CLINICAL ANATOMY
OF LARYNX
Epiglottis (Upper border)
Cricoid (Lower border)
INTRODUCTION
• Level:- C3-C6 vertebrae- Adults
C1-C4 vertebrae- Children
• Extension:- Upper border of epiglottis
Lower border of cricoid cartilage
• Functions:-Protecting of lower airway, phonation, respiration, fixation of chest
• Narrowest part of larynx :- Glottis (in adults)
Subglottis (in children)
Physiology of Larynx
• Protection--- FB Bronchous
• Phonation--- Speech / Voice Production
• Respiration--- Inspiration & Expiration of Air
• Fixation of the chest--- Coughing, Micturition, Defaecation, Lifting.
FRAMEWORK OF LARYNX
• BONE- HYOID
• CARTILAGE UNPAIRED:-
-EPIGLOTTIS
-THYROID
-CRICOID
PAIRED:-
-ARYTENOID
-CORNICULATE
-CUNIEFORM
• MUSCLES
• JOINTS
• MEMBRANES & LIGAMENTS
Cricoid Cartilage
• One muscle- Cricothyroid Muscle- Tensor of vocal cord
- Adductor of VC ( extra function)
• 2 Joints- Cricoarytenoid joint
- Cricothyroid joint
Contraction of CT Muscle – Posterior part of Cricoid C moves inferiorly – Vocal cord stretches/ Tenson in VC
CA Joint
CT Joint
MUSCLES
INTRINSIC MUSCLES EXTRINSIC MUSCLES
• Abductors:
•Elevators:
Posterior cricoarytenoid (PCA)
(a)Primary elevators:
• Adductors: Stylopharyngeus
Salpingopharyngeus
Lateral cricoarytenoid (LCA)
Palatopharyngeus
Interarytenoid Thyrohyoid
Thyroarytenoid (b)Secondary elevators:
Mylohyoid, Digastric, Stylohyoid and Geniohyoid.
• Tensors: •Depressors:
Cricothyroid
Sternohyoid
Vocalis
Sternothyroid
Omohyoid
JOINTS
(1) Cricoarytenoid joint
(2) Cricothyroid joint
• Both are synovial joints.
(LCA)
(PCA)
(LCA)
(PCA)
MEMBRANES
EXTRINSIC INTRINSIC
THYROHYOID CRICOVOCAL
MEMBRANE MEMBRANE
CRICOTRACHEAL QUADRANGULAR
MEMBRANE MEMBRANE
INTRINSIC MEMBRANES
HYOID BONE
• It is a U shaped bone
• Consists of -body
-greater cornua
-lesser cornua
Movement of larynx during deglutition and phonation
• Hyoid bone is attatched to the mandible
and the skull base by:-
- Stylohyoid ligament
- Digastric muscle
- Mylohyoid muscle
- Stylohyoid muscle
- Geniohyoid muscle
- Hyoglossus muscle
EPIGLOTTIC CARTILAGE
• Leaf like elastic cartilage
• Attached:-
-Inferiorly to the thyroid cartilage, just below the
thyroid notch in the midline, by the thyroepiglottic
ligament.
-Superiorly to the hyoid bone anteriorly by the
hyoepiglottic ligament.
• Dorsal surface: stratified squamous epithelium
• Ventral surface: ciliated columnar epithelium(resp
epithelium)
THYROID CARTILAGE
• It is a hyaline cartilage
• Angle of fusion is 90 degrees (male)
120 degrees (female)
• Parts:-
o Lamina
o Superior horn
o Inferior horn prominence
o Oblique line
CRICOID CARTILAGE
• The cricoid cartilage is the only complete
cartilaginous ring in the airway present at
level C6
• Parts:- Arch (anteriorly)
Lamina (posteriorly)
• Lamina having a facet for thyroid cartilage
a facet for arytenoid cartilage
A P
Cricothyroid Muscle (Only Extralaryngeal muscle of larynx)
Tensor & Adductor of Vocal cord
ARYTENOIDS
• Pyramid shaped cartilage
• PARTS:-
• Vocal process is the attachment of vocal
ligament
Apex
• Muscular process-attachment of posterior
cricoarytenoid, lateral cricoarytenoid. Muscular
process
• Apex – Corniculate sits over it Vocal
process
CORNICULATE CARTILAGE
• Also known as cartilage of santorini
• Arytenocorniculate joint-It is Synovial or
cartilaginous joints link the arytenoid and
corniculate cartilages
CUNEIFORM CARTILAGES
• Also known as cartilage of wrisberg
• They may act to provide structural
rigidity to the aryepiglottic folds
NERVE SUPPLY
• Larynx is innervated by the vagus nerve
• The motor neurons arise from the nucleus
ambiguus of the medulla
• The vagus nerve exits through the jugular
foramen and then travels within the carotid
sheath in the neck.
Nerve supply of Larynx ( Vagus
Nerve )
• Sensory supply.
• Motor supply.
Course of Recurrent laryngeal nerve-
• Rt.R.L.N-It arises from vagus , at the level of
subclavian artery ,hook around it and then
ascends between trachea and oesophagus
• Lt.R.L.N-It arises from vagus in the mediastinum at
the level of arch of aorta,loop around it and then
ascends into the neck in the tracheo-esophageal
groove.
• Thus, Lt.R.L.N has a much longer course ,which
makes it more prone to paralysis compared to
right.
Course of superior laryngeal nerve:
• It arises from inferior ganglion of vagus,descends
behind internal carotid artery,at level of greater
cornue of hyoid bone,devides into external and
internal branches
• External- cricothyroid muscle
• Internal-pierces the thyrohyoid membrane and
supply sensory innervation to the larynx and
hypopharynx
VAGUS
NERVE
Recurrent
Superior LN
LN
External LN Internal LN
Cricothyroid Other
muscle muscles
Tensor of VC
PCA Remaning Muscles
Adductors
Only
Abductor
BLOOD SUPPLY
• Supraglottis-Superior laryngeal (branch of superior thyroid A)
• Vocal cord- Both Superior and inferior laryngeal A
• Subglottis-Inferior laryngeal (branch of inferior thyroid A)
VENOUS DRAINAGE
• Superior Laryngeal vein drains into IJV
• Inferior laryngeal vein drains into inferior
thyroid vein which further drains into
bracheocephalic vein.
• Middle thyroid vein then into IJV
LYMPHATIC DRAINAGE
A
LARYNGEAL INLET
Epiglottis
Ary-epiglottic fold
Arytenoids
Inter-arytenoid area
GLOTTIS
• Extension: Space between two vocal Fold(True vocal cord).
• consists of : Vocal cord
Ant commisure
Post commisure
ARYEPIGLOTTIC FOLDS
• Extends from arytenoid to epiglottis
• contains corniculae and cuneiform cartilage
• flabby- laryngomalacia
• Aryepiglottic fold, false cord, true cord forms 3
sphincters during pharyngeal phase of swallowing
CROSS SECTION OF VOCAL CORD:
Vocal cord has 3 layers-
• Mucosa(Having Squamous Epithelium)
• Lamina propria
Superficial – Reinkes space
Intermediate-
Deep layer---- Vocal ligament
• Muscular layer – thyroaytenoid(Vocalis).
Cricovocal
membrane
Spaces:-
• PRE-EPIGLOTIC SPACE • PARA-GLOTTIC SPACE
THANK YOU
