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Neuro 2019 Exam 2 > Larynx Anatomy > Flashcards

Larynx Anatomy Flashcards

1
Q

General Features of Larynx

A

A. The larynx serves both a respiratory and voice-producing (phonation) function.

B. Connects pharynx to trachea; thus directing air to respiratory passages.

C. Also acts to prevent passage of food materials into the airways.

D. Located in the neck, anterior to CV3 – CV6.

E. Composed of cartilages, membranes, and muscles which control the rate and amount of air flowing through the larynx; thus altering the pitch, tone, and volume of voice.

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2
Q

Internal Features of Larynx

A

A. Laryngeal aditus – superior opening from pharynx

B. Vestibule – area proximal (above) vestibular folds

C. Vestibular (false) folds

D. Rima vestibuli – opening between vestibular folds

E. Ventricle – between vestibular and vocal folds

F. True vocal folds

G. Rima glottidis – opening between true vocal folds

  1. Shape varies depending on position of vocal folds
  2. Variation in the tension and length of the vocal folds, and width of rima produces changes in pitch of the voice.

H. Glottis – rima glottidis plus vocal folds

I. Infraglottic cavity - distal (below) true vocal folds

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3
Q

Clinical correlation cricoid cartilage

A

– landmark for CV6

  1. Site where carotid artery can be compressed against CV6
  2. Junction of larynx and trachea
  3. Junction of pharynx and esophagus
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4
Q

Tracheotomy

A
  1. Obstruction of the upper airway can be overcome by puncturing the larynx or trachea.
  2. Incision is made between the cricoid cartilage and the first tracheal cartilages.
  3. Incision can also be made between the cricoid and thyroid cartilages (through the cricothyroid ligament).
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5
Q

Laryngeal Cartilages

A

Thyroid, Cricoid, Arytenoid, Epiglottic, Corniculate, CUneiform

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6
Q

Thyroid Cartilage

A
  1. Lies anterior to CV4, CV5
  2. Features
    a. Laminae (2) fuse anteriorly and remain open posteriorly.
    b. Superior horn – attached to hyoid bone by lateral thyrohyoid ligament
    c. Inferior horn – articulates with cricoid cartilage
    d. Laryngeal prominence (Adam’s apple)
    e. Superior thyroid notch
    f. Oblique line
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7
Q

Cricoid cartilage

A
  1. Lies anterior to CV6
  2. Features
    a. Immobile ring attached via membrane to first tracheal cartilage
    b. Anterior arch
    c. Posterior lamina
    d. Articulates with arytenoid and thyroid cartilages
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8
Q

Arytenoid cartilages

A
  1. Lie perched atop the posterior portion of the cricoid cartilage
  2. Features
    a. Apex – attaches to aryepiglottic fold
    b. Vocal process – attaches to vocal ligament
    c. Muscular process – attaches to posterior and lateral cricoarytenoid muscles
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9
Q

Epiglottic cartilage

A
  1. Leaf-shaped, elastic cartilage situated posterior to root of tongue.
  2. Broad, superior end is free; inferior end is attached to the thyroid cartilage.
  3. Muscles of the pharynx pull the thyroid cartilage against the epiglottis during swallowing to prevent food from moving into the larynx.
  4. Ligaments
    a. Thyroepiglottic ligament
    b. Hyoepiglottic ligament
    c. Aryepiglottic ligament
    d. Glossoepiglottic ligaments (median and lateral)
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10
Q

Corniculate cartilages

A

lie atop the apex of the arytenoid cartilages

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11
Q

Cuneiform cartilages

A

lie within aryepiglottic folds

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12
Q

Laryngeal Ligaments - External

A
  1. Thyrohyoid membrane
    a. Attaches hyoid bone to superior border of thyroid cartilage
    b. Thickened laterally (lateral thyrohyoid ligament) and medially (median thyrohyoid ligament)
    c. Pierced by the internal laryngeal nerve and superior laryngeal artery.
  2. Cricotracheal ligament – attaches cricoid to first tracheal cartilage
  3. Hyoepiglottic ligament
  4. Glossoepiglottic ligament
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13
Q

Laryngeal ligaments- Intrinsic ligaments

A

Quadrangular ligament

Cricovocal (conus elasticus) ligament

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14
Q

Quadrangular ligament

A

a. Attaches anteriorly to the thyroid and epiglottic cartilages
b. Attaches posteriorly to the arytenoid cartilage
c. Forms vestibular ligaments; covered with mucosa = vestibular fold
d. Forms aryepiglottic ligament; covered with mucosa = aryepiglottic fold

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15
Q

*** Cricovocal (conus elasticus) ligament **

A

a. Attaches inferiorly to cricoid cartilage.
b. Attaches superiorly to thyroid and arytenoid cartilages.

c. Thickened regions:
1. Median cricothyroid ligament
2. Lateral cricothyroid ligament
3. Vocal ligament – extends from internal surface of thyroid lamina to vocal process of arytenoid; covered with mucosa = vocal fold

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16
Q

Laryngeal folds

A

Vocal and Vestibular

17
Q

Vocal folds

A
  1. Formed from mucosa overlying vocal ligament and vocalis muscle.
  2. Vocal ligament – innermost portion of cricovocal ligament; extends from thyroid cartilage to vocal process of arytenoid cartilage.
  3. Vocalis muscle – innermost portion of thyroarytenoid muscle.
  4. Vocal ligaments change tension/length in order to control pitch of voice.
18
Q

Vestibular folds

A
  1. Formed from mucosa overlying vestibular ligament

2. Covered with highly vascularized mucosa; contains many mucus-secreting glands.

19
Q

Joints of Larynx

A

Cricothyroid and cricoarytenoid joints

20
Q

Cricothyroid joint

A
  1. Articulation between cricoid cartilage and inferior horn of thyroid cartilage.
  2. Synovial – mainly gliding movements
  3. Allows thyroid to glide on cricoid in order change vocal cord length.
21
Q

Cricoarytenoid joint

A
  1. Articulation between cricoid cartilage and arytenoid cartilage.
  2. Synovial – mainly gliding and rotational movements (condylar joint)
  3. Allows arytenoid cartilages to rotate, glide toward one another.
22
Q

Primary motions of laryngeal cartilages

A
  1. Rotation of arytenoid cartilages to abduct (posterior cricoarytenoid) and adduct (lateral cricoarytenoid) vocal ligaments.
  2. Gliding of arytenoids to adduct vocal ligaments (to close rima glottitis) (transverse and oblique artenoids).
  3. Rotating of thyroid cartilage on cricothyroid joint to increase (cricothyroid muscle) and decrease (thyroarytenoid muscle) tension on the vocal ligaments.
23
Q

cricothyroid muscle

A

tilts thyroid forward to elongate and tighten vocal ligament

24
Q

Transverse and oblique arytenoids

A
  1. Adduct arytenoid cartilages

2. Close laryngeal inlet by approximating the arytenoid cartilages

25
Q

Thyroarytenoid

A

rotates thyroid cartilage back to shorten and loosen vocal ligament

26
Q

Vocalis muscle

A
  1. Innermost portion of thyroarytenoid muscle
  2. Lateral to vocal ligament
  3. Locally controls vocal ligament; produces minute adjustments or vocal ligament tension and length.
27
Q

Innervation of laryngeal muscles

A
  1. External branch of superior laryngeal n – cricothyroid

2. Recurrent laryngeal nerve (inferior laryngeal n) – all other muscles

28
Q

Innervation of larynx

A

A. Superior laryngeal nerve (CN X)

  1. Internal laryngeal nerve
    a. Pierces thyrohyoid membrane
    b. Provides:
    - –GVE-P and GVA proximal to true vocal folds (supraglottic region)
    - –SVA to epiglottic region of tongue
  2. External laryngeal nerve – SVE to cricothyroid muscle

B. Inferior laryngeal nerve (CN X)

  1. Continuation of recurrent laryngeal nerve.
  2. Enters larynx by passing inferior to inferior constrictor m.
  3. Provides:
    a. GVE-P and GVA distal to true vocal folds (infraglottic region)
    b. SVE to all muscles of larynx, except cricothyroid
29
Q

CLINICAL CORRELATION: COUGH REFLEX

A

There is a very strong reflex, mediated by CN X, which functions to prevent foreign objects from entering the airways. When foreign objects (ex: food) enter the larynx, the superior laryngeal nerve is stimulated (GVA) and causes contraction of laryngeal muscles which close the larynx. Vagus nerve will stimulate a cough in order to force air out of the larynx. Injury to the superior laryngeal nn will ablate this protective function due to anesthesia of the laryngeal mucosa. Cough reflex – afferent limb is CN X; efferent limb is CN X.

30
Q

CLINICAL CORRELATION – Superior laryngeal nerve lesion

A

will result in loss of the cough reflex (loss of sensation to supraglottic region). The cricothyroid m will also be paralyzed which often causes a monotonous voice.

31
Q

CLINICAL CORRELATION: Choking and the Heimlich Maneuver:

A

If a foreign object enters the larynx, above reflex is engaged and the rima glottidis closes tightly. The Heimlich maneuver is used to dislodge the foreign object by increasing intrathoracic pressure.

32
Q

CLINICAL CORRELATION: Superior laryngeal nerve block

A

is administered when inserting an endotracheal tube. The needle is inserted halfway between the hyoid bone and superior border of the thyroid cartilage. The needle pierces the thyrohyoid membrane and anesthetic agent will bath the superior laryngeal n.

33
Q

CLINICAL CORRELATION: Injury to the recurrent laryngeal nerve

A

can occur with neck or thoracic damage or surgery. Recall that the left recurrent laryngeal nerve branches in the thorax (aortic aneurysms, tumors, enlarged lymph nodes in the thorax can compress and damage the recurrent laryngeal nerve). Injury to the nerve will affect the function of the larynx due to the fact that all but one laryngeal muscle are innervated by the recurrent laryngeal nerve. If damage is unilateral, patient will present with hoarseness; if bilateral will present with aphonia.

34
Q

Arterial supply of the larynx

A
  1. Superior laryngeal artery
    a. Branch of superior thyroid artery
    b. Pierces thyrohyoid membrane
    c. Supplies larynx above true vocal folds
  2. Cricothyroid artery
    a. Branch of superior thyroid artery
    b. Supplies cricothyroid muscle
  3. Inferior laryngeal artery
    a. Branch of inferior thyroid artery
    b. Supplies larynx below true vocal folds
35
Q

Venous drainage of the larynx

A
  1. Superior laryngeal vein → internal jugular vein

2. Inferior laryngeal vein → left brachiocephalic vein

36
Q

Lymphatic drainage of the larynx

A

A. Proximal (above) true vocal folds → superior deep cervical lymph nodes

B. Distal (below) true vocal folds → inferior deep cervical lymph nodes

Neuro 2019 Exam 2 (14 decks)

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