Anatomy & Physiology of larynx

1. Anatomy & Physiology of larynx

2. consist of either hyaline or elastic • 4 Major • Thyroid(甲状软骨) (hyaline) • 2 superior horns（上角） attach to hyoid bone（舌骨） • 2 inferior horns（下角） attach to cricoid（环状软骨） • Cricoid（环状软骨） (hyaline) • inferior edge is the top portion of tracheal ring（气管环） Cartilages

4. Arytenoids（杓状软骨）(hyaline) • paired • rest on the superior-posterior cricoid（附着于杓状软骨后上缘） • apex is superior point（顶端是上角） • posterolateral portion is muscle process（后外侧部分是肌突） • anterosuperior is vocal process（前上是声突） Cartilages - 4 major continued

5. Epiglottis（会厌软骨）(elastic) • attached to thyroid at the angle, just below the thyroid notch and is fastened to the hyoid bone（附着于甲状软骨交角内面上切迹下方，舌骨后方） Cartilages - 4 major continued

7. 2 Minor • Corniculates（小角软骨） • (elastic) paired • sit above apex of arytenoids（杓状软骨顶部） • Cuniforms （楔状软骨） • (elastic) paired • sit on aryepiglottic folds（杓会厌皱襞） Cartilages

9. only bone in larynx superior portion of larynx inferior attachment for bulk of tongue Hyoid bone（舌骨）

12. Intrinsic • attachments are all in larynx • Extrinsic • attachments to larynx and other structures Muscles

13. Interarytenoids （杓间肌） - 2 parts • Transverse（横肌） • arise from lateral margin and posterior surface of one arytenoid and course to the opposite arytenoid 起于一侧杓状软骨后外侧缘，止于对侧杓状软骨后外侧缘 • movement = glides arytenoids 滑动杓状软骨 • Oblique（斜肌） • arise from posterior surface of muscular process and crosses to apex of other arytenoid 起于一侧杓状软骨肌突，横穿至对侧顶端 • movement = rocks arytenoids medially 带动杓状软骨之间翻转 Intrinsic muscles

16. Lateral cricoarytenoid（环杓侧肌） • fan shaped • originates from anterolateral portion of cricoid and inserts into muscle process 起于环状软骨弓两侧上缘，止于杓状软骨肌突前面 • movement = rocks arytenoids medially 带动杓状软骨之间翻转 • Posterior cricoarytenoid（环杓后肌） • fan shaped • originates from posterior surface of cricoid lamina and inserts into muscle process 起于环状软骨后前的浅凹，止于杓状软骨肌突后部 • movement = rocks arytenoids laterally 带动两杓状软骨的侧面滑动 Intrinsic muscles continued

19. Cricothyroid（环甲肌） • fan shaped • originates from anterolateral arch of cricoid and inserts into anterior portion of thyroid 起于环状软骨弓前外侧，止于甲状软骨下缘 • movement = shortens distance of cartilages收缩两软骨的距离 Intrinsic muscles continued

22. Thyroarytenoids（甲杓肌）- bulk of the vocal folds（声带肌） • Thyrovocalis（声带肌) • originates from anterior thyroid and inserts into vocal process 起 于甲状软骨前面，止于声突 • movement = moves muscle process and vocal process closer to thyroid 拉近肌突声突与甲状软骨的距离 • Thyromuscularis（甲杓肌外侧部) • same as above although insertion is anterior-superior & is lateral of vocalis 起于甲状软骨前面，止于杓状软骨肌突前内侧和外侧缘 • movement = bring arytenoids closer to thyroid 拉近甲杓距离 Intrinsic muscles continued

25. 2 groups • Suprahyoids（舌骨上肌群）- sling muscles • Anterior digastric（前二腹肌） • Geniohyoid （颏舌骨肌） • Mylohyoid（下颌舌骨肌） • movement = pull hyoid anteriorly and slightly superiorly • Stylohyoid（茎突舌骨肌） • Posterior digastric（后二腹肌） • movement = pull hyoid posteriorly and superiorly Extrinsic muscles of larynx

26. Infrahyoids（舌骨下肌群） • Thyrohyoid（甲状舌骨肌） • Sternothyroid（胸骨甲状肌） • movement = pulls thyroid inferiorly • Sternohyoid（胸骨舌骨肌） • Omohyoid（肩胛舌骨肌） • movement = pulls hyoid inferiorly Extrinsic muscles continued

28. Epithelium（上皮层） • Lamina propria 固有层 • superficial layer（浅层） • intermediate or middle layer（中层） • deep layer（深层） • Vocalis muscle（声带肌） • Membranous（膜部） and cartilaginous portions（软骨部）of vocal folds Vocal Fold Structure

31. Aryepiglottic folds（杓会厌皱襞） Ventricular folds（室皱襞或室带或假声带） Supraglottic cavity（声门上区） Ventricle（喉室） Glottis（声门） Subglottic cavity (声门下区) Other anatomical structures of the larynx

34. Cortex（大脑皮层） • Subcortex（大脑皮层下） - thalamus（丘脑） • Midbrain（中脑） • Brainstem（脑干）- nucleus ambiguus （疑核） • Cerebellum（小脑） • Vagus nerve （迷走神经）or Cranial Nerve X (CN X)(第十对脑神经) • Superior laryngeal nerve (SLN) （喉上神经） • Recurrent laryngeal nerve (RLN) （喉返神经） Neuroanatomy

36. Infants • larynx at 3rd cervical vertebrae • total VF length is 6-8 mm • 1-4 years • larynx at C4-5 • total VF length is 8-12 mm • 5-12 years • larynx at C6 • total VF length at puberty is 12-15 mm Development and change in structure of larynx

37. 15-20 years • larynx at C7 • total VF length: • men = 17-23 mm • women = 12-17 mm • Geriatrics（老年人） • larynx at low C7 • total VF length is same as adults Structure of larynx continued

38. 3 vibratory divisions • Cover被覆层 • epithelium & superficial layer（上皮层/浅层） • Compliant（顺应性）,fluid movement of VF（声带的振动） • Transition过渡层 • intermediate & deep layers • Coupling of superficial mucosa & muscle • Body体层 • vocalis muscle • Mass and stability（质量和稳定） Body-cover theory of VF vibration

39. Model describing voice production 描述嗓音产生的模型 Vibration of vocal folds 声带振动 Myoelastic-aerodynamic theory（肌弹性-空气动力学说）

42. Pattern of vibratory cycle opening phase（渐开相） = 50% of cycle 周期的50% closing phase（渐闭相） = 37% of cycle 周期的37% closed phase（闭相） = 13% of cycle 周期的13%

43. Horizontal（水平位） • medial to lateral movement • Longitudinal（纵向位） • anterior to posterior “zipperlike” wave(波浪状) • Vertical phase （垂直位） • inferior to superior opening and closing of VF’s Structural changes of VF’s during vibration

44. Anatomy of the Larynx

45. Frequency acoustic correlate of pitch range during conversational speech is 2 octaves measured in hertz (Hz)

46. Vocal Registers glottal fry （气泡音区）or pulse register（脉冲音区） chest or modal register（胸音或自然音区） falsetto or loft register（假音或顶音区）

47. Physiologic elements for changing frequency Tension（紧张度） mass （质量） Length（长度）

48. Intensity 强度 Sound Pressure Level is the acoustic correlate of intensity 声学上的强度与声门压力水平有关 greater changes in modal register measured in decibels (dB)

49. Changing intensity subglottic pressure 声门下压 closed phase of vocal folds声带的关闭相

50. Quality 音质 spectrum acoustic（声学频谱）correlate for quality relates to pattern of vibration 与声带振动形式有关 resonance of vocal tract 声道的共鸣