L1 Larynx PDF
L1 Larynx PDF
L1 Larynx PDF
Laryngeal cartilages:
Unpaired cartilages: These are three:
1. Thyroid cartilage:
Is the largest one and each half consists of:
- Ala (lamina) which meet in the midline forming an angle of about 90 degree in men and about
120 degree in women.
- Superior cornu: arises from the posterosuperior angle of the ala.
- Inferior cornu: arises from the posteroinferior angle of the ala and articulate with the cricoid
cartilage.
2. Cricoid cartilage:
Thicker and stronger than the thyroid cartilage, resembles a signet ring (narrow in front
and broad. behind), articulate with the arytenoids cartilages on the upper border of the cricoid
lamina.
3. Cartilage of epiglottis:
Rises up behind the tongue, it is leaf like sheet of elastic fibro cartilage the stem
directed downwards & is attached to the posterior surface of the thyroid ala at their
junction -while the upper free border directed upwards.
Paired cartilages: thesearethreepairs:
1.Arytenoid cartilages:
They are the largest, pyramidal-in shape, have the muscular process postero-laterally & the
vocal process anterolaterally, articulate inferiorly with the cricoid cartilage -while the apex,
curves backwards to articulate with the corniculate cartilage.
2. Corniculate cartilages (the cartilages of Santorini):
These are small articulate with the apices of the arytenoid cartilages and prolong
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them backward and medially.
3. Cuneiform cartilages (the cartilages of Wrisberg):
These are small bars of yellow elastic cartilages in each ary-epiglottic fold.
Laryngeal joints:
There are two important joints in the larynx on each side.
1. Crico-thyroid joint:
It is between the inferior cornu of the thyroid cartilage and cricoid cartilage. It is a synovial
joint with two movements (rotation and gliding).
2. Crico-arytenoid joint:
It is also a synovial joint with the same two movements.
Laryngeal muscles:
These are two types:
I. Intrinsic (between the laryngeal cartilages):
- Abductors of the vocal cords:
There is only one on each side named the posterior crico-arytenoid muscles which opens the glottis.
- Adductors of the vocal cords: There are three on each side:
1. Lateral crico-arytenoid muscle.
2. Interarytenoid muscle.
3. Thyroarytenoid muscle.
- Tensors of the vocal cords: these are two on each side:
1. Cricothyroid muscle (external tensor).
2. Internal portion of the thyro-arytenoid (Vocalis, internal tensor).
II. Extrinsic (Between the larynx and the neighboring structures): There are two main groups:
1. Strap muscles of the neck: sternothyroid & thyrohyoid muscles.
2. Pharyngeal muscles: stylopharyngeus, palatopharyngeus & inferior constrictor muscles.
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2. Recurrent laryngeal nerve:
It has a much longer course on the left side than on the right. On the left side it turns round
the arch of the aorta, while on the right side it turns round the subclavian artery, both of them runs
upward on both sides between the trachea and esophagus, as they approach the larynx they supply all
the muscles of the larynx except the cricothyroid muscle, also they give sensation to the cavity of the
larynx below the level of the vocal cords.
Lymphatic drainage of the larynx
The edges of the vocal cords divide the lymphatic system of the larynx into two parts:
L Supraglottic above the vocal cords: the vessels drain into:
- Preglottic nodes.
- Upper deep cervical nodes.
2. Subglottic below the vocal cords: the vessels drain into:
-Prelaryngealandpretrachealnodes.
- Lower deep cervical nodes.
3. The vocal cords themselves have no lymphatic vessels.
Functions of the larynx
1. Protection of air passages.
2. Phonation.
3. Aspiration.
4. Fixation of the chest.
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Diseases of the larynx
Laryngeal cyst
Lead to muffled cry & sometimes stridor.
Laryngeal web
Web consist of a fibrous tissue stroma covered by epithelium in the anterior half of
the glottis due to arrest in development, sometimes atresia may be complete.
Clinical features:
- Hoarseness.
- Inspiratory stridor.
Diagnosis:
- Fibroptic laryngoscopy or direct laryngoscopy.
Treatment:
1. No treatment in the milder forms.
2. Laser excision.
3. excision by laryngofissure, which may be advised later until the larynx developed fully.
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Vocal cord palsy
This causes inspiratory stridor & hoarseness in neonate; diagnosed by fibroptic
laryngoscopy, caused by damage to the recurrent laryngeal nerve in the neck or chest
usually from, birth trauma.