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Laryngology

Laryngology. Embryology Anatomy Physiology. Embryology. Fish gills and Branchial clefts-1st to 6th Windpipe, trachea-glottis, framework Swim bladder -> lungs. Halsey-VS Conf-5/7/09. Embryology. Halsey-VS Conf-5/7/09. Embryology of Larynx. Halsey-VS Conf-5/7/09. Comparative Anatomy.

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Laryngology

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  1. Laryngology Embryology Anatomy Physiology

  2. Embryology • Fish gills and Branchial clefts-1st to 6th • Windpipe, trachea-glottis, framework • Swim bladder -> lungs Halsey-VS Conf-5/7/09

  3. Embryology Halsey-VS Conf-5/7/09

  4. Embryology of Larynx Halsey-VS Conf-5/7/09

  5. Comparative Anatomy • Crossroads of breathing, swallowing and vocalizing • Larynx is often positioned high in neck even in non-human primates • Infant humans retain this until descent • Adult human descends Halsey-VS Conf-5/7/09

  6. Malformations • Atresia • Laryngomalacia • Congenital Subglottic stenosis • Laryngeal webs • Branchial Clefts and Cysts Halsey-VS Conf-5/7/09

  7. Anomalies Halsey-VS Conf-5/7/09

  8. Anomalies Halsey-VS Conf-5/7/09

  9. Subglottic Stenosis Halsey-VS Conf-5/7/09

  10. Physiology • Descent of larynx occurred • Two stages • Thyroid in relation to hyoid to prevent aspiration • Descent of hyoid in neck in speech development • Combined respiration and deglutition • Better in infant • Poor in adult • Olfaction – consider epiglottis role Halsey-VS Conf-5/7/09

  11. Anatomy • Pharynx • Naso • Oro • Hypo • Larynx • Supraglottic • Glottic • Subglottic • Trachea and Lungs • Esophagus Halsey-VS Conf-5/7/09

  12. Protection Levels • First level-Epiglottis, aryepiglottic folds & arytenoids • Second level-False vocal folds • Third level-True vocal folds • Anomalies of any of this structures lead to aspiration and swallowing dysfunction • Symptoms-coughing, choking and gagging episodes, stasis of secretion, and recurrent pneumonia Halsey-VS Conf-5/7/09

  13. Laryngopharynx Halsey-VS Conf-5/7/09

  14. Laryngeal Framework Cricoid cartilage Only complete cartilaginous ring in the airway Strongest of the laryngeal cartilages. Lies directly below the thyroid cartilage at: C6- C7 level in adults and C3-C4 level in children Composed of hyaline cartilage, but may become partially ossified later in life (can be fractured in blunt laryngeal trauma) Signet ring shape, widest posteriorl An infant’s airway is most narrow at the level of the cricoid

  15. Laryngeal Framework

  16. Anatomy Halsey-VS Conf-5/7/09

  17. Anatomy Halsey-VS Conf-5/7/09

  18. Muscles Halsey-VS Conf-5/7/09

  19. Membranes Halsey-VS Conf-5/7/09

  20. Valve Halsey-VS Conf-5/7/09

  21. Arytenoid Rotation Halsey-VS Conf-5/7/09

  22. Larynx Halsey-VS Conf-5/7/09

  23. Adductors

  24. Cricothyroid-Adducts and stiffens the vocal folds

  25. Posterior Cricoarytenoid-the ONLY abductor of the vocal folds

  26. Intrinsic Muscles of the Larynx Cricothyroid: adducts, stiffens VF Posterior cricoarytenoid: ONLY abductor; Also elevates, elongates, thins VF Lateral cricoarytenoid: adducts, depresses, elongates, thins VF Thyroarytenoid: medial portion forms the vocalis muscle; adducts, shortens, depresses, and thickens VF Interarytenoid: adducts VF

  27. Gaps • Above the superior pharyngeal constrictor: • auditory tube (AT) • levator palati (LP) • ascending palatine artery (APA) • Between the superior and middle constrictors: stylopharyngeus muscle (SP) • glossopharyngeal nerve (IX) • Between the middle and inferior constrictors: internal laryngeal branch of the superior laryngeal nerve (IL) • superior laryngeal artery from the superior thyroid artery (SLA) • Below the inferior constrictor: inferior laryngeal nerve ( ILN) (recurrent laryngeal branch of the vagus) • inferior laryngeal artery (ILA) (inferior thyroid) Halsey-VS Conf-5/7/09

  28. Nerves • CN IX -- Glossopharyngeal • contains both sensory and motor fibers • important for taste to posterior tongue, sensory and motor functions of the pharynx • CN X -- Vagus • contains both sensory and motor fibers • important for taste to oropharynx, and sensation and motor function to larynx and laryngopharynx. • important for airway protection • CN XII -- Hypoglossal • contains motor fibers that primarily innervate the tongue Halsey-VS Conf-5/7/09

  29. Laryngeal Innervation Superior laryngeal nerve: leaves CN X at the inferior vagal ganglion, travels deep and medial to ICA At level of hyoid greater cornu, SLN branches into internal and external Internal SLN: through thyrohyoid membrane; innervates supraglottic larynx and pharynx and supraglottic minor salivary glands External SLN: along inferior constrictor to the CT muscle and inferior pharyngeal constrictor; also contributes to pharyngeal plexus

  30. Laryngeal Innervation Right recurrent laryngeal nerve: originates from CN X near right subclavian artery Travels around subclavian a. and then runs in right TE groove Left RLN: loops around aortic arch to travel in left TE groove RLNs give off branches to the esophagus, trachea, and inferior constrictor muscles RLN innervates all intrinsic laryngeal muscles except CT; also subglottic sensation

  31. Innervation

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