Anatomy of Larynx

• Lies opposite 3rd to 6th cervical vertebra

• Laryngeal cartilages
• Un Paired –Thyroid,Cricoid,Epiglottis
• Paired-Arytenoid,Corniculate,Cunneiform
Cricoid cartilage
Epiglottis
Arytenoid cartliage
Corniculate and cunneiform cartilages
Membranes
• Extrinsic :
1]thyrohyoid
2]cricotracheal

Intrinsic
1]cricovocal
2] quadrangular membrane
3]Cricothyroid mebrane
 Muscles of larynx
Intrinsic muscles

Acting on the vocal cord Acting on the laryngeal inlet

ADDUCTOR
ABDUCTOR – 1]Lateral cricoarytenoid Tensor – Cricothyroid Opener Closer-
Posterior cricoarytenoid 2] Interarytenoid /Vocalis Thyroepiglottic interarytenoid/aryepiglottic
3] Thyroarytenoid
Lymphatics
• Supraglottis – drains into upper deep cervical lumphnodes

Subglottis – prelaryngeal and pretracheal lymphnodes

Glottis-No lymphatics
LARYNGEAL CAVITY
Spaces of larynx
• Preepiglottic space of Boyer
• Paraglottic space
• Reinkes space
Paraglottic space
Functions of larynx
• Protection of lower airways
• Phonation
• Respiration
• Fixation of the chest
Identify
Identify
Identify
Differences between adult and infant larynx
Infants Adults
Position C-2- c3 C-3 4 5 6
Epiglottis Curled Leaf shaped
Thyroid cartilage Flat Angulated
Narrowest part Subglottis Glottis
Submucosal tissue More less
Cartilages Soft Ossified
One liners
• Larynx develops from ……………………..arch

• Supraglottis develops from…………………..

• Glottis and subglottis develops from………….

• Larynx lies against ……………….vertebrae

• Laryngeal crepitus occurs due to movement
of………………….against……………….

• Laryngeal crepitus is absent in ……………………

• Hyaline cartilages in larynx are ……………….

• Elastic cartilages in larynx are ………………..

• Largest cartilage in larynx …………………..

• Signet ring cartilage is ………….

• Angle at which thyroid ala meets in male ……………….. And

female…………………

• Oblique line of the thyroid cartilage gives attachment to ………………

• Only complete cartilaginous ring in the entire airway

• Narrowest portion of the adult larynx is …………….. And paediatric

larynx is …………………….
• Cartilage of Santorini is …………….

• Cartilage of wrisberg is ………………….

• Sinus of Morgagni of larynx is …………….

• Rima vestibuli is …………….

• Rima glottidis is ………………..

• Space of Tucker is ………….

• Space of boyer is ……………

• Only unpaired laryngeal muscle is ……………..

• Only muscle which receives dual innervation ………….

• Only Abductor of vocal cord

• Tensor is ………………..
Mcq
• Safety muscle of the larynx is

• 1]Posterior cricoarytenoid
• 2Thyroarytenoid
• 3]Cricothyroid
• 4]Cricovocal
 Acute and chronic
inflammations of larynx
Three common inflammatrory conditions of
larynx
• 1. Acute laryngitis: Inflammation of larynx
• 2. Acute epiglottitis: Inflammation of epiglottis
• 3. Acute Laryngo-tracheo-bronchitis: Inflammation of larynx-trachea
and bronchus.
Few important points to remember
• Acute laryngitis is caused due to low grade infections or vocal abuse
and epilogttitis and laryngotracheobronchitis are due to rapidly
progressive infections.
• Epiglottitis is due to bacterial infection (H.Influenza) and
laryngotracheo-bronchitis is due to viral infections (parainfluenza).
• Epiglottits and laryngotracheobronchitis are commonly seen in
children.
• Epiglottitis and laryngotracheobronchitis are paediatric emergencies
• Chances of resp obstruction are higher in children because of smaller
airways and also in rapidly progressive infections.
• Involvement of epiglottis alone does not cause cough.
• Voice is affected only if vocal cords are involved
• Racemic adrenaline and steroids are used to decrease edema.
 Acute laryngitis Acute Epiglottitis Laryngo-tracheo-
bronchitis

Structures involved Entire larynx Only supraglottic Larynx-trachea and

structures: epiglottis, bronchus
aryepiglottic folds and
arytenoids. Vocal
cords are spared

Cause Infectious or non- Infectious Infectious

inectious (vocal
abuse)

Age Adults and sometimes Children very Children ( 3mon to 3

children common (2-7) years years)

Organisms Strept.pneumoniae, H.Influenza B Para influenza virus

H.influenza, type I and II. Can be
streptococcus, secondarily invaded
S.aureus by bacteria
 Acute Laryngitis Acute epiglottitis Acute Laryngo-
tracheo-Bronchitis
Onset Sudden Sudden slow
Progression Moderate Rapid progression Can progress to
in children obstruction but
slowly
Malaise, Fever Present Present. In children Present but low
it can go up to 40 grade or no fever
degrees Celsius and and child is not
child looks toxic toxic
Sore throat Present Present. Severe present
odynophagia with
drooling of saliva
leading to
dehydration
Cough Dry, irritating. Usually absent Present ( Barking
Worse at night seal like)
Hoarseness of voice Severe Absent Present
Dyspnoea and Less common Very common in Common in
Stridor children due to children due to
obstruction in supra obstruction in sub-
glottic area glottic area
 Acute laryngitis Acute Epiglottitis Acute laryngo-tracheo-
bronchits
Examination Inflammation of entire DO NOT EXAMINE IN
larynx, including vocal OPD. CHILD MAY HAVE
cords LARYNGEAL
OBSTRUCTION.

Hospitalisation Usually not required Compulsorly admit admit

Radiological features Thumb sign due to Steeple sign on AP view

swollen epiglottis in of neck.
lateral x-ray
Voice rest Most important Not compulsory required
Cough suppresants Required Not required Required
Analgesics Required Required Required
Antibiotics Depends on organism Directed against For secondary infections
H.Influenza
Steroids Not indicated unless due Important to decrease Required to decrease
to chemicals or abuse oedema and prevent oedema
resp obstruction
Racemic adrenaline Act as bronchodilator to Acts as bronchodilator
nebulisation or injection reduce obstruction
Intubation or Usually not required May be required May be required
tracheostomy
Hydration Usually not required. Very important Important
• Thumb sign due to swollen • Steeple sign: Smooth
epiglottis in lateral x-ray constriction seen on AP view
due to subglottic stenosis.
Congenital lesions of larynx
and stridor
Laryngomalacia-inspiration and expiration
Laryngomalacia-supine and prone
Laryngomalacia- Omega shaped epiglottis
Subglottic stenosis Laryngeal web Subglottic hemangioma
 Laryngomalacia Congenital Laryngeal web Subglottic
subglottic hemangioma
stenosis

Pathology Excessive Abnormal Due to Hemangioma in

flaccidity of thickening of incomplete subglottic region
supraglottic cricoid cartilage recanalisation of
larynx which is or fibrous tissue larynx: web at
sucked in during below vocal the level of
inspiration cords vocal cords
Age At birth Asymptomatic At birth Asymptomatic at
birth. By 3-6
months
hemangioma
grows in size
and becomes
symptomatic
Course Usually appears Spontaneously Depends of Depends on size
by 2 years of age resolves as thicknes and but usually
larynx grows extent of web resolves with
with age age
 Laryngomalacia Congenital Laryngeal web Subglottic
subglottic stenosis hemangioma

Stridor In inspiration No stridor . Stridor Present Present

is seen only after
infection

Affect of crying on Increases Normal Increases Increases as

stridor hemangioma
increases insize
during crying
Prone Decreases No effect No effect No effect

Cry Normal Normal Weak cry or Normal

aphonia
Direct 1. Omega shaped Subglottic diameter Web is seen Reddish blue mass
epiglottis less than 4mm in between the vocal in subglottic region
laryngoscopy 2. Floppy aryepiglottic full term neonate ( cords and has a
folds normal 4.5-5.5mm) concave posterior
3. Prominent margin
arytenoids

Treatment Conservative Conservative Thin web: Cut with Steroids may

CO2 laser or knife. decrease the size of
Thick web: lesion. Majority of
Laryngofissure and lesions involute
placement of a with time. So do
silicon keel tracheostomy and
observe.