located at the subepithelial connective tissue layer over the vocal ligament. It Extends along the full length of the true cord in its free margin. Superiorly & Inferiorly the space is limited by superior & inferior arcuate line 2mm from the margin.

Blood Supply :
Laryngeal branch of superior thyroid (br. of external carotid). Laryngeal branch of inferior thyroid (br. of thyrocervical trunk of 1st part of subclavian). Cricothyroid branch of superior thyroid Superior & middle thyroid vein, facial vein > internal jugular. Inferior thyroid vein > brachiocephalic veins.

Lymphatic Drainage :

Lymphatic drainage is Separated by vocal

fold into upper and lower group. Above vocal fold -> upper deep cervical nodes. Below vocal fold -> prelaryngeal, pretracheal & lower deep cervical. Vocal folds firmly bound down to vocal ligament -> there is relative absence of lymphatics.

Nerve Supply :

- Recurrent laryngeal Vagus superior laryngeal nerve

nerve . Superior laryngeal arises from the inferior ganglion of the vagus + br. from superior cervical sympathetic ganglion. At level of greater horn of the hyoid divides into external & internal branches. External > cricothyroid . Internal > pierces thyrohyoid membrane >Divides into upper & lower branches > pierces inferior constrictor > unites with ascending branch of recurrent laryngeal nerve (Galens anastomosis).

 Recurrent laryngeal nerve

Right loops around right subclavian artery. Left Loops around the aortic arch & ligamentum arteriosum Ascends in the tracheo-esophageal groove. Enters the larynx behind cricotracheal joint. Divides into motor & sensory branch. Motor all intrinsic muscles of larynx except cricothyroid Sensory below the level of vocal folds


~~~End Of Anatomy ~~~