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Larynx
| Term | Definition |
|---|---|
| Larynx function | Protective airway sphincter guarding entrance to lower respiratory tract, cord closure (coughing, sneezing, abd straining), houses vocal cords (phonation), swallowing |
| Coughing mechanism | Cords suddenly abducted via posterior cricoarytenoid contraction -> compressed air explodes through larynx |
| Abd straining mechanism | Lateral/internal arytenoid contraction -> close vocal folds -> prevent upward diaphragm displacement and increase intra-abd Pa -> during evacuation/heavy lifting -> diaphragm forced up -> compressed air escapes -> distinctive grunt |
| Swallowing mechanism | Larynx moves superior/anterior -> aryepiglottis contraction -> close laryngeal inlet, extrinsic laryngeal muscle contraction -> elevate pharynx/larynx, epiglottis flaps down -> protect laryngeal inlet |
| Swallowing during ingestion | Bolus reaches oesophagus -> thyroepiglottis contraction -> open laryngeal inlet -> bolus passes -> passive elastic recoil -> epiglottis flaps up/larynx depresses to original positions |
| Larynx location | Upper respiratory tract in ant triangle of neck -> suspended from superior hyoid, inf to tongue -> C3-C7 |
| Laryngeal cartilages | Unpaired epiglottis, unpaired thyroid, unpaired cricoid, paired arytenoids, paired cuneiform, paired corniculate cartilages |
| Epiglottis location/shape | Leaf shaped -> deep to hyoid body w/ inferior stem -> tip rises 1 cm above hyoid body at posterior tongue |
| Epiglottis attachments | Attached to posterior surface of ant thyroid cartilage via thyroepiglottic ligament in midline midway btwn superior/inferior thyroid notch |
| Epiglottis structure | Yellow elastic cartilage that does not calcify, mucus membrane -> reflected from ant epiglottis to posterior tongue via 3 longitudinal ridges (median and lateral glossoepiglottic folds), posterior surface slightly raised (epiglottic tubercle) |
| Thyroid cartilage location | Inferior to hyoid bone (C3), spans C4-6 -> bifurcation of common carotid at C4 (superior edge of thyroid cartilage) |
| Thyroid cartilage structure | Hyaline cartilage -> calcifies/ossifies w/ age, 2 lateral laminae -> separate posteriorly but joined by laryngeal prominence anteriorly, palpable superior thyroid notch sits above laryngeal prominence, post superior/inferior horns w/ oblique line (ant) |
| Superior horn | Posterior margin of thyroid cartilage laminae -> attachment for lateral thyrohyoid ligament to posterior end of hyoid bone greater horn |
| Inferior horn | Posterior margin of thyroid cartilage laminae -> facet for cricoid cartilage articulation |
| Oblique line | Ant to thyroid cartilage posterior horns -> attachment for extrinsic laryngeal muscles (sternothyroid, thyrohyoid, inferior constrictor muscle) |
| Cricoid cartilage location/shape | Posterior facing signet ring at C6 -> posterior lamina taller than anterior circling arch, medial ridge on posterior surface w/ lateral depressions eitherside |
| Cricoid cartilage structure | Hyaline cartilage -> calcifies/ossifes w/ age -> only complete cartilaginous ring in entire respiratory tract -> foundation of laryngeal skeleton |
| Cricoid cartilage articulations | Posterior lateral arch surface -> articulating facets w/ thyroid cartilage inferior horns, superior posterior rim -> articulating facets w/ arytenoid cartilages |
| Cricoid cartilage clinical | Emergency cricothyroidotomy -> emergency opening for airway below cords when choking/unconscious w/ acute airway obstruction -> pierce through skin and cricothyroid membrane -> not long-term solution |
| Tracheostomy | Drill hole btwn 1st/2nd/3rd tracheal rings |
| Arytenoid cartilages location/shape | Sitting on cricoid cartilage superior posterior rim (synovial joint w/ rotary/gliding mvmt) -> inferior base, superior apex of 3-sided pyramid |
| Arytenoid cartilage attachments | Anterior basal elongation -> vocal process (vocal ligaments), lateral projection -> muscular process (post/lateral cricoarytenoid muscles), superior projection -> apex (corniculate cartilages), anterolateral surface -> quadrangular membrane |
| Corniculate cartilages location | Sitting on arytenoid cartilage apex, underneath cuneiform cartilages |
| Cuneiform cartilages location/structure | Sitting on corniculate cartilages -> suspended in larynx fibroelastic membrane -> attach arytenoids to lateral epiglottis margin |
| What are the 3 laryngeal membranes? | Thyrohyoid membrane, cricothyroid membrane, quadrangular membrane |
| What is the location/structure/function of the thyrohyoid membrane? | Btwn hyoid bone and superior thyroid cartilage -> tough fibroelastic ligament -> lateral aperture pierced by superior laryngeal neurovascular/lymphatics |
| What is the location/clinical application of the cricothyroid membrane? | Superior arch of cricoid cartilage -> inferior thyroid cartilage -> cut during emergency cricothyrotomy for upper airway obstruction, free upper edge of cricothyroid ligament = vocal ligament |
| What is the structure of the true vocal cords? | Superficial non-keratinised stratified squamous epithelium (protection), Reinke's space (watery glycosaminoglycan layer -> free epithelium vibration), vocal ligament (free upper margin of cricothyroid ligament), deep vocalis muscle |
| Where is the vocal ligament? | Free upper margin of cricothyroid membrane |
| What is the space btwn the vocal folds? | Rima glottidis |
| What is the location/structure of the quadrangular membrane? | Lateral epiglottis -> anterolateral surface of arytenoid cartilage, superior aspect (free upper margin) -> aryepiglottic folds (growling), inferior aspect -> vestibular ligament covered by mucus membrane -> vestibular fold (false vocal cords) |
| What is the structure/function of the false vocal cords? | Inferior aspect of quadrangular membrane -> vestibular ligament covered by mucus membrane -> fixed folds for protection |
| What is the innervation for the intrinsic laryngeal muscles? | CN X recurrent laryngeal xcp cricothyroid (superior laryngeal) |
| What are the consequences of a completely severed CN X RL? | Cords relaxed (not ab/adducted) -> can't speak/cough (no manipulation), can ventilate (space btwn vocal folds) |
| What are the consequences of partial transection CN X RL? | Bilateral -> both cords semi-abducted -> difficulty protecting glottis/phonation/coughing -> emergency cricothyrotomy/tracheostomy, unilateral -> affected cord semi-abducted -> partial contralateral compensation -> minimal phonation defects |
| What are the intrinsic laryngeal muscles? | Aryepiglottis, thyroepiglottis, cricothyroid, thyroarytenoid (vocalis), posterior cricoarytenoid, lateral/internal arytenoid |
| Which intrinsic laryngeal muscles are responsible for the inlet? | Aryepiglottis -> draw epiglottis down, meet arytenoids -> close laryngeal inlet, thyroepiglottis -> widens laryngeal inlet |
| Which intrinsic laryngeal muscles are responsble for cord tension? | Cricothyroid -> tilt cricoid cartilage posteriorly -> lengthens vocal cords -> raise pitch, thyroarytenoid (vocalis) -> loosen/thicken cords |
| Which intrinsic laryngeal muscles abduct/adduct vocal folds? | Posterior cricoarytenoid -> rotate arytenoid muscular processes posterolaterally -> abduct vocal folds, lateral/internal arytenoid -> adduct vocal folds |
| What is a clinical condition of the larynx? | Laryngitis -> vocal fold inflammation (hoarseness/aphonia), vocal cord nodules -> overuse of vocal cords, carcinoma -> squamous cells of smokers, scarring post-healing -> deformity of vocal fold edge -> dsrupt LPS viscosity/stiffness |
| What are the consequences of a laryngectomy? | Difficulties w/ feeding (changed anatomy), breathing/swimming (lungs disconnected -> no inhaled air), speech (lungs disconnected -> no air flow) |
| What are the techniques to aid feeding post-laryngectomy? | Dysphagia (abnormal swallowing), anosmia (polite yawning -> -ve oral cavity Pa -> nasal airflow -> improve sense of smell), introduce oral feeding 7-10 days post surgery -> prevent pharyngo-cutaneous fistula development |
| What are the techniques to aid breathing post-laryngectomy? | Stoma from tracheostomy (no humidification -> irritate lungs), add breathing aid -> oral/nasal cavity to stoma (swimming) to bypass larynx, cover stoma w/ heat moisture exchangers (absorbs H2O to saturate inhaled air, filter for dust) |
| What are the techniques to aid speech post-laryngectomy? | Electrolarynx -> tone generator w/ vibrations from skin to throat but monotonous and uses 1 hand, oesophageal speech -> oesophagus/stomach air expelled for pharyngo/oesophageal mucosa vibrations but difficult technique |
Created by:
vykleung
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