Anatomy

Page 1

Anatomy and Embryology of the Phonatory System

Kim M. Corbin-Lewis, Ph.D., CCC-SLP - E-mail
Utah State University Logan, UT 84322-1000

Introduction Objectives: Phonation requires the synergistic performance of anatomical structures across a number of physiologic systems such as the respiratory, laryngeal, articulatory, and resonatory systems. In order to appreciate the coordinated effort necessary to produce and maintain voice, it is necessary to examine some of the structures in these dynamically related systems. The respiratory system acts as the power source to drive phonation. Airflow and pressure are generated by the paired structure -- the lungs. Since it is the driving force behind voice production, and plays such a prominent role in some voice disorders, a brief overview of the respiratory tract anatomy will be provided. The section addressing embryological development of the phonatory system will be presented at the end of the unit following complete explanation of the morphology present. This, hopefully, will avoid confusion over terminology. At the end of this unit, students should be able to: 1. Describe the basic structures of the respiratory system (including the bony framework -- the ribs, sternum, pectoral girdle and pelvic girdle; the upper and lower airways -- mouth, nose, pharynx, larynx, trachea, bronchi, lungs; and the muscles of inspiration and expiration). 2. Describe the three vocal tract cavities (including the nasal cavity, oral cavity and pharyngeal cavity). 3. Describe osseous and cartilaginous structures of the laryngeal region (including the hyoid bone; epiglottis, thyroid cartilage, cricoid cartilage, paired arytenoid cartilages, paired corniculate cartilages, paired cuneiform cartilages; and the cricothyroid and cricoarytenoid joints). 4. Describe soft tissue morphology of the laryngeal region (including extrinsic and intrinsic laryngeal muscles, suprahyoid and infrahyoid muscles; membranes and ligaments). 5. Describe the histological composition of the vocal folds (including five layers and molecular components; and functional divisions of the layer structure). 6. Describe laryngeal vascular and lymphatic supply. 7. Describe the embryological development of the phonatory system and describe the contributions of the individual branchial arches.

Anatomy And Embryology of the Phonatory System: Objectives 1-3

Objective 1: Anatomy of the Respiratory System Thorax The respiratory system is housed within the torso which consists of a skeletal framework and muscular tissues divided in to an upper and lower cavity. The upper cavity is called the thorax or thoracic cavity and houses the heart and pulmonary (or lung) structures. The bony framework for the respiratory system consists of the vertebral column posteriorly. The 33 vertebrae are divided based on their location -- there are 7 cervical (neck) vertebrae, 12 thoracic (chest) vertebrae, 5 lumbar (back), 5 sacral (lower back), and 4 coccygeal (tail bone) vertebrae. The pectoral girdle is the superior bony boundary and consists of the paired clavicles anteriorly and scapulae (shoulder blades) posteriorly. The rib cage forms the anterolateral bony framework for the respiratory system and consists of 12 pairs of ribs that attach to the thoracic vertebrae posteriorly and to the sternum anteriorly. The upper ribs attach individually to the sternum by way of costal cartilage while the lower ribs share costal cartilage and the inferior two pairs of ribs float with only a posterior attachment to the vertebrae. The inferior boundary of the thoracic cavity or chest cavity is the muscular diaphragm which is dome shaped at rest. (Diagram to be included at later date) Abdomen The lower cavity is the abdominal cavity and houses the majority of the digestive system, organs, and glands. The abdomen is bounded superiorly by the diaphragm, inferiorly by the pelvic girdle (which consists of the ilium, ischium, and pubis bones, sacrum

http://www.otoweb.org/clinics_folder/voice_clinic_folder/courses/kim/index.htm

06/01/2007 04:43:13 AM

Anatomy

Page 2

and coccyx), posteriorly by the lumbar, sacral and coccygeal vertebrae, and anterolaterally by muscle and connective tissue. (Diagram to be included at later date) Airway/Lungs The pulmonary system can be anatomically divided into an upper and lower airway. The upper airway consists of the nose, mouth, pharynx, and larynx. The level of the vocal folds is used as a boundary -- the upper airway includes the structures above the true vocal folds while the lower airway begins just below the true vocal folds. The lower airway includes the trachea, bronchi , lungs, terminal bronchioles, alveolar ducts, and alveolar sacs. The bronchi extend from the bifurcation (or division) of the trachea to the lungs. The bronchi arborize or subdivide from mainstem bronchi , which connect the trachea to the lungs, to secondary bronchi , which subserve the lobes of the lungs, to tertiary bronchi which subserve lung segments. The lungs rest on the surface of the diaphragm. Each lung is encased in the visceral or pulmonary pleura while each thoracic wall and superior surface of the diaphragm are lined with the parietal or costal pleura. These two serous membranes adhere to each other. The potential space between these two membranes is under negative pressure which serves to firmly bind the pleurae, and the structures they adhere to, together. Since the resting position of the lungs without the influence of the thorax is collapsed, and the resting position of the ribs without the influence of the lungs is expanded, the combination of these opposite forces (known as pleural linkage) results in a resting position where the lungs are pulled to a slightly expanded position while the ribcage is pulled down to a slightly compressed position. (Diagram to be included at later date) Muscles of Inspiration The diaphragm and external intercostal muscles are muscles of quiet respiration. Forced inspiration recruits accessory muscles which are attached to the pectoral girdle and upper ribs. These muscles are the costal elevators, the sternocleidomastoid , and the scalenes. The diaphragm is a unpaired muscle which receives bilateral neural innervation. Upon contraction it increases the thoracic volume by increasing the vertical dimension of the thorax -- it moves from its domed position at rest, to a flattened position upon contraction. The external intercostal muscles consist of 11 pairs of muscles that run between the ribs in a downward and medial direction (angled as though you were putting your hands in your pockets). Upon contraction, they function to raise and expand the rib cage. The costal elevators are a group of 12 paired muscles of the thorax located on the posterior portion of the ribs. They run from the transverse processes of the seventh cervical and upper 11 thoracic vertebrae to the rib immediately below between the tubercle (which articulates with the vertebrae) and angle of the rib. The sternocleidomastoid muscle is a paired muscle located laterally on the neck. Its name provides sites of origin and insertion. A muscular head arises from the sternum and from the clavicle. The fibers join together as they travel superiorly and insert into the mastoid process of the temporal bone. This muscle is responsible for turning the head. When the head is in a fixed position the sternocleidomastoid, along with the scalene muscles, can lift the sternum and upper two ribs in an inspiratory direction. The scalene muscles are a group of deep muscles of the neck. The outer group of scalene muscles originate on the transverse processes of the cervical vertebrae and insert into the top two ribs. They can assist in raising the ribcage. They are considered accessory muscles of inspiration when the head is in a fixed position. Muscles of Expiration In quiet or resting breathing expiration is passive, that is muscle contraction is not required. Muscular activity is encountered when the expiration is forced out rapidly, when expiration goes below the resting level, or when the expiratory flow is controlled as during speech breathing. While speaking, muscular force can be used to prevent the ribcage from descending too quickly. The following muscles can be used to forcefully exhale, to exhale below the resting level or to check the expiratory direction of the ribcage. The internal intercostal muscles consist of 11 muscle pairs that lie deep to the external intercostals described above. The muscles originate on the lower border of the ribs and insert into the inner face of the rib immediately below. The muscle fibers run in an opposite direction to the external intercostals - they run down and laterally. The rectus abdominus muscle is a paired muscle which lies lateral to the abdominal midline. The rectus abdominus arise from the crest of the pubic bone and run vertically up to the fifth through seventh ribs and xiphoid process of the sternum where the muscles insert. (Diagram to be included at later date) The external oblique muscle is a paired muscle which runs in the same direction that the external intercostal muscles travel. They arise from the inferior surface of ribs 5 through 12 and travel down and medially to the iliac crest. As with the external intercostal muscles, placing your hands in your pockets mimics the direction of muscle fibers. (Diagram to be included at later date) The internal oblique muscle is a paired muscle which underlies the external obliques and runs in the opposite direction with fibers originating from the iliac crest and inguinal ligament and inserting into the cartilaginous portion of the lower 4 ribs. (Diagram to be included at later date) The transverse abdominus muscle is a paired muscle that forms the deepest muscular layer of the abdomen. The muscles run

http://www.otoweb.org/clinics_folder/voice_clinic_folder/courses/kim/index.htm

06/01/2007 04:43:13 AM

Anatomy

Page 3

horizontally. Fibers originate from a number of sites -- the inner surfaces of the inferior 6 ribs, iliac crest, and the inguinal ligament. The muscular insertion points are the deep layer of the abdominal aponeurosis and the pubic bone. (Diagram to be included at later date) The quadratus lumborum is a quadrilateral-shaped sheet of muscle which runs from the iliac crest and insert into the transverse processes of the lumbar vertebrae and the twelfth rib. As its origin and insertion points suggest, this is a muscle of the posterior abdominal wall. (Diagram to be included at later date) Objective 2: The Vocal Tract Cavities In voice production the oral, nasal, and pharyngeal cavities play a role in shaping the acoustic signal created by vocal fold vibration and modulation of the airflow generated by the respiratory system. This shaping of the signal is accomplished through articulation, carried out primarily in the oral cavity, and resonation, carried out in all three vocal tract cavities. These cavities and their structures as they relate to human voice production are briefly described. Nasal Cavity The nasal cavity is positioned at the superior aspect of the vocal tract. It is bounded by cranial bones superiorly, nasal turbinates laterally, the hard and soft palates inferiorly and the pharyngeal wall posteriorly. Anteriorly the nasal cavity communicates via the nostrils to the outside air. Posteriorly the nasal cavity communicates directly with the nasopharynx when the soft palate is at rest. The nasal cavity participates in resonation of the voice signal and determines the perception of nasalance. When airflow is directed through the nasal cavity the listener perceives a nasal quality. In English, there are three nasal phonemes -- /m/, /n/, and /n/ which require nasal resonation. The remaining speech sounds in English are considered oral sounds and are produced without nasal resonance. When nasal resonance is heard inappropriately the voice is described perceptually as being hypernasal . When nasal resonance is necessary, as in production of /m/, /n/, or /n/, but is not heard, the voice is described perceptually as sounding hyponasal . The separation of the nasal cavity from the other resonating cavities is accomplished through closure of the velopharyngeal port. This port or connection between nasal and oropharyngeal regions is closed off by posterior movement of the soft palate and lateral movement of the faucial pillars (palatoglossus and palatopharyngeus muscles). This results in the nasal cavity being separated functionally from the oral and pharyngeal cavities. Oral Cavity The oral cavity is a primary location for the articulatory shaping of the voice signal. The articulators -- the lips, tongue, teeth, and jaws -- are responsible for shaping the voiced signal into the different types of phonemes such as consonants and vowels. The oral cavity is bounded by the lips anteriorly, the cheeks laterally, the hard and soft palates superiorly, the tongue inferiorly, and the faucial pillars and pharyngeal wall posteriorly. (Diagram to be included at later date) Pharyngeal Cavity The pharyngeal cavity runs from the base of the cranium to the top of the esophagus at an approximate level of the sixth cervical vertebrae. The pharynx is formed primarily by three muscles arranged in a circular pattern that attach to structures anteriorly. The pharyngeal muscles, also known as the constrictors, include the superior, middle and inferior pharyngeal constrictor muscles. The pharyngeal space allows communication between the nasal, oral, and laryngeal cavities. It forms a connecting corridor located posteriorly to the nose, mouth, and larynx. The pharynx is subdivided into three functional levels that correspond to the structures found anteriorly. The nasopharynx is located posterior to the nasal cavity, the oropharynx is located posterior to the oral cavity, and the laryngopharynx is located posterior to the larynx. (Diagram to be included at later date) Objective 3: Laryngeal Framework The larynx is a musculocartilaginous structure located in the anterior neck which is suspended by muscle and ligaments to the hyoid bone superiorly and attached to the trachea inferiorly. There are 9 laryngeal cartilages: the thyroid, cricoid, paired arytenoid cartilages, paired corniculate and cuneiform cartilages, and the epiglottis.

Cartilage Number Cartilage Type Location epiglottis thyroid cricoid arytenoid single single single paired elastic hyaline hyaline elastic elastic elastic posterior to hyoid bone and tongue base anterior neck at midline superior to trachea; inferior to thyroid articulates with posterolateral cricoid cartilage set on apex of arytenoid cartilages embedded in aryepiglottic folds

corniculate paired cuneiform paired

Table 1. Laryngeal Cartilages

The single bone in the laryngeal complex is the hyoid bone. The central portion of the hyoid is termed the body or corpus. The hyoid has two greater horns on the supero-lateral aspect and two lesser horns on the infero-lateral aspect of the bone. The hyoid bone is a site of attachment for muscles of the tongue and pharynx superiorly and the larynx inferiorly. As such, it can be adjusted in the vertical plane as well as in an anterior- posterior plane. Through the muscular attachments the hyoid bone provides a link between

http://www.otoweb.org/clinics_folder/voice_clinic_folder/courses/kim/index.htm

06/01/2007 04:43:13 AM

Anatomy

Page 4

tongue position and laryngeal position. The hyoid bone does not articulate with any other bones. (Diagram to be included at later date)

Ligament Name thyroepiglottic hyoepiglottic median glossoepiglottic lateral glossoepiglottic cricothyroid vocal ventricular Table 2. Laryngeal Ligaments

Number single single single single paired paired paired

Location epiglottis to angle of thyroid cartilage epiglottis to hyoid bone epiglottis to tongue root epiglottis to tongue root epiglottis to tongue root inner surface of angle of thyroid cartilage to vocal process of arytenoid cartilage runs superior to vocal ligament from inner surface of thyroid cartilage to corniculate cartilages and arytenoid cartilage

The epiglottis is an unpaired cartilaginous structure located posterior to the hyoid bone and base of the tongue. It is a leaf-like structure composed of elastic cartilage which is large at the top and narrows down to a triangular-shaped base inferiorly called the petiolus. The epiglottis attaches to the angle of the thyroid cartilage by the thyroepiglottic ligament ; to the hyoid bone by the hyoepiglottic ligament ; and to the root of the tongue by a median and 2 lateral glossoepiglottic ligaments . Note that the names of these ligaments provide the origin and insertion sites. On either side of the median glossoepiglottic ligament two recesses known as the valleculae are seen. Tissue running from the lateral border of the epiglottis in a posterior and inferior direction to the arytenoid cartilages is known as the aryepiglottic folds. The thyroid cartilage is an unpaired structure which is the largest of the laryngeal cartilages. It consists of two quadrilateral plates known as the thyroid lamina which are fused at midline. The superior aspect of the thyroid has a v-shaped thyroid notch. The fusion point of the thyroid lamina, which runs vertically, forms the angle of the thyroid cartilage. The prominence can be palpated anteriorly as the Adams apple. The angle of fusion differs between men, women, and children with children exhibiting the most obtuse angle and men demonstrating the most acute angle. The thyroid lamina each have two projections known as the superior and inferior cornua or thyroid horns. The superior horns are directed superiorly and posteriorly and have a ligamental attachment to the hyoid bone (lateral thyroid ligament). The inferior horns project inferiorly and medially with articular facets for connection to the cricoid cartilage. This is the cricothyroid joint. A ligamental connection between the cricoid below and the thyroid cartilage above is medially placed and designated the cricothyroid ligament . (Diagram to be included at later date) The cricoid cartilage is a hyaline cartilaginous structure shaped like a signet ring with the signet part facing posteriorly and the thin or band-like portion of the ring facing anteriorly. The cricoid is located above the trachea and is connected to the first tracheal ring by the cricotracheal membrane or ligament . The arytenoid cartilage is a paired structure, triangular shaped with a broad base, apex, and three faces. The arytenoids are positioned on articular facets at the posterolateral portion of the cricoid cartilage. This location where the two cartilages articulate is called the cricoarytenoid joint. Two arytenoid processes are attachment sites for muscles and ligaments -- the vocal process and the muscular process. The vocal process is oriented in an anterior direction, toward the angle of the thyroid cartilage. The vocal ligament runs from the vocal process of the arytenoid to the angle of the thyroid cartilage. The vocal ligament is a part of the vocal fold. The muscular process projects posterolaterally and is the attachment site for the lateral and posterior cricoarytenoid muscles and a portion of the thyroarytenoid muscle. (Diagram to be included at later date)

Joint Name cricothyroid

Number Location/Movement paired inferior cornu of thyroid and outer aspect of lateral cricoid cartilage; pivot joint allows decrease of distance between the anterior of the thyroid and cricoid cartilages arytenoid sits on inner aspect of lateral cricoid cartilage; saddle joint allows rocking motion of arytenoid and limited sliding

cricoarytenoid paired Table 3. Laryngeal Joints

The corniculate cartilage is a paired structure located on the apex of the arytenoid cartilages. The cuneiform cartilage, when present, is a paired structure located in the aryepiglottic folds.

Objective 4: Laryngeal Soft Tissue Morphology

http://www.otoweb.org/clinics_folder/voice_clinic_folder/courses/kim/index.htm

06/01/2007 04:43:13 AM

Anatomy

Page 5

Laryngeal Orientation The vocal folds, a combination of muscle and mucosa, are located in the larynx. In the most general of divisions, the area superior to the true vocal folds is termed the supraglottal region. The area immediately inferior to the true vocal folds is the subglottic region. The space between the vocal folds is designated the glottis or glottal area. As is apparent, the level of the true vocal folds is the dividing structure in the laryngeal region for classification purposes. The vocal folds are deep to the laryngeal aditus or vestibule which is formed by the epiglottis, the aryepiglottic folds, and the arytenoid cartilages. The aditus is an entryway which can be closed off to protect the airway below it. The inferior boundary of the aditus is the ventricular or false vocal folds. The vocal folds (thyroarytenoid muscles) are situated in an anterior to posterior direction over the lower airway. The origin of the thyroarytenoid (TA) is the angle of the thyroid cartilage. The thyroarytenoid (TA) inserts on the vocal process of the arytenoid cartilage which is mobile in a medio-lateral direction. Immediately superior to the vocal folds (TA) is a groove known as the laryngeal ventricle. Superior to the ventricle is the paired ventricular or false vocal fold which contain muscle fibers but is not generally involved during phonation. Laryngeal membranes Mucous membrane lines the entire larynx with ciliated columnar epithelial cells. The cilia beat in an superior direction toward the pharynx. The hyothyroid membrane originates at the hyoid bone and travels inferiorly to insert on the superior border of the thyroid cartilage. The cricotracheal membrane originates on the lower border of the cricoid cartilage and inserts on the upper border of the first tracheal ring. The cricovocal membrane (also known as the conus elasticus) originates on the superior border of the cricoid cartilage and travels as a continuous fibroelastic sheet that connects the cricoid, thyroid, and arytenoid cartilages together. The cricovocal membrane inserts into the true vocal folds. The quadrangular membrane originates on the lateral margins of the epiglottis and thyroid cartilages and inserts onto the corniculate and medial surfaces of the arytenoid cartilages. Laryngeal Musculature Musculature which influences the position of the larynx along the vertical dimension can be grouped according to their ability to elevate or depress the larynx. There are six suprahyoid muscles which act as laryngeal elevators and two infrahyoid muscles which are considered laryngeal depressors. The laryngeal elevators include the: digastric stylohyoid mylohyoid geniohyoid hyoglossus genioglossus muscles

Table 6. Suprahyoid Muscles - Laryngeal Elevators

Muscle digastric stylohyoid mylohyoid geniohyoid hyoglossus

Origin/Insertion anterior belly: inner surface of lower mandibular border/lesser horn of hyoid bone posterior belly: mastoid process of temporal bone/hyoid bone styloid process of temporal bone/body of hyoid bone mylohyoid ridge on inner surface of mandible/tendinous medial raphe extending from mandible and body of hyoid bone mental symphysis of mandible/anterior surface of body of hyoid bone hyoid bone/posterior and lateral regions of tongue

genioglossus mental symphysis of mandible/inferior surface of tongue and hyoid bone

The laryngeal depressors are the sternohyoid and omohyoid muscles.

http://www.otoweb.org/clinics_folder/voice_clinic_folder/courses/kim/index.htm

06/01/2007 04:43:13 AM

Anatomy

Page 6

Table 7. Infrahyoid Muscles - Laryngeal Depressors Muscle omohyoid Origin/Insertion scapula/hyoid bone

sternohyoid manubrium of sternum and clavicle/hyoid bone

As with any muscular system, laryngeal muscles can be anatomically or functionally divided in a number of ways. For the purpose of this voice class, the laryngeal musculature is functionally divided into extrinsic muscles, which connect to laryngeal structures outside of the larynx, and intrinsic muscles which have both origin and insertion points to laryngeal structures. The extrinsic muscles include the sternothyroid, thyrohyoid , and inferior pharyngeal constrictor muscle.

Table 4. Extrinsic Laryngeal Muscles Muscle sternothyroid thyrohyoid Origin/Insertion posterior surface of sternum/oblique line thyroid cartilage oblique line of thyroid cartilage/inferior portion of greater horn of hyoid bone

inferior pharyngeal constrictor thyroid cartilage/fibers from each side meet at midline to form the pharyngeal tube

The five intrinsic muscles are responsible for altering the position and action of the true vocal folds. The intrinsic muscles include the paired posterior cricoarytenoid muscle, the interarytenoid muscles, the paired lateral cricoarytenoid muscle, the paired cricothyroid muscle, and the paired thyroarytenoid muscle. The intrinsic laryngeal muscles receive neural innervation from the recurrent laryngeal nerve branch of the vagus (CN X). <

Table 5. Intrinsic Laryngeal Muscles Muscle posterior cricoarytenoid inter arytenoid - oblique (located superficially) transverse lateral cricoarytenoid cricothyroid - two insertion segments; pars oblique (lateral portion of muscle), pars recta (medial portion of muscle) thyroarytenoid (may be described as a two-part muscle with the thyromuscularis placed laterally; thyrovocalis located medially) Origin/Insertion posterior surface cricoid cartilage oblique - posterior surface of muscular process of arytenoid/near apex of controlateral arytenoid transverse - lateral edge and posterior surface of one arytenoid/ contralateral edge and posterior surface of arytenoid upper border anterolateral arch of cricoid/muscular process of arytenoid cartilage anterolateral arch of cricoid/pars oblique inserts into anterior margin of inferior horn of thyroid; pars recta inserts into inner aspect of the thyroid inferior edge inner surface at angle of thyroid/lateral and inferior aspect of vocal process of arytenoid cartilage

...to top of page Objective 5: Vocal Fold Histology The true vocal folds are a five-layered structure, each layer with differing mechanical properties. The five layers are: epithelium - consists of stratified squamous cells; outer covering which maintains the shape of the vocal fold superficial layer of the lamina propria - is composed of loose fibrous components and matrix which has a gelatinous overall consistency. This layer is also known as Reinke's space. intermediate layer of lamina propria - location where elastic fibers predominate deep layer of lamina propria - collagen fibers predominate

http://www.otoweb.org/clinics_folder/voice_clinic_folder/courses/kim/index.htm

06/01/2007 04:43:13 AM

Anatomy

Page 7

vocalis muscle - striated muscle fibers

Objective 6: Laryngeal Vascular and Lymphatic Supply (Under construction)

...to top of page Objective 7: Embryology of the Phonatory System This section focuses exclusively on oro-pharyngo-laryngeal structures and is not meant as an all inclusive explanation of embryological development of the speech and hearing mechanism. For further information, students are referred to the referenced anatomy textbooks.

Primitive structures of the head and neck begin to form during the third week of gestation. Tissue in the cephalic (head) region begins to develop a prominence with a groove underneath, the primary oral groove (also known as the stomodeum ). This groove, or primitive mouth, extends inward to the buccopharyngeal membrane which separates the primitive mouth from the foregut. Tissue anterior to the buccopharyngeal membrane will develop into structures of the oral cavity while tissue posterior to the membrane will become the pharynx. The larynx is the entryway into the respiratory system and forms from the midventral portion of the tissue posterior to the buccopharyngeal membrane. Just below the primitive mouth branchial grooves (gill clefts) form transversely placed rounded prominences and depressions. These rounded prominences meet at midline to form six branchial arches. (Diagram to be inserted at later date)

The fourth week of gestation begins what is considered to be the most important period of time during prenatal development for the structures of the head and neck. The branchial arches (pharyngeal arches) are six ridges of tissue that develop into the orofacial structures and muscles, the ears, and the pharynx. The precursor to the larynx is seen at the superior end of a vertical groove, the laryngotracheal groove, near the sixth branchial arch. In week four the epiglottis appears as a transverse ridge posterior to the tongue. Contributions of each arch are outlined:

Arch 1 - mandibular arch - will form the lower lip, anterior portion of the tongue, anterior belly of digastric muscle, mylohyoid muscle, muscles of mastication; middle ear structures (malleus and incus) and tensor tympani muscle; tensor veli palatini muscle of the soft palate; and the mandible. The trigeminal nerve, cranial nerve (CN) V, (mandibular portion) arises from the first arch. Arch 2 - hyoid arch - will form the body and lesser horn of the hyoid bone; stapes of the middle ear and stapedius muscle; styloid process of temporal bone; posterior belly of digastric, stylohyoid, and the muscles of facial expression. The facial nerve, CN VII, arises from the second arch. Arch 3 - will form the major horn of the hyoid bone and the posterior portion of the tongue, stylopharyngeus and superior constrictor muscle; cricothyroid muscle of the larynx. The glossopharyngeal nerve, CN IX, arises from the third arch (**differences in innervation of the anterior and posterior tongue are related to the origin of the tongue to the mandibular and third branchial arch). Arch 4 and 5 - will form the thyroid, arytenoid, corniculate and cuneiform cartilages of the larynx and the cartilaginous rings of the trachea; middle and inferior pharyngeal constrictor muscles. The vagus nerve, CN X, arises from these two arches. Arch 6 - will form the cricoid cartilage, intrinsic laryngeal muscles (except cricothyroid),

A primitive laryngeal orifice (opening) is observed below branchial arch 4. (Diagram to be inserted at later date)

Nasal or olfactory placodes appear on the frontal process of the forebrain and develop into nasal pits by week's end. These pits subdivide the frontonasal process into a medial and two lateral nasal processes.

The buccopharyngeal membrane breaks down establishing communication between the primitive mouth and the foregut.

Week 5 sees a continuation of development of the speech and hearing mechanism. The first branchial arch develops a maxillary process which grows medially but does not fuse. The frontonasal process of the cephalic prominence fuses to the maxillary processes. The fourth branchial arch now forms the thyroid cartilage of the larynx and the fifth branchial arch forms the vocal folds. The sixth branchial arch forms the intrinsic laryngeal muscles. Swellings lateral to the laryngeal orifice (below Arch 4) are the

http://www.otoweb.org/clinics_folder/voice_clinic_folder/courses/kim/index.htm

06/01/2007 04:43:13 AM

Anatomy

Page 8

precursors to the arytenoid cartilages while the swelling anterior to the orifice will become the epiglottis.

During the sixth gestational week the medial and lateral nasal processes fuse giving rise to the nostrils; the maxillary and medial nasal processes fuse giving rise to the primary palate; the maxillary process grows in an inferior direction because the tongue is positioned high in the oral cavity preventing medial growth. The tongue drops late in week 6 enabling the medial growth of the maxillary process. Continued growth in the region of the laryngeal orifice results in a T- shaped aditus or entry into the larynx. The aditus will remain a blind depression until approximately the tenth week.

Week 7 is considered the last week of embryonic development. The embryo is approximately 30 mm long; has limbs, fingers and toes; the eyes are on the anterior surface of the face; and organ systems are essentially complete. The speech and hearing mechanism growth in this week includes the differentiation of the oral and nasal cavities; the fusion of the maxillary process anteriorly producing the premaxilla; chondrification of the cricoid cartilage; and rapid growth of the laryngeal structures. (Diagram to be inserted at later date)

Week 8 begins the fetal period which is characterized by continued growth of all the structures and organ systems formed during the first seven weeks of development. During this week, the head grows in the vertical plane resulting in an increased vertical height of the oral cavity. Swellings on the maxillary process, the palatine processes of the maxilla, will move medially and fuse between the eighth and tenth weeks forming the secondary palate or soft palate only if the tongue has dropped down in the oral cavity. In summary, the hard palate is intact by 10 weeks and the soft palate by 12 weeks. Cleft palates appear during weeks 6-12.

Epithelial tissue occluding the laryngeal aditus breaks down in the tenth week. The ventricles develop with the mucosal tissue above becoming the false or ventricular folds and the mucosa below developing into the true vocal folds.

References

Aronson, A. E. (1985). Clinical Voice Disorders: An Interdisciplinary Approach . Second Edition. NY: Thieme, Inc. Bateman, H. E., & Mason, R. M. (1984). Applied Anatomy and Physiology of the Speech and Hearing Mechanism. Springfield, IL: Charles C. Thomas. Boone, D. R. & McFarlane, S. C. (1994). The Voice and Voice Therapy, Fifth Edition. Englewood Cliffs, NJ: Prentice Hall, Inc. Case, J. L. (1996). Clinical Management of Voice Disorders. Austin, TX: Pro-Ed. Colton, R. & Casper, J. K. (1996). Understanding Voice Problems: A Physiological Perspective for Diagnosis and Treatment, Second Edition. Baltimore, MD: Williams & Wilkins. Rohen, J. W., & Yokochi, C. (1988). Color Atlas of Anatomy, Second Edition. New York: Igaku-Shoin. Titze, I. R. (1994). Principles of Voice Production . Englewood Cliffs, NJ: Prentice Hall, Inc. Zemlin, W. R. (1988). Speech and Hearing Science: Anatomy and Physiology, Third Edition. Englewood Cliffs, NJ: Prentice Hall, Inc.

...to top of page

http://www.otoweb.org/clinics_folder/voice_clinic_folder/courses/kim/index.htm

06/01/2007 04:43:13 AM