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CLINICAL ANATOMY OF THE LARYNX

The larynx is a hollow organ that consists of a cartilaginous skeleton, ligamentous apparatus and own muscles. The laryngeal cavity is lined with a mucous membrane from the inside. The larynx has the appearance of a short socket located above the trachea at the level of the bodies of IV, V and VI cervical vertebrae. However, when swallowing and voice formation, it significantly exceeds the specified boundaries, shifting up and down. The mobility of the organ is due to a direct connection with the hyoid bone. The latter is set in motion by the muscles of the neck. The larynx is well palpated, and its individual parts are contoured under the skin, being identification points for a tracheostomy. In men, the protrusion of the thyroid cartilage (“Adam's apple” or “Adam's apple”) serves as such a guideline, and in women or children - the arch of the cricoid cartilage. From above the larynx opens with an opening called the entrance to the larynx, aditus laryngis. Below the larynx passes into the trachea. The lateral surfaces of the organ are in contact with the lobes of the thyroid gland and the neurovascular bundles of the neck. Behind the larynx is the larynx.

Cartilage of the larynx. The laryngeal skeleton consists of cartilage of various shapes. The base of the skeleton is a hyaline ring-shaped cartilage, the shape of which is similar to the shape of the ring, i.e. a signet ring. The arc of this ring is in front, the “signet” in the form of a wide quadrangular plate is in the back. The cartilage has two pairs of articular sites: one at the upper corners of the signet for articulation with the arytenoid cartilage and the second at the junction of the arch into the plate for articulation with the thyroid cartilage. The thyroid cartilage, also hyaline, is the most massive of the cartilage of the larynx. Located above the cricoid cartilage. It consists of two plates of a fairly regular quadrangular shape, connecting at the front at an angle open to the rear. The junction of the plates forms a protrusion, which in men is easily felt under the skin (Fig. 4.1). The arytenoid cartilage is paired, located behind the plates of the thyroid cartilage at the upper corners of the signet of the cricoid cartilage. In shape, it is compared with a three-sided pyramid, in which the apex is turned upward, posteriorly and medially, and the base on which there is an articular platform for connection with the cricoid cartilage (Fig. 4.2). From the base, a long, thin process, built of elastic fabric, extends. It is called the vocal process, because the posterior end of the vocal cord and vocal muscle is attached to it. Another process, thick and short, departs from the base back. This process is called muscle, because mm cricoarytenoidea posterior et lateralis are attached to it. At the apex of the arytenoid cartilage there is a small pair of cartilage having the shape of a hook - horn-shaped or Santorini cartilage (Fig. 4.3).

These cartilages make up the walls of the larynx. Moreover, the cricoid cartilage is located at the base and forms the foundation on which the thyroid and arytenoid cartilages stand. All of these cartilages are hyaline in their structure, with the exception of the vocal processes of the arytenoid cartilage - the latter are elastic.

The entrance to the larynx is closed by an unpaired elastic epiglottis cartilage, or epiglottis. In form, it is compared with a tongue or petal.

The connection of the cartilage of the larynx. Cartilages of the larynx are connected with each other, with the hyoid bone, pharynx and trachea.

The most massive cartilage - the thyroid and cricoid - are connected by a ligament and a paired joint. The cricoid-thyroid or conical ligament is stretched between the arch of the cricoid cartilage and the lower edge of the thyroid cartilage (Fig. 4.4). It has a yellowish color due to the large number of elastic fibers in its composition. Joints of the same name are formed using articular sites on the small horns of the thyroid cartilage and their corresponding articular sites on the cricoid cartilage.

The arytenoid cartilages, which have articular platforms at their base, are connected with those at the upper corners of the signet ring of the cartilage, forming a paired joint.

The epiglottis is strengthened by three ligaments: 1 - with the thyroid cartilage - the shield-epiglottis ligament connecting the leg of the epiglottis with the inner surface of prominentia laringis; 2 - with the hyoid bone - the hyoid-epiglottis ligament connecting the wide part of the epiglottis with the body of the hyoid bone.

The muscles of the larynx. The larynx muscles can be divided into skeletal and own. Skeletal muscles begin on the skeleton (sternum, scapula, hyoid bone, lower jaw, etc.) and attach to the thyroid cartilage or hyoid bone. These include the following neck muscles: sternum-thyroid, sternum-hyoid, thyroid-hyoid, scapular-hyoid, an awl-hyoid and two-abdominal.

Own muscles of the larynx are divided into external and internal by location. The external is the paired finger-thyroid muscle (Fig. 4.2), in which the straight part, represented by the medial bundles of fibers, and the oblique part, by the lateral bundles of fibers, are distinguished.


The internal muscles of the larynx are located mainly on the posterior-lateral surface of the larynx (Fig. 4.5), as part of the vocal and scooped palatine folds. One of the muscles is located on the inner surface of the thyroid cartilage and acts on the epiglottis, it is the shield-epiglottis muscle.

The following muscles are located on the posterior-lateral surface of the larynx: the posterior cricoid-arytenoid muscle, the lateral cricoid-arytenoid muscle, the transverse arytenoid muscle, the oblique arytenoid muscle, the carob-cricoid muscle. The structure of the vocal fold is the thyroid-arytenoid muscle. The named muscles change the tension of the vocal cords or change the width of the glottis. As part of the scooped-epiglottis fold, there is the eponymous scooped-epiglottis muscle, which changes the width of the entrance to the larynx.

Functionally, the muscles of the larynx can be divided into four groups.

Table 4.1.1

Laryngeal cavity. Three sections are distinguished in the laryngeal cavity: the upper, called the vestibule of the larynx, the middle, the ventricle of the larynx, and the lower, the sub-vocal cavity (Fig. 4.6). At the frontal section, the laryngeal cavity resembles the shape of an hourglass, since its upper and lower sections are expanded, and the middle one is narrowed. This narrowing is due to the presence on the side walls of two pairs of folds of the mucous membrane protruding into the lumen of the larynx and located one above the other. The upper pair is called vestibular, or false vocal folds. The lower folds are called voice or true voice folds. Both folds have a sagittal direction. The vestibule of the larynx is the part of its cavity located between the entrance to the larynx and the false vocal folds. The front wall of the vestibule of the larynx has an average length of 4 cm, the rear - 1-1.5 cm. The entrance to the larynx is a hole that communicates the cavity of the pharynx and larynx. It is bounded by the epiglottis, going from it to the tops of the arytenoid cartilage of the paired folds of the mucous membrane, called the scooped-epiglottis folds and the unpaired intercarpal fold. The middle narrow part of the laryngeal cavity includes the false and true vocal folds, the gaps between them and the recesses, called the morgan ventricles. Thanks to this device, the sagittal fissure, limited by these folds and called the glottis, is divided into two unequal parts. The anterior, most of them, corresponds to the length of the vocal cords and is called inter membranous. The back part, corresponding to the length of the vocal processes, is called interchondral.

Laryngeal blood vessels. The larynx receives blood from the upper and lower laryngeal arteries. The superior laryngeal artery is a branch of the superior thyroid artery extending from the external carotid artery. From the upper thyroid artery, it branches at or slightly above the upper edge of the thyroid cartilage and through the hole in the hyoid-thyroid membrane, along with the eponymous nerve, enters the wall of the larynx, where it branches. One of the branches of the superior thyroid artery is called the middle laryngeal artery. It anastomoses along the midline with the same-named artery of the opposite side and sends the branch through the conical ligament into the larynx, where it supplies the lower part.

The lower laryngeal artery is a branch of the lower thyroid artery, extending from the thyroid-cervical trunk of the subclavian artery. It passes behind the finger-thyroid joint, blood supply to the posterior surface of the larynx, anastomoses with the upper and middle laryngeal arteries.

From the venous plexuses of the larynx, blood flows through the veins of the same name. The superior laryngeal vein flows into the superior thyroid vein, which is an inflow of the internal jugular vein. The inferior laryngeal vein flows into the inferior thyroid vein, which is an inflow of the brachiocephalic vein.

Innervation of the larynx. The innervation of the larynx is carried out by the upper and lower laryngeal nerves. Both are branches of the vagus nerve. The upper laryngeal nerve departs very high from the vagus nerve (at the base of the skull), descends medially, going behind the external and internal carotid arteries. The lower laryngeal nerve does not depart from the trunk of the vagus nerve itself, but is the final segment of its large branch - the recurrent laryngeal nerve. The left and right recurrent laryngeal nerves lie between the trachea and esophagus. From the level of the lower edge of the cricoid cartilage, they are called the lower laryngeal nerves. The latter depart from the vagus nerve to the left at the level of the aortic arch, to the right of the subclavian artery, around them. The lower laryngeal nerves innervate the mucous membrane below the glottis and all the muscles of the larynx, with the exception of the ring thyroid. Both laryngeal nerves have connections with the sympathetic nerves of the upper cervical node of the sympathetic trunk, which provides secretory innervation and a vasoconstrictor effect.
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CLINICAL ANATOMY OF THE LARYNX

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