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Head and Neck 11 -- Larynx


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What are the parts of the larynx?


How are they viewed?
Like the spleen, kidney, and liver. They are near each other, they together constitute the larynx, but they are treated very differently by surgeons and radiation oncologists.
What is the larynx supported by?
Cartilaginous backbone
Where does the larynx begin?
In order, what are the cartilaginous structures of the larynx?

Thyroid cartilage


What is the function of the epiglottis?
Protect airway during swallowing
What is the function of the thyroid cartilage?
Protect vocal cords and vocal ligament
What is the function of the arytenoids?
Support the true vocal cords
How do they do this?
Via the vocal ligament
What is the special trait of the cricoid cartilage?
It makes a 360 degree ring around airway
What is cricoid needed for?
Only cartilage needed for providing airway patency
What are the main parts of the thyroid cartilage?
Two anterior laminae
What do they do?
Meet together in the midline at an acute outpouching angle
What is at the top of the throid cartilage anteriorly
The superior thyroid notch
What happens posteriorly?
Each lamina is elongated to form a superior and inferior cornua
What does the superior cornua do?
Provides attachment for the thyrohyoid ligament
What does the inferior conua do?
Articulates medially with the sides of the cricoid cartilage
What is this articulation?
Cricothyroid joint
Which is wider, thyroid or cricoid?
Thyroid is much wider. Cricoid is only a little wider than a tracheal ring
What is between the thyroid and the hyoid anterolaterally?
The thyrohyoid membrane
What penetrates the thyrohyoid membrane?
Superior laryngeal nerve

Laryngeal artery
What is located between the cricoid and thyroid?
Cricothyroid ligament
Where is the ligament located?
What penetrates the cricothyroid ligament?
The recurrent laryngeal nerve on its way to innervate the major laryngeal muscles
Where is the arytenoid cartilage?
Buried deep within the depths of the thyroid cartilage, posteriorly
What does the arytenoid cartilage give rise to?
The vocal ligament
Where does the vocal ligament insert?
Inner aspect of thyroid cartilage
What does this look like diagrammatically?

What is revealing about this picture?
The superior tip of the epiglottis is actually superior to the hyoid!
What does the vocal ligament support?
The thyroarytenoid muscle
What is the thyroarytenoid muscle?
True vocal cord
What constitutes the supraglottis?

Aryepiglottic folds


False vocal cords

Laryngeal ventricle
What else is in the supraglottis?
Two spaces
What are these spaces?
Pre-epiglottic space

Paraglottic space
What is the other name for paraglottic space?
Paralaryngeal space
Where is the actual extent of the supraglottis?
Tip of the epiglottis to the laryngeal ventricle
What is definitely not part of the supraglottis, despite its proximity?
The valleculae and pyriform sinuses
What are these then?
The vallecula are in the lower oropharynx, and pyriform sinuses are part of the hypopharynx
If they are so close, does it really matter?
Crucial differences.
Because below the hyoid you get into the paraglottic and pre-epiglottic spaces.
What is the epiglottis shaped like?
A leaf
What is crucial about epiglottic anatomy?
If there is a tumor, you must state whether it is confined to the suprahyoid epiglottis or extends into infrahyoid epiglottis
What is the difference
If supraglottic only, they can do an epiglottectomy, or even laser surgery to treat it.

If it extends into the infrahyoid epiglottis, the game changes, and treatment is radically more complicated.
Where is the epiglottis in relation to the hyoid?
Directly posterior
What is directly posterior to the hyoid bone?
The preepiglottic space
What is posterior to the pre-epiglottic space?
The valleculae
What is posterior to the valleculae?
The epiglottis
What attaches the epiglottis to the hyoid?
The hyoepiglottic ligament
What covers this ligament?
A mucosal fold
What is this fold better known as?
The glossoepiglottic fold
What does this ligament/fold do?
Attaches epiglottis to hyoid

Splits the vallecula into 2 separate structures
What connects the epiglottis to the pharynx?
Pharyngoepiglottic fold
What do the glossoepiglottic and pharyngoepiglottic ligaments do as a team?
Separate the supraglottis from the oropharynx (tongue base and vallecula)
What separates the pyriform sinus from the supraglottis?
Aryepiglottic folds

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