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RS Anatomy

Respiratory System Anatomy- Larynx

What is the larynx? A box of cartilage made up of 9 cartilages
What's the inside of the larynx made up of? Mucous membrane
What's the outside of the larynx made up of? Ligaments and membrane
The larynx extends from? C3-C6
The larynx continues as: The trachea
Above it, the larynx opens into the: Laryngopharynx
The larynx is suspended from which bone? Hyoid
What are the functions of the larynx? 1) Acts as an open valve in respiration 2) Acts as a closed valve in deglutition 3) Acts as a partially closed valve in phonation 4) During coughing, the trachea opens suddenly to release compressed air
How is voice produced? During expiration, a column of air is formed Partition of that column of air by vibration of the true vocal cords produces sounds
What are the single cartilages of the larynx? 1) Thyroid 2) Cricoid 3) Epiglottis
What are the paired cartilages of the larynx? 1) Arytenoid 2) Cuneiform 3) Corniculate
Which is the most inferior of the laryngeal cartilages? Cricoid cartilage
Which cartilage completely encircles the larynx? Cricoid
Which cartilage doesn't have a posterior part? Thyroid
Which cartilage has two wide lamina on either side? Thyroid
What is the cricoid cartilage made up of? Broad lamina of cricoid posterior Arch of cricoid anterior
The posterior surface of the lamina of the cricoid has: Two oval depression separated by a ridge
What is the function of the ridge? Attachment to the Esophagus
What is the function of the oval depressions? Attachment of the posterior cricothyroid muscles
The superolateral facet articulates with: The base of the arytenoid cartilage
The lateral facet articulates with: The inferior horn of the thyroid cartilage
Posterior margin at each lamina is elongated to form the: Superior and Inferior horn
The most superior point of fusion of the two lamina is: The laryngeal prominence (adam's apple)
What is the purpose of the adam's apple? Attachment of the vocal chord (same as arytenoid)
The angle between the two lamina in men is: Less than 90 degrees (acute)
The angle between the two lamina in women is: More than 120 degrees (obtuse)
Superior to the laryngeal prominence is: The superior thyroid notch
What are the palpable parts of the thyroid cartilage? The superior thyroid notch and laryngeal prominence
Along the inferior base of the thyroid cartilage is: The inferior thyroid notch (less distinct)
The medial surface of the inferior horn has a facet for articulation with: The cricoid cartilage
The superior horn is connected to: The hyoid bone by a ligament
The lateral surface of the lamina is marked by: The oblique line
Ends of the oblique line are expanded to form: Superior and inferior thyroid tubercles
What is the purpose of the oblique line? Site of attachment for extrinsic muscles (sternothyroid, thyrohyoid, and inferior constrictor)
What is the epiglottis? A 'leaf-shaped' cartilage attached by its stem to the angle of the thyroid cartilage
Attachment to the thyroid cartilage is via: Thyroepiglottic ligament
The inferior half of the posterior surface of the epiglottis is raised slightly to form: an epiglottic tubercle
Arytenoid cartilages are: pyramid-shaped cartilages with three surfaces
The base of arytenoid cartilage articulates with: Cricoid
The apex of the arytenoid articulates with: Corniculate
The medial surface of each cartilage: Faces the other
The anterolateral surface of the arytenoid has two: Depressions
These two depressions are separated by a: Ridge for muscle and ligament attachment
What are the muscle and ligament? Vocalis muscle and vestibular ligament
The vocal ligament is attached to: The vocal process of the anterior angle of the base of the arytenoid cartilage
The lateral angle is elongated into: A muscular process for attachment of the posterior and lateral crico arytenoid
The corniculate cartilages are: Two small conical cartilages
Bases of the corniculate cartilages articulate with: The apices of the arytenoid cartilages
The cuneiform cartilages are: Two small clubshaped cartilages
Where are the cuneiform cartilages found? Suspended in the part of the fibroelastic membrane that attaches the arytenoid to the epiglottis
What are the extrinsic ligaments? 1) Thyrohyoid membrane 2) Hyo-epiglottic ligament 3) Cricotracheal ligament
Tough fibroelastic ligament that spans between the superior margin of the thyroid cartilage below and the hyoid bone: Thyrohyoid
Where on the thyroid cartilage is the thyrohyoid ligament attached? The thyroid laminae and adjacent anterior margins of the superior horns
How does the ligament ascend to the hyoid bone? Medial to the greater horns and posterior to the body of the hyoid bone to attach to the superior margins
An aperture in the lateral part of the thyrohyoid membrane on each side is for the: Superior laryngeal arteries, nerves, and lymphatics
The posterior borders of the thyrohyoid membrane are thickened to form the: Lateral thyrohyoid ligaments
The posterior borders of the thyrohyoid membrane are thickened anteriorly to form: The median thyrohyoid ligament
In each lateral thyrohyoid ligament, there is an additional small cartilage: Triticeal cartilage
Cricotracheal ligament runs from: The lower border of the cricoid cartilage to the adjacent upper border of the first tracheal cartilage
The hyo-epiglottic ligament extends from: The midline of the epiglottis, anterosuperiorly to the body of the hyoid bone
The intrinsic ligaments are: 1) Cricothyroid ligament 2) Quadrangular membrane
Cricothyroid ligament attachments: Extends superiorly Ends in a free upper margin: space enclosed by the thyroid cartilage Upper free margin attaches: Anteriorly to the thyroid Posteriorly: to the vocal processes of the arytenoid
The cricothyroid ligament thickened anteriorly to form Median cricothyroid ligament
Free margin thickened to form the: The vocal ligament, under vocal fold
In emergency situations, the median cricothyroid ligament can be: Perforated to establish an airway
Quadrangular membrane runs between: The lateral margin of the epiglottis and the anterolateral surface of the arytenoid cartilage
Also attached to the: Corniculate cartilage
Free lower margin is thickened to form the: Vestibular ligament under the vestibular fold (false 'vocal cord')
Vestibular ligament is ____ to the vocal ligament Lateral
Laryngeal joints: 1) Cricothyroid 2) Cricoarytenoid
The placement and function of the cricothyroid joint: Between the inferior horns of the thyroid cartilage and the cricoid cartilage, are synovial 1)Lengthens and puts tension on the vocal ligaments 2)Enable the thyroid cartilage to move forward and tilt downwards on the cricoid cartilage
The placement of the cricoarytenoid joint: Between articular facets on the superolateral surfaces of the cricoid cartilage and the bases of the arytenoid cartilages
Functions of the cricoarytenoid joint: 1) Enable arytenoid cartilages to slide away or towards each other and rotate 2) Vocal processes pivot towards or away from the midline. 3) Abduct/adduct the vocal ligaments
Laryngeal inlet is Oblique and points posterosuperiorly
What is the depression between the two corniculate tubercles? Interarytenoid notch
Aryepiglottic folds enclose: The superior margins of the quadrangular membranes
Three major regions of the larynx; 1) The vestibule 2) Middle chamber (Glottis) 3) The infraglottic cavity
Vocal folds consist of: 1) Vocal ligament 2) Mucous membrane (stratified squamous) 3) Vocalis muscle 4) No submucosa 5) No blood vessels
Vocal folds are longer in males or females? Males
Vestibular folds are: The false vocal cords
Which vocal cords are more superior: The false vocal cords
What are the characteristics of false vocal cords? 1) Vestibular folds enclose the vestibular ligaments and associated soft tissue 2) Vascularised (red) 3) Fixed and unmovable like the true vocal chords
On each side, the mucosa of the middle cavity bulges laterally through the gap between the vestibular and vocal ligaments to produce: A laryngeal ventricle
The tubular extension of each ventricle is called a: Saccule
Within the walls of these saccules: Numerous mucous glands
What is the function of mucus secreted into the saccules: It lubricates the vocal folds
What is the rima vestibuli? A triangular-shaped opening between the two adjacent vestibular folds
The Rima glottidis is formed by the: Vocal folds (true vocal cords)
The rima glottidis separates which two chambers: The middle chamber above from the infraglottic cavity
Rima glottidis and the Rima vestibuli can be opened and closed by movement of: The arytenoid cartilages
What is the function of the intrinsic muscles of the larynx? 1) Adjust tension in the vocal ligaments, 2) Open and close the rima glottidis, 3) Control the inner dimensions of the vestibule, 4) Close the rima vestibuli
How are the cricothyroid muscles shaped? Fan-shaped
What are the anterior and posterior attachments of the cricothyroid muscles? Anterior: anterolateral surfaces of the cricoid cartilage Superiorly and posteriorly: Attach to the thyroid cartilage
The oblique part runs : Posteriorly from the arch of the cricoid to the inferior horn of the thyroid cartilage
The straight part runs: Vertically from the arch of the cricoid to the posteroinferior margin of the thyroid lamina
What is the function of the cricothyroid muscles? Pull the thyroid cartilage forward and rotate it down relative to the cricoid cartilage Tenses vocal cords
What is characteristic about the innervation of these cricothyroid muscles? Only intrinsic muscles innervated by the superior laryngeal branches (of vagus)
All other intrinsic muscles are innervated by: The recurrent laryngeal branches
Origin and insertion of the posterior crico-arytenoid muscles (of which there is a right and left) : Origin: from the Back of cricoid cartilage Superiorly and laterally: to the muscular processes of the arytenoid cartilage
Function of the posterior crico-arytenoid muscles: Abducts the vocal cords by rotating arytenoid cartilage
Origin and insertion of the lateral crico-arytenoid muscles: originates Origin: Upper border of cricoid cartilage Posteriorly and superiorly: insert on the muscular process of the arytenoid
Function of the lateral crico-arytenoid muscles: Adducts the vocal cords by internally rotating arytenoid cartilage
Origin and insertion of the transverse arytenoid muscles: Originates: Back and medial surface of arytenoid cartilage Insertion: Back and medial surface of opposite arytenoid cartilage
Function of the transverse arytenoid muscles: Closes posterior part of rima glottidis by approximating arytenoid cartilages
Origin and insertion of the Thyroarytenoid (vocalis): Origin: Inner surface of thyroid cartilage Insertion: Arytenoid cartilage
Function of thyroarytenoid (vocalis): Relaxes vocal cords
Origin and insertion of Oblique arytenoid: Muscular Origin: process of arytenoid cartilage Insertion: Apex of opposite arytenoid cartilage Forms an x shape
Function of oblique arytenoid: Narrows the inlet by bringing the aryepiglottic folds together
Origin and insertion of the thyroepiglottic (aryepiglottic) muscles: Origin: Medial surface of thyroid cartilage Insertion: Lateral margin of epiglottis and aryepiglottic fold
Function of the thyroepiglottic fold: Widens the inlet by pulling the aryepiglottic folds apart
The extrinsic muscles are: (The elevators of the larynx) 1) Digastric muscle 2) Stylohyoid 3) Myelohyoid 4) Geniohyoid
The extrinsic muscles are: (The muscles which move the larynx upwards) 1) Stylopharngeus 2) Salpingo-pharngeus 3) Palatopharngeus.
The extrinsic muscles are: (The depressors of the larynx) 1) Sternothyroid 2) Sternohyoid 3) Omohyoid
Function of the larynx: 1) Respiration 2) Phonation 3) Effort closure 4) Swallowing
What is the larynx doing during quiet respiration? the Laryngeal inlet, vestibule, rima vestibuli, and rima glottidis are open
What is the larynx doing during forced inspiration? Arytenoid cartilages are rotated laterally, mainly by the action of the posterior crico-arytenoid muscles
What does the larynx do as a result? 1) Vocal folds are abducted 2) Rima glottidis widens into a rhomboid shape 3) Diameter of the laryngeal airway increases
When phonating, what does the larynx do? 1) Arytenoid cartilages and vocal folds are adducted and air is forced through the closed rima glottidis 2) Vocal folds vibrate against each other and produce sounds 3) Tension in the vocal folds adjusted by the vocalis and cricothyroid muscles
What does the larynx do during effort closure? 1) Air is retained in the thoracic cavity to stabilize the trunk 2) The rima glottidis is completely closed, as is the rima vestibuli and lower parts of the vestibule 3) The result is to completely and forcefully shut the airway
What does the larynx do during swallowing? 1) The rima glottidis, the rima vestibuli, and vestibule are closed 2) Laryngeal inlet is narrowed (epiglottis swings downward) 3) Larynx moves up and forward opening the esophagus 4) These actions prevent solids and liquids from entering the airway
What is the major blood supply to the larynx? The superior and inferior laryngeal arteries
The superior laryngeal artery originates from: Superior thyroid branch of the external carotid artery Accompanies the internal branch of the superior laryngeal nerve through the thyrohyoid membrane
The inferior laryngeal artery originates from Inferior thyroid branch of the thyrocervical trunk of the subclavian artery Together with the recurrent laryngeal nerve, ascends in the groove between the esophagus and trachea
Superior laryngeal veins drain into Superior thyroid veins, which in turn drain into the internal jugular veins
Inferior laryngeal veins drain into The inferior thyroid veins, which drain into the left brachiocephalic veins
Lymphatics above the vocal folds follow the superior laryngeal artery and terminate in: Deep cervical nodes
Those below the vocal folds drain into: Deep nodes associated with the inferior thyroid artery or with nodes associated with the front of the cricothyroid ligament or upper trachea.
The superior laryngeal nerves originate from: The inferior vagal ganglia high in the neck
They descend medial to the internal carotid artery and divide into Internal and external branches above the hyoid bone
The external branch (external laryngeal nerve) descends along the lateral wall of the pharynx to supply the Inferior constrictor of the pharynx and ends by supplying the cricothyroid muscle
The internal laryngeal nerve passes anteroinferiorly to penetrate The thyrohyoid membrane
Internal nerve is mainly Sensory
The internal nerve supplies the laryngeal cavity down to the level of the: Vocal folds
The recurrent laryngeal nerves are: 1)Sensory to the laryngeal cavity below the level of the vocal folds 2) Motor to all intrinsic muscles of the larynx except for the cricothyroid.
The left recurrent laryngeal nerve originates in the Thorax
The right recurrent laryngeal nerve originates in the Root of the neck
Relations of the larynx: On each side : Carotid sheath (contents), and lateral lobe of the thyroid gland Posterior: Pharynx and the right recurrent laryngeal nerve Anterior: Skin, fascia and its contents, 4 infra-hyoid muscles
Sectioning of the external laryngeal nerve might happen in: Thyroidoctomy Due to the close relationship between the external laryngeal nerve and the superior thyroid artery
What is the consequence of this? Weakness in voice since the vocal cords cannot be tensed (criciothyroid M.)
What are the possible recurrent laryngeal nerve sections? 1) Unilateral complete 2) Unilateral partial 3) Bilateral complete 4) Bilateral partial
What are the consequences of a unilateral partial section? Speech not greatly affected as the other vocal cord compensate for the action
What are the consequences of a unilateral partial section? Hoarseness of the voice (the other vocal fold compensates the action)
What are the consequences of a bilateral complete section? Breathing is impaired since the rima glottis is partially close and speech is lost
What are the consequences of a bilateral partial section? This results in bilateral paralysis of the abductor muscles Acute breathlessness (Dyspnea) and stridor follow Lead to suffocation so tracheostmy is necessary Most severe
Created by: Ulaisl