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LARYNX REVIEW: LOCATION HYOID BONE STERNOCLEIDOMASTOID MUSCLE LARYNGEAL PROMINENCE OF THYROID CARTILAGE = ADAM'S APPLE - LEVEL C4 Larynx Functions - produces sound - regulates opening to trachea, respiratory system CLINICAL - OBSTRUCTION OF LARYNX CAN PRODUCE SUFFOCATION THRYOID GLAND TRACHEA LARYNX: IMAGING CADAVER SECTION CT SECTION LARYNX LARYNX PHARYNX + ESOPHAGUS COMMON CAROTID A., IJV BODIES OF CERVICAL VERTEBRAE CLINICAL: PALPATE CAROTID BIFURCATION LATERAL TO LARYNGEAL PROMINENCE - NERVES TO LARYNX CAN BE DAMAGED DURING CERVICAL DISC REPAIR LARYNX REVIEW: CARTILAGES ARYTENOID - 2 pyramidal shaped cartilages above lamina of cricoid Sup. Horn Corniculate Cartilages Arytenoid lamina Laryngeal prominence = Adam's apple Cricoid Inf. Horn THYROID CARTILAGE - shield shaped - has Sup. and Inf. Horns - Laryngeal prominence CRICOID = signet ring - complete ring of cartilage - narrow Arch ant., broad Lamina post. LARYNX REVIEW: SYNOVIAL JOINTS THYROID and CRICOID ARYTENOID and CRICOID SLIDING ROTATION TILT SYNOVIAL JOINT BETWEEN ARYTENOID AND CRICOID HINGE JOINT JOINTS PERMIT TILTING OF THYROID-CRICOID: - CHANGE PITCH OF SOUND (TENSE OR RELAX VOCAL LIGAMENTS) JOINTS PERMIT ROTATION AND SLIDING: - OPEN OR CLOSE LARYNX (ABDUCT OR ADDUCT VOCAL LIGAMENTS) SOUND PRODUCTION: CONUS ELASTICUS top view CONUS ELASTICUS VOCAL LIGAMENTS = FREE EDGE OF CONUS RIMA GLOTTIDIS = opening CONUS ELASTICUS -= INTERNAL ELASTIC MEMBRANE ATTACHED TO CRIOCID; UPPER FREE EDGES = VOCAL LIGAMENTS VOCAL LIGAMENTS EXTEND FROM ARYTENOID TO THYROID, ACROSS TWO JOINTS CHANGE PITCH BY TILTING AT HINGE JOINT – Thyroid cartilage tilts down; cricoid tilts up THYROID Tilting - STRETCHES vocal ligaments ARYTENOID HINGE JOINT CRICOID RELAX vocal ligament DECREASE PITCH THYROARYTENOID HINGE JOINT STRETCH vocal ligament INCREASE PITCH CRICOTHYROID MUSCLES OF LARYNX Tilting - STRETCHES vocal ligaments HINGE JOINT CRICOTHYROID M. - Tenses Vocal Ligament Increasing Pitch STRETCH vocal ligament INCREASE PITCH CRICOTHYROID MUSCLES OF LARYNX NOT SEE THYROID THYROARYTENOID MUSCLES - adjacent to vocal ligament Relaxes Vocal Ligaments Decreases pitch HINGE JOINT CRICOID RELAX vocal ligament DECREASE PITCH THYROARYTENOID OPEN AND CLOSE RIMA GLOTTIDIS BY ROTATING/SLIDING ARYTENOIDS Rotate laterally opens; Rotate medially or slide closes OPEN ROTATE LATERALLY REST POSITION POSTERIOR CRICOARYTENOID CLOSE CLOSE ROTATE MEDIALLY SLIDE LATERAL CRICOARYTENOID ARYTENOIDEUS Larynx open for deep breathing; close for speech; completely close to raise abdominal pressure (Valsalva maneuver) ARYTENOIDEUS MUSCLES OF LARYNX 5) ARYTENOID (Transverse and oblique arytenoid) - Adduct vocal folds 4) LATERAL CRICOARYTENOID - Adduct vocal folds 3) POSTERIOR CRICOARYTENOID – Abducts vocal fold POSTERIOR CRICOARYTENOID LATERAL CRICOARYTENOID Adduct closes rima glottidis Abduct opens rima glottidis LARYNGOSCOPE VIEW OF LARYNX Post. Vocal Folds Corniculate cartilage (true vocal folds) Vestibular Folds Ant. (false vocal folds) Pyriform recess Cuneiform cartilage Epiglottis Tongue NOSE VIEW FOR INTUBATION CORONAL SECTION Quadrangular membrane VENTRICLE lateral outpocketing Conus elasticus VESTIBULE - inlet above false vocal folds VESTIBULAR (FALSE VOCAL) FOLDS - overlie vestibular ligaments (lower edge of Quadrangular membrane) VOCAL (TRUE VOCAL) FOLDS - overlie vocal ligaments (upper edge of Conus elasticus) CLINICAL - MUCOSA SWELLS IN ANAPHYLAXIS; OBSTRUCTION CAN RESULT FROM SWELLING AT VESTIBULAR (FALSE VOCAL FOLDS) NERVES OF LARYNX – Branches of Vagus SUP. LARYNG. N. Int. Laryng. N. Ext. Laryng. N. RECURRENT LARYNG. N. 1) Superior Laryngeal N. a) Internal Laryngeal N. Visceral Sensory (GVA) to Larynx Above (true vocal folds) b) External Laryngeal N. Branchial motor (SVE) to Cricothyroid 2) Recurrent Laryngeal n. - Visceral Sensory (GVA) to Larynx Below True Vocal Folds - Branchial motor (SVE) to all other Muscles of Larynx Clinical - damage to Recurrent Laryngeal nerve in Thyroid surgery NERVES OF LARYNX – Branches of Vagus X SUPERIOR LARYNGEAL NERVE RIGHT RECURRENT LARYNGEAL NERVE - passes under Subclavian Artery X SUPERIOR LARYNGEAL NERVE - pierces thyrohyoid membrane LEFT RECURRENT LARYNGEAL NERVE - passes under Arch of Aorta OBSTRUCTION OF LARYNX: CRICOTHYROTOMY Cricothyroid Membrane CLINICAL - IN OBSTRUCTION OF LARYNX, EMERGENCY OPENING MADE IN CRICOTHYROID MEMBRANE (CRICOTHYROTOMY); AVOIDS BLLEDING THAT CAN OCCUR IN TRACHEOTOMY (FROM INFERIOR THYROID VEINS) Good luck!
