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The cavity, muscles and the mucosa of the larynx

The cavity, muscles and the mucosa of the larynx. Mark Kozsurek, M.D., Ph.D. mark@kozsurek.hu. ED II, 22/02/2018. Triticeal cartilage. Epiglottis. Cuneiform cartilages [Wrisberg’s]. Corniculate cartilages [Santorini’s]. Arithenoid cartilage. Thyroid cartilage. Cricoid cartilage.

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The cavity, muscles and the mucosa of the larynx

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  1. The cavity, muscles and the mucosa of the larynx Mark Kozsurek, M.D., Ph.D. mark@kozsurek.hu ED II, 22/02/2018

  2. Triticeal cartilage Epiglottis Cuneiform cartilages [Wrisberg’s] Corniculate cartilages [Santorini’s] Arithenoid cartilage Thyroid cartilage Cricoid cartilage

  3. Lat. thyrohyoid lig. Median thyrohyoid lig. Thyrohyoid membrane Lat. thyrohyoid lig. Hyoepiglottic lig. Thyroepiglottic lig. Vestibular lig. Vocal lig. Median cricothyroid lig. (conic lig.) Cricopharyngeal lig.

  4. A now we put muscles onto this membranous-cartilagineus frame!

  5. Thyroarythenoid* (Inter)- arythenoid Lat. crico-arythenoid Post. cricoarythenoid Cricothyroid Cricothyroid *: individual parts: Aryepiglottic, Thyroepiglottic, Oblique thyroarythenoid

  6. Laryngeal muscles do not exclusively open or close the rima glottidis! – the most of the students only know these two possibilities! Vocal fold is stretched by the Cricothyroid and is relaxed by the Vocalis and Thyroarythenoid muscles. The Thyroarythenoid - especially during swallowing - also constricts the supraglottic part of the larynx, thus, acts as a sphincter muscle.

  7. The only muscle which opens the rima glottidis is the Post. cricoarythenoid. Membranous part of the rima glottidis is closed by the Lat. cricoarythenoid, while the cartilagineous part requires the action of (Inter)arythenoid muscles for complete closure!

  8. Drawingsrequiredonthefinalexam...

  9. Lining the membranous-cartilagineus-muscular frame with mucosal membrane inside

  10. Note: • Laminae of thethyroidcartilagefuseanteriorly, whilethelaminaofthecricoidcartilage is foundposteriorly! • The onlymuscle of thelarynxpassingoverthemidline is the (Inter)arythenoid, sothisistheonlyoneobservableinsagittalsection! quadrangular membrane: vestibular and aryepiglottic folds, lateral margin of epiglottis and the arythenoid cartilage (2 folds and two cartilages!) conus elasticus (triangular membrane taken twice): vocal fold, superior margin of cricoid cartilage, median cricothyroid lig.

  11. Note: • Boundaries of thefibroelasticmembranes, • thecut (Inter)arythenoidmuscle, • sagittalycutlamina of cricioidcartilage, • and Vocalismuscletogetherwiththeobliqueandstraightparts of theCricothyroidmuscleaswellasthemediancricothyroid ligament aftertheremoval of themucosa and theconuselasticus!

  12. frontal aspect vestibule ventricle subglottic space Identify cross sections of muscles seen on the image!

  13. Thyroarythenoid, aryepiglottic part Thyrohyoid Vocalis Superior pharyngeal constrictor Lat. cricoarythenoid Sternothyroid Cricothyroid

  14. Bloodsupply and innervation of thelarynx

  15. Vessels and nerves arrive from two different sources!

  16. ext. carotid artery → sup. thyroid artery → sup. laryngeal artery subclavian artery →thyrocervical trunk → inf. thyroid artery → inf. laryngeal artery

  17. superiorly: identical to the arterious blood supply inferiorly: toward the internal jugular and left brachiocephalic veins

  18. VAGUS NERVE sup. laryngeal nerve: int. branch: supraglottic mucosa ext. branch: Cricothyroid muscle inf. laryngeal nerve: (terminal br. of recurrent laryngeal n.) infraglottic mucosa and all the other muscles not innervated by the superior laryngeal nerve ACCESSORY NERVE mainly contributes to the innervation of the Interarythenoid muscles

  19. ambiguusnucl.branchialmotor dorsalvagusnucl. generalvisceromotor spinaltrigeminalnucl. generalsomatosensory lateralnucl. of alacinereageneralviscerosensory solitarynucl. specialviscerosensory (taste)

  20. Histology of thelarynx

  21. Respiratory epithelium (pseudostratified columnar epithelium with kinocilia) and goblet cells. According to the increased mechanical demand vocal folds are lined by stratified squamous non-keratinized epithelium! Skeletal muscle, hyalin cartilage, elastic cartilage, mixed glands, vessels and nerves.

  22. Development of thelarynx

  23. Clinicalconsiderations

  24. Laryngoscopy

  25. Conicotomy We arrive into the subglottic space after cutting the conic (median cricothyroid) ligament!

  26. Thankyouforyourattention!

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