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1. LARYNX DR MAYURA SETIYA ASSISTANT PROF ESSOR

2. LARYNX It is the upper expanded part of the lower respiratory tract...( Organ of Respiration ) It is modified for producing voice... PHONATION Called as VOICE BOX or ORGAN OF PHONATION.. It acts as a sphincter at the inlet of lower respiratory tract to protect the trachea.( Protection) It also helps in swallowing(Deglutition)

3. LOCATION It is situated in the anterior midline of upper part of neck above trachea in front of laryngopharynx.... It extends from the root of the tongue to the trachea ... From EPIGLOTTIS to Lower border of CRICOID CARTILAGE It lies in front of 3 rd ,4 th ,5 th and 6 th cervical vertebrae

4. SKELETAL FRAMEWORK Lumen of the larynx is kept patent by its cartilaginous framework.. It is composed of 9 cartilages : 3 PAIRED 3 UNPAIRED 3 Unpaired- 1)THYROID 2) CRICOID 3)EPIGLOTTIS 3PAIRED -1)ARYTENOID 2)CORNICULATE 3)CUNEIFORM

5. All laryngeal cartilages are hyaline except epiglottis, corniculate , cuneiform, vocal process & apex of arytenoid which are elastic cartilage Hyaline cartilage ossify with age but not elastic cartilage Length -44mm in male and 36 mm in female

6. THYROID CARTILAGE Acts As a shield to protect the larynx from the front.. Consist of Two Laminae ... These two meet in front at an angle called THYROID ANGLE.. It is prominent in males and responsible for prominence in front of neck called ADAM’S APPLE

7. ATTACHMENT POSTERIOR SURFACE of the THYROID CARILAGE in the MEDIAN PLANE provides attachment to.... 1)THYROEPIGLOTTIC LIGAMENT 2)Pair of VESTIBULAR LIGAMENTS 3)Pair of VOCAL LIGAMENTS

8. POSTERIOR BORDER of each lamina is free and prolonged upwards and downwards as SUPERIOR and INFERIOR CORNU/HORNS It provides conjoint insertion to 1) Palatopharyngeus 2) Salpingopharyngeus 3)Stylopharyngeus

9. OUTER SURFACE of each lamina presents an oblique line and provides attachment : 1)THYROHYOID (ORIGIN ) 2)STERNOTHYROID (Insertion) 3)INFERIOR CONSTRICTOR(THYROPHARYNGEUS )

10. CRICOID CARTILAGE Signet shaped ring of cartilage.. NARROW ANTERIOR ARCH BROAD POSTERIOR LAMINA It is situated at the level of C6 vertebrae .. Posterior surface of lamina presents a MEDIAN RIDGE and Depression on each side

11. EPIGLOTTIS Leaf like Extends up behind the hyoid bone and the base of the tongue... BROAD upper end is free and forms the upper boundary of laryngeal inlet. Lower end is pointed and is connected to the posterior surface by of the angle of thyroid THYROEPIGLOTTIC LIGAMENT

12. The anterior surface of epiglottis is connected to base of tongue by MEDIAN and LATERAL GLOSSOEPIGLOTIC FOLDS.. Depression on each side of median fold is called VALLECULA

13. ARYTENOID CARTILAGES Paired arytenoid cartilages articulate with the upper border of the lamina of cricoid cartilage.. It is pyramidal and presents: Apex Base Three surfaces Two processes (MUSCULAR and VOCAL )

14. Muscular process projects laterally and backwards .. Vocal process is directed forwards BASE articulates with the upper border of lamina of cricoid cartilage APEX articulates with the corniculate cartilage.

15. CORNICULATE CARTILAGES (0f SANTORINI) Two small conical nodules which articulate with the apices of arytenoid cartilages.. These lie in the posterior parts of aryepiglottic fold .

16. CUNEIFORM CARTILAGES (of WRISBERG) Tiny rod shaped Cartilages. They also lie in the posterior parts of aryepiglottic fold

17. JOINTS CRICOTHYROID (Plane synovial jt ) CRICOARYTENOID (Plane synovial jt ) ARYTENOCORNICULATE

18. LIGAMENTS and MEMBRANES The skeletal framework of the larynx is interconnected by a number of ligaments and fibrous membranes.. EXTRINSIC 1)THYROHYOID MEMBRANE And LIGAMENTS 2) CRICOTRACHEAL ligament 3) THYROEPIGLOTTIC ligament 4) HYOEPIGLOTTIC ligament 5) CRICOTHYROID ligament

19. THYROHYOID MEMBRANE It extends from the upper border of thyroid cartilage to the upper border of hyoid bone. It ascends behind the posterior surface of hyoid bone . Between the posterior surface of hyoid bone and the membrane lies the subhyoid bursa

20. THYROHYOID MEMBRANE Thyrohyoid membrane is thickened to form MEDIAN and LATERAL THYROHYOID ligaments.. THYROHYOID MEMBRANE is pierced on either side by 1)INTERNAL LARYNGEAL NERVE 2)SUPERIOR LARYNGEAL VESSELS

21. CRICOTRACHEAL LIGAMENT CRICOTHYROID LIGAMENT CRICOTRACHEAL LIGAMENT: It connects cricoid cartilage with the first tracheal ring CRICOTHYROID LIGAMENT: It connects the lower border of thyroid cartilage to cricoid cartilage in the midline

22. THYROEPIGLOTTIC LIGAMENT HYOEPIGLOTTIC LIGAMENT THYROEPIGLOTTIC LIGAMENT: It attaches the lower end of epiglottis to the posterior surface of thyroid angle. HYOEPIGLOTTIC LIGAMENT: It connects the posterior aspect of hyoid with anterior surface of the upper end of epiglottis

23. INTRINSIC MEMBRANE and LIGAMENTS CRICOVOCAL MEMBRANE: (CONUS ELASTICUS) It extends upwards and medially from the upper border of the arch of cricoid cartilage. It s upper edge is free and attached anteriorly to the posterior surface of the thyroid cartilage and posteriorly to the vocal process of the arytenoid cartilage It is thickened to form the vocal ligament. Fold of mucous membrane over it is called vocal fold

24. QUADRANGULAR MEMBRANE: It extends from the sides of epiglottis to arytenoids . Its lower edge is free and attached anteriorly to the posterior surface of thyroid cartilage and posteriorly to the lateral surface of arytenoid cartilage. Its lower edge is thickened to form the VESTIBULAR LIGAMENT

25. MUSCLES EXTRINSIC They attach the larynx to the surrounding structures and are responsible for the movement of larynx as a whole E 1) Palatopharyngeus L 2) Salpingopharyngeu s E 3)Stylopharyngeus V 4)Thyrohyoid A T E 5) Sternothyroid (Depress) INTRINSIC They attach the laryngeal cartilages to each other and are responsible for their movements 1)They open or close the laryngeal inlet 2)They adduct or abduct the vocal cords 3)Increase or decrease the tension of vocal cords

26. MUSCLES that open or closes the Laryngeal inlet 1)OBLIQUE ARYTENOIDS (CLOSES) 2)ARYEPIGLOTTICUS (CLOSES) 3)THYROEPIGLOTTICUS (OPENS)

27. MUSCLES that ABDUCTS or ADDUCTS the vocal cords 1)POSTERIOR CRICOARYTENOIDS (ABDUCTS) 2)LATERAL CRICOARTENOIDS (ADDUCTS) 3)TRANSVERSE ARYTENOIDS (ADDUCTS)

28. MUSCLES that increases or decrease the tension of vocal cords 1)CRICOTHYROID (TENSES) 2)VOCALIS (TENSES) 3)THYROARYTENOIDS (RELAXES)

29. All intrinsic muscles of larynx are paired except transverse arytenoid Cricothyroid is the only muscle lying on the outer aspect of the larynx

30. CRICOTHYROID Only muscle which lies on the external surface of larynx.. It arise from the anterolateral aspect of the cricoid It is inserted into the inferior cornu and lower border of lamina of thyroid cartilage

31. It is supplied by EXTERNAL LARYNGEAL NERVE. Its contraction makes the thyroid cartilage to tilt slightly downwards and forward at the cricothyroid joint It causes LENGTHENING and TENSING of vocal cord It also helps in Adduction of vocal cord Also called TUNING FORK OF LARYNX

32. VOCALIS It is the detached medial part of the thyroarytenoid It lies within the vocal fold just lateral and cranial to vocal ligament On its contraction the anterior part of the vocal ligament tenses and posterior part is relaxed

33. It is supplied by RECURRENT LARYNGEAL NERVE SEGMENTAL TENSION of vocal ligament helps in MODULATION OF VOICE

34. POSTERIOR CRICOARYTENOID Triangular muscle which arises from Posterior surface of cricoid lamina It is inserted into the muscular process of the arytenoid It is supplied by RECURRENT LARYNGEAL NERVE Abducts vocal cords Also called the SAFETY MUSCLE OF LARYNX

35. NERVE SUPPLY All the muscles of larynx are supplied by Recurrent laryngeal nerve except CRICOTHYROID which is supplied by EXTERNAL LARYNGEAL NERVE

36. CAVITY OF LARYNX It extends from the inlet of larynx where it communicates with the lumen of laryngopharynx to the lower border of cricoid cartilage where it is continuous with the lumen of trachea.

37. LARYNGEAL INLET Anteriorly: Epiglottis Posterior: Interaryyenoid fold of mucous membrane Lateral: Aryepiglottic fold of mucous membrane

38. Within the laryngeal cavity, two pairs of folds of mucous membrane extend posteroanteriorly from arytenoid cartilage to the thyroid cartilage.. 1)Upper folds are produced by vestibular ligaments called vestibular folds or false vocal cords 2)Lower folds are produced by the vocal ligaments and vocalis muscle are called vocal folds or true vocal cords

39. Space between vestibular folds is called RIMA VESTIBULI Space between vocal folds is called RIMA GLOTTIDIS.. It is the narrowest part of laryngeal cavity Deep elliptical space between vestibular and vocal folds is called SINUS OF LARYNX

40. SUBDIVISIONS of LARYNGEAL CAVITY 1)VESTIBULE (SUPRAGLOTTIC COMPARTMENT): It extends from laryngeal inlet to the vestibular folds Anteriorly: Mucous membrane covering the posterior surface of epiglottis.. POSTERIORLY: Mucous membrane covering the apices of arytenoid cartilages, and corniculate cartilages. SIDES: ARYEPIGLOTTIC FOLDS Aryepiglottic fold separates the vestibule from the piriform recess

41. VENTRICLE or SINUS of LARYNX GLOTTIC COMPARTMENT: Deep elliptical space between the vestibular and vocal folds. On each side, a narrow blind diverticulum of the mucous membrane extends posterosuperiorly called the SACCULE of the LARYNX. It is provided with mucous glands whose secretions lubricate the vocal cords.. Also called OIL CAN OF LARYNX

42. INFRAGLOTTIC COMPARTMENT It extends from the vocal folds to the lower border of cricoid cartilage

43. MUCOUS MEMBRANE Whole of the laryngeal cavity is lined by CILIATED COLUMNAR EPITHELIUM except 1)anterior surface and upper half of the posterior surface of epiglottis 2)Upper parts of Aryepiglottic folds 3)vocal folds These are lined by STRATIFIED SQUAMOUS EPITHELIUUM Mucous glands are distributed all over except vocal folds

44. NERVE SUPPLY MOTOR NERVE SUPPLY: INTERNAL LARYNGEAL NERVE EXTERNAL LARYNGEAL NERVE SENSORY NERVE SUPPLY : Mucous membrane above the vocal folds is supplied by INTERNAL LARYNGEAL NERVE Below the vocal folds : RECURRENT LARYNGEAL NERVE

45. BLOOD SUPPLY Above the vocal folds: SUPERIOR LARYNGEAL ARTERY (Br of SUPERIOR THYROID ARTERY) SUPERIOR LARYNGEAL VEIN Below the vocal folds : INFERIOR LARYNGEAL ARTERY (Br of INFERIOR THYROID ARTERY) INFERIOR LARYNGEAL VEIN RIMA GLOTTIS has dual blood supply

46. LYMPHATIC DRAINAGE Above the vocal cords Lymphatics pierce the thyrohyoid membrane and drain into UPPER DEEP CERVICAL LN Below the vocal cords Lymphatics pierce the cricothyroid membrane PRELARYNGEAL and PRETRACHEAL LN LOWER DEEP CERVICAL LN

47. RIMA GLOTTIDIS It is the narrowest anteroposterior cleft of the laryngeal cavity.. SUBDIVISIONS of RIMA GLOTTIDIS INTERMEMBRNOUS PART : Anterior 3/5 th between the vocal cords INTERCARTILAGINOUS PART: Posterior 2/5 th between the vocal process of arytenoid cartilages

48. SHAPE OF RIMA GLOTTIDIS IN QUIET BREATHING: Intermembranous part is triangular Intercartilaginous part is rectangular GLOTTIS IS PENTAGONAL IN FULL INSPIRATION Glottis widens and become diamond shape due to abduction of vocal cords

49. SHAPE OF RIMA GLOTTIDIS DURING HIGH PITCHED VOICE : Rima glottidis is reduced to a linear chink due to adduction of both parts of rima glottidis DURING WHISPERING: Intermembranous part is adducted Intercartilaginous part is separated by a triangular gap INVERTED FUNNEL SHAPED

50. APPLIED LARYNGITIS LARYNGEAL OEDEMA FOREIGN BODY VOCAL NODULES/SINGER or SCREAMERS NODULES LARYNGOSCOPY-DIRECT/INDIRECT