1. Dr Pedro Amarante Andrade
Head & Neck 4 Larynx & Phonation
Dr Pedro Amarante Andrade
Marianne Bos-Clark

2. LARYNX/PHONATION SOURCES/READING
Atkinson & McHanwell (2002) Basic Medical Science for SLT students London: Whurr
Ch.16 Neck/Larynx
Ch.17 Phonation
Mathieson (2001) Greene & Mathiesosn’s The Voice & Its Disorders London: Whurr
Ch.2 Larynx/ Upper resp. tract
Ch.4 Voice and phonation
Standard anatomy/physiology texts
Internet

3. LARYNX/PHONATION Structure Lx: Cartilages Muscles Vocal folds
Innervation
Function:
Normal voice production
Voice quality

4. Breathing Protection Phonation
Culture & Language Sciences – Information pack
Breathing
Protection
Phonation
Taken from Blausen.com staff: “Blausen galery 2014”. Wikiversity Journal of Medicine

5. THE LARYNX

6. LARYNX LOCATION
Laryngeal cartilages. Taken from (Olias 2004)

7. LARYNX – ANTERIOR & POSTERIOR VIEWS
Laryngeal cartilages. Taken from (Olias 2004)

8. LARYNX – POSTERIOR & LATERAL VIEWS
Laryngeal cartilages. Taken from (Olias 2004)

9. LARYNX- SAGITTAL VIEW
From Gray's Anatomy 1918 edition. Public domain

10. LARYNX – POSTERIOR & FROM ABOVE
From Gray's Anatomy 1918 edition. Public domain

11. THE LARYNX CARTILAGES

12. LARYNGEAL CARTILAGES 9 cartilages, 3 unpaired, 3 paired
Thyroid cartilage
Cricoid cartilage
Epiglottis
Arytenoid cartilages
Minor cartilages: corniculate & cuneiform

13. EPIGLOTTIS
Culture & Language Sciences – Information pack

14. EPIGLOTTIS Epiglottis in action
Culture & Language Sciences – Information pack

15. THYROID Largest of the laryngeal cartilages;
Titze IR. Physiologic and acoustic differences between male and female voices. J. Acoust. Soc. Am. 1989;85(4):
Culture & Language Sciences – Information pack
Largest of the laryngeal cartilages;
Composed by two plate-like laminae;
Laryngeal prominence – Adam’s apple;
Houses the vocal folds;

16. THYROID – SAGITTAL VIEW
Epiglottis
Hyoid Bone
Thyroid cartilage
Vocal folds
Arytenoid
Culture & Language Sciences – Information pack
Cricoid

17. CRICOID from Greek ‘ring-shaped’;
Culture & Language Sciences – Information pack
from Greek ‘ring-shaped’;
Only complete ring of cartilage around the trachea;
Sits on the top of the trachea;

18. ARYTENOIDS Pyramid-shaped pair of cartilages;
Culture & Language Sciences – Information pack
Pyramid-shaped pair of cartilages;
Base slides on the top to of the cricoid;
its lateral angle is called muscular process
Its anterior angle is called the vocal process;

19. LARYNGEAL STRUCTURE Laryngeal membranes Thyrohyoid membrane
Cricotracheal membrane
Cricothyroid membrane ligament
Laryngeal Joints
Cricothyroid
Cricoarytenoid

20. LARYNX – ANTERIOR VIEW

21. LARYNX – POSTERIOR VIEW

22. LARYNGEAL INLET Laryngeal vestibule infra/supra-glottis True VF
False VF/vestibular folds
Ventricular/laryngeal sinus

23. VOCAL FOLDS
vocal fold (left/right); ventricular fold; trachea; epiglottis; arytenoid cartilage;

24. LARYNGEAL MUSCLES EXTRINSIC

25. EXTRINSIC LARYNGEAL MUSCLES
Suprahyoid (elevators)
Digastric
Stylohyoid
Mylohyoid
Geniohyoid
Infrahyoid (depressors)
Sternohyoid
Sternothyroid
Omohyoid
Thyrohyoid

26. LARYNGEAL MUSCLES Intrinsic

27. CRICOTHYROID MUSCLE (CT)
Divided into two parts: Vertical/Straight and Oblique;
Only intrinsic muscles innervated by the ‘external branch of the superior laryngeal nerve’
Contraction of vertical part of CT rotates the thyroid forward;
Contraction of the oblique part pulls the thyroid forward;
Cricothyroid joint;

28. OTHER INTRINSIC MUSCLES
(TA) Thyroarytenoid
muscles
(IA) Interarytenoid
muscle
(LCA) Lateral Cricoarytenoid muscle
( PCA) Posterior Cricoarytenoid muscle

29. All above muscles are innervated by the ‘recurrent laryngeal nerve’
INTRINSIC MUSCLES
and their function
All above muscles are innervated by the ‘recurrent laryngeal nerve’

30. VOCAL FOLDS Histology

31. Principles of Voice Production. Titze, 2000
VOCAL FOLDS HISTOLOGY
Principles of Voice Production. Titze, 2000

32. VOCAL FOLDS HISTOLOGY

33. VOCAL FOLDS: MEMBRANOUS AND CARTILAGINOUS PORTION

34. LARYNX Innervation

35. LARYNGEAL INNERVATION
X VAGUS
All innervation intrinsic laryngeal muscles
Sensory structures larynx
Superior laryngeal nerve:
internal & external superior branches
Left & right recurrent laryngeal nerve

36. LARYNGEAL INNERVATION
X Vagus
All innervation intrinsic laryngeal muscles
Sensory structures Lx

37. LARYNGEAL INNERVATION
X Vagus
Superior laryngeal nerve:
internal & external superior branches
Left & right recurrent laryngeal nerve

38. PHONATION
Own Work, following M. Hirano, The vocal cord during phonation, Igaku no Ayumi 80 (1968), no. 10.
Author: Reinhard

39. PHONATION

40. VOICE ASSESSMENT SUBJECTIVE

41. PERCEPTUAL VOICE EVALUATION GRBAS (Hirano 1986)
Rate the voice samples, for parameters
Grade
Rough
Breathy
Asthenia (weakness)
Strain
Scoring
0 = normal
1 = mild
2 = moderate
3 = severe
If relevant, comment on amplitude & fundamental frequency or anything else you may notice about the voice
LCSD08H | Voice and Fluency

42. PHONATION: VOICE QUALITY
Judging voice quality on perceptual scales
such as the GRBAS (Hirano 1986)
G2R2B2A1S0
0=normal; 1=mild; 2=moderate; 3=severe

43. PHONATION: VOICE QUALITY
GRBAS it:
0=normal; 1=mild; 2=moderate; 3=severe
VOICE 01
VOICE 02
VOICE 03
VOICE 04
VOICE 05

44. EXAM PREP Explore the larynx on Anatomy TV
Make sure you have a good understanding of the basic structure and function of the larynx, as well as the methods of examination used by ENT/Specialist SLTs