Larynx

1. Hollow, musculoligamentous structure,with a cartilaginous

framework,that caps the lower respiratory tract
2. Cartilages:
i)Unpaired- Cricoid cartilage
-Thyroid cartilage
-Epiglottis
ii)Paired-Arytenoid cartilage
-Corniculate cartilage
-Cuneiform cartilage
Larynx
4.Ligaments:
i)Extrinsic






Ligaments Description
Thyrohyoid membrane -between the superior margin of the thyroid cartilage below and the hyoid bone
above
-Aperture in each side is for superior laryngeal artery, the internal branch of the
superior laryngeal nerve and lymphatics
-posterior borders thickened to form the lateral thyrohyoid ligaments
-Anterior border thickened to form median thyrohyoid ligaments
Hyo-epiglottic ligament Extends from midline of the epiglottis to the body of the hyoid bone
Cricotracheal ligament Extends from lower border of the cricoid cartilage to first tracheal cartilage
ii)Intrinsic

Ligaments Description
Quadrangular membrane -Free upper margin,which is between the top
of the epiglottis and the corniculate cartilage
-Free lower margin, thickened to form the
vestibular ligament under the vestibular fold
Cricothyroid ligament - attached to the arch of cricoid cartilage
- forms the vocal ligament, which is under the
vocal fold
- thickened anteriorly in the midline to form a
distinct median cricothyroid ligament(It is
perforated for tracheostomy,during
emergencies)
5.Cavity of the larynx:
i)Laryngeal inlet-Opens into the anterior aspect of the pharynx just below and posterior to the tongue
-Anterior border is formed by mucosa covering the superior margin of the epiglottis
-Lateral border formed by mucosal folds (ariepiglottic folds)
-Posterior border formed by interarytenoid notch
-Can be closed by downward movement of the epiglottis
ii)Laryngeal outlet-continuous with the lumen of the trachea
- completely encircled by the cricoid cartilage
- continuously open
iii)Laryngeal cavity-Divided by the vestibular and vocal folds to 3 main regions:
a)Vestibule(Supraglottic cavity) - between the laryngeal inlet and the vestibular folds

b)Middle - between the vestibular folds above and the vocal folds below
- bulges laterally to form ventricle.Elongate tubular extension of each
ventricle is called the saccule,which has numerous mucous glands to
lubricate the vocal folds
c)Infraglottic cavity -between the between the vocal folds and laryngeal outlet

iv)Rima vestibule-space between the 2 vestibular folds

v)Rima glottidis-space between the 2 vocal folds


6.Intrinsic muscles of the larynx

Muscle Function(In relation to vocal cords)
Cricothyroid Tensor of vocal cords
Posterior cricoarytenoid Abduction of vocal cords
Lateral cricoarythenoid Adduction of vocal cords
Transverse arythenoid Adduction of vocal cords
Oblique arythenoid Adduction of vocal cords
Thyroarythenoid Relaxes the vocal cords
Vocalis
8.Blood supply of the larynx:
i)Superior laryngeal vessels
ii)Inferior laryngeal vessels

9.Nerve supply of the larynx
i)Recurrent laryngeal nerve-Motor to all intrinsic mucles except
cricothyroid
-Sensory to infraglottic region
ii)Superior laryngeal nerve-Motor to cricothyroid(through branch of
external laryngeal nerve)
-Sensory to supraglottic area

10.Lymphatic drainage of the larynx:
i)Above the vocal folds-Anterosuperior group of deep cervical lymph nodes
ii)Below the voca; folds-Posteroinferior group of deep cervical lymph nodes
-Prelaryngeal lymph nodes

Classifications of Laryngeal Diseases
Laryngeal Diseases
Congenital
-Laryngomalacia
-Laryngeal web
-Subglottic
Stenosis
-Congenital Cord
Proplase
-Laryngotracheo-
oesophageal cleft
-Laryngocele
-Laryngeal cyst
Trauma
-MVA
Tumour
i)Benign Tumours
-Neoplastic
-Non-neoplastic
ii)Malignant tumours
-CA of the larynx
Inflammatory
-Laryngitis
Infectious
-Tuberculosis
-Syphilis
-Leprosy
-Mycosis
Laryngomalacia
1. Most common congenital abnormality of the larynx
2. Excessive flaccidity of the supraglottic region of the larynx,resulting it to
collapse during inspiration.
3. Leads to airway obstruction and stridor
4. Course of the disease:
-manifest at birth-few weeks
-reaches peak after few months,resolves spontaneously at 18-24 months of
age
Laryngomalacia
5.Clinical features:
i)Inspiratory stridor-increase in supine position,sleep,feeding,crying
-decrease on prone position,neck extension
ii)Normal feeding
iii)Normal developmental milestones
iv)Sleep disturbance-apnea
v)Cynotic spells
6.Investigations:
i)Pulse oximetry-Detect hypoxemia
ii)Laryngoscope -Omega-shaped epiglottis
-Prominent arytenoids
-Floppy aryepiglottic folds
Laryngomalacia
7.Management
i)Conservative-Normal developmental milestone
-Normal vital signs
ii)Surgery- Failure to thrive
-Hypoxemia
-obstructive sleep apnea
a)Supraglottoplasty
b)Aryepiglottolysis
c)Laser epiglottopexy

8.Complications:
-Pulmonary hypertension
-Cor pulmonale
Laryngeal web
1. Congenital abnormality due to incomplete recanalization of the
larynx
2. Most common site of development is at the level of the vocal folds
anteriorly.Can occur at posterior interarytenoid ,supraglottic or
infraglottic area
3. Clinical features:
i)weak cry
ii)Dysphonia
iii)Airway obstruction,leading to dyspnea
iv)Stridor-If web is at the posterior interarytenoid area
Laryngeal web
4.Investigations:
i)Laryngoscopy-Laryngeal web(white or pink in colour)
(Thin or thick in thickness)
(Curved posterior border)
5.Management:
i)Conservative-In mild cases
ii)Surgical:
a) Thin webs-Endoscopic laser excision
b)Thick webs- laryngofissure approach and placement of keel
-
iii)Tracheostomy(if stridor is severe)