Anatomy of the Larynx &

Physiology of Phonation
Samantha Soriano-Castaeda,
MD

Objectives
Anatomy of the larynx

Cartilage
Ligaments
Muscles
Nerves
Blood supply
Lymphatic drainage

Function of the larynx

Clinical correlates

Thyroid cartilage
Laminae fuse
anteriorly
Laryngeal
prominence
Superior & inferior
thyroid notch
Superior horn
Inferior horn

Cricoid cartilage
Only complete ring
Thicker posteriorly
than anteriorly

Arytenoid cartilage
Paired pyramidal
cartilage
Apex
Vocal process
Muscular process

Epiglottis
Elastic cartilage
Posterior to the
tongue, hyoid
Hyoepiglottic
ligament
Thyro-epiglottic
ligament
Aryepiglottic fold

Ligaments
Thyrohyoid
ligament
Cricothyroid
ligament
Cricotracheal
ligament

Innervation
All laryngeal muscles are innervated
by the recurrent laryngeal nerve
(inferior) except the cricothyroid
muscle which is innervated by the
external branch of the superior
laryngeal nerve
Sensory innervation: supraglottic
internal branch of the superior
laryngeal nerve
Glottis downwards recurrent laryngeal

Arteries & Veins

Superior thyroid superior laryngeal
thyrohyoid membrane
Inferior thyroid inferior laryngeal
cricothyroid membran

Lymphatics
Supraglottic level II
Subglottic level VI then level IV
Glottic area no lymphatic drainage

Laryngeal cancer

Larynx function
Protection most important
Phonation

Phonation
sound production arises from
movement of the true vocal cords
Pitch
Quality
Volume

Vocal folds
Superior & inferior pseudostratified
squamous epithelium
Medial vocal fold non-keratinizing
stratified squamous epithelium
3 layers
Superficial layer Reinkes space few
elastic fibers
Intermediate more elastic fibers
Deep few elastic, collagen fibers

Body Cover Theory

Cover epithelium & Reinkes space
Body intermediate & deep layer
Changes in stiffness or tension in the
fold alters the mucosal wave

Myoelastic Aerodynamic
Theory

Contraction of abdominal muscles

Closed VCs
Rise in subglottic pressure
VCs open
Dec in subglottic pressure, sucks in
the vocal cords (Bernoullis effect)
Closure of the VCs
Horizontal & vertical movement of the
VCs mucosal wave

J Voice. 20
11 Jul; 25(
4): 395-405

Which of the following muscles

Abduct the vocal cords?
A) Posterior cricoarytenoid
B) Lateral cricoarytenoid
C) Cricothyroid
D) Interarytenoid

The inferior boundary of the

subglottis is the:
A) Vestibular fold
B) Ventricle
C) Inferior border of the thyroid
cartilage
D) Inferior border of the cricoid
cartilage

The vestibule is the space:

A) Between the vocal cords
B) Between the true & false vocal cords
C) Extending up from the ventricle
D) Between the epiglottis &
aryepiglottic fold

The inferior boundary of the conus

elasticus is the:
A) Vestibular fold
B) Vocal fold
C) Cricoid cartilage
D) Thyroid cartilage