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Who am Ioooo

Who am Ioooo. p. Anatomy & Physiology of Larynx Dr Sheetal Rai Dr Vijayalakshmi S Dept of ENT Yenepoya Medical College. Specific Learning Objectives Define the position and extent of the larynx Outline the structures forming the framework of the larynx

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Who am Ioooo

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  1. Who am Ioooo p

  2. Anatomy & Physiology of Larynx Dr Sheetal Rai Dr Vijayalakshmi S Dept of ENT Yenepoya Medical College

  3. Specific Learning Objectives Define the position and extent of the larynx Outline the structures forming the framework of the larynx Outline the structure of cavity of the larynx Describe the lining of the interior of the larynx Describe the lymphatic drainage of the larynx Describe the nerve supply of the larynx

  4. Specific Learning Objectives Define the spaces of the larynx List the differences between paediatric and adult larynx List the functions of the larynx

  5. Larynx (anterior)

  6. Larynx (posterior)

  7. Larynx (lateral)

  8. Larynx (superior)

  9. Larynx (sagittal section)

  10. Larynx (coronal section)

  11. Laryngeal Cartilages 3 single & 3 paired Single Paired Epiglottis Arytenoid Thyroid Corniculate (Santorini) Cricoid Cuneiform (Wrisberg)

  12. Thyroid Cartilage • Shield shaped, open posteriorly, angulated anteriorly • Angulation more acute in males • Its function is to shield larynx from injury and provide an attachment to vocal cords

  13. Cartilages (anterior)

  14. Cricoid Cartilage • Signet ring shaped • Stronger than thyroid cartilage. • Lamina – 2 to 3 cm from above downwards, considerably broader than anterior arch.

  15. Important from structural & functional point of view • Base for entire larynx • Support to arytenoid • Attachment to intrinsic muscles • Only part of cartilagenous framework that forms continuous 360 degree ring • Once injured or strictured , difficult to • resect while preserving • laryngeal function

  16. Epiglottis • Thin leaf shaped fibro-cartilage, situated in midline • Upper free end broad & rounded, projects up behind base of tongue • Narrow base called petiole • This attachment forms lower limit of pre-epiglottic space

  17. Arytenoids • Paired cartilages, pyramidal in shape • Base articulated with cricoid • PCA & LCA muscles attach on muscular process • Anterior angle elongated into vocal process which receives insertion of vocal ligament

  18. Cartilages (posterior)

  19. Cartilages (posterior)

  20. Cartilage Histology Elastic: Epiglottis, corniculate, cuneiform & apex of arytenoid. Little or no calcification. Hyaline:Thyroid, cricoid & remaining arytenoid. Calcify as age advances. Ossification begins by 25-30 yr & is completed by 60 yr.

  21. Indirect Laryngoscopy

  22. Flexible Laryngoscopy RIGHT LEFT

  23. Laryngeal cavity 1. Laryngeal inlet 2. Laryngeal Vestibule 3. Laryngeal Ventricle 4. Rima glottis 5. Subglottis

  24. Pediatric Larynx • Conical in shape & subglottis is narrowest part • Positioned high (C3-C4) • Moves higher during swallowing allowing simultaneous breathing & feeding • Loose sub-mucosal tissues (swell up easily) • Soft cartilages that collapse easily

  25. Membranes & Ligaments • Extrinsic: • connect thyroid cartilage & epiglottis with hyoid bone; cricoid cartilage with trachea. • Intrinsic: • connect cartilages of larynx to each other.

  26. Extrinsic • Thyrohyoid membrane • Hyoepiglottic ligament • Cricotracheal ligament

  27. Intrinsic

  28. Intrinsic

  29. Intrinsic 1. Quadrangular membrane  Ary-epiglottic ligament  Vestibular ligament 2. Crico-vocal membrane  Vocal ligament  Cricothyroid membrane 3. Thyro-epiglottic ligament

  30. Oncological Divisions A. Supraglottis: laryngeal inlet to apex of ventricle B. Glottis:apex of ventricle to 10 mm below C. Subglottis: lower glottic border to lower cricoid border

  31. Subsites A. Supraglottis: 1. Epiglottis 2. Aryepiglottic folds 3. Ventricular bands 4. Laryngeal Ventricle B. Glottis:1. True vocal cords 2. Anterior commissure 3. Posterior commissure C. Subglottis

  32. Intrinsic Muscles A. Acting on vocal cords Abduction  Posterior crico-arytenoideus Adduction  Lateral crico-arytenoideus  Transverse inter-arytenoideus  Thyro-arytenoideus externa Tension + lengthening  Cricothyroid Relaxation + shortening  Vocalis

  33. Adductors of the Vocal Folds

  34. Abductor of Larynx

  35. Cricothyroid Muscle

  36. Intrinsic Muscles B. Acting on laryngeal inlet Opener  Thyro-epiglottic Closer  Oblique inter-arytenoideus  Ary-epiglottic

  37. Oblique Inter-arytenoid

  38. Extrinsic Muscles Primary Elevators Secondary Elevators  Stylopharyngeus  Mylohyoid  Salpingopharyngeus  Stylohyoid  Palatopharyngeus  Geniohyoid  Thyrohyoid  Digastric Depressors  Sternohyoid  Sternothyroid  Omohyoid

  39. Spaces of Larynx

  40. Reinke’s Space • Mucosa over the vocal ligament loosely attached to ligaments • Thus there is a submucosal space along most of the length of truer VC

  41. Reinke’s space

  42. Pre-Epiglottic Space • Bound sup by hyo-epiglottic ligament, ant by thyrohyoid memb. & thyroid cartilage and posteriorly by epiglottis • Filled with fat and areolar tissue • Continuous with para-glottic space • Cx of laryngeal surface of epiglottis readily spread to PreEpiSpace

  43. Para-glottic space

  44. Shape of Glottis

  45. Shape of Glottis Quiet Respiration Forced Inspiration

  46. Inspiration

  47. Shape of Glottis Normal voice Whisper

  48. Normal phonation

  49. Whisper

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