Respiratory System Anatomy- Larynx
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| What is the larynx? | A box of cartilage made up of 9 cartilages
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| What's the inside of the larynx made up of? | Mucous membrane
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| What's the outside of the larynx made up of? | Ligaments and membrane
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| The larynx extends from? | C3-C6
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| The larynx continues as: | The trachea
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| Above it, the larynx opens into the: | Laryngopharynx
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| The larynx is suspended from which bone? | Hyoid
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| 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
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| 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
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| What are the single cartilages of the larynx? | 1) Thyroid
2) Cricoid
3) Epiglottis
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| What are the paired cartilages of the larynx? | 1) Arytenoid
2) Cuneiform
3) Corniculate
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| Which is the most inferior of the laryngeal cartilages? | Cricoid cartilage
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| Which cartilage completely encircles the larynx? | Cricoid
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| Which cartilage doesn't have a posterior part? | Thyroid
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| Which cartilage has two wide lamina on either side? | Thyroid
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| What is the cricoid cartilage made up of? | Broad lamina of cricoid posterior
Arch of cricoid anterior
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| The posterior surface of the lamina of the cricoid has: | Two oval depression separated by a ridge
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| What is the function of the ridge? | Attachment to the Esophagus
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| What is the function of the oval depressions? | Attachment of the posterior cricothyroid muscles
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| The superolateral facet articulates with: | The base of the arytenoid cartilage
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| The lateral facet articulates with: | The inferior horn of the thyroid cartilage
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| Posterior margin at each lamina is elongated to form the: | Superior and Inferior horn
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| The most superior point of fusion of the two lamina is: | The laryngeal prominence (adam's apple)
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| What is the purpose of the adam's apple? | Attachment of the vocal chord (same as arytenoid)
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| The angle between the two lamina in men is: | Less than 90 degrees (acute)
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| The angle between the two lamina in women is: | More than 120 degrees (obtuse)
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| Superior to the laryngeal prominence is: | The superior thyroid notch
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| What are the palpable parts of the thyroid cartilage? | The superior thyroid notch and laryngeal prominence
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| Along the inferior base of the thyroid cartilage is: | The inferior thyroid notch (less distinct)
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| The medial surface of the inferior horn has a facet for articulation with: | The cricoid cartilage
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| The superior horn is connected to: | The hyoid bone by a ligament
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| The lateral surface of the lamina is marked by: | The oblique line
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| Ends of the oblique line are expanded to form: | Superior and inferior thyroid tubercles
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| What is the purpose of the oblique line? | Site of attachment for extrinsic muscles (sternothyroid, thyrohyoid, and inferior constrictor)
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| What is the epiglottis? | A 'leaf-shaped' cartilage attached by its stem to the angle of the thyroid cartilage
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| Attachment to the thyroid cartilage is via: | Thyroepiglottic ligament
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| The inferior half of the posterior surface of the epiglottis is raised slightly to form: | an epiglottic tubercle
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| Arytenoid cartilages are: | pyramid-shaped cartilages with three surfaces
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| The base of arytenoid cartilage articulates with: | Cricoid
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| The apex of the arytenoid articulates with: | Corniculate
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| The medial surface of each cartilage: | Faces the other
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| The anterolateral surface of the arytenoid has two: | Depressions
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| These two depressions are separated by a: | Ridge for muscle and ligament attachment
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| What are the muscle and ligament? | Vocalis muscle and vestibular ligament
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| The vocal ligament is attached to: | The vocal process of the anterior angle of the base of the arytenoid cartilage
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| The lateral angle is elongated into: | A muscular process for attachment of the posterior and lateral crico arytenoid
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| The corniculate cartilages are: | Two small conical cartilages
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| Bases of the corniculate cartilages articulate with: | The apices of the arytenoid cartilages
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| The cuneiform cartilages are: | Two small clubshaped cartilages
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| Where are the cuneiform cartilages found? | Suspended in the part of the fibroelastic membrane that attaches the arytenoid to the epiglottis
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| What are the extrinsic ligaments? | 1) Thyrohyoid membrane
2) Hyo-epiglottic ligament
3) Cricotracheal ligament
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| Tough fibroelastic ligament that spans between the superior margin of the thyroid cartilage below and the hyoid bone: | Thyrohyoid
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| Where on the thyroid cartilage is the thyrohyoid ligament attached? | The thyroid laminae and adjacent anterior margins of the superior horns
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| 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
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| An aperture in the lateral part of the thyrohyoid membrane on each side is for the: | Superior laryngeal arteries, nerves, and lymphatics
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| The posterior borders of the thyrohyoid membrane are thickened to form the: | Lateral thyrohyoid ligaments
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| The posterior borders of the thyrohyoid membrane are thickened anteriorly to form: | The median thyrohyoid ligament
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| In each lateral thyrohyoid ligament, there is an additional small cartilage: | Triticeal cartilage
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| Cricotracheal ligament runs from: | The lower border of the cricoid cartilage to the adjacent upper border of the first tracheal cartilage
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| The hyo-epiglottic ligament extends from: | The midline of the epiglottis, anterosuperiorly to the body of the hyoid bone
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| The intrinsic ligaments are: | 1) Cricothyroid ligament
2) Quadrangular membrane
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| 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
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| The cricothyroid ligament thickened anteriorly to form | Median cricothyroid ligament
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| Free margin thickened to form the: | The vocal ligament, under vocal fold
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| In emergency situations, the median cricothyroid ligament can be: | Perforated to establish an airway
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| Quadrangular membrane runs between: | The lateral margin of the epiglottis and the anterolateral
surface of the arytenoid cartilage
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| Also attached to the: | Corniculate cartilage
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| Free lower margin is thickened to form the: | Vestibular ligament under the vestibular fold (false 'vocal cord')
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| Vestibular ligament is ____ to the vocal ligament | Lateral
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| Laryngeal joints: | 1) Cricothyroid
2) Cricoarytenoid
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| 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
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| The placement of the cricoarytenoid joint: | Between articular facets on the superolateral surfaces of the cricoid cartilage and the bases of the arytenoid cartilages
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| 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
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| Laryngeal inlet is | Oblique and points posterosuperiorly
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| What is the depression between the two corniculate tubercles? | Interarytenoid notch
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| Aryepiglottic folds enclose: | The superior margins of the quadrangular membranes
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| Three major regions of the larynx; | 1) The vestibule
2) Middle chamber (Glottis)
3) The infraglottic cavity
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| Vocal folds consist of: | 1) Vocal ligament
2) Mucous membrane (stratified squamous)
3) Vocalis muscle
4) No submucosa
5) No blood vessels
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| Vocal folds are longer in males or females? | Males
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| Vestibular folds are: | The false vocal cords
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| Which vocal cords are more superior: | The false vocal cords
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| 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
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| 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
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| The tubular extension of each ventricle is called a: | Saccule
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| Within the walls of these saccules: | Numerous mucous glands
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| What is the function of mucus secreted into the saccules: | It lubricates the vocal folds
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| What is the rima vestibuli? | A triangular-shaped opening between the two adjacent vestibular folds
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| The Rima glottidis is formed by the: | Vocal folds (true vocal cords)
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| The rima glottidis separates which two chambers: | The middle chamber above from the infraglottic cavity
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| Rima glottidis and the Rima vestibuli can be opened and closed by movement of: | The arytenoid cartilages
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| 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
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| How are the cricothyroid muscles shaped? | Fan-shaped
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| 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
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| The oblique part runs : | Posteriorly from the arch of the cricoid to the inferior horn of the thyroid cartilage
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| The straight part runs: | Vertically from the arch of the cricoid to the posteroinferior margin of the thyroid lamina
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| 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
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| What is characteristic about the innervation of these cricothyroid muscles? | Only intrinsic muscles innervated by the superior laryngeal branches (of vagus)
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| All other intrinsic muscles are innervated by: | The recurrent laryngeal branches
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| 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
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| Function of the posterior crico-arytenoid muscles: | Abducts the vocal cords by rotating arytenoid cartilage
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| 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
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| Function of the lateral crico-arytenoid muscles: | Adducts the vocal cords by internally rotating arytenoid cartilage
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| 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
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| Function of the transverse arytenoid muscles: | Closes posterior part of rima glottidis by approximating arytenoid cartilages
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| Origin and insertion of the Thyroarytenoid (vocalis): | Origin: Inner surface of thyroid cartilage
Insertion: Arytenoid cartilage
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| Function of thyroarytenoid (vocalis): | Relaxes vocal cords
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| Origin and insertion of Oblique arytenoid: | Muscular
Origin: process of arytenoid cartilage
Insertion: Apex of opposite arytenoid cartilage
Forms an x shape
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| Function of oblique arytenoid: | Narrows the inlet by bringing the aryepiglottic folds together
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| Origin and insertion of the thyroepiglottic (aryepiglottic) muscles: | Origin: Medial surface of thyroid cartilage
Insertion: Lateral margin of epiglottis and aryepiglottic fold
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| Function of the thyroepiglottic fold: | Widens the inlet by pulling the aryepiglottic folds apart
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| The extrinsic muscles are: (The elevators of the larynx) | 1) Digastric muscle
2) Stylohyoid
3) Myelohyoid
4) Geniohyoid
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| The extrinsic muscles are: (The muscles which move the larynx upwards) | 1) Stylopharngeus
2) Salpingo-pharngeus
3) Palatopharngeus.
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| The extrinsic muscles are: (The depressors of the larynx) | 1) Sternothyroid
2) Sternohyoid
3) Omohyoid
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| Function of the larynx: | 1) Respiration
2) Phonation
3) Effort closure
4) Swallowing
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| What is the larynx doing during quiet respiration? | the
Laryngeal inlet, vestibule, rima vestibuli, and rima glottidis are open
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| What is the larynx doing during forced inspiration? | Arytenoid cartilages are rotated laterally, mainly by the action of the posterior crico-arytenoid muscles
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| 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
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| 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
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| 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
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| 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
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| What is the major blood supply to the larynx? | The superior and inferior laryngeal arteries
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| 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
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| 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
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| Superior laryngeal veins drain into | Superior thyroid veins, which in turn drain into the internal jugular veins
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| Inferior laryngeal veins drain into | The inferior thyroid veins, which drain into the left brachiocephalic veins
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| Lymphatics above the vocal folds follow the superior laryngeal artery and terminate in: | Deep cervical nodes
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| 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.
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| The superior laryngeal nerves originate from: | The inferior vagal ganglia high in the neck
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| They descend medial to the internal carotid artery and divide into | Internal and external branches above the hyoid bone
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| 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
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| The internal laryngeal nerve passes anteroinferiorly to penetrate | The thyrohyoid membrane
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| Internal nerve is mainly | Sensory
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| The internal nerve supplies the laryngeal cavity down to the level of the: | Vocal folds
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| 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.
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| The left recurrent laryngeal nerve originates in the | Thorax
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| The right recurrent laryngeal nerve originates in the | Root of the neck
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| 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
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| 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
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| What is the consequence of this? | Weakness in voice since the vocal cords cannot be tensed (criciothyroid M.)
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| What are the possible recurrent laryngeal nerve sections? | 1) Unilateral complete
2) Unilateral partial
3) Bilateral complete
4) Bilateral partial
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| What are the consequences of a unilateral partial section? | Speech not greatly affected as the other vocal cord compensate for the action
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| What are the consequences of a unilateral partial section? | Hoarseness of the voice (the other vocal fold compensates the action)
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| What are the consequences of a bilateral complete section? | Breathing is impaired since the rima glottis is partially close and speech is lost
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| 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
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