Head And Neck Final - Larynx

Front 1

Define the term "larynx"

Back 1

The larynx is a specialized part of the upper respiratory tract. It is a continuation of the laryngopharynx.

Front 2

What is the location and relation of the larynx?

Back 2

The larynx is located at the point where the respiratory and digestive tracts diverge.

Located in the anterior part of the neck between C3-6 vertebrae.

Anterior to esophagus.

Front 3

What are the functions of the larynx?

Back 3

Vocalization - speaking, singing

Upper part of respiratory tract - joins the nasopharynx and oropharynx with trachea

Protects air passages during swallowing

Front 4

What is a major potential problem with the location of the larynx and trachea?

Back 4

blockage of upper airway (airway obstruction)

Front 5

Why are the larynx and pharynx arranged in such a manner?

Back 5

Because in the 4th -5th week of gestation the trachea buds off of the pharynx, creating a division between the two structures.

Front 6

What is the term for the opening of the larynx and where is it located?

Back 6

Laryngeal inlet in the anterior wall of the laryngopharynx

Front 7

What helps to maintain the patency of the larynx?

Back 7

cartilages in the walls

Front 8

What structure closes the entrance to the laryngeal inlet during swallowing?

Back 8

epiglottis

Front 9

What do you find internally, on the wall of the larynx?

Back 9

vocal cords, formed by a modification of the larynx wall

Front 10

Below the cricoid cartilage (C6 vertebral level), the larynx is continuous with the......

Back 10

trachea

Front 11

True or false: the laryngeal skeleton is cartilaginous?

Back 11

true!

Front 12

How many cartilages make up the laryngeal skeleton?

Back 12

9

Front 13

How many cartilages in the laryngeal skeleton are:

paired?

unpaired?

Back 13

3 paired

3 unpaired

Front 14

How are the cartilages in the laryngeal skeleton connected?

Back 14

by ligaments and membranes

Front 15

Why do laryngeal fractures frequently occur?

Back 15

Frequent injury due to superficial location

eg. hockey goalies, baseball catchers wear throat guards

Front 16

Name the 6 cartilages in the larynx

Back 16

epiglottis

thyroid

cuneiform

corniculate

arytenoid

cricoid

I made this up to remember them....

Even The Coo Coo Aunts Cry

Front 17

Name the parts of the thyroid cartilage

Back 17

two laminae meet at mid-line to form the laryngeal (thyroid) prominence - the adam's apple, which for some reason is also called the superior thyroid notch

superior and inferior horns (cornua) project from each lamina posteriorly

oblique line - lateral side of lamina - site of muscle attachment

Front 18

The inferior horns of the thyroid cartilage articulate with what cartilage?

What type of joint is this?

Back 18

cricoid cartilage

cricothyroid joint - a synovial joint

Front 19

What suspends the thyroid cartilage from the hyoid bone?

Back 19

thyrohyoid membrane

this is thickened in the midline and laterally as the median and lateral thyrohyoid ligaments

Front 20

Which cartilage forms the only complete ring of cartilage in the respiratory tract?

Back 20

cricoid cartilage

Front 21

The cricoid cartilage has two pairs of articular facets.

Which cartilages does the cricoid articulate with?

Back 21

arytenoids and thyroid cartilages

Front 22

The anterior of the cricoid cartilage lies inferior to the thyroid cartilage and is what shape?

Back 22

narrow arch

Front 23

The posterior of the cricoid cartilage lies between the posterior margins of the thyroid laminae. What shape does it have?

Back 23

enlarges to form the lamina

Front 24

What does the word cricoid mean?

Back 24

ring-shaped

Front 25

What does the word arytenoid mean?

Back 25

pitcher-shaped

Front 26

Where do the arytenoids rest?

Back 26

On the superior surface of the (posterior) cricoid lamina.

Front 27

The arytenoids form a synovial joint with the cricoid cartilage.

What does this allow the arytenoids to do?

Back 27

the joint allows the arytenoids to rotate and slide over the lamina

Front 28

The muscular process of the arytenoids is located....

Back 28

postero-laterally

Front 29

The vocal process for attachment of the vocal cords on the arytenoids is located....

Back 29

anteriorly

Front 30

At the tapered, superior apex of the arytenoids, what articular facets will you find?

Back 30

articular facets for corniculate cartilages

Front 31

The arytenoids articulate with two cartilages. What are they?

Back 31

the corniculate cartilages (superiorly) and the cricoid cartilages (inferiorly)

Front 32

What does the word epiglottis mean?

Back 32

leaf-shaped

Front 33

What type of cartilage does the epiglottis have that makes it so flexible?

Back 33

Elastic cartilage

Front 34

How does the epiglottis attach to the back of the thyroid cartilage?

Back 34

via a thyroepiglottic ligament

Front 35

How does the epiglottis attach to hyoid bone?

Back 35

via the hyoepiglottic ligament

Front 36

The upper, anterior margin of the laryngeal inlet is formed by....

Back 36

the epiglottis!

Front 37

In the larynx, which cartilage normally remains unossified over time?

Back 37

the epiglottis!

Front 38

What are the age related changes in the larynx?

Back 38

In infants - epiglottis is furled, larger arytenoids are present

In adult - the leaflet of the epiglottis is flatter and more prominent, the arytenoids are smaller

Front 39

What is laryngomalacia?

Back 39

Laryngomalacia (literally, "soft larynx") is the most common cause of stridor in infancy, in which the soft, immature cartilage of the upper larynx collapses inward during inhalation, causing airway obstruction.

It can also be seen in older patients, especially those with neuromuscular conditions resulting in weakness of the muscles of the throat. However, the infantile form is much more common.

Front 40

What 2 sets of joints act on the vocal folds of the larynx?

Back 40

cricoarytenoid joints

and

thyrocricoid joints

Front 41

Where are the cricoarytenoid joints?

Back 41

between the cricoid and arytenoid cartilages

Front 42

What do the cricoarytenoid joints do?

Back 42

allow vocal folds to abduct and adduct

specifically, allows a pivoting motion of arytenoids on cricoid, as well as medial/lateral motion

..... this allows the vocal cords to open and close

Front 43

Where are the thyrocricoid joints?

Back 43

between the thyroid and cricoid cartilages

... specifically between inferior horn of thyroid cartilage and lateral aspect of cricoid cartilage

Front 44

What do the thyrocricoid joints do?

Back 44

allow the vocal folds to lengthen

... does so by allowing the thyroid cartilage to tilt on the cricoid, lengthening the vocal cords

Front 45

What holds the cricoid cartilage to the thyroid cartilage?

Back 45

cricothyroid membrane (conus elasticus) and the median cricothyroid ligament

Front 46

Where does the cricothyroid membrane (conus elasticus) attach?

Back 46

- attached on each side to the upper border of the arch of the cricoid cartilage

- has a superior free border that extends between the vocal process of the arytenoid cartilage, and the posterior surface of the thyroid cartilage, in the midline

Front 47

The upper margin of the cricothyroid membrane (conus elasticus) thickens to form what ligament?

Back 47

The vocal ligament

Front 48

What tightly adheres to the vocal ligament?

Together, what does this form?

Back 48

an overlying mucous membrane (stratified squamous epithelium)

vocal fold, or true vocal cord

Front 49

What makes up the vocal fold / true vocal cord?

Back 49

the vocal ligament and the overlying mucous membrane

Front 50

When viewed from above, the upper margins of the two vocal cords outline the opening between the vocal folds... what is this opening called?

Back 50

the rima glottidis

Front 51

You would see the rima glottidis when the vocal cords are (choose one):

A. adducted (closed)

B. abducted (open)

Back 51

B. abducted (open)

because the rima glottidis is between the opening of the vocal cords

Front 52

When the arytenoid cartilages adduct, what happens to the vocal cords?

Back 52

the vocal cords close

Front 53

When the arytenoid cartilages abduct, what happens to the vocal cords?

Back 53

the vocal cords open

Front 54

Between the vestibular and vocal folds, on each side, is a lateral depression lined by mucosal membrane.

What is this known as?

Back 54

The ventricle of the larynx

Front 55

What is the ventricle of the larynx continuous with?

Back 55

a space (the saccule) which extends upwards for a variable distance between the vestibular fold and the thyroid cartilage

Front 56

What kind of tissue makes up the quadrangular (quadrate) membrane?

Back 56

fibrous connective tissue

Front 57

The quadrate membrane extends between the anterior margin of each ______________ cartilage and the lateral margin of the ________________.

Back 57

arytenoid

epiglottis

Front 58

The superior, free border of the quadrate membrane is covered by a mucous membrane and is called the _________________ ________.

Back 58

aryepiglottic fold

Front 59

The aryepiglottic fold forms the lateral margin of the ____________ __________.

Back 59

laryngeal inlet

Front 60

What does the lower free border of the quadrate membrane thicken to form?

Back 60

the vestibular ligament

Front 61

The vestibular ligament is covered by a thick mucous membrane... together with this membrane, what does this form?

Back 61

the vestibular fold or false vocal cord!

Front 62

The false vocal cord is made up of....

Back 62

the vestibular ligament and the thick mucous membrane covering it

Front 63

Describe the laryngeal inlet

Back 63

- almost a vertical slit

- formed anteriorly by the upper margin of the epiglottis, laterally by the ariepiglottic folds, posteriorly by the two arytenoid cartilages, with a fold of mucous membrane between them

Front 64

What is the area of the larynx lying between the laryngeal inlet and the vestibular folds referred to?

Back 64

The vestibule of the larynx

Front 65

What membrane connects the thyroid cartilage to the hyoid cartilage?

Back 65

the thyrohyoid membrane

Front 66

The thyrohyoid membrane has two thickened areas which are ligaments. Where are they located?

Back 66

Medially and laterally

- known as the medial thyrohyoid ligament (from thyroid prominence to body of hyoid) and the lateral thyrohyoid ligaments (laterals from the superior horn of thyroid to greater horn of hyoid)

Front 67

Name the 3 main membranes that connect the cartilages of the larynx

Back 67

thyrohyoid membrane

cricothyroid membrane (conus elasticus)

quadrate membrane

Front 68

When is a cricothyrotomy performed and where does it puncture?

Back 68

A cricothyrotomy establishes an emergency airway. It is quicker and easier than a tracheostomy.

You puncture through the median cricothyroid ligament.

Front 69

Name the laryngeal cavities

Back 69

Front 70

There are two main muscle groups of the larynx, the extrinsic and intrinsic.

What is the role of the extrinsic?

What is the role of the intrinsic?

Back 70

Extrinsic - change position of larynx in the neck by pulling on the thyroid cartilage or hyoid bone from above and below

Intrinsic - control movements and length (tension) of the vocal folds

Front 71

Intrinsic muscle

Cricothyroid - what is the origin and insertion?

Back 71

origin: anterior arch of the cricoid

insertion: the inferior margin and inferior horn of the thyroid cartilage

Front 72

Intrinsic muscle

Cricothyroid - what does it do?

Back 72

acts on cricothyroid joint, causes an increase in the length and/or tension of the vocal cords

- essentially stretches the vocal cords

is opposed by the thyroarytenoid muscle

Front 73

Intrinsic muscle

thyroarytenoid joined with the vocalis muscles - where are they?

Back 73

lies on the lateral side of the vocal ligament, passing between the thyroid and arytenoid cartilages

Front 74

Intrinsic muscle

thyroarytenoid and vocalis muscles - what do they do?

Back 74

thyroarytenoid - helps close vestibule... contracts to shorten/decrease tension in vocal cord

vocalis - shortens the vocal cords

Front 75

Intrinsic muscle

the thyroarytenoid and vocalis muscles have a separate part of the muscle that may attach to the epiglottis. What is this muscle called?

Back 75

thyroepiglottic muscle

Front 76

Intrinsic muscle

thyroepiglottic muscle - what does it do?

where is it located?

Back 76

- aid in depressing epiglottis and closing off the larynx during swallowing (helps close the vestibule)

origin: thyroid cartilage

insertion: epiglottis

Front 77

intrinsic muscle

posterior cricoarytenoid - what does it do?

Back 77

ABduct - open vocal cords by rotating and separating the two arytenoid cartilages

Front 78

intrinsic muscle

posterior cricoarytenoid - where is it located?

Back 78

origin: posterior aspect of cricoid cartilage

insertion: muscular process of arytenoid cartilage

Front 79

intrinsic muscle

lateral cricoarytenoid - what does it do?

Back 79

ADduct - close vocal cords

does so by rotating the arytenoid cartilages so that the vocal process swings toward the mid-line

Front 80

intrinsic muscle

lateral cricoarytenoid - where is it?

Back 80

origin: lateral aspect of cricoid cartilage

insertion: muscular process of arytenoid cartilage

Front 81

intrinsic muscle

transverse arytenoid - what does it do?

Back 81

draws arytenoids towards each other - ADduction of vocal cords

Front 82

intrinsic muscle

transverse arytenoid - where is it?

Back 82

transverse part extends between the two arytenoids...

origin: muscular process of arytenoid

insertion: muscular process of other arytenoid

Front 83

intrinsic muscle

ariepiglottic (oblique part of arytenoid muscles) - what does it do?

Back 83

pulls epiglottis over airway (laryngeal inlet) during swallowing

Front 84

intrinsic muscle

ariepiglottic (oblique part of arytenoid muscles) - where is it?

Back 84

origin: muscular process of arytenoid cartilage

insertion: apex of opposite arytenoid and (extends along the ariepiglottic fold to) the epiglottis

Front 85

In the intrinsic muscles....

ABductors - open

ADductors - close

tensors - ___________

relaxors - ___________

Back 85

tensors - lengthen

relaxers - shorten

Front 86

The extrinsic muscles elevate and depress the larynx, acting on the entire laryngeal skeleton.

What are the elevator muscles?

Back 86

digastric

mylohyoid

geniohyoid

stylopharyngeus

palatopharyngeus

Front 87

The extrinsic muscles elevate and depress the larynx, acting on the entire laryngeal skeleton.

What are the depressor muscles?

Back 87

omohyoid

sternohyoid

sternothyroid

Front 88

During breathing, the vocal cords are......

Back 88

ABducted

Front 89

Voice production is due to......

Back 89

the escape of small amounts of air between the loosely adducted vocal cords

Front 90

The larynx is responsible for the __________ and the ____________ of sound produced.

Back 90

pitch, quantity

Front 91

What does the quality of voice depend on?

Back 91

resonators, such as paranasal air sinuses, and formation of different sound by lips, tongue, etc.

Front 92

When are vocal cords tightly adducted (closed)?

Back 92

straining efforts like before a cough or sneeze

Front 93

during swallowing, the epiglottis folds back to seal off the....

Back 93

laryngeal inlet

Front 94

Which arteries supply the larynx?

Back 94

superior and inferior laryngeal arteries

Front 95

Which veins supply the larynx

Back 95

superior and inferior laryngeal veins

Front 96

What nerve supplies the larynx?

Back 96

Vagus (CN X) branches, entirely!

Front 97

What are the sensory branches of the vagus nerve that supply the larynx?

Back 97

internal laryngeal branch of the superior laryngeal nerve (above vocal cords)

recurrent laryngeal nerve (below vocal cords)

Front 98

What are the motor branches of the vagus nerve that supply the larynx?

Back 98

- all intrinsic muscles *except cricothyroid*: recurrent laryngeal nerve

- all extrinsic muscles *AND cricothyroid*: external laryngeal branch of the superior laryngeal nerve

Front 99

The thyroid, cricoid and arytenoid cartilages may ossify to some extent. Why is it important that the epiglottis remain unossified?

Back 99

So that it can maintain flexibility and movement, so you can continue to swallow properly without airway obstruction by food.

Front 100

The cartilages of the intrinsic muscles are derived from the _______ and _______ pharyngeal arches, as is the vagus nerve (CN X).

Back 100

4th, 6th

Front 101

When would you do a tracheostomy?

Back 101

for upper airway obstruction or respiratory failure

Front 102

How do you do a tracheostomy?

Back 102

vertical or transverse incision in neck and anterior part of trachea

usually between 1st and 2nd tracheal rings or 2nd-4th tracheal rings

insert tube and hold in place with neck straps

Front 103

what structures are in danger of being cut during tracheostomy?

Back 103

Inferior thyroid artery and vein

thyroid

internal laryngeal nerve

** any more?

Front 104

Structures at risk during cricothryotomy

Back 104

true vocal cords

cricoid muscles

cricoid cartilage

Front 105

What is the movement of the vocal folds during forced respiration?

Back 105

wide open

Front 106

What is the movement of the vocal folds during quiet respiration?

Back 106

open a bit

Front 107

What is the movement of the vocal folds during normal phonation?

Back 107

open a bit (but less than quiet respiration)

Front 108

What is the movement of the vocal folds during whispering?

Back 108

small opening (almost closed)