Clinical Anatomy Of Larynx Part 2

Question 1

Division of larynx by true vocal cords

Answer 1

Above the level of true vocal cords - supraglottis
At the level of true vocal cords - glottis
Below the level of true vocal cords - sub glottis

Question 2

What are the subsites of supraglottis ?

Answer 2

Epiglottis
Aryepiglottic fold
Arytenoid
Quadrangular membrane
False vocal cords
Vestibule
Ventricle

Question 3

What is epilarynx ?

Answer 3

Epilarynx is the inlet of larynx ; formed by
Anterior - epiglottis
Laterally - Aryepiglottic fold
Posteriorly - arytenoids

Question 4

What is the anterior and posterior commissure of true vocal cords ?

Answer 4

Anterior commissure is the point of attachment to the thyroid cartilage

Posterior commissure is the attachment of true vocal cords to the vocal process of arytenoid

Question 5

What are the parts of true vocal cords ?

Answer 5

Cartilagenous part and membranous part

Anterior 2/3 rd - membranous and vibrates during talking

Posterior 1/3 rd - cartilagenous and is responsible for adduction and abduction of vocal cords

Question 6

What is the point of maximum vibration of true vocal cords ?

Answer 6

Mid point of membranous part ; this point is most commonly affected due to vocal abuse , most common site of nodule or polyp of formation

Anterior 1/3 rd and posterior 2/3

Question 7

What are the boundaries of glottis ?

Answer 7

Upper boundary - lower border of ventricle
Lower boundary - 1 cm below the true vocal cord’s edge

Question 8

With what the anterior commissure of true vocal cords is attached to the thyroid cartilage ?

Answer 8

It is attached with the help of BROYLE ‘ S LIGAMENT also known and ANTERIOR COMMISSURE LIGAMENT

Purpose of this tendon is to limit the spread of carcinoma ; all the membrane of larynx prevent the spread of tumour from the larynx

Question 9

What are the cavities of larynx ?

Answer 9

From above downwards :

Inlet / epilarynx
Vestibule
Rima vestibuli
Ventricle
Rima glottidis
Subglottis

Question 10

What is saccule of larynx ?

Answer 10

The lining epithelium of false vocal cords is not just continuous over the true vocal cords but before lining the true vocal cords , the epithelium is forming a sac like structure called saccule that is having mucous glands in it

Question 11

What the other name of saccule and purpose of saccule ?

Answer 11

Saccule is also called as oil can of larynx

The purpose of this saccule is to lubricate the true vocal cords as it is constantly rubbing against one another

This lubrication is essentially by the saccule as the true vocal cords are lined by non keratinised stratified squamous epithelium which doesn’t have mucus glands

Question 12

What is the ventricle otherwise called as ?

Answer 12

Sinus of morgagni of larynx

Question 13

What is laryngocoele?

Answer 13

Laryngocele is the enlargement of saccule

This enlargement occurs when the person blows down against a closed glottis (glottis are closed when the person speaks) and air doesn’t find way to move down hence enters the saccule causing it’s enlargement

Question 14

In whom laryngocoele is commonly seen ?

Answer 14

Weight lifters
Trumpet blowers
Glassblowers
Tumours of ventricles

CAN ALSO BE SEEN CONGENITALLY

Question 15

What are the types of laryngocele ?

Answer 15

Intrinsic
Extrinsic : pierces the Thyrohyoid membrane

Question 16

Clinical features of laryngocele

Answer 16

Difficulty in breathing (due to obstruction of lumen of larynx)
Voice change (due to compression of vocal cords)

Infection leads to the formation of laryngopyocele

Question 17

How to identify that a neck swelling is laryngocele ?

Answer 17

The size of the swelling increases on Valsalva manoeuvre

Bryce sign : sudden gush of hissing sound produced on compression

Question 18

Management of laryngocele

Answer 18

Excision - either externally or endoscopically

Question 19

What is the primary function of larynx ?

Answer 19

The earliest function of larynx is protection of airways

This protection is achieved with the help of three sphincters

Inlet / epilarynx - MOST EFFECTIVE SPHINCTER
False vocal cords - PREVENTS ASPIRATION
True vocal cords

Question 20

Pre epiglottic space is also known as

Answer 20

Space of BOYER

Question 21

Boundaries of pre-epiglottic / space of Boyer

Answer 21

Anteriorly - hyoid , Thyrohyoid ,thyroid
Posteriorly - epiglottis (infra hyoid part)
Superiorly - Hyoepiglottic ligament

Question 22

Contents of pre epiglottic space

Answer 22

Fats , LYMPHATICS ,vessels

Important route of spread of carcinoma of larynx

Question 23

Para epiglottic space is also known as

Answer 23

Space of tucker

Question 24

Boundaries of para-epiglottic / space of tucker

Answer 24

Anteriorly - communicates with the pre-epiglottic space
Posteriorly - pyriform fossa
Laterally - thyroid ala
Medially - quadrangular membrane , ventricle , cricovocal ‘ conus elasticus

Question 25

Contents of para - epiglottic space

Answer 25

Same as pre - epiglottic space

Question 26

What is reinke’s space ?

Answer 26

Space in the true vocal cords bounded by the vocal epithelium medially and vocal ligament laterally

Question 27

Boundaries of reinke’s space

Answer 27

Medially : vocal epithelium Laterally : vocal ligament Anteriorly : anterior commissure Posterior : posterior commissure Contents : loose areolar tissue Significance : enables the free movement of vocal cords

Question 28

Lymphatic drainage of larynx

Answer 28

Supra glottis - richest supply of lymphatics Glottis - no lymphatics Sub glottis - some lymphatics

Question 29

Where does supra glottis drain into ?

Answer 29

Upper and middle deep cervical (part of lateral group of lymph nodes) - level 2 & 3

Question 30

Where does glottis drain into ?

Answer 30

Glottis do not have lymphatics So there will be , no spread of carcinoma and reinke’s edema is seen in vocal cords as there are no lymphatics

Question 31

Where does subglottis drain into ?

Answer 31

Lower deep cervical and anterior group of lymph nodes (level 4 and 6) Anterior group - pre tracheal /pre cricoid also known as DELPHIAN NODES

Question 32

On the whole larynx drains into what levels of lymph nodes?

Answer 32

Level 2 , 3 , 4 ,6

Question 33

Common anterior lesions

Answer 33

Nodules and polyp

Question 34

Common posterior lesion

Answer 34

Granuloma

Question 35

Position for direct laryngoscope

Answer 35

Boyle’s position : extension at atlanto-occipital joint and flexion at cervicothoracic joint

Question 36

What is stroboscope used for ?

Answer 36

To find the even the smallest lesion of vocal cords Light appears in flashes

Question 37

Average anteroposterior diameter of larynx for male and female

Answer 37

Male : 36mm Female : 26mm

Question 38

What makes it possible for the infant to breathe simultaneously while suckling the milk?

Answer 38

High larynx

Question 39

What are the hyaline and elastic cartilages of larynx ?

Answer 39

Hyaline : will undergo calcification between 25-65 yrs of age Thyroid Cricoid Most of arytenoid Elastic cartilage : will not undergo calcification Epiglottis Corniculate Cuneiform Tip of arytenoid

Question 40

Muscle of whispering

Answer 40

Lateral cricoarytenoid

Question 41

Why vocalis is called the modulater?

Answer 41

Anterior part of vocalis - tense the vocal cords Posterior part of vocalis - relaxes the vocal cords