Larynx Class Slides

8/6/2019 Larynx Class Slides

1/64

Unit5:Anatomyandphysiology

ofLarynx

1


2/64

2


3/64

inneckalongwithassistancefromstructures

.

Un t5:Stu yt eanatomy p ys o ogyan diseasesofthelarynx.

3


4/64

Larynx,commonlycalledVOICEBOX

Locatedinfront,inthemiddleofthe.

Perchedontheto ofthetrachea(windpipe).

4


5/64

5


6/64

withage,gender,headpositionand

.

The

length

of

larynx

is

about

44

mm

in

an

.

6


7/64

Biologicalfunctions

Buildingintrathoracicpressureforexcretion

an carry ngou s renuousp ys ca ac v es

Nonbiologicalfunctions

S eech

Singing

7


8/64

Madeofabone,cartilages,muscles,

.

Hyoidbonesupportslarynx.

8


9/64

Ushapedsinglebone presentabovethethyroid

.

ssuspen e rom e pso

Styloid processes

of

the

Temporal

.

Itisnotconnectedtoanyotherbonedirectly.

Hyoidboneissupportedbymanymuscles&it

canmakevarietyofmovements. 9


10/64

10


11/64

Hyoidhas3parts:abodyand2pairsofhorns.

theThyroidcartilage.

11


12/64

NOTE:ligamentvs.cartilagevs.

tendon Ligament:Fibroustissuethatconnectsbonestoother

.

Cartilage:Stiffyetflexibleconnectivetissuefoundin,

bones.Itisnotashardandrigidasbonebutisstifferand

lessflexiblethanmuscle.

Tendon:Toughbandoffibrousconnectivetissuethatusuallyconnectsmuscletoboneandiscapableof

withstandingtension.Tendonsaresimilartoligaments

12


13/64

13


14/64

3unpaired&3pairedcartilagesinlarynx.

um er

Epiglottis single Behind the hyoid bone and base of the

Thyroid single Front of the neck in the midline

Cricoid single Above the trachea; below thyroid cartilage

Arytenoids paired Rests on the back surface of cricoid

cartilage

orn cu ates pa re ests on t e aryteno cart agesCuneiform paired Embedded in aryepiglottic folds

14List of cartilages & location in larynx


15/64

Itisleafshapedcartilage.

Attac e toupper,inner

surfaceofThyroid.

ItattachestoArytenoidsat

thebackbythe

Quadrilateralmembrane.

Theu ermar insare

formedbytheAryepiglottic

olds.

15


16/64

food,water,salivaintotrachea.

swallowing.

16


17/64

Biggestcartilageinlarynxpresent

.

Protectsvoiceboxinthefront.

2laminas(quadrangularplatesof

cartilage1onrightside&1on

leftside)

Laminas oinatmidlinetoform

thethyroidprominence(Adams

a leinmen Feltorseenon

17

surfaceoftheneckinmostmen.


18/64

Thyroid(Cartilage)

2bighornlikestructures(greaterorns toattac tot e yo one.

2smallhorns(lesserhorns)to

attachmentwithCricoidcartilage.

LesserhornsattachTh roidtoCricoid

throughtheCricothyroidligament&

Cricoth roid CT oints.CT ointsare

importantforchangingthepitch.

18


19/64

Itforms baseoflarynx.

ac e o yro a ove roug Cricothyroidligament,Cricothyroidjoints

rac ea e ow y r co rac ea

ligament.

Ringshapedcartilage

Frontsurfaceisthin,narrow(calledArch)

&backsurface(knownasLamina)is

broad,thickandwide. Arytenoidsare

19

presentonthelaminaofCricoid


20/64

Thesearepaired,pyramidshapedcart agespresentonupper

marginsoflaminaofCricoid

cart age.

EachArytenoidhasabase,anapex&3surfaces.

Vocal rocess resentonthe

medialsurfaceisanimportant

structure,becausethe formthe

20

posterior1/3rd oftruevocalfolds.


21/64

Arytenoidsareattachedto

VestibularandVocal

.

They

are

attached

to

Cricoid

t roug t eCricoarytenoi

ligaments&joints.

Theseligaments&jointsareimportantfortheopening&

closingofvocalfolds.21


22/64

22


23/64

Corniculates:Small,paired,nodularstructures

.

Theymaybe2orevenabsentsometimes.

Cuneiform:Small,paired,rodlikestructurespresentabovetheCorniculates.

Presentinafewindividuals

23


24/64

Bronchial Tree Model - Larynx - Sagittal View.flv

24


25/64

Joints/ligamentsoflarynx ar agesareconnec e oeac o erw e

helpofjoints,musclesandmembranes.

25


26/64

Joints/ ligaments Connects Action

Cricothyroidligament and joints

Thyroid toCricoid

Helps in changing the pitch ofvoice

Cricoarytenoid joints

and ligaments

Cricoid to

Arytenoid

Important for opening and closing

of vocal folds

Vestibular ligaments Arytenoids

to Thyroid

Helps in changing the pitch of

voice

Vocal ligaments Arytenoidsto Thyroid

Helps in changing the pitch ofvoice

26


27/64

voice(sound)arethevocalfolds.

Truevocalfolds.

T eirmain unctionisprotectiono t e owerairway.

27


28/64

Ventricularfolds/FalseVocal

Folds

withveryfewmuscles,bloodvessels&nerves.

(insert)tothearytenoidscartilagesattheback

.

Notsuitedforvoice productionastheyarebulky

an onot avemanymusc es, oo vesse san nerves.

28


29/64

TheyarepresentjustbeneaththeVentricularfolds.

eyor g na e rom e yro car age, n e

frontandinsertintotheArytenoidcartilagesatthe

ac roug e oca gamen s.

The

true

vocal

folds are

light

pink

in

color

but

on

laryngoscopyappearglossywhitebutthecolor

changesinclinicalconditions.

Thespacebetweenthetruevocalfoldsiscalledthe

Glottis.

29


30/64

VFsaremadeofmucousmembranes,ligaments&

.

Undermicroscope,5differentlayerscanbe

en e :

1. Epithelium2. SuperficiallayerofLaminapropria (Reinkes

space)

3. IntermediatelayerofLaminapropria

.

5. Vocalis muscle 30


31/64

TrueVocalFolds/Vocalfolds

Crosssection

view31


32/64

" "

anditiscontinuouswiththeliningofmouth,

.

Laminapropria as3 istinct ayers,eac wit adifferentconsistency.TheIntermediatelayerand

eep ayero am na ropr a ormst e oca ligament.

32


33/64

,

surface

, ,

likerubberbands

Deep ayer at rea i eco agenous i er ayer

Vocalismuscle isthemainbodyofthevocalfold

andverystiff.

33


34/64

34


35/64

superior&inferiorthyroidarteries andcricothyroid

.

35


36/64

(i)Superiorthyroidartery

ranc ranc o esuper or yro o esuper or yro artery(branchoftheexternalartery(branchoftheexternal

entersentersthelarynxthroughthethelarynxthroughthe

withtheinternalbranchofthewiththeinternalbranchofthe

ri r lar n al n rvri r lar n al n rv

mucousmembranesinthemucousmembranesintheri r rti n f th lar nxri r rti n f th lar nx


37/64

thyroidartery(thyroidartery(thyrocervicalthyrocervical trunkofthetrunkofthesubclaviansubclavian

AscendsAscendsonthetrachea,togetherwiththeonthetrachea,togetherwiththe

,,

fromlowerbordersfromlowerborders

upp esupp est emusc esan mucousmem ranes nt emusc esan mucousmem ranes nthelowerpartofthelarynxthelowerpartofthelarynx


38/64

38Figure in SLM


39/64

BranchBranchofthesuperiorofthesuperior

PassesPassesacrossthesuperioracrossthesuperior

portiono t eportiono t ecricot yroicricot yroi

ligamentligament


40/64

drainedbyvesselswhichaccompanythesuperior

,

andemptyintotheupperdeepcervicallymph

Whereasthezonebelowthevocalfoldsdrains,

.

40


41/64

ADDITIONALINFORMATION

VENOUSDRAINAGEVENOUSDRAINAGE

superiorandinferiorlaryngealveinssuperiorandinferiorlaryngealveins (followthearteriesintheircourse)(followthearteriesintheircourse)

superiordrainagesuperiordrainage joinsthesuperiorandmiddlethyroidveinsandthenthejoinsthesuperiorandmiddlethyroidveinsandthenthe

internaljugularinternaljugular inferiordrainageinferiordrainagejoinsthemiddlethyroidveinandtheinferiorthyroidvein,joinsthemiddlethyroidveinandtheinferiorthyroidvein,

whichemptiesintothesuperiorvenacavawhichemptiesintothesuperiorvenacava

LYMPHATICDRAINAGELYMPHATICDRAINAGE

larynxwellsuppliedwithlymphatics,withtheexceptionofthefreemarginsofthelarynxwellsuppliedwithlymphatics,withtheexceptionofthefreemarginsofthe

vocalfoldsthemselvesvocalfoldsthemselves

SuperiorgroupSuperiorgroup

area of the lar nx above the vocal cords is drained into the su erior and middlearea of the lar nx above the vocal cords is drained into the su erior and middle

jugularnodesjugularnodesInferiorgroupInferiorgroup

nodesaswellastotheparatracheallymphnodes.nodesaswellastotheparatracheallymphnodes.

41


42/64

ItisfromtheVagusbywayofitssuperiorandrecurrentlaryngealbranches. Itdescendslateraltothepharynx,behindtheinternalcarotid,supplytothe

cricothyroid

muscle,

divides

into

two

main

sensory

and

motor

branches.

Externallaryngealnerve suppliesthemucousmembraneofthelowerpartofthehar nx e i lottis valleculaandvestibuleofthelar nx ar e i lotticfold mucous

membranedowntothelevelofvocalfolds.

Internallaryngealnerve alsocarriesfibersfromneuromuscularspindlesandotherstretchreceptorsinthelarynx.

Suppliestheinferiorconstrictormuscleofthepharynx,anduniteswithanascendin branchoftherecurrentlar n ealnerve. ThisbranchiscalledGatens

anastomosis

or

loop

and

is

purely

sensory


43/64

recurrent(inferior)laryngealnerve ontherightsideleavestheVagusasthelattercrossestherightsubclavianarteryand

thenloopsunderthearteryandascendstothelarynx,betweentheoesophagusandtrachea

Thenervethendividesintomotorandsensorybranches

Themotorbranchsupplyalltheintrinsicmusclesofthe.

Thesensorybranchsuppliesthelaryngealmucousmembranebelowthelevelofthevocalfoldsandalsocarriesafferent

ers romstretc receptors nt e arynx.


44/64

Laryngeal membranes Location

Epithelium)

r covoca mem rane onus

Elasticus)

r g na es rom r co car age

and connects the Cricoid, Thyroid,

and Arytenoid cartilages together.Inserts into the true vocal folds

Quadrangular membrane Connects Epiglottis and Thyroid to

e ry eno car ages a e

back

44


45/64

surroundingstructures. Intrinsicmuscles

.

Muscle Origin Insertion Action


46/64

Posterior

cricoar tenoid

Back surface of

Cricoid lamina

Back surface of the

muscular rocess of

opens the glottis by

o enin the vocal folds

(PCA) Arytenoids

Lateral

cricoarytenoid

upper border of the

Cricoid arch

Front surface of the

muscular process of the

closes the glottis by

closing the vocal folds

(LCA) Arytenoids

Cricothyroid(CT)

Front and sides ofthe Cricoid arch

Thyroid lamina andlower horns of thyroid

Increases the lengthand tension of the vocal

folds

Vocalis inner surface of the

Thyroid

Front surface and vocal

process of Arytenoid

Increases tension of

vocal folds

Transverse

arytenoid

Muscular process

of one Arytenoid

Muscular process

of the opposite

Ar tenoid


Obliquearytenoid

Muscular processof one Arytenoid

Muscular processof the opposite

Arytenoid


Thyroarytenoi

d

inner surface of the

Thyroid

Front surface and vocal

process of Arytenoid

Relaxes the vocal folds


47/64

47


48/64

Includes

1 respiratoryo struction

2) Stridor

3) weakenedorabnormalcry,

5) Tachypnea (rapidshallowbreaths)

6 Aspiration7) episodesofcyanosis(bluecolorationdue

deoxygenatedhemoglob)

8 suddendeath.48


49/64

Highpitchedsoundresultingfromturbulent airflow

.

Indicativeofseriousairway obstructionfromsevere

con onssuc asep g o s,a ore gn o y.

Duringfetaldevelopment,thestructuresinthe

larynxmaynotfullydevelop.

Stridorisindicativeofapotentialmedical

emergency andshouldalwayscommandattention Itcanresolvesonitsown withoutmedical

intervention(apparentuntilabouttheageof5)49


50/64

commonanomaly(causeisunknown)

structuresoninspiration

Stridorduringinspirationwhich

worsensinthesupineposition,

feeding,agitationwithNormalPhonation

Thesymptomsmayincreasebutusuallyresolvesby

Tracheotomy

in

place

for

2

years

spont.

recovery50


51/64

Symptomsvarydependingonwhetherunilateralor

bilateralvocalcords aral zed.

BilateralVCparalysis:CNS immaturity,lesionsin, , .

Symptoms:

nsp ratorystr oratrestt atworsensupon

agitationinchildren

Progressiveairwayobstruction

Aspirationsresultinginrecurrentchestinfections

andafailuretothrive51


52/64

UnilateralVocalCordParalysis:usuallyidiopathic,

,

totheleftrecurrentlaryngeal.

n a era para ys smayman es ur ng e rs

fewweeksoflife,oritmaygounnoticed.

Symptoms:

Hoarse,breathycrythatisaggravatedbyagitation,

Feedingdifficulties

52


53/64

Incompletedevelopmentduringthethirdmonthof

subglotticstenosis

Symptoms

Respiratory

stridor

(duringinspiration&expiration)

Cryisusuallynormal

Prognosisisusua ygoo . Mostsymptoms a eas

thebabymatures.53


54/64

rarecongenitalanomaliesduetoIncomplete

thirdmonthofgestation.

Symptoms:

Stridor

Aphonia,ormildhoarseorbreathycrythatis

aggravatedbyagitation Feedin difficulties

Aspiration &Obstructivecyanosis

54

Vocal Nodules


55/64

VocalNodules o u esare nyswe ngson o e s.

Excessivetalking,shouting,screaming,constant

throatclearing,imitationofothersvoices

noticedinchildrenandwomen

preventtheVFsfrommeetinginthemidline&

cause air leak throu h the vocal folds.

Symptoms:

rea yvo ce oarsevo ce

tirednessontalkingforafewminutes

noduleswilldisappearwhenvoicerest&voice

therapy55


56/64

Polypsarebenignlesionsofthelarynx(mostlyin

locatedontheoutermostsurfaceofthevocal

Symptoms

Breathyvoice&/Hoarsevoice

Feelingoftirednessontalkingforafewminutes

Voicetherapyaftersurgeryisnecessary.

56


57/64

Contactulcersarewearingawayofthemucous

membraneovertheVFs

causedbyvoiceabuse,pressedvoice,hyperacidity,.

Symptoms:

oarsevo ce

Painwhileswallowing

Painwhilephonation/speaking

condition.57


58/64

Laryngitisisinflammation(tenderness,redness,&

Duetoviralinfectionorvocalabuse/overuse.

Symptoms:

Change

in

voiceHoarsevoice

Dependingonthecause,treatmentvaries.

Voicerest,coughsuppressants,andsteam

inhalationsrelievesymptoms.58

Dysphonia Plica Ventricularis


59/64

DysphoniaPlica Ventricularis

(VentricularDysphonia) WhenthefunctionsofthetrueVFsareaffected,

ventr cu ar o s a se o s v rate

Paralysisoftruevocalfolds,vocalabuse,andsevere

laryngitiscauseventriculardysphonia.

S m tomsHarshvoice

Voicerestandvoicetherapycanrelievethesymptoms.

59


60/64

Causedbyinvoluntarymovementsofoneormore

Causeisunknown,oftennoticedafterURTI,

3majortypesofSD:

1. Adductortype(spasmoftheVFscausesstrained,strangledandeffortfulvoice)

2. Abductortype(laryngealspasmsresultsinsudden

spurtsofwhispered/breathyvoice)

3. Mixedtype(laryngealspasmscausessuddenstrained,

strangulatedvoicealongwithspurtsofbreathiness) 60


61/64

Causedbytheabnormalrefluxofthestomachacid

Mucosaofthepharynxandlarynxmaybedamaged

Symptoms:

Heartburn

Swallowingdifficulties

Regurgitationofstomachacid

Hoarse/

Harsh

voice61


62/64

Cancer candevelopinanypartofthelarynx.

3

anatomic

regions:

the

glottis,

the

supraglottis

Mostlaryngealcancersoriginateintheglottis.

Hoarsevoice&Sorethroat

Swallowing

difficulties

LumpEarpain

PersistentcoughwithStridor62


63/64

Surgicalremovalofthelarynxdue

.

typesTotallaryngectomy:completeremovalofthelarynx

Hemi

laryngectomy:

partial

removal

of

the

larynx Alaryngectomee istaughttospeakusingeither,an

artificial lar nx

treachoesophegeal speechor

esop agea speec .

63


64/64

64

Larynx Class Slides

Documents

Transcript of Larynx Class Slides