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Anatomy of Larynx
2
LARYNX (voice box)
Organ Of Phonation
Air Passage
Sphincter At The Inlet Of Lower Respiratory Passage
3
Epithelium – endoderm of laryngotracheal groove
Cartilage and muscles – mesenchyme of 4th & 6th pharyngeal arches
Arytenoid swelling – laryngotracheal groove – mesenchyme proliferation
Laryngeal ventricles – 10th week of gestation
Epiglottis – hypobranchial eminence
Superior laryngeal nerves – 4th pharyngeal arch
Recurrent laryngeal nerve – 6th pharyngeal arch
EMBRYOLOGY
4
SITUATIONAnterior Midline Of Neck
Root Of Tongue To Trachea
Adult – C3 To C6
Higher In Children And Females
5
Mal
e –
44m
m
Female – 36m
mSize
6
Skeletal Framework
Ligaments Cartilages
JointsMembranes
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3 Paired &3 Unpaired
TotalThyroid , Cricoid and Epiglottis
Unpaired
Arytenoid , Corniculate and Cuneiform
Paired
Cartilages• Thyroid cartilage• Cricoid cartilage• Arytenoid cartilage (base)
Hyaline cartilage
• Epiglottis• Cuneiform cartilage• Cuneiform cartilage• Tritiate cartilage• Arytenoid cartilage (apex)
Elastic cartilage
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C3 - Body of hyoid & its
greater cornua
C3 to C4 - Upper thyroid
cartilage
C4 to C5 - Thyroid
cartilage
C6 - Cricoid cartilage
Levels
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EpiglottisLeaf shaped, curved, flat – anterior wall of upper
larynx
Upper end – free, broad
Lower end/ Petiole – long, narrow
Thryoepiglottic ligament
Aryepiglottic Folds
Tongue – medial & lateral glossoepiglottic folds
Hyoid bone – hyoepiglottic ligament
Posterior surface
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EpiglottisQuadrangular membrane runs on lateral sides of epiglottis & arytenoid cartilages on either side
Aryepiglottic fold = upper free margin Quadrangular membrane and covering mucosa
During swallowing,
• It overlies laryngeal inlet• Aryepiglottic muscle closes the inlet.
Thryoepiglottic muscle – keeps inlet patent during breathing
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Thyroid Cartilage
Largest , ‘V’ shaped
Lamina – Right and Left
Anterior border – fused• Males – 90 degrees• Females – 120
degrees
Laryngeal prominence – Adam’s apple
Thyroid notch
Posterior border – apart• Superior cornua
• Inferior cornua
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Thyroid Cartilage
Superior cornua• Thyrohyoid ligament
• Cartilago triticia
Inferior cornua:• Cricothyroid
joint Conus Elasticus
Outer surface – oblique line• Thryohyoid ,
Inferior constrictors of pharynx , Sternothyroid
Cricoid cartilage –
Cricothyroid membrane
Hyoid – Thyroid
membrane
13Signet ring shaped
Anterior part – arch
Posterior part – lamina
Lamina – arytenoids cartilage
Inferior cornua of thyroid cartilage
Junction of arch and lamina
Cricoid Cartilage
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Cricothyroid and Cricovocal
membranes
Lamina – “ Posterior
Cricoarytenoid muscle ”
Anterolateral part – Lateral
Cricoarytenoid muscle
Anterior part – Cricothyroid
muscle
Cricoid Cartilage
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Arytenoids CartilagePyramid shaped Upper border of
Cricoid lamina
Apex – Corniculate cartilage, aryepiglottic
folds
Base – Lateral part of upper Cricoid Lamina
Vocal process
Muscular process
Vocal process – Vocal fold & Vocalis muscle
Above – Vestibular
fold
Muscular process – Posterior
Cricoarytenoid, Lateral Cricoarytenoids
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Cartilage of Santorini
Small conical shaped
Apex of arytenoids
Aryepiglottic folds
Corniculate Cartilage
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Cartilage of Wrisberg
Small rod shaped
Aryepiglottic folds
Cuneiform Cartilage
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Laryngeal JointsCricothyroid Joint• B/w Inferior cornua of Thyroid
cartilage & side of Cricoid cartilage• Synovial joint• Rotatory movements• Gliding movements
Cricoarytenoid Joint• B/w base of arytenoid cartilage & upper
lamina Cricoid cartilage• Synovial joint• Rotatory movements• Gliding movements
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Extrinsic• Thryohyoid
membrane• Hyoepiglottic
ligament• Cricotracheal
ligament
Intrinsic• Quadrate membrane• Cricovocal
membrane• Cricothyroid ligament• Thryoepiglottic
ligament
Laryngeal Ligaments & Membranes
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Thry
ohyo
id m
embr
ane Connects Thyroid
cartilage to Hyoid boneMedian – Median Thyrohyoid ligament Lateral – Lateral Thyrohyoid ligamentInternal laryngeal nerve & Superior laryngeal vessels
Hyo
epig
lotti
c lig
amen
t Connects upper Epiglottic cartilage to hyoid bone
Cric
otra
chea
l lig
amen
t Connects Cricoid cartilage to upper Trachea
Extrinsic
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Intrinsic ligaments – part of Fibroelastic membrane of larynx
Intrinsic
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Inlet of larynx Anteriorly – Epiglottis Posteriorly – arytenoids cartilages Either side – aryepiglottic folds
Folds – Vestibular & Vocal folds
Rima Vestibuli
Rima Glottidis Narrowest part of larynx, longer in males
Cavity of Larynx
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Three parts•Vestibule•Ventricle•Infraglottic part
Sinus of Morgagni – cleft B/w vestibular and vocal folds
Saccule – blind conical pouch•Extends from inferior ventricle B/w vestibular fold and inner thyroid lamina
•Mucous glands – help in lubrication (Oil can of Larynx)
Cavity of Larynx
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Multi-layered , white structure
B/w Anterior commissure & anterior end of arytenoids
Arcuate lines – limit it
Layers• St. Sq. Epithelium
lined mucosa• Lamina propria
Superficial layer• Lamina propria
Intermediate layer
• Lamina propria Deep layer
• Vocalis muscle
Reinke’s Space
Anatomy of Vocal Cord
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Stratified Squamous Epithelium
Non – keratinising squamous epithelium
Pseudo stratified ciliated
columnar epithelium
Mucous membrane of Larynx
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Up to vocal folds• Superior laryngeal
artery• Superior laryngeal vein
Below vocal folds• Inferior laryngeal artery• Inferior laryngeal vein
Blood Supply
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Nerve Supply
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Upper Deep Cervical lymph nodes
Pretracheal, Paratracheal &
Lower Deep Cervical lymph nodes• Vocal cords – sub
epithelial layer – Lymphatic watershed
Lymphatic Drainage
29
Pre glottic space ( Boyer’s Space )
• Reinke’s edemaReinke’s space
Para glottic space
Anatomical Spaces
30
Sub glottis
Glottis
Supra glottis
Surgical subdivisions of Larynx
31
“7S”
Size –
small
Shape –
funnel shaped
Softness –
laryngeal cartilage
s
Superiorly – placed
Straighter & less
oblique
Sensitivity –
greater, spasm
Subglottis – narro
w
Infant larynx
32
Thanks for ur attention..!!