The Larynx

Today , we will start with a new topic , it's (the larynx).. So, Do you know what does "larynx" mean???? The larynx is that Organ, which is made of group of cartilages which are connected to each other by connective tissue membranes & ligaments and to move these cartilages we need skeletal muscles to attach to them so we can move them.

**Definition ::
A special part of the body consists of group of cartilages which are connected to each other by membranes & ligaments and moved by Skeletal muscles. ##so from the previous definition, There are three major components of larynx: 1-group of cartilages. 2- Connective tissue of membranes & ligaments. 3- Skeletal muscles. Location: Larynx is located in the neck at the vertebral level of C4, C5 and C6. At the level of C6 "larynx" will become the "Trachea", and behind the larynx there is the laryngeal part of the pharynx>> the laryngeal pharynx!

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So you will find: *Larynx (ant) --- pharynx (post) And at the level of C6: * Trachea (ant) --- esophagus (post) *Functions of the larynx: 1-Protective sphincter for inlet of airway passage to the lungs "9ammam" ,if we close this sphincter , we will prevent Foreign objects to enter Trachea (the lungs)." the most important function " .. 2-Voice production (larynx contains the vocal cords or vocal ligaments which help in the production of sound).. So, let's start with the components of this organ, we'll talk about each one separately, as we said we have "cartilages" then "membranes & ligaments " and "skeletal muscles". 1. Cartilages: Cartilages of the larynx can be Classified: into two different types based on their number - : *Single Cartilages (only one). *Paired Cartilages (two, couple: right and left).

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First of all : The single cartilages :

*Thyroid cartilage*:

*Thyroid cartilage *: (hyaline cartilage) Oid means like it's shield like structure ,that shield for remaining parts of the larynx which protected by this Cartilages so it looks like a shield protecting the upper part of the larynx.

So its Singular, the largest, and the most prominent one, we can notice it in the neck by Adams apple or what we called laryngeal prominence (which is a part of thyroid cartilage). **This cartilage Consists of: 1- two Laminae one on each side : these laminae meet in the midline to form a sharp angle in this region which is called ( Adams apple) or laryngeal prominence (because it's very prominent), also inside these laminae we can see a Linear elevation which is passing Obliquely to form (Oblique line)this line indicates an attachment for muscles, we have three muscles attached to the oblique line on each side , so what are these muscle? 1-stenothyroid muscle: one of the infra hyoid muscles "comes from the sternum to the thyroid to the oblique line of thyroid-". 2- thyrohyoid: from the oblique line up to the hyoid . 3-inferior constrictor muscle of the pharynx, which is the lowest muscle, forms the wall of the pharynx.

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** the pharynx :
Large organ made of three muscles ( the 3 constrictors :Sup., mid. & inf.), arranged like a funnel ! They contract consequently from Sup, then mid, then inf. to produce swallowing action and push food from sup all the way down to esophagus, finally next lecture we will explain it more .

we can see two horns :at the end of each laminae Laterally ,, - Superior Horn, which goes superiorly.. - Inferior Horn, which goes inferiorly..

Note: the superior horn usually articulates with the hyoid bone through the lateral Thyrohyoid ligament, while the inferior Horn articulates with the inferior cartilage of the larynx, we call it Cricoid Cartilage, these articulations are synovial joints by the way.

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**Cricoids cartilage:

This Cartilage is considered as the lowest part of larynx, it is small ring of hyaline cartilage Located inferior to the thyroid cartilage,. **This cartilage Consists of: -Anterior arch narrow -Broad Posterior lamina "more deep ". So this cartilage becomes bigger and wider as we move posteriorly !

**Epiglottis cartilage: Epimeans: above, glottis: means larynx. This cartilage considered as the highest (most sup.) cartilage, it's a leaf-shaped of elastic cartilage tissue covered with a mucus membrane. Why is it elastic cartilage( not hyaline)???? To allow for its movement! (this sphincteric function of larynx wall when epiglottis returns back it will close superior open of larynx (this usually happens when you are swallowing *move food there* so epiglottis goes post. to close this open, but after food goes down, the epiglottis will open to allow air go through larynx to trachea. So larynx must be elastic to close and open .. So again it's leaf like shape contains two parts >> 1. Inferior one >> the stalk .2.superior one >> upper edge . Epiglottis cartilage attachments : -sup. Upper edge: free, to allow its movements. -Inf. Part (stalk) : attached to the thyroid cartilage. -at the sides: it's attached through a membrane
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To a post cartilage called "arytenoid cartilage" this membrane is called Aryepiglottic membrane which extends from arytenoid (post) all the way to the epiglottis (ant), but the upper free margin of this membrane is called aryepiglottic fold ( because this membrane goes up then descends down to form a fold) .

In Post view of larynx : you will find ( lamina of cricoids) no thyroid cartilage so the thyroid shield (open post.) , just protected anterio- laterally. Now, when you look to the larynx from the posterior, You will see that the mucus membrane that covers the epiglottis, is extended forward toward the tongue and covers the surface of the tongue, this means that the mucus membrane covers the tongue and continue to cover the epiglottis, by this it is forming a fold, we call it glossepiglottic membrane which is the mucus membrane between the epiglottis and the tongue, this reflection of the mucus membrane between the epiglottis & the dorsal surface of the tongue when you look to it you will see that there is
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an elevation & a depression, the elevation represents a fold, we call it glossoepiglottic fold, the one in the midline we call it the median glossoepiglottic fold, and two folds on the lateral sides, we call them lateral glossoepiglottic folds . The depression on each side of median glossoepiglottic fold is called the Valleculae (singular; Vallecula).

-Valleculae:: prevent the swallowing of sharp( foreign) objects , those objects can easily cause injury to the esophagus. ** so singular cartilages of the larynx are : Thyroid. Epiglottis. Cricoid. **Paired cartilages **: Arytenoid cartilage, pair of small pyramidal shape cartilages with its apex superiorly & its base inferiorly- In the post. Larynx, on cricoid cartilage. *The base : is resting on the lamina of cricoid cartilage; hence the lamina of cricoid is located in the posterior Aspect of the larynx than the arytenoid is in the post Part of the larynx.
THE LAMINA OF CRICOI D CARTILAG E:: ARTICULATES WITH THE CRICOIDS BY A SYNOVIAL JOINT THAT MEANS THERE IS FREE RANGE OF MOVEMENT .

The apex :of these paired cartilages articulate with smaller cartilages, called the Corniculate cartilages, corniculate mean like a horn.

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This pyramidal shape has 2processes "two long elevations" , one extends anteriorly on each of arytenoid the Vocal processes extends anteriorly from the arytenoid , the Vocal ligaments or the true vocal cords attach there , the vocal ligaments attach from the vocal processes of arytenoid all the way anteriorly to the thyroid ligaments anteriorly .

The lateral processes, extend laterally, not as sharp as ant. processes because there are more structures with larger attaching these processes are called the Muscular processes, muscular because they provide muscles attachment . The muscles that attach with the muscular processes are : _the lateral cricoarytenoid muscles, come from the lateral side of cricoid to the muscular processes of arytenoid. _the posterior cricoarytenoid muscles , from behind of cricoid up to arytenoid .

The function of cricoarytenoid muscles : Because the cricoid is fixed ,the arytenoid is smaller, resting on it and rotating (movable) , these muscles start to move the muscular processes whether anteriorly or posteriorlyso they will move the arytenoid , and due to the attachment between arytenoid and vocal ligaments this movement will cause vocal ligaments to move and produce the sound .

The function of the larynx is voice production, the ligaments and muscles attached to the cartilages will move, movement of arytenoid will move these ligaments producing the voice.

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In the Larynx the attachment of any ligament membrane or muscle from its name , cricoarytenoid from cricoid to arytenoid , thyroarytenoid from thyroid to arytenoid like the thyroarytenoid membrane .

**Corniculate cartilages Two small conical shape above the arytenoid

**Cuneiform Cartilages Small cartilages ,hidden by the free margins of the aryepiglottic membrane , in the middle within the membrane there are 2 small cuneiform cartilages , to strengthen the aryepiglottic fold .

Membranes of the Larynx : 2 membranes between the cartilages of the larynx, Intrinsic membranes they connect the cartilages of the larynx together

2 Other membranes connecting the cartilages to the outer structures of the larynx, extrinsic membranes. _The superior one connect the larynx with the hyoid bone , it extends from thyroid cartilage to the hyoid bone , the thyrohyoid membrane _The other one is below,it connects the cricoid which is the lowest part of the larynx with the first tracheal ring "the trachea" , so it's called "Cricotracheal membrane".

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The 2 intrinsic membranes : If I cut the larynx and look inside (sagittal, midline cut) and look laterally we can see two membranes : The aryepiglottic membrane connecting the epiglottis anteriorly to the arytenoid cartilage , it's quadrangular in shape it has 4 angles- , so we also can name it as "Quadrangular membrane".. So, Aryepiglotticmem. = Quadrangular membrane.

So 4 margins to it, the anterior margin connect to the epiglottis , the posterior margin to the arytenoid , the upper and lower margins not attached they are free

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_Free upper margin is the Aryepiglottic fold and it's containing within it the cuneiform cartilage ,it's function is : strengthen the upper margin . -Free lower margin become thickened and referred to it as Vestibular fold , because it holed within the vestibule (the space of the larynx) , any space or cavity = vestibule.

The vestibular folds are fixed (there is no muscle to move them) , so we refer to them as False vocal cords , false vocal cords = lower margin of quadrangular membrane .

The other intrinsic membrane is the Cricothyroid membrane , between thyroid and cricoid cartilages , its like a triangle, going all the way in three dimensions along the cricoid arch, attached anteriorly only to the thyroid cartilage , the membrane going all the way to the other side , see in the picture the upper margin of our side toward us (left side) , it will go to the right side see the upper margin of the right side , try to imagine it in 3D . The membrane go from the upper border of cricoid cartilage all the way UP , the upper free margins are not attached to anything BUT to fix them they are attached to their ends ONLY (ant. & post. ends), in order to tense them, BUT the whole margin is not attached , those UPPER 2 margins are the True vocal cords .

Its superior margin is free but to tense it & keep it fixed , its attached anteriorly to the thyroid cartilage at the (ant. end) , the posterior end is attached by vocal process of arytenoid cartilage. **It extended from the cricoid to the thyroid then to the arytenoid**

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look to the larynx from above , see the shield which is the thyroid cartilage , the most superior part the epiglottis , see the cricoid lamina , the arytenoids , from the cricoid you see the inferior margin of the cricothyroid membrane The upper free margins of cricothyroid membrane form the Vocal cords

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Vocal Ligaments, free upper margin

Membrane

SO 2 kinds of ligaments there : _The Vestibular ligaments, fixed ones, the lower margin of the quadrangular membrane, false vocal cords. _the upper margin of the cricothyroid membrane, true vocal cords .

Cricothyroidotomy Not complete ectomy just a cut between thyroid and cricothyroid in the cricothyroid membrane

If you place your finger on Adams apple there is very rigid area which is the thyroid cartilage , at a certain distance you will feel that there is a gap (soft area) , after the soft area there is another hard rigid tissue which is the arch of cricoid .
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Thyroid cartilage Cricothyroid membrane Cricoid cartilage

In the cricothyroid membrane there is nothing important no arteries nerves & even veins so its very easily to penetrate this area to get into the airways , clinically it can be used during emergency (car accident), if there is an obstruction in the upper airways , if broken mandible closing the oral cavity and there is bleeding from the nose , the patient cant respirate (oral and nasal incubation not possible), or fractures Le Fort II fractures ,,

To maintain airways just penetrating in this area or do a small cut so the air can enter .

*Cricothyroidotomy just emergency NOT in the clinic *clinically cut a part of the tracheal rings and place a tube there (trachiostomy) .

The patient gets into a coma if there is an obstruction . Sometimes they dont cut, they just insert a needle and leave it open , avoiding reclosing again !

Good luck all :) Done by : Rahaf Hassan Malak Abu saqulah

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