1. ANATOMY AND PHYSIOLOGY OF THE LARYNX
Yard.Doc.Dr.Müzeyyen Doğan

2. Learning goal and objectives of the lesson
Learning goal of the lesson: The learner should know the basic anatomic structures, embryology and physiology of the larynx
Learning objectives of the lesson the learner will be able to
identify the anatomic structures of the larynx
identify the physiology of the larynx

3. LARYNX Adult: between 3th and 6th cervical vertebra
İnfant: between 1st and 4th cervical vertebra
Attaches to the hyoid bone and opens into the laryngopharynx superiorly
Continuous with the trachea posteriorly

4. Embryology I Respiratory primordium Third week– 26 days
Respiratory primordium separated by tracheoesophageal folds
Fuse to form septum (4-5 weeks)

5. Embryology II Larynx from 4th and 5th arches
Primitive larynx altered by hypobranchial eminence, epiglottis, arytenoids
Laryngeal lumen obliterated and recanalized

6. Differences in adults and infants
1/3 size at birth
Narrow dimensions (subglottis vs. glottis)
Higher in neck and more pliable
Epiglottis narrower

7. Framework of the Larynx

8. Osseous Structure HYOID BONE Greater cornu(cornu majus)
Lesser cornu (cornu minus)
Corpus hyoideum (body)

9. Cartilage -1 unpaired cartilages thyroid, cricoid, and epiglottis
paired cartilages arytenoids, corniculates, and cuneiforms

10. Cartilage -2

11. Epıglottic Cartilage
This leaf shaped cartilage is composed mainly of elastic cartilage
elastic cartilage that covers the laryngeal inlet during swallowing

12. Thyroid cartilage
The thyroid cartilage is also known as the Adam’s apple. It is a large V-shaped cartilage that houses and protects the vocal cords and the opening to the trachea. The vocal cords attach to the thyroid cartilage at the front of the neck, just under the epiglottis.

13. Cricoid cartilage Arcus cricoidea Lamina cricoidea
The cricoid cartilage may be regarded as the base and support for the entire larynx.

14. Paired cartilages
arytenoids, corniculates, and cuneiforms

15. Arytenoid cartilage Pyramidal shape Joint with corniculate cartilage.
Processus vocalis lig.vocale
Processus muscularis m.cricoaritenoideus lateralis and posterior

16. Joints
CRICOTHYROID JOINT
CRICOARYTENOID JOINT

17. Cricoarytenoid Joint
Cricoid cartilage articulates with the arytenoids via the cricoarytenoid joints. (synovial joint).

18. Cricothyroid Joint
Cricoid cartilage articulates with the thyroid cartilage via the cricothyroid joints (synovial joint)

19. Ligaments and Membranes I
extrinsic ligaments
thyrohyoid membrane
thyrohyoid ligaments
thyroepiglottic ligament,
hyoepiglottic ligament,
cricotracheal ligament.

20. Ligaments and Membranes II
intrinsic ligaments
quadrangular membrane
vestibular ligament
conus elasticus
median cricothyroid ligament
vocal ligament

21. Thyrohyoid membran
This broad fibroelastic sheet is attached from the superior border and the superior horn of the thyroid cartilage to the posterior surface of the body and greater cornua of the hyoid bone )

22. Conus Elasticus
This membrane arises from the inner surface of the cricoid arch

23. Quadrangular Membrane
It extends from the lateral margins of the epiglottis within the aryepiglottic fold and attaches to the arytenoid and corniculate cartilages. The inferior free edge is thickened to form the vestibular ligament (false vocal cord). The superior edge is also free and it is covered with aryepiglottic fold of mucosa.

24. Vocal cords Örtü-Gövde (Hirano) Epitel Reinke tabakası Vokal ligaman
Vokalis kası

25. Larinks Kasları Intrinsic muscles:
cricothyroids, posterior cricoarytenoids, lateral cricoarytenoids, transverse arytenoid, oblique arytenoids, and thyroarytenoids
extrinsic muscles :
strap muscles

26. Intrinsic Muscles Cricoarytenoid Cricothyroid Interarytenoid
Thyroarytenoid
Thyroepiglottic muscles

27. Extrinsic muscles Infrahyoid muscles Omohyoid Sternohyoid
Sternothyroid
Thyrohyoid

28. Extrinsic muscles Suprahyoid muscles digastric geniohyoid mylohyoid
stylohyoid
stylopharyngeus
thyrohyoid .

29. Suprahyoid muscles

30. Intrinsic Muscles abduction of the vf. Posteroir cricoarytenoid m
adduction of the vf
thyroarytenoid / vocalis muscle
Lateral cricoarytenoid m
İnterarytenoid and obliq muscles
tension of the vf.
krikotiroid m

31. m.interarytenoideus
Transvers Part: Adduction of the vocal folds by approximating the arytenoid cartilages
Obliq Part: Sphincter of the inlet of the larynx during the act of swallowing Closes laryngeal inlet by approximating arytenoid cartilages.

32. m.cricoarytenoideus m.cricoarytenoideus posterior
abductor of the vocal cords
m.Cricoarytenoideus lateralis
closes the glottis by adducting the vocal folds

33. m.tyroaritenoideus
Thyroarytenoideus internus or vocalis muscle is the major tensor of the free edge of the vocal fold.
Thyroarytenoideus externa contraction draws the arytenoid cartilages foreward toward the thyroid, thus shortening the vocal ligament.
Thyroepiglotticus widens the inlet of the larynx

34. m.cricothyroideus
The CT produces elongation and tension of the vocal fold ligament by elevating the arch of the cricoid cartilage upward toward the lowermost aspect of the thyroid ala. Contraction of the CT also rotates the arytenoids medially, adducting the vocal folds.
Innervation
external branch of the superior laryngeal nerve

35. Intrinsic Muscles

36. Vascular System Arterleri a.thyroidea superior ve inferiordan gelir
Venleri (v.laringea superior ve inferior) 
v.thyroidea superior ve inferior
v.jugularis interna

37. Arterial Drainage a.carotis eksterna a.thyroidea superior
a.thyroidea superior
a.laryngea superior
a.cricothyroideus
Subclavian arter 
Turuncus thyroservicalis
A.thyroidea inferior
A.laryngea inferior

38. Arterial Drainage SUPERIOR LARYNGEAL A. INFERIOR LARYNGEAL A.
CRICOTHYROID ARTER

39. Venous Drainage
SUPERIOR LARYNGEAL V.
INFERIOR LARYNGEAL V.

40. Lymphatic Drainage Glottik bölgenin lenf drenajı zayıf
Suprglottik bölgenin lenf drenajı derin servikal lenf nodları
Subglottik bölgenin lenf drenajı alt derin servikal lenf nodları, pretrakeal lenf nodları, prelaringeal lenf nodları

41. Nerve -1 Motor to all intrinsic muscles Sensory to infra-glottic area
Recurrent laryngeal nerve
Motor to all intrinsic muscles
Sensory to infra-glottic area
Frequency dependent
Superior laryngeal nerve
Supra-glottic afferent (int.)
Cricothyroid muscles (ext.)

42. Nerve -2

43. Internal cavity of the larynx
supraglottic space (also called the vestibule which is surrounded by the piriform fossa)
preepiglottic space
paraglottic space (which contains the ventricles)
subglottic space (which is the area below the true vocal folds).

44. supraglottic space
Superior border : free margin of the epiglottis and aryepiglottic folds
Inferior border: lower margin of the ventricular or false vocal folds

45. preepiglottic space Superior border : hyoepiglottic ligament
Anterior border: thyrohyoid membrane and ligament
Posterior border: anterior surface of the epiglottis and thyroepiglottic ligament

46. supraglottic space
Superior border : free margin of the epiglottis and aryepiglottic folds
Inferior border: lower margin of the ventricular or false vocal folds

47. paraglottic space Superior border : quadrangular membrane
Inferior border: conus elasticus
Lateral border: inner surface of the thyroid cartilage
Medial border: ventricle

48. Laryngeal Histology
It is lined mainly by a pseudostratified, ciliated, columnar epithelium .
It also contains a mucosa with laryngeal glands and a few taste buds.
The true vocal folds have a specialized histology different from the rest of the larynx.
Virtually all the laryngeal membranes and ligaments consist of elastic and collagenous fibers.
All the laryngeal muscle is cross-striated muscle. .

49. Laryngeal Physiology 1.protection 2.respiration 3.phonation
4.effort closure

50. Speech Production begins in cerebral cortex
precentral gyrus to motor nuclei then coordinated activity

51. Phonation

52. Myoelastic - aerodynamic theory
1.glottis closed
2.subglottal pressure increases
3.vocal folds are blown open in a zipper-like fashion (from lower towards the upper lip)
4.glottis open
5.subglottal pressure decreases
6.recoiling forces and the Bernoulli effect adduct the vocal folds back together (also in a zipper-like fashion with the edges of the lower lip closing first)

53. Phonatory cycle vocal folds approximated
infraglottic pressure builds up
pressure opens folds from bottom up
upper portion with strong elastic properties

54. Movements of Vocal Cords

55. PHONATION

56. Physıcal Examination I
Inspection
Palpation
Indirect Laryngoscopy
Direct Laryngoscopy
Radiography
Neck films, chest films
Barium swallow
CT/MRI

57. Physical Examination Iı
Videolaryngostroboscopy
Glottography
Laryngeal EMG

58. CADAVER I

59. CADAVER II

60. CADAVER III