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119 Cards in this Set
- Front
- Back
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Larynx description
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Musculocartilaginous structure
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Larynx location
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Lies superior to trachea
Located midline on anterior neck Larynx is located between hyoid bone superiorly and trachea inferiorly Located at about 3rd-5th cervical vertebrae |
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The position of the larynx may vary according to:
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Age (lowers with age)
Sex Head position laryngeal activity (eg: swallowing) |
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Biological function of the larynx
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Component of the respiratory system. Functions as protective device for lower airway.
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3 ways larynx acts (biological function)
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1. Prevents foreign objects from entering lungs
2. Prevents air from escaping the lungs (thoracic fixation) 3. Forcefully expels foreign substances which threaten to enter the larynx or trachea |
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What is the non-biologic function of the larynx?
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Sound production: only functions as a sound generator when it is not fulfilling biological functions. Represents variable resistance to flow of air.
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Variable resistance
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Vocal folds adduct to provide changing amounts of resistance to outward flowing air. Vocal folds are held closely together so the air can come underneath and blow them apart.
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During quiet breathing, VFs are:
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Abducted
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The vocal folds can be (6)
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Tensed, relaxed, elongated, shortened, adducted, abducted
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Adducted
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brought together
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Abducted
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Moved apart
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When phonating, VFs come back together with which margin first?
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Lower margin first then upper.
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When Vfs are blown apart, which margin is blown apart first?
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Lower margin first, then upper
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Hyoid bone
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Unique in that it's not attached to any other bone in skeleton, highly mobile structure. Larynx is somewhat suspended from it. Serves as superior attachment from some extrinsic muscles
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Muscles which attach to hyoid bone and suspend it comprise...
What are they? |
Hyoid sling muscles
Muscles from tongue and mandible, muscles and ligaments from temporal bone approach from behind and superiorly. Extrinsic larygeal muscles from below attach to hyoid as do muscles from sternum and clavicle. |
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Name the 3 parts of the hyoid bone. Where is it located within the neck?
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Corpus/body, greater and lesser horns/cornu.
Located at level of C3 |
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Why is the hyoid bone convex?
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Decreases the weight of the structure without compromising the strength.
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What do the greater horns of the hyoid articulate with?
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The superior horns of the thyroid cartilage
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http://bioweb.uwlax.edu/APLab/Table_of_Contents/Lab_03/Hyoid_Bone/Unit_03-14a.jpg
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1. Greater horn
2. Lesser horn 3. Corpus |
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The larynx is composed of ? cartilages?
How many are paired? How many are unpaired? Which ones are larger? |
Nine.
Three pairs Three unpaired Unpaired=larger |
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What are the cartilages made up of?
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Either hyaline or elastic
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Can you break your larynx?
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Yes, it ossifies with age.
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Paired cartilages of the larynx
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Arytenoids, cunieform, corniculate
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Unpaired cartilages of the larynx
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Cricoid, thyroid, epiglottis
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Thyroid cartilage
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Largest of the laryngeal cartilages.
A. Laminae B. Superior/Inferior Cornu C. Foramen |
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Thyroid laminae
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Two quadrilateral plates, fused at midline. Fused at midline and form anterior and lateral walls of the larynx.
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3 parts of the thyroid laminae
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1. Angle of thyroid
>80 degree in males, 90 in females 2. Thyroid notch (V Shaped) 3. Thyroid prominence >AKA Adam's apple |
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http://faculty.ucc.edu/biology-potter/larynx.jpg
1. Find angle of thyroid 2. Thyroid notch 3. Thyroid prominence |
1. Where 2 laminae meet
2. V Shaped part 3. Anterior projection |
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What does the thyroid cartilage protect?
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The vocal folds which are under the thyroid notch
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Cricoid cartilage
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Hyaline cartilage located immediately above the uppermost tracheal ring.
A. Cricoid laminae B. Anterior arch |
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Which cricoid structure has articular facets for articulating with inferior horns of the thyroid? Why is this joint important? What else does this structure articulate with?
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Anterior arch, important for pitch.
Arytenoid cartilages. |
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Arytenoid cartilages
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Located on cricoid cartilage, hyaline cartilage
A. Muscular process B. Vocal process |
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Muscular process
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Articulates with cricoid.
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Vocal process
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Anterior angle, pointed projection. The vocal ligament-an impt part of the vocal fold inserts on vocal process.
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Corniculate cartilages
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apexes of arytenoid cartilages are capped by this pair. Sometimes are absent.
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Epiglottis
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Made up elastic cartilage. Attaches to thyroid cartilage at angle just beneath thyroid notch by means of a ligament. Broadest portion connects to hyoid bone.
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What is the function of the epiglottis?
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Prevent food from entering the larynx during deglutition. Contributes very little to speech.
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Valleculae
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pits formed between epiglottis and root of tongue. Food may fall into valleculae and remain before or after a swallow.
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What problems could be associated with the valleculae?
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If you don't have strong swallowing, liquid stuck in the valleculae can end up in the lungs when the epiglottis comes back up and the folds open.
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Cunieform cartilages
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Imbedded in aryepiglottic folds. Anterior and lateral to corniculate cartilages.
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Function of cunieform cartilages
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Lend support to aryepiglottic folds and stiffen them to help maintain the opening to the larynx.
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What is the name of the membrane which stretches between hyoid to epiglottis?
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Hyoepiglottic membrane
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Aryepiglottic folds
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fold of membrane which extends from sides of epiglottis to apexes of arytenoid cartilages. Entrance to larynx. Top part of quadrangular membrane.
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Cricoarytenoid joint
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Permits rocking motion and some gliding action. Rocking motion causes an upward and outward motion of the vocal process during abduction and an inward and downward swing during adduction. Medial and leteral sliding of the arytenoid cartilage toward or away from midline which brings the arytenoids toward or away from each other.
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Cricothyroid joint
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Pivot joint-rotational. In neutral position, ligaments surrounding joint are somewhat slack, so limited gliding action can take place. Rotational and gliding action place vocal folds under increased tension, which INCREASES pitch. Action decreases distance between thyroid and cricoid anteriorly and increase distance between vocal processes of arytenoid and angle of thyroid.
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3 Extrinsic membranes and ligaments
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Hyothyroid membrane and ligaments
Hyoepiglottic ligament Cricotracheal membrane |
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What is the distinction between hyothyroid membrane and ligaments?
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Ligaments are the thickened portions
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Cricotracheal membrane
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Connects lower border of cricoid with 1st tracheal ring.
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2 intrinsic membranes
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Conus elasticus
Quadrangular |
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Conus elasticus
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Lower portion of elastic membrane. Cavity below vocal folds is cone shaped. Continuous sheet of membrane connects thyroid, cricoid, arytenoid cartilages with one another. Extends from superior border of arch and lamina of cricoid to true vocal folds.
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Intrinsic membranes: function, description
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Interconnect various laryngeal cartilages, help to regulate extent and direction of movements. Almost all originate from broad sheet of conenctive tissue called elastic membrane, which lines almost entire larynx.
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Quadrangular membrane
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Arise from lateral margins of epiglottis and thyroid cartilage near angle. Fibers attach to corniculate cartilages and arytenoids. Inferiorly, terminate as free, thicken borders called ventricular ligaments (false folds!)
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From which membrane do the false folds arise?
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Quadrangular
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Membrane
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Larynx is lined with mucus membrane that is continuous with lining of oral cavity and trachea. It is rich in mucus glads in area between vocal and ventricular ligaments.
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Laryngeal cavity
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Goes from aditus laryngus to inferior border of cricoid.
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Pyriform sinus
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Bounded laterally by thyroid cartilages and membrane, medially by epiglottic folds
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Rima glottis
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Glottis; Space between vocal folds.
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Supraglottic region
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Between ventricular/false folds and aditus: called vestibule. Small region between ventricular folds and vocal folds is called ventricle.
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Ventricular folds
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Soft and flaccid. Incapable of becoming tense. Move with arytenoids but are further apart then vocal folds during phonation.
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Space between ventricular fold is called...
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false glottis
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What is used to compensate for vocal fold damage and is also seen in hyperfunctional patients?
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Ventricular phonation
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Subglottal region
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Bounded above by vocal folds and below by interior margin of cricoid cartilage. Lined with ciliated tissue, extending into trachea and bronchi. Cilia beat toward pharynx in larynx, helping to remove accumulations of mucus and foreign matter.
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Vocal folds
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Origin: thyroid cartilage, near angle, below notch. May be attached in front, course posteriorly toward posterior commisure to insert on arytenoid cartilages.
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Which portion of VF appear to be most active in vibration?
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Membranous, although cartilaginous also vibrates
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Glottis
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Anterior portion bounded by vocal ligament called membranous glottis. Posterior 2/5 is bounded by vocal process and medial arytenoid cartilage (cartilaginous glottis). At rest glottis is 8mm in males.
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During forced inhalation the size of the glottis...
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may double
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Thyroarytenoid
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Adductor, but mainly tensor or relaxer. Muscular portion of the VF. Origin=inner surface of angle of thyroid. Superior fibers flank vocal ligament, insert into vocal process of arytenoids. Inferior fibers are twisted, insert along base of arytenoid cartilage.
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Function of thyroarytenoid
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Acts as regulator of longitudinal tension. Moves the arytenoids forward.
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Posterior cricoarytenoid
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Only abductor muscle!! Origin-posterior surface of cricoid. Insertion-muscular process of the arytenoids.
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Two muscles act as antagonists to PCA..
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Lateral cricoarytenoid, the arytenoid muscles
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Lateral cricoarytenoid
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Adductor, relaxer. Located deep to cricoid cartilage. Origin- upper border of anterolateral arch of cricoid. Insertion-muscular process of arytenoid.
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Function of LCA
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Rotates arytenoids to bring vocal processes toward midline. Also instrumental in regulating medial compression of VF. Acting unopposed, will shape glottis for whisper. Increases medial compression (VF coming together).
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How does the LCA change the glottis for whispering?
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Adducts VF with more area in posterior glottal chink (space between arytenoids).
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Arytenoid muscles
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Adductors. Two parts: oblique and transverse.
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Oblique arytenoid
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More superficial. Origin-muscular process. Crosses like X and inserts near apex of opposite arytenoid. Function-approximate arytenoids and regulate medial compression.
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Transverse arytenoid
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Origin-lateral margin and posterior sufrace of one arytenoid. Insert-lateral margin and posterior surface of other arytenoid. Function-approximate arytenoids by causing them to slide along axis toward midline.
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What increases medial compression?
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Talking louder
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Cricothyroid
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One of only two muscles that acts as tensor. Origin-anterolateral arch of cricoid. Fibers diverge into Pars oblique and pars recta.
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Pars oblique of cricothyroid
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Insertion-inferior horn of thyroid.
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Pars recta of cricothyroid
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Insertion-inner aspect of lower margin of thyroid lamina
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Function of pars recta and pars oblique
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Contraction of anterior fibers, which decreases distance between cricoid arch and thyroid cart. If cricoid fixed, thyroid moves and vice versa. Results in increasing distance between thyroid and vocal processes of arytenoids resulting in elongation of the vocal folds, necessary for pitch change.
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Cover of the vocal folds
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Epithelium and superficial layers of the lamina propria. Superficial layer called Reinke's space. This layer vibrates most during phonation.
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What is the result of stiffened Reinke's space?
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Dysphonia.
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3 layers of the vocal folds
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1. Cover
2. Transition 3. Body |
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Transition of the vocal folds
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Intermediate (elastic fibers) and deep layers of lamina propria. Likened to cotton. Also called vocal ligament. Provides for resiliency and extendibility, longitudinal stability to VFs. Enables VFs to be responsive to the intrinsic laryngeal muscles, especially the TA.
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Body of the vocal folds
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Vocalis portion of the thryoarytenoid muscle
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The transition of the VF gets_________ as you go deeper in the folds.
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Stiffer
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Name for disease in superficial layer of the VF
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Reinke's edema
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Vagus
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Originates from nucleus ambiguous of medulla. Exits cranium through jugular foramina. Has 3 branches.
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Pharyngeal nerve
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Of the vagus. Levator veli palatini: elevates soft palate.
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Superior laryngeal nerve
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Of the vagus. Divides into internal and external branches.
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Internal laryngeal nerve
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Divides from Superior laryngeal nerve. Enters through thyrohyoid membrane. Sensory function~ supraglottal areas.
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External laryngeal nerve
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Divides from superior laryngeal nerve. Motor function~ innervates cricothyroid (pitch changes)
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Recurrent laryngeal nerve
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Of the vagus. Motor function~innervates all intrinsic muscles of larynx except cricothyroid. Sensory function~innervates sensory receptors in mucous membrane below vocal folds.
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Vagus nerve lesion above pharyngeal branch
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Adductor paralysis with palatopharyngeal paralysis. Soft palate droops, instrinsic laryngeal musc are cut off. VF is paralyzed in open position.
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Symptoms of lesion above pharyngeal branch:
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Hypernasal, hoarse, breathy.
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Damage to vagus will result in contralateral or ipsilateral damage? Why?
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Ipsilateral b/c it is a PNS issue.
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Vagus lesions below pharyngeal branch and symptoms
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Involve SLN and RLN and result in adductor paralysis. Symptoms same as pharyngeal branch lesion issues but without resonance problems ie-no hypernasality.
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Unilateral lesion affecting SLN only
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Symptoms-pitch range (esp when singing), vocal fatigue, reduced loudness. On phonation, larynx shifts away from affected side.
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Bilateral lesion affected SLN only
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Bowing of the VF, breathy voice
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Symptoms of lesion above pharyngeal branch:
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Hypernasal, hoarse, breathy.
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Damage to vagus will result in contralateral or ipsilateral damage? Why?
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Ipsilateral b/c it is a PNS issue.
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Vagus lesions below pharyngeal branch and symptoms
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Involve SLN and RLN and result in adductor paralysis. Symptoms same as pharyngeal branch lesion issues but without resonance problems ie-no hypernasality.
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Unilateral lesion affecting SLN only
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Symptoms-pitch range (esp when singing), vocal fatigue, reduced loudness. On phonation, larynx shifts away from affected side.
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Bilateral lesion affected SLN only
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Bowing of the VF, breathy voice
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Lesion affecting RLN only
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Abductor paralysis. Fold on affected side won't open. Voice may sound normal, with perhaps mild hoarseness. May have weak cough or weak glottal attack.
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Bilateral lesion affected RLN only
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problem is breathing not necessarily voice. Inhalatory stridor. May have to have arytenoidectomy. Danger of aspiration.
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Myoelastic aerodynamic theory
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Phonation made possible due aerodynamic and tissue force of laryngeal muscles.
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Bernoulli effect
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As air pressure decreases, velocity increases.
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Folds vibrate due to myoelastic aerodynamic theory and also..?
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Myoelastic properties
-Muscles adduct folds and apply tension to VF. |
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Viscous or elastic force is created by
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density of VF
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The more viscous, more.........to air flow
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resistance
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Mechanical coupling stiffness
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outermost layer of VF functions as if composed of two different masses. Lower mass pulls upper mass away from midline when air pressure is great enough.
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What is the problem with myoelastic aerodynamic theory
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It doesn't explain how VF sustain oscillation
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Folds vibrate due to myoelastic aerodynamic theory and also..?
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Myoelastic properties
-Muscles adduct folds and apply tension to VF. |
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Viscous or elastic force is created by
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density of VF
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The more viscous, more.........to air flow
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resistance
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Mechanical coupling stiffness
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outermost layer of VF functions as if composed of two different masses. Lower mass pulls upper mass away from midline when air pressure is great enough.
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What is the problem with myoelastic aerodynamic theory
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It doesn't explain how VF sustain oscillation
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