بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

2. larynx

3. Objectives • Describe anatomical structure of larynx. • Enlist the cartilages of the larynx. • Define inlet of the larynx. • Enlist the extrinsic and intrinsic muscles of the larynx with their nerve supply and actions.

4. larynx

6. larynx - The larynx is the organ of phonation (voice production) in addition to its respiratory function (air way). It is formed of a group of cartilages connected by Muscles, Ligaments and joints. Site:It lies below the hyoid bone in the midline of the neck at the level of C 4 - 6 vertebrae. Lateral view Anterior view

7. Structure • The larynx consists of four basic components: • A cartilaginous skeleton • Membranes and ligaments • Intrinsic and extrinsic muscles • Mucosal lining

8. Cartilages of the Larynx • All the cartilages, except the epiglottis, are of hyaline type. • Epiglottis is formed of elastic cartilage • The cartilages are: • Connected by joints, membranes & ligaments • Moved by muscles

9. 1. Thyroid cartilage It consists of two laminaewhich are fused anteriorly to form the laryngeal prominence (Adam’s apple) but they are separated posteriorly. - Superiorly the area between the two laminae is called the superior thyroid notch.

10. 2. Cricoid cartilage • It is signet-ring in shape (it is the only complete cartilaginous ring in the upper respiratory airway). - It lies at the level of C. 6.

12. 3. Epiglottis - It is leaf-shaped elastic cartilage which lies behind the tongue. - It has superior rounded free border and an inferior tapering end which is attached to the upper part of the thyroid notch.

13. 4.Arytenoid cartilage It is pyramidalin shape. - The base articulates with the upper facet of the quadrate lamina of the cricoid cartilage.

14. 6. Cuneiform cartilage - It is another small cartilaginous nodule which articulates with the upper surface of the corniculate cartilage and lies in the aryepiglottic fold 5. Corniculate cartilage - It is a small cartilaginous nodule. - It articulates with the apex of each arytenoid and lies in the aryepiglottic fold.

15. Ligaments and Membranes 1. Thyrohyoid membrane: - It connects the upper border of the thyroid lamina to the body and the greater horns of the hyoid bone.

16. 2. Hyoepiglottic ligament - It is a small elastic ligament which connects the lower part of the anterior surface of the epiglottis to the hyoid bone. 3. Thyroepiglottic ligament - It is a small elastic ligament which connects the tapering lower end of the epiglottis to the inner surface of the thyroid cartilage.

17. Quadrangular membrane: • Extends between the epiglottis and the arytenoid cartilages • Its lower free margin forms the vestibular ligament that lies within the vestibular fold • Cricothyroid membrane (conuselasticus): • Lower margin is attached to upper border of cricoid cartilage • Upper free margin forms vocal ligament

18. Cavity of larynx

19. Inlet of the larynx Boundaries: a. Anterior: Upper edge of the epiglottis.(E) b. On each side:Aryepiglottic folds.(AEF) c. Posterior: Mucous fold between the arytenoids.(A)

21. Laryngeal Cavity Rima vestibuli • Extends from laryngeal inlet to lower border of the cricoid cartilage • Narrow in the region of the vestibular folds (rimavestibuli) • Narrowest in the region of the vocal folds (rimaglottidis) • Divided into three parts: • Supraglottic part, the part above the vestibular folds, is called the vestibule • The part between the vestibular & the vocal folds, is called the ventricle • Infraglottic part, the part below the vocal folds Rima glottidis A B C

22. Muscles Divided into two groups: • Extrinsic muscles: divided into two groups • Elevators of the larynx • Depressors of the larynx • Intrinsic muscles: divided into two groups • Muscles controlling the laryngeal inlet • Muscles controlling the movements of the vocal cords Mucous Membrane • The cavity is lined with ciliated columnar epithelium • The surface of vocal folds, because of exposure to continuous trauma during phonation, is covered with stratified squamous epithelium • Contains many mucous glands, more numerous in the saccule (for lubrication of vocal folds)

23. Elevators of the Larynx • The Suprahyoid Muscles • Digastric • Stylohyoid • Mylohyoid • Geniohyoid • The Longitudinal Muscles of the Pharynx • Stylopharyngeus • Salpingopharyngeus • Palatopharyngeus Depressors of the Larynx • The Infrahyoid Muscles • Sternohyoid • Sternothyroid • Omohyoid

24. Muscles of the Larynx I. Muscles acting on the laryngeal inlet =Muscles closing the laryngeal inlet: 1. Aryepiglottic muscles : Action: Closure of the laryngeal inlet. 2. Transverse arytenoid : Actions: (narrowing the laryngeal inlet) and adducts the vocal cords.

25. 3. Oblique arytenoids : Actions: They narrow the laryngeal inlet) and adducts the vocal cords.

26. II. Muscles acting on the vocal cords A: Muscles producing abductionof the vocal cords: * Posterior crico-arytenoid: - It is the ONLY abductor to the vocal cords Origin:Posterior surface of the lamina of the cricoid cartilage. Insertion:Muscular process of the arytenoid. Actions: - Abduction of the vocal cords.

27. B. Muscles producing adduction of the vocal cords 1. Lateral crico-arytenoid: Action: It draws the muscular process forwards so it rotates the vocal process inwards and adducts (closes) the vocal cords. 2. Transverse arytenoid 3. Oblique arytenoid

28. C. Muscles stretching (tensing) the vocal cords 1. Cricothyroid muscle - It lies on the outer surface of the larynx. Origin: Lateral aspect of the cricoid arch. Insertion: Into the inferior horn and lower border of the thyroid lamina. Actions: It draws the thyroid cartilage downwards and forwards, so it lengthens and tenses the vocal cords (responsible for the sharp loud voice).

29. D. Muscles relaxing the vocal cords 1. Thyroarytenoid muscle Actions: It shortens and relaxes the vocal cords, so it changes the pitch of the voice. 2. Vocalis muscle(it is the lower fibers of the thyro-arytenoid muscle) Action: Relaxation of the vocal cords.

30. Adductors • Lateral cricoarytenoid • Transverse arytenoid • Abductor • Posterior cricoarytenoid • Movements of the Vocal Cords Adduction Abduction

31. Nerve supply A. Motor supply - All intrinsic muscles of the larynx are supplied by the “recurrent laryngeal nerve” EXCEPTcricothyroidwhich is supplied by the external laryngeal nerve. B. Sensory supply - Above the vocal cords ----------------- Internal laryngeal nerve (from vagus N). - Below the vocal cords ----------------- Recurrent laryngeal nerve (from vagus N).

32. Blood supply Blood supply: A. Arterial supply: 1. Above the vocal cords: Superior laryngeal artery (from the superior thyroid artery). 2. Below the vocal cords: Inferior laryngeal artery (from the inferior thyroid artery). B. Venous drainage: - It drains its venous blood into the corresponding superior and inferior thyroid veins respectively.

33. Thank You