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MD3001resp > Larynx > Flashcards

Larynx Flashcards

1
Q

What is the larynx?

What does the larynx consist of?

A

The larynx is the membranous tube of cartillage, muscle and fibrous membranes (ligaments and folds)
It connects the oropharynx with the trachea via the laryngeal inlet.

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2
Q

3 functions of the larynx?

A

1- conduct air
2- protect the airway from food, liquids etc
3- vocalisation

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3
Q

Describe the location of the larynx?

What is the difference in it location in infants/newborns.

A

Anterior/median neck.
- laryngeal inlet = C3
- trachea begins = C6

The laryngeal prominence will be palpable below the skin.
Mobile during use.
It will be higher in newborns and infants and will take about 4-6 weeks to descend.

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4
Q

Why is the larynx slightly higher in newborns?

A

Because they have to be able to respirate while breast feeding.

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5
Q

Describe the structure of the larynx?

A
  • Inferior to hyoid bone via the thyrohyoid membrane
  • has a thickened membrane due to the median thyrohyoid ligament and paired lateral thyroid ligaments.
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6
Q

Briefly describe the cartilaginous structure of the larynx?

A

3 large unpaired cartilages
4 pairs of smaller cartilages
All made of hyaline cartilage except the epiglottis which is made from elastic cartilage.

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7
Q

Name the 3 single cartilages in the laryngeal skeleton?

A

1- epiglottis
2- thyroid
3- cricoid

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8
Q

Name 3 of the smaller paired cartilages?

A

1- arytenoid cartilages
2- cuneiform cartilage
3- cornice late cartilages

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9
Q

What type of cartilage may be present in 1/3 of people?

A

Tritceal cartilages may be present within lateral thyrohyoid ligament

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10
Q

Name each part

A
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11
Q

Thyroid cartilage connects too:
Superiorly?
Inferiorly?
Posteriorly?

A

Superiorly= hyoid
Inferiorly = cricoid
Posteriorly= epiglottis on the posterior aspect of the laryngeal prominence
Arytenoids via the vocal and vestibular ligaments

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12
Q

Epiglottis:
Function?
Attachments?

A

Function = to close over the laryngeal inlet while swallowing

Attaches too:
Superiorly = the hyoid bone via the hypoepiglotic ligament
Inferiorly = thyroid cartilage

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13
Q

What do the attachments of the epiglottis allow?

A

The hypoepiglottic ligament will allow the opening of the laryngeal inset at the end of swallowing and pulls the epiglottis back to its original position

The thyroepiglottic ligament keeps the epiglottis in place

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14
Q

Describe the shape of the cricoid cartilage?

Cricoid connects to?
Cricoid articulates with?

A

The cricoid is an the shape of a signet ring

Connects with:
Thyroid superiorly
Trachea Inferiorly

Articulates with:
Inferior horn of thyroid
Arytenoid cartilage
Synovial joints

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15
Q

What is each facet for articulation with?

A
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16
Q

Describe the shape of arytenoid cartilages?

Where does the base sit?

What sits at the apex?

What is the depression for on the anterolateral surface?

A

1- pyramid shapes

2- the base sits on the cricoid cartilage with each medial aspect facing each other. (Inferior articulation)

3- the corniculate cartilage will sit at the apex (superior articulation)

4- depression on the anterolateral surface is for the vestibular ligament and vocalisation muscle.

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17
Q

What are the 2 processes of the arytenoid cartillage?

A

1- vocal process = located anteriorly for attachment of the vocal ligament

2- muscular process = located posteriorly for attachment of the posterior and lateral cricoid-arytenoid muscles

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18
Q

Position of corniculate cartilage?

Position of cuneiform cartilage?

A

Corniculate cartilage sits on top of arytenoids

Cuneiform sits within the quadrangular membrane.

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19
Q

Describe the structure of the thyro-hyoid membrane?

A

Fibro-elastic

Thickened anteriorly and posteriorly due to the medial and lateral thyro-hyoid ligaments.

It will be pierced by the superior laryngeal vessels (artery and vein) and superior laryngeal nerve (internal branch)

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20
Q

What are the 3 extrinsic ligaments within the larynx?

A

hypo epiglottis ligament
Cricotrachael ligament
Thyrohyoid membrane

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21
Q

What are the intrinsic ligaments of the larynx?

A

Fibroelastic membrane
Vocal ligaments = form the true vocal fold
Vestibular ligaments = forms false vocal folds

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22
Q

What makes up the fibroelastic membrane?

What are the separated by?

A

Quadrangular membrane
Conus elasticus

Separated from each other by the laryngeal ventricle

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23
Q

What are the 2 superiorand inferior borders of the qudrangular membrane ?

A

1- aryepiglotic fold (superior border)
2- vestibular ligament (inferior border)

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24
Q

What will the cartilages and membranes be covered by?

A

Mucosa

25
Q

What will the vestibular and vocal folds divide the larynx into?

What makes up the anterior aspect of the ventricles?

What does the aryepiglotic fold form?

What are vocal folds?

What is the space between the vocal folds?

A

1- Vestibule
Ventricle
Infraepiglottic space

2- saccule = lubricates the vocal folds

3- aryepiglotic folds form the lateral border of the laryngeal inlet

4- vocal folds are stratified non keratinised squamous epithelium

5- Irma glottis

26
Q

What are the extrinsic muscles of the larynx?

What muscles make up the pharyngeal elevators?

A

1- pharyngeal elevators
2- suprahyoid muscles
3- infrahyoid muscles

1- stylopharyngeus
2- palatopharyngeus
3- salpingopharyngeus

27
Q

What are the infrahyoid muscles?

What is elevation of the larynx is a key step in what?

A

They will depress the larynx

1- sternohyoid
2- thyrohyoid
3- sternothyroid

Thyrohyoid function varies on wether hyoid bone is fixed or not (can depress or elevate thyroid)

Elevation of the larynx during swallowing is a key step in protection of the airway.

28
Q

What are the 5 laryngeal elevators?

A

Digastric
Mylohyoid
Stylohyoid
Geniohyoid
Thyrohyoid

29
Q

What 3 things is the laryngeal cavity split into?

A

1- the vestibule
2- the laryngeal ventricle
3- the infraglottic cavity

30
Q

What is the function of the laryngeal muscles?

A

1- protection/ closure of the airway
2- controlling size of the rims glottidis
3- altering tension of vocal ligaments

31
Q

Innervation f the intrinsic laryngeal muscles?

A

Recurrent laryngeal nerve (from the vagus nerve) except cricothyroid muscle

32
Q

What is the laryngeal inlet?

What is it bound by?

What is the rima glottis?

A

Laryngeal inlet is the opening of the vestibule.
Bound by the aryepiglotic fold.

The rima glottis is the opening between the vocal folds and muscular processes of the arytenoid cartilages.

33
Q

What 3 extrinsic muscles will elevate the pharynx?

What 5 extrinsic muscles will elevate the larynx?

What 3 extrinsic muscles will depress the larynx?

A

3 that will elevate the pharynx:
- salpingopharyngeus
- palatopharyngeus
- stylopharyngeus

5 muscles the elevate the larynx:
- stylohoid
- digastric
- mylohoid
- geniohyoid
- thyrohyoid

3 muscles that depress the larynx;
- sternothyroid
- thyrohyoid
- sternohyoid

34
Q

What 4 muscles are involved in closure of the laryngeal inlet?

How do they do this?

A
  • Salpingopharyngeus
  • palatopharyngeus
  • stylopharyngeus
  • stylohyoid

They do this by elevation of the pharynx, which is also connected to the larynx.

35
Q

Function of oblique arytenoids?

Connections of oblique aretenoids?

A

1- protection/ closure of the airway using the sphincter of laryngeal inlet.

2- posterior surface of the muscular process of one of the arytenoids to the posterior apex of the other.
Fibres will also extend into the ary-epiglottis fold

36
Q

Function of thyro-arytenoid?

Connections of thyro-arytenoid?

A

1- protection/closure of the airway using the sphincter of laryngeal inlet and vestibule.

2- connected between the thyroid angle and cricothyroid ligament to the anterolateral surface of arytenoid cartilage
- fibres also extend into the ary-epiglottic fold to the lateral margin of epiglottis

37
Q

What 2 muscles are involved in protection/closure of the airway?

A

1- oblique arytenoids
2- thyro arytenoids

38
Q

What 4 muscles are involved in controlling the diameter of the rima glottis?

A

1- posterior crico-arytenoid
2- lateral crico-arytenoid
3- transverse arytenoid
4- vocalis

39
Q

Function of vocalis?

Connections?

A

1- controlling diameter of rima glottis by adjusting tension in vocal ligaments

2- the lateral surface of the vocal process of arytenoid cartilage will connect to the vocal ligament and thyroid angle

40
Q

Function Of transverse arytenoid?

Connections of transverse arytenoid?

A

1- it controls the diameter of the rima glottis by adducting the arytenoid cartilages

2- it connects to the lateral border of the posterior surface of arytenoid cartilage

41
Q

Function of the lateral crico-arytenoid muscle?

Connections?

A

1- controlling diameter of the rimaglottis by adducting the vocal folds via internal rotation of arytenoids closing the rima glottis.

2- connects to the superior surface of the cricoid cartilage to the anterior surface of the muscular process of the arytenoid cartilage

42
Q

Function of the posterior cricoid-arytenoid?

Connections?

A

1- controlling the diameter of rima glottis by abducting vocal folds via the external rotation of arytenoids (main openers of the rima glottis)

2- connects the posterior surface of the lamina of cricoid cartilage to the posterior surface of the muscular process of arytenoid cartilage.

43
Q

What 2 muscles close the laryngeal inlet?

A

Ary-epiglottis fold muscle
Superior fibres of thyro-arytenoid muscle

44
Q

What muscle is used in forced respiration?

A

Posterior crico-arytenoid

45
Q

What muscles are used in phonation? (Closing of the airway)

A

Oblique and transverse arytenoids and lateral crico arytenoids

A stronger contraction will lead to the valsalve manoeuvre

46
Q

What muscles are involved in whispering?

A

Lateral cricoid-arytenoid will be active with oblique and transverse arytenoids relaxed.

47
Q

What are the steps in closure and protection of the airway?

A

1- elevation of larynx
2- adduction of the vocal folds
3- approximation of the vestibular folds
4- constriction of the laryngeal inlet
5- anterior movement of arytenoids
6- epiglottis inversion

48
Q

What muscle is responsible for changing the tension, but not the length of the vocal cords?

How does this altering tension change the pitch of the voice?

A

1- vocalis

2- it does this by increasing the tension of the vocal folds with the vocalis muscle, the position of the cricothyroid muscle and vocal folds will remain the same.

49
Q

What are 2 laryngeal changes during swallowing?

A

1- laryngeal elevation
2- closure of the laryngeal inlet by epiglotttis

50
Q

What are the 2 main nerve branches of that innervate the larynx?

A

1- superior laryngeal
2- inferior laryngeal

(Branches of the vagus nerve)

51
Q

2 branches of the superior laryngeal?

Branch of the recurrent laryngeal nerve?

A

Internal branch = sensory above vocal cords
External branch = motor to cricothyroid

Inferior laryngeal= motor supply to all other laryngeal muscles and sensory to vocal cords and below

52
Q

Arterial supply of the larynx?

A

1- superior laryngeal arteries (from superior thyroid which is from the ECA)

2- inferior thyroid arteries (from the thyrocervical trunk, from subclavian)

53
Q

Describe the venous drainage of the larynx?

A

1- superior laryngeal veins… superior thyroid veins… internal jugular veins

2- inferior laryngeal veins …. Inferior thyroid veins… brachiocephlic veins

54
Q

Describe the lymphatics of the larynx?

A

Above vocal folds = superior deep cervical nodes

Below vocal folds = pre and paratrachael nodes … inferior deep cervical nodes

55
Q

Anaphylaxis?

A

Can affect airway at multiple levels
- causes laryngeal angioedema
- first give epinephrine

56
Q

What is a cricothyroidotomy?

A

Gain access to the airway in an emergency situation
- the cricothyroid membrane is relatively superficial
- a vertical incision will be given to avoid the anterior jugular veins, then a transverse incision in the cricothyroid membrane.

57
Q

How can the recurrent laryngeal nerve be damaged?
What will this cause?

A

1- thyroid surgery
- neurological
- compression via tumour

2- will case a hoarse voice due to vocal cord paralysis
If unilateral damage the other cord can compensate
- if bilateral, then phonation will not be possible
- partial damage will effect adductors, leading to median position of cords and increased dysponae

58
Q

Laryngospams?

Aspiration pneumonia?

A

Larygospams =stimulation of internal superior laryngeal fibres triggering reflex closure of the airway

Aspiration pneumonia= compromised swallowing co-ordination often due to stroke or neurological condition.

MD3001resp (41 decks)

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