1. CARTILAGES, JOINTS AND MUSCLES OF THE LARYNX
Dr. Andrea D. Székely
SEMMELWEIS UNIVERSITY
Department of Anatomy, Histology and Embryology

2. THE LARYNX MAJOR FUNCTIONS Clinical relevances
To separate the respiratory and digestive tracts
Phonation
respiration
Cough
Abdominal crunch
Os hyoideum
Cartilago thyroidea
Clinical relevances
Loose Submucosa (Glottic edema)
Laryngitis
Croup (Diphteria)
Pseudocroup (subglottic laryngitis)
Oncological diseases
Conicotomy, Intubation
Cartilago cricoidea
Glandula
thyroidea
Trachea

3. DESCENT OF THE LARYNX Newborn babies C 3 - 4 Adults C 4 - 6
upper edge of thyroid C4/5,
cricoid cartilage C6

4. COMPONENTS OF THE LARYNX
Skeleton
Muscle
Ligaments/membranes
Fibroelastic Membranes
Mucosa
Nerves, vessels and lymph vessels +
MAJOR CARTILAGES
Thyroid cartilage
Cricoid cartilage
Epiglottis
Arytenoid cartilage
MINOR CARTILAGES
Corniculate cartilage (Santorini)
Cunieform cartilage (Wrisberg)
Triticeal cartilage

5. THYROID CARTILAGE Right Lamina Superior thyroid notch Superior horn
Laryngeal Prominence
(Adam’s apple)
Right lamina
Left lamina
Oblique Line
Inferior horn
Articular facet
of cricoid
Inferior thyroid notch
LATERAL A S P E C T
Right
Lamina
superior thyroid tubercle
Oblique Line
inferior thyroid tubercle

6. CRICOID CARTILAGE Lamina Articular facet for arytenoid Lamina
Arch
Lamina L A T E R S P C
CRICOID CARTILAGE S U P E R I O A C T
Lamina
Articular facet
for arytenoid
Articular facet
for thyroid
Arch
Lamina
Facies articularis
arytenoidea
thyroidea
POSTERIOR ASPECT

7. Articular surface of cricoid Anterolateral surface
ARYTENOID CARTILAGE D O R S M E I A L P C T
Apex L A T E R S P C
Vocal
Process
Corniculate Cartilage (Santorini)
Apex
Posterior
surface
Medial
surface
Muscular
Process
Vocal
Process .
Articular surface of cricoid
Basis =
VENTROLATERAL ASPECT
Apex
Oblong fovea
Triangular Fovea
Arcuate Crest
Colliculus
Cartilago corniculata (Santorini)
Anterolateral surface
Vocal Process
Muscular Process

8. EPIGLOTTIS
Carina epiglottidis
Petiolus epiglottidis

9. LET’S COMPOSE THE SKELETON OF THE LARYNX
Epiglottis
Epiglottis
Petiolus epiglottidis
thyroid
thyroid
articular facet
of cricoid
Basis or
arytenoid
arytenoid
articular facet
of arytenoid
articular facet
of arytenoid
cricoid
cricoid
articular facet
of thyroid

10. CARTILAGES ARE CONNECTED BY MEMBRANES AND LIGAMENTS
Hyoid bone
epiglottis
Corniculate cartilage
Thyroid cartilage
Arytenoid cartilage
Cricoid cartilage
trachea

11. MEMBRANES AND LIGAMENTS
Triticeal Cartilages L
Thyrohyoid membrane
+ median and lateral
Thyrohyoid Ligaments M L M
Cricothyroid Lig.
(Conic Lig)
Conicotomy
Cricotracheal Lig.

12. Corniculopharyngeal lig.
INTERNAL LIGAMENTS
Thyrohyoid membrane +
median and lateral
thyrohyoid ligaments L
Vestibular Ligament M
Corniculopharyngeal lig.
Thyroepiglottic Lig.
Medial
cricothyroid Lig.
(Lig. conicum)
Vocal Process
Cricotracheal Lig.
Vocal Ligament

13. JOINTS OF THE LARYNX Cricothyroid joint Cricothyroid joint
Os hyoideum
Epiglottis
Thyrohyoid
foramen
(sup. laryngeal a,v,n. )
Cricothyroid joint
HEAD: inferior horn of the thyroid
(articular facet)
SOCKET: thyroid surface of the cricoid
(between arch and lamina)
CAPSULE: tight
LIGAMENTS: ant, post, lat,
(enforce the capsule)
TYPE: hinge
Tilts the thyroid around the
transverse axis
(stretches the vocal cord)
Cornu superius
Membrana
thyrohyoidea
Cartilago thyroidea,
lamina dex.
Cornu
inferius
Membrana crico-
thyroidea
(lig. conicum)
Trachea
Lig. crico-
tracheale
Cricothyroid joint
Lig. anulare

14. JOINTS OF THE LARYNX CricoARYTENoid joint Cricoarytenoid joint
Membrana thyrohyoidea
CricoARYTENoid joint
Head: arytenoid articular facet of the cricoid
Socket: cricoid articular facet of the arytenoid
CAPSULE: +
Ligaments: ant, post
Type: trochoid
Rotation and gliding
Cartilago
triticea
Epoglottis
Lig. thyrohioideum
laterale
Cornu
superius
Cartilago
corniculata
Cartilago
arytenoidea *
Cartilago thyroidea
(lamina dex.)
Cornu
inferius
Cartilago
cricoidea
Processus muscularis
Trachea
Cricoarytenoid joint
*corniculopharyngeal lig.

15. PARTS AN BORDERS OF THE RIMA GLOTTIDIS
GLOTTIS
PARTS AN BORDERS OF THE RIMA GLOTTIDIS
Rima glottidis
2-2,5 cm long
0,5-1,5 cm wide
Intermembranous Part
Intercartilaginous Part

16. LARYNGEAL MUSCLES Lateral cricoarytenoid muscle 1. 2.
Cartilago
thyroidea,
lamina
Processus
vocalis
Arcus cart.
cricoideae
Cartilago
thyroidea,
lamina
Processus
vocalis
Lig. vocale
muscularis
Lig. vocale
Cartilago
arytenoidea 1. 2.
Rima glottidis
1. Pars inter-
membranacea
2. Pars inter-
cartilaginea
Processus
muscularis
Cricoid
Arch
(anulus)
ORIGIN cricoid arch (upper lateral edge)
INSERTION muscular proc. of arytenoid
CLOSES THE RIMA GLOTTIDIS
At the pars intermembranacea

17. POSTERIOR CRICOARYTENOID muscle THE ONLY OPENER OF the RIMA glottiDIs
LARYNGEAL MUSCLES
POSTERIOR CRICOARYTENOID muscle
„POSTICUS”
ORIGIN cricoid lamina
INSERTION muscular proc. of arytenoid
Aditus laryngis 1. 2.
Rima glottidis
1. Pars inter-
membranacea
2. Pars inter-
cartilaginea
Posterior
cricoarytenoid m.
(POSTICUS)
Arytenoid m.
transverse part
oblique part
Aryepiglottic m.
Aryepiglottic
fold
THE ONLY OPENER OF the RIMA glottiDIs

18. CLOSES THE RIMA GLOTTIDIS At the pars intercartilaginea
LARYNGEAL MUSCLES
Cartilago
thyroidea,
lamina
(INTER)arytenoid muscle
Transverse PART
Cartilago
thyroidea,
lamina
Arcus cart.
cricoideae
Processus
vocalis
Lig. vocale
muscularis
Cartilago
arytenoidea
Rima glottidis 1. 2.
1. Pars inter-
membranacea
2. Pars inter-
cartilaginea
Lamina cart.
cricoideae
Trachea
CLOSES THE RIMA GLOTTIDIS
At the pars intercartilaginea
ORIGIN:
INSERION:
On the back of the arytenoid
(the muscle lies internal to the vertical
axis of the cricoarytenoid joint

19. LARYNGEAL MUSCLES (INTER)arytenoid muscle Aryepiglottic muscle
Aditus laryngis
Posterior
cricoarytenoid m.
(POSTICUS)
Arytenoid m.
transverse part
oblique part
Aryepiglottic m.
Aryepiglottic
fold
(INTER)arytenoid muscle
OBLIQUE PART
Cricoid
Lamina
Aryepiglottic muscle
ORIGIN continuation of the obl. arytenoid muscle.
INSERTION aryepiglottic fold
Arytenoid
cartilage
Closes the RIMA glottiDIs
at the Pars intercartilaginea
Pulls down the epiglottis,
tightening the larynx

20. Lateral thyroarytenoid mUSCLE
LARYNGEAL MUSCLES
Cartilago
cricoidea,
lamina
Mm. arytenoidei
M. cricoarytenoideus posterior
Cartilago
arytenoidea
M. cricoarytenoideus lateralis R I M A G L O T D S
Lateral thyroarytenoid mUSCLE
ORIGIN: lateral rim of the arytenoid cartilage
INSERTION: post aspect of the plate of thyroid
M. cricothyroideus
Lig. vocale
Shortens and relaxes the vocal fold
CLOSES THE RIMA GLOTTIDIS
Cartilago thyroidea, lamina
Vocalis muscle
(medial thyroarytenoid)
CLOSES THE RIMA GLOTTIDIS
At the pars intermembranacea
ORIGIN: antero-lateral surface of the arytenoid cartilage
INSERTION: lamina cartilaginis thyroideae hintere Fläche
It fills the vocal fold
During contraction the vocal cord is stretched and vibrates „better”.

21. LARYNGEAL MUSCLES THYROEPIGLOTTIC MUSCLE Thyroarytenoid m. (lateral)
Os hyoideum
M. aryepiglotticus
Plica aryepiglottica
Cartilago
thyroidea,
lamina
Mm. arytenoidei
THYROEPIGLOTTIC MUSCLE
Continuation of the lateral thyroarytenoid
Thyroarytenoid m.
(lateral)
ORIGIN: thyroarytenoid (lateralis) m.
INSERTION: aryepiglottic fold
M. cricoarytenoideus
posterior
Protects the larynx, works as a sphincter
M. cricoarytenoideus
lateralis
M. cricothyroideus

22. INNERVATION OF THE LARYNGEAL MUSCLES
N. laryngeus reccurens
N. laryngeus superior
M. aryepiglotticus
N. laryngeus inferior
(ramus ant. et post.)
Trachea
M. cricoarytenoideus
lateralis 1.
posterior
Mm. arytenoidei
M. vocalis
M. thyro-
arytenoideus
epiglotticus
Anastomosis
N. laryngeus superior
Foramen
thyrohyoideum
1.: ramus interus
(sensibel)
Os hyoideum
2.: ramus externus
(motorische)
Membrana
thyrohyoidea 1.
M. constrictor
pharyngis inferior
Cartilago
thyroidea,
lamina 2.
M. crico-
thyroideus
Oesophagus
Arcus cart.
cricoideae
Trachea
N. laryngeus reccurens

23. LARYNGOSCOPY

24. TUTORIALS  http://www.youtube.com/watch?v=KFv_zeRBH0c

25. MUCOUS LINING OF THE CAVITIES
EPIGLOTTIS
Glossoepiglottic folds
Epiglottic Vallecules
piriform Recess
Fold of the superior laryngeal nerv
Aditus laryngis (borders)
Aryepiglottic fold
Cuneiforme tubercle (Wrisberg)
Corniculate tubercle (Santorinus)
Interarytenoid notch
Stratified nonkeratinizing squamous epithelium vs. Respiratory epithelium

26. ADITUS LARYNGIS Aryepiglottic fold Lateral Glossoepiglottic fold
Piriform recess
Corniculate and cuneiform tubercles
Interarytenoid notch

27. FIBROELASTIC MEMBRANES OF THE LARYNX
Epiglottis
Membrana
quadrangularis
Plica aryepiglottica
Tuberculum cuneiforme
Ligamentum vestibulare
M. arytenoideus
Cartilago arytenoidea
Plica vestibularis
Ventriculus
Plica vocalis
Processus vocalis
Ligamentum vocale
Conus elasticus
Lamina cricoidea
Trachea, Schleimhaut
Tracheaknorpeln

28. FIBROELASTIC MEMBRANES OF THE LARYNX
Epiglottis
Aryepiglottic fold
quadrangularmembrane
Corniculate and cuneiform tubercles
Vestibular fold
Vestibulum
Ventricle
Infraglottic Space
Vocal fold
triangular
membrane

29. QUADRANGULAR MEMBRANE

30. CONUS ELASTICUS
Vocal Ligament
Triangular Membrane

31. MUCOUS MEMBRANE

32. MUCOUS MEMBRANE Quadrangular Membrane HOURGLASS vestibular fold
Vestibulum
Quadrangular
Membrane
HOURGLASS
vestibular fold
Rima glottidis
Ventricle
Vocal fold
Cavum subglotticum
Conus elasticus

33. HISTOLOGY OF THE LARYNX
Laryngeal vestibule
Vestibular folds
Respiratory epithelium
Loose CT (! Glottis edema !)
seromucous glands
Quadrangular Membrane
Saccule
Extension of the ventricle
(acts as an amplifyer in
phonation, vocalization) s
ventricle
MALT or solitary lymph follicles
VOCAL FOLDS
Stratified non-keratinizing squamous epithelium
Strictly adherent to the vocal folds
No glands
Large muscle content (vocalis m)
Triangular Membrane

34. INNERVATION superior laryngeal nerve (CN 10.) - cricothyroid
- Mucosa above the rima
Superior laryngeal artery EXTERNAL CAROTID
(branch of the sup. thyroid)
Inferior laryngeal artery SUBCLAVIAN
(branch of the inf. thyroid)
inferior (recurrent) laryngeal nerve (CN 10.)
- all internal muscles
- Mucosa below the rima

35. INTUBATIO

36. LARYNGOSCOPY Middle respiratory position Strong respiration
Phonation (closure of Glottis)
whisper

37. rima glottidis is closed
LARYNGOSCOPY
Maximum inhalation
rima glottidis is open
Normal speech
rima glottidis is closed
whisper
Phonation position

38. PHONATION, VOCALIZATION
air is expelled from the lungs through the glottis
Causing pressure drop across the larynx
(Threshold 2-3 H2Ocm)
the vocal folds start to oscillate (mostly laterally)
The oscillation modulates the pressure and flow of the air through the larynx
Sound = harmonic series
It consists of a fundamental tone (or fundamental frequency, the main acoustic cue for the percept pitch) accompanied by harmonic overtones, which are multiples of the fundamental frequency.
It can be varied by
- Pressure changes (lung capacity)
- Muscles large scale: CRICOTHYROID.
minor changes: THYROARYTENOID
- Positional changes (due to attm to the hyoid bone)
OR PARALYSIS

39. LARYNGOSCOPY PATHOLOGIE
Singers’ nodule = Fibroma
Laryngeal CC
Polypus
Reinke Edema

40. CLOSURE OF THE ADITUS DURING SWALLOWING
ROOT OF THE TONGUE – EPIGLOTTIS
Mechanism
The muscles of the floor of the oral cavity des Mundbodens
(Mm. mylohyoideus,
digastrici et thyrohyoidei) 
The larynx is elevated
The aditus is approaching
(lifted to) the epiglottis
ADIPOSE BODY – EPIGLOTTIS
Mechanism
The root of the tongue is driven posterior 
The preepiglottic adipose tissue is pushed against the epiglottis 
aryepiglottic and thyroepiglottic muscles contract to pull the larynx and the epiglottis closer

41. CLOSURE OF THE ADITUS DURING SWALLOWING There is no complete closure
NORMAL POSITION
SWALLOWING
There is no complete closure
The pharyngeal constrictors contract, closing the Aditus from behind
The soft palate and the uvula are lifted to block the pharynx from above
Reflex
CN 10.

42. LARYNX ABLATION LARYNX CC

43. REGIO COLLI MEDIANA
Conicotomie
Tracheotomie