The pharynx , larynx

and soft palate

By : Dr. Yuliani Sp.THT

Description of pharynx
The pharynx is situated
behind the nasal cavities, the
mouth, and the larynx
It may be divided into nasal,
oral, and laryngeal parts
Its upper, wider end lying
under the skull
Its lower, narrow end
becoming continuous with the
esophagus opposite the sixth
cervical vertebra

The pharynx has a

musculomembranous wall,
which is deficient anteriorly
Here, it is replaced by the
posterior openings into the
nose (choanae), the opening
into the mouth, and the inlet
of the larynx

 By means of the
auditory tube, the
mucous membrane is
also continuous with
that of the tympanic
cavity

Muscles of the Pharynx

Wall of the pharynx consist
of the superior, middle, and
inferior constrictor muscles
Fibers of these muscles
run in a somewhat circular
direction
Stylopharyngeus and
salpingopharyngeus
muscles
Their fibers run in a
somewhat longitudinal
direction

Muscles of the Pharynx

The three constrictor muscles extend

around the pharyngeal wall to be
inserted into a fibrous band or raphe
The raphe extends from the
pharyngeal tubercle on the basilar
part of the occipital bone of the skull
down to the esophagus
The three constrictor muscles overlap
each other so that the middle
constrictor lies on the outside of the
lower part of the superior constrictor
and the inferior constrictor lies outside
the lower part of the middle constrictor

Muscles of the Pharynx

The lower part of the inferior constrictor, which arises from
the cricoid cartilage, is called the cricopharyngeus muscle
The fibers of the cricopharyngeus pass horizontally around
the lowest and narrowest part of the pharynx and act as a
sphincter

Nasal Pharynx ( Nasopharynx)

This lies above the soft palate and behind the nasal
cavities
In the submucosa of the roof is a collection of lymphoid
tissue called the pharyngeal tonsil
The pharyngeal isthmus is the opening in the floor
between the soft palate and the posterior pharyngeal wall
On the lateral wall is the opening of the auditory tube, the
elevated ridge of which is called the tubal elevation

Nasal Pharynx
The pharyngeal recess is a depression in the
pharyngeal wall behind the tubal elevation
The salpingopharyngeal fold is a vertical fold of
mucous membrane covering the salpingopharyngeus
muscle

Oral Pharynx ( Oropharynx)

This lies behind the oral cavity
The floor is formed by the posterior one third of the tongue and the
interval between the tongue and epiglottis
In the midline is the median glossoepiglottic fold
on each side the lateral glossoepiglottic fold
The depression on each side of the median glossoepiglottic fold is
called the vallecula

Oral Pharynx
On the lateral wall on each side are the palatoglossal and the
palatopharyngeal arches or folds and the palatine tonsils between
them
The palatoglossal arch is a fold of mucous membrane covering the
palatoglossus muscle
The interval between the two palatoglossal arches is called the
oropharyngeal isthmus
It marks the boundary between the mouth and pharynx

Oral Pharynx
The palatopharyngeal arch is a fold of mucous membrane
covering the palatopharyngeus muscle
The
recess
between
the
palatoglossal
and
palatopharyngeal arches is occupied by the palatine tonsil

Lymphoid Tissue of Pharynx

At the junction of the mouth with the oral part of the
pharynx, and the nose with the nasal part of the pharynx, are
collections of lymphoid tissue
They are of considerable clinical importance
The palatine tonsils and the nasopharyngeal tonsils are the
most important

Tonsils and Tonsilitis

The palatine tonsils reach their maximum normal size in
early childhood
After puberty, together with other lymphoid tissues in the
body, they gradually atrophy
The palatine tonsils are a common site of infection,
producing the characteristic sore throat and pyrexia.

Tonsils and Tonsilitis

The deep cervical lymph node situated below and behind
the angle of the mandible, which drains lymph from this
organ, is usually enlarged and tender
Recurrent attacks of tonsillitis are best treated by
tonsillectomy
After tonsillectomy, the external palatine vein, which lies
lateral to the tonsil, may be the source of troublesome
postoperative bleeding

Quinsy
A peritonsillar abscess (quinsy) is caused by spread of
infection from the palatine tonsil to the loose connective
tissue outside the capsule
The nasopharyngeal tonsil or pharyngeal tonsil consists of a
collection of lymphoid tissue beneath the epithelium of the
roof of the nasal part of the pharynx
Like the palatine tonsil, it is largest in early childhood and
starts to atrophy after puberty

Adenoids
Excessive hypertrophy of the lymphoid tissue, usually
associated with infection, causes the pharyngeal tonsils to
become enlarged
They are then commonly referred to as adenoids
Marked hypertrophy blocks the posterior nasal openings
and causes the patient to snore loudly at night and to
breathe through the open mouth

Adenoids
The close relationship of the infected lymphoid tissue to the
auditory tube may be the cause of deafness and recurrent
otitis media
Adenoidectomy is the treatment of choice for hypertrophied
adenoids with infection
The nasal part of the pharynx may be viewed clinically by a
mirror passed through the mouth

Laryngeal Pharynx
This lies behind the opening into the larynx
The lateral wall is formed by the thyroid
cartilage and the thyrohyoid membrane
The piriform fossa is a depression in the
mucous membrane on each side of the
laryngeal inlet

Sensory Nerve Supply of the Pharyngeal Mucous

Membrane
Nasal pharynx ( Nasopharinx): The maxillary nerve
Oral pharynx (Oropharynx) : The glossopharyngeal nerve
Laryngeal pharynx (Hipopharynx/laryngopharynx): The
internal laryngeal branch of the vagus nerve

Blood Supply
Ascending pharyngeal, tonsillar
branches of facial arteries, and
branches of maxillary and lingual
arteries

Lymph Drainage
Directly into the deep
cervical lymph nodes or
indirectly
via
the
retropharyngeal
or
paratracheal nodes into
the deep cervical nodes

Swallowing or Deglutition
Masticated food is formed into a ball or bolus on the dorsum of the
tongue and voluntarily pushed upward and backward against the
undersurface of the hard palate
This is brought about by the contraction of the styloglossus muscles
on both sides, which pull the root of the tongue upward and backward
The palatoglossus muscles then squeeze the bolus backward into the
pharynx
From this point onward the process of swallowing becomes an
involuntary act

Swallowing or Deglutition
The nasal part of the pharynx is now shut off from the oral
part of the pharynx by the elevation of the soft palate
By the pulling forward of the posterior wall of the pharynx
by the upper fibers of the superior constrictor muscle
And by the contraction of the palatopharyngeus muscles
This prevents the passage of food and drink into the nasal
cavities

Swallowing or Deglutition
The larynx and the laryngeal part of the pharynx are pulled upward
by the contraction of the stylopharyngeus, salpingopharyngeus,
thyrohyoid, and palatopharyngeus muscles
The main part of the larynx is thus elevated to the posterior surface
of the epiglottis, and the entrance into the larynx is closed
The laryngeal entrance is made smaller by the approximation of the
aryepiglottic folds, and the arytenoid cartilages are pulled forward
by the contraction of the aryepiglottic, oblique arytenoid, and
thyroarytenoid muscles

Swallowing or Deglutition
The bolus moves downward over the epiglottis, the closed entrance
into the larynx, and reaches the lower part of the pharynx as the
result of the successive contraction of the superior, middle, and
inferior constrictor muscles
Some of the food slides down the groove on either side of the
entrance into the larynx, that is, down through the piriform fossae
Finally, the lower part of the pharyngeal wall (the cricopharyngeus
muscle) relaxes and the bolus enters the esophagus

Palatine Tonsils
The palatine tonsils are two masses of lymphoid tissue, each located in the
depression on the lateral wall of the oral part of the pharynx between the
palatoglossal and palatopharyngeal arches
Each tonsil is covered by mucous membrane, and its free medial surface
projects into the pharynx
The surface is pitted by numerous small openings that lead into the tonsillar
crypts

Palatine Tonsils
The tonsil is covered on its lateral surface by a fibrous
capsule
The capsule is separated from the superior constrictor
muscle by loose areolar tissue
The external palatine vein descends from the soft
palate in this tissue to join the pharyngeal venous
plexus
Lateral to the superior constrictor muscle lie the
styloglossus muscle, the loop of the facial artery, and
the internal carotid artery

Blood Supply
The tonsillar branch of the facial artery
The veins pierce the superior constrictor muscle and join
the external palatine, the pharyngeal, or the facial veins
Lymph drains into the upper deep cervical lymph nodes, just
below and behind the angle of the mandible

Waldeyer's Ring of Lymphoid Tissue

The lymphoid tissue that surrounds the opening into the respiratory
and digestive systems forms a ring
The lateral part of the ring is formed by the palatine tonsils and tubal
tonsils
The pharyngeal tonsil in the roof of the nasopharynx forms the upper
part, and the lingual tonsil on the posterior third of the tongue forms the
lower part

LARYNX
The original use of the larynx was to keep us alive
through breakfast. Its main function is stop solids and
liquids from entering the trachea and choking us to death.
Its secondary functions are to bear down, phonation and
speech. The larynx of humans and great apes in infancy
is higher in the neck so that they can breathe and suckle
at the same time. In humans it descends before the age
of two.

ANATOMY OF THE LARYNX

Introduction:
Situated above the trachea.
Extends from the laryngeal inlet to the inferior border of the cricoid cartilage .
Opposite the third to sixth cervical vertebrae, being a little higher in women
than in men.
The infantile larynx:
Smaller than the adult compared to body size
More funnel shaped.
Its narrowest part is at the junction of the subglottic larynx with the trachea
and even slight swelling in this area may result in marked airway obstruction .
Cartilages are much softer and collapse more easily on forced inspiration.
The larynx starts high up under the tongue in early life and with age assumes
an increasingly lower position in the neck .

The larynx is divided anatomically in to :

supra glottis .
glottis . And
sub glottis .
By the falls and
true vocal cords.

 The supraglottis consists of superiorly the

epiglottis and aryepiglottic folds as they sweep down to
the arytenoids. Its lower border is the ventricular bands
false cords) which form the upper border of the glottis .
The glottis includes the vocal cords and anterior
commissure and posterior commissure.
The sub glottis becomes the trachea at the lower border of
the cricoid .( between true v.c . and lower border of the
cricoid ) .

The framework of the larynx

Consists of :
hyoid bone
number of cartilages
connected by ligaments, membranes and intrinsic and extrinsic muscles
to give it stability.
They move in relation to one another by
the action of the two groups of muscles.
Lined with a mucous membrane
that is continuous above with the pharynx
and below with that of the trachea .

HYOID BONE :
U-shaped bone.
Provides the upper attachment for many of the extrinsic muscles of the larynx.
Suspends the larynx in the neck .

It consists of:
Body anteriorly
Greater cornua project backwards on each side.
Lesser cornua _two small conical eminences _attached to the upper part of
the body of the hyoid by a fibrous band and sometimes to the greater cornua
by way of a synovial joint .

Cartilaginous skeleton of larynx

9 different cartilages present in the larynx .
Unpaired cartilages:
(thyroid, cricoid , epiglottis)
Paired cartilages:
(arytenoid , corniculate ,cuneiform)

THYROID CARTILAGE:
Thyroid cartilage:
Shield like.
Largest of the laryngeal cartilages.
Has two laminae meet in the midline inferiorly.
The angle of fusion between the laminae is about 90 degree in
men and 120 degrees in women.
The fused anterior borders in men form a projection, which can
be easily palpated known as Adams apple.

 The laminae diverge posteriorly.

The posterior border of the two laminae are prolonged as tw
slender processes known as the superior and inferior
cornua.

 The Oblique Line:

The oblique line extends from the superior thryoid tubercle
to the inferior thyroid tubercle.
The oblique line gives attachment to the following muscles:
1. Thyrohyoid muscle .
2. Sternohyoid muscle .
3. Inferior constrictor muscle .

Ligaments attached to the thyroid cartilage:

Thyroepiglottic ligament:

elastic ligament connecting the epiglottis to the

angle of the thyroid cartilage.

Vestibular ligament: Also known as the false vocal cord.

Vocal ligament: Also known as the true vocal cord is responsible for the
generation of voice.

 CRICOID CARTILAGE
The only complete cartilage ring in the whole of the respiratory pathway.
Shaped like a signet ring.
Composed of of a deep broad quadrilateral lamina posteriorly and a narrow arch anteriorly.

 The lamina of the cricoid cartilage has articular facets for arytenoid
cartilage . These joints are synovial in nature. The cricoid cartilage
also articulates with the thyroid cartilage .

THE ARYTENOID CARTILAGES

Small paired cartilages placed close together on the upper and lateral borders of the
cricoid lamina.
Pyramidal shaped.
Has two projections, forward and lateral projections.
The forward projection is also known as vocal process. The vocal folds are attached to the
vocal process.
The lateral processes are also known as muscular process .

CORNICULATE AND CUNEIFORM CARTILAGES

The corniculate cartilages are two small conical nodules of elastic fibrocartilage which
articulate through a synovial joint with the apices of the arytenoid cartilages. They are
situated in the posterior part of the aryepiglottic fold.
The cuneiform cartilages are two small elongated flakes of fibroelastic cartilage, one in
each margin of the aryepiglottic fold.

 EPIGLOTTIS

Leaf shaped fibroelastic cartilage .

Projects upwards behind the tongue and the body of the hyoid bone.
Its upper part is broad and is directed upwards and backwards.
Superior margin is free.
The sides of the epiglottis is attached to the arytenoid cartilages by aryepiglottic folds.

 The anterior surface of the epiglottis is free and is covered with the same mucous
membrane which is of the of pharynx.
Forms a single median glossoepiglottic fold and two lateral glossoepiglottic folds.
Between these folds lie a depression known as the vallecula.
In neonates and infants the epiglottis is omega shaped.
This long, deeply grooved, floppy epiglottis protects the nasotracheal air passage during
sucking.

Laryngeal joints
Crico-thyroid joint : between thyroid and cricoid cartilages. Its a synovial
joint.
Two movements occur :
Rotation through a transverse axis .
Gliding , slightly .

 Crico- arytenoid joint :

Between arytenoid and the cricoid cartilage . Its a synovial joint.
Tow movements occur :
Rotation .of the arytenoid , on vertical axis . The vocal process moves medially or laterally .
Gliding . the arytenoid moves toward or away from each other .

Ligaments and membranes of the larynx

Extrinsic and Intrinsic ligaments .
Extrinsic ligaments: connect the laryngeal cartilages to the hyoid bone
above and trachea below.
Thyro-hyoid membrane: between the upper border of the thyroid and the
the body and greater cornua of the hyoid bone.

 Crico-tracheal ligament: Unites the lower border of the cricoid cartilage with the first

tracheal ring .

Hyo-epiglottic ligament: connects the epiglottis to the back of the body of the hyoid
bone.

Intrinsic ligaments:

ligaments that connect the laryngeal cartilages.

Strengthen the capsule of intercartilagenous joints.
Form a broad sheet of fibroelastic tissue which lie beneath the mucous
membrane of the larynx creating an internal framework .

The fibroelastic membrane:

Divided into :

upper and lower part by the presence of laryngeal ventricle.

The upper membrane is the quadrilateral membrane.
It extends between epiglottis and the arytenoid cartilage.
Its upper margin forms a framework for the aryepiglottic fold.
Its lower margin is thickened to form the vestibular ligament, which underlies the vestibular fold or
false vocal cord.

The lower part is a thicker membrane, containing many elastic fibers. It

is also known as cricovocal ligament or cricothryoid ligament or
conus elasticus.
Below it is attached to the upper border of the cricoid cartilage.
Above it is stretched between the midpoint of thyroid cartilage
anteriorly and the vocal process of the arytenoid behind.
The free upper border of this membrane forms the vocal cord.

Muscles of the larynx

The extrinsic muscles .

intrinsic muscles .

extrinsic muscles of the larynx

connect the laryngeal cartilages to
Hyoid bone above and trachea below .
and maintain the position of the
larynx in the neck .
Divided Into :
Infra hyoid group ( strap muscles )
( Thyrohyoid , Sternothyroid ,
Sternohyoid , omohyoid ) .

Supra hyoid group

( Mylohyoid , Geniohyoid, Stylohyoid ,
Digastric , Stylopharyngeus ,
Palatopharyngeus , Salpingopharyngeus (

Fig. show strap muscles of the neck

Action

Insertion

origin

muscle

draws the larynx

downwards .

lower edge of the

body of the hyoid

posterir surface of the

manubrium sterni and
the 1st costal cartilage

Sterno hyoid

rises the larynx if the

hyoid is fixed .
Depress the hyoid if
the larynx is fixed .

lower border of the

greater horn of the
hyoid bone

oblique line on the

thyroid ala

Thyrohyoid

Depresses the larynx

oblique line on the

. thyroid lamina

posterir surface of the

manubrium and the
1st costal cartilage

Sternothyroid

Depresses the larynx

intermediate tendon

superior border of
scapula

omohyoid
(inferior belly )

Depresses the larynx

Lateral surface of
hyoid bone

intermediate tendon

omohyoid
(superior belly )

All of the infrahyoid muscles are innervated by theansa cervicalisfrom the

cervical plexus(c1-c3 ) except the thyrohyoid muscle, which is innervated by
fibres only from the1st cervical signal nervetravelling with the hypoglosal nerve
.

 Suprahyoid group
inervation

Action

Insertion

origin

muscle

Nerve to mylohyoid
inferior alveolar(
)branch of v3

Raises and pulls

.the hyoid

Midline raphe and

.body of hyoid

Mylohyoid line on
the inner aspect of
.Mndible

Mylohyoid

Hypoglossal (C1
root)

Raises and pulls

.the hyoid forward

Upper border of the

.body of hyoid

Genial tubercle on
.Mndible

Geniohyoid

.Facial nerve

Retractor and
elevator of hyoid for
.swallowing

Base of greater
.cornu of thyroid

Back of the styloid

split around(
)digastric process

Stylohyoid

Posterior belly facial

.nerve
Anterior belly - nerve
.to mylohyoid

Anterior belly pulls the

.Hyoid anterior and up
posterior belly pulls
.Hyoid post. and up

Lower border of the

Mandible .fibrous sling
holds the tendon to
.lesser cornu of hyoid

Digastric notch on
the medial surface
.Mastoid process

Digastric

Glossopharyngeal
nerve

Elevates the larynx

post. Border of lamina

of th. Cart.( side wall
)Of pharynx

Medial aspect of
the styloid
.process

Stylopharyng
eous

Accessory nerve
))pharyngeal plexus

Helps tilts the

.larynx forward

post . Border of thyroid

.alar and cornu

Palatine aponeurosis
And post. Margin of
.palat

Palatopharyn
geus

Pharyngeal plexus

Elevates the larynx

post . Border of thyroid

cart. .( side wall of
pharynx )

Eustachian tube

Salpingophar
yngeus

Intrinsic muscles of larynx

The intrinsic muscles are all paired and move

the cartilages in the larynx and regulate the
mechanical properties of the larynx. They control the
position and shape of the vocal
folds and control the elasticity and viscosity of each
layer .

Divided into :
Open and close the glottis:(lateral and posterior cricoarytenoid
muscles, transverse and oblique arytenoids).
Control the tension of vocal ligaments :(thyroarytenoids, vocalis and
cricothyroids).
Alter the shape of the inlet of the larynx :(aryepiglotticus and the
thyroepiglotticus).
Except transverse arytenoid, all these muscles are paired.

Abductor of vocal cords : there is only one each side .

Posterior cricoarytenoid muscle : is the only muscle that opens
the glottis, separating the vocal processes and thus abducts the vocal
cords.

Adductors of vocal cords :

three on each side .
Lateral cricoarytenoid muscle:
Adducts the vocal ligaments by rotating the arytenoids
medially.

 Transvers portion of inter arytenoid muscle :

A single muscle.

Adduct the vocal cord .

 External portion of thyroarytenoid muscle :

A thin sheet which lies out side the vocal cord , venticle and
saccule of the larynx .
It closes the rima glottis by medial rotation of Arytenoid cartilage
around longitudinal axis .

Tensors of the vocal cords : 2 on each side .

cricothyroid muscle :

The only intrinsic muscle that lie outside the cartilaginuos framewo
the larynx .
It is known as the External tensor .

 Internal portion of thyro- arytenoid ( vocalis ) m.

:

A specialized portion of the lower and deeper fibers of the

thyro-arytenoid muscle .

It forms a triangular bundle.

Some of its fibers gain its attachment to the vocal ligament.
It is known as the internal tensor .

 Opener of laryngeal inlet :

Fibers of thyro-epiglottic muscle is apart of the thyro-arytenoid muscle
widens the inlet of the larynx by pulling the ary-epiglottic folds slightly
apart .

Closers of the laryngeal inlet :

Oblique portion of inter-arytenoid muscle is superficial to the
transvers portion . The two bundle of fibers cross each other ; closes
the rima glttis .
Ary-epiglotic muscle is prolongation of the oblique fibers of interarytenoid muscle
in to the ary- epiglotic fold .

All intrinsic muscles of the larynx are supplied by recurren

laryngeal nerve except
Crico-thyroid m. which is supplied by external laryngeal nerve ..

 Interior of larynx :
The laryngeal cavity extends from the level of 3rd cervical vertebra to the
lower border of the cricoid cartilage (c6) level. At the level of cricoid
cartilage it becomes continuous with that of the trachea.

Laryngeal cavity is divided by the presence of vestibular

and vocal folds into:
Larynx above the vestibular fold is known as superior
vestibule.
The ventricle or sinus of the larynx lies between the
vestibular and vocal folds.
Below the vocal folds is the subglottic space which
extends to the level of the lower border of the cricoid
cartilage.

 False vocal cord ( the ventricular bands): which are

formed by the mucous membrane covering the ventricular
ligament and the upper part of the external portion of the
thyroarytenoid muscle.

True vocal cords : Project further into than the false cords,
and
lie at a lower level. The covering epithelium is closely bound
down to the underlying vocal ligament. The blood supply is poor,
hence the pearly white appearance of the vocal cords.

Histologically the vocal fold:

contains 5 layers:
Layer 1 (squamous epithelial lining): It is very thin .
Layer 2 (Superfical layer of the lamina propria =Reinke's space ):
composed of loose fibers and matrix.. This layer contains only minimal
elastic and collagenous fibers and offers least resistance to vibration. The
integrity of this layer is vital for proper phonatory function.
Layer 3 (Intermediate layer of lamina propria): a higher
concentration of elastic and collagenous fibres. Provides protection to the
vocal folds from mechanical damage.
Layer 4 (Deep layer of lamina propria): a dense collection of elastic
and collagenous fibers.
Along with the intermediate layer constitute the vocal ligament.
Layer 5 (vocalis muscle) :

portion of thyro _arytenoid muscle.

 Fig showing ultra structure of vocal cord

 Vestibule :Lies between the laryngeal inlet and the edges

of the false cords.
Bounderies:
Posterior surface of epiglottis in front.
Interval between the arytenoid cartilages behind.
Inner surface of the aryepiglottic folds and upper surfaces of
the false cords on each side.

 Laryngeal inlet:

is bounded

superiorly by the free edge of epiglottis

and on each side by the aryepiglottic folds.
Posteriorly by the mucous membrane between the
arytenoid cartilages.

 Mucous membranes of the larynx :

Most of the larynx is lined by pseudo stratified ciliated columnar
'respiratory' -type epithelium.
The upper half of the posterior surface of the epiglottis, the upper
part of the aryepiglottic fold, the posterior glottis and the vocal
folds are covered with nonkeratinizing stratified squamous
epithelium.
Mucous glands are freely distributed throughout the mucous
membranes and are particularly numerous on the posterior surface
of the epiglottis and in the margins of the lower part of the
aryepiglottic folds and in the saccules.
The vocal folds do not possess any glands and the mucous
membrane is lubricated by mucus from the glands within the
saccules.
The squamous epethelium of the vocal folds is therefor Pron to
desiccation if these glands cease to function, for example after
radiation .

 Ventricle of larynx:
between the vestibular and vocal folds, overlie the ligaments of the same name.
On each side the laryngeal ventricle opens into an elongated recess known as the
laryngeal sinus.
From the anterior part of the ventricle, a pouch called the saccule of the larynx
ascends between the vestibular folds and the inner surface of the thyroid
cartilage.
The mucous membrane of saccule contains numerous mucous secreting glands.
These secretions lubricates the vocal cord.

 Rima glottis: is an elongated fissure present between the two vocal folds.

Rima vestibuli :The rima vestibuli is the triangular-shaped opening between

the 2 adjacent vestibular folds.

 Pyriform recesses :
The pyriform recesses (pyriform sinuses) are present on either
side of the anterolateral wall of the laryngopharynx. They are
bounded medially by the aryepiglottic folds and laterally by the
thyroid cartilage and thyrohyoid membrane. They are a common
place for food to become trapped.

Spaces within the larynx :

Preepiglottic space: Is a wedge shaped space

lying in front of the

epiglottis. It is bounded anteriorly by the thyrohyoid ligament and the hyoid bone.
This space is continuous laterally with that of paraglottic space. Tumour may
spread into this area through small perforations in the epiglottis or directly
through, the hyoepiglottic ligament.

 Paraglottic space: is a potential space present on either side of glottis. It is

bounded by the mucosa covering the lamina of thyroid cartilage laterally, the
conus elasticus and quadrangular membranes medially and the anterior reflection
of the pyriform fossa mucosa posteriorly .

Blood supply of the larynx : Is derived from the

laryngeal branches of the superior thyroid arteriy . .

laryngeal branches of the inferior thyroid arteriy .
the cricothryoid branch of the superior thyroid artery.
The superior thyroid artery arises from the external carotid artery, and the inferior thyroid
artery arises from the thyrocervical trunk.

The veins leaving the larynx accompany the arteries;

The superior vessels drain to the internal jugular vein by
way of the superior thyroid or facial veins ,
The inferior vessels drain by way of inferior thyroid vein
into the brachiocephalic veins.
Some venous drainage also occur
through the middle thyroid vein into the internal jugular vein.

 Lymphatic drainage:

Separated by the vocal folds

into an upper and lower group:
The part of the larynx above
the vocal folds is drained by
vessels accompanying the
superior laryngeal vein,
The zone below the vocal folds
drains together with the
inferior vein, into the lower part
of the deep cervical chain often
through the prelaryngeal and
pretracheal nodes.
The vocal folds are devoid of
lymphatics, and it infact clearly
forms the watershed zone
between the upper and the
lower group of lymphatics.

 Nerve supply of the larynx :

The larynx is supplied by branches of vagus nerve .
Superior laryngeal nerve has two laryngeal branches :
Internal branch . Entirly sensory . It pierces the thyrohyoid
membrane with the
superior laryngeal artery and vien . It supplies the cavity of the
larynx as far down
the level of the vocal cords .
External branch . Travels down on the inferior constrictor muscle
of the pharynx . It supplies the cricothyroid muscle and part of
the ant. Subglottis .

 Recurrent laryngeal branch of the vagus

nerve (CN X) :
It has much longer course on the left side than on the
right side .
On the lt. side it Turns round the arch of aorta .
On the rt. Side it Turns round the subclavian artery.
In the neck it lies between the trachea and oesophagus
as
it approach the larynx .
Its terminal part pass upwards , under cover of ala
of the
thyroid cartilage , immidiately

behind the cricothyroid

joint .
Devided In to :
An antero lateral ( motor branch ) : which supply
all the intrinsic ms. Of the larynx except the
cricothyroid m.
Posteromedial ( sensory branch) : which supplies
the cavity of the larynx below the level of vocal cords
.

Functions of larynx:
1. Airway protection
2. Respiration
3. Swallowing
4. Coghing
5. phonation

Airway protection:
The most important function of human larynx.
A sphincter protecting the lower airway from secretions of
oropharynx.
Protects the airway from spillage of food during deglutition.
Larynx

has

three protective mechanisms (from above

downwards):
Aryepiglottic fold, ventricular band and vocal cords.

Respiration:
Larynx is part of the upper airway passages .
keeps the airway open during respiration.
Contributes to the regulation of the acid-base balance in the
blood by influencing CO 2 tension .

Swallowing:
During swallowing the sphincters of larynx stay contracted preventing aspiration of
food into the air passage.

Coughing :

Coughing is the process by which material is expelled

from the airway.
It is preceded by rapid inspiration, followed by forceful closure of both
the vocal and vestibular folds.
Air pressure is then built up below the adducted folds.
The diaphragm ascends spasmodically until the folds separate
explosively and mucus or foreign material is expelled.

 Phonation:

The larynx acts as a transducer during phonation converting the

aerodynamic forces generated by the lungs, diaphragm, chest and
abdominal muscles into acoustic energy.
The requirements of normal phonation are as follows:
1. Active respiratory support
2. Adequate glottic closure
3. Normal mucosal covering of the vocal cord
4. Adequate control of vocal fold length and tension.

The cycle of sound production involves glottic opening and

closing at set frequencies determined by the subglottic air
pressure.

The function of vocal folds is to produce sound varying in

intensity and pitch. This sound is then modified by various
resonating chambers present above and below the larynx and
are converted into words by the articulating action of the pharynx,
tongue, palate, teeth and lips.

Palate
Palate, roof of the mouth, consisting of two portions. The hard palate in front and
the soft palate behind.
The uvula, hangs from the lower border of the soft palate.
The first well-developed palates are found in the reptiles.
Similar to humans palates occurs only in birds and some mammals.
In few whales the mucous membrane forms toughened plates known as
whalebone.
The roof of the oral cavity is formed of :
Hard palate.
Soft palate.

Hard palate :

The hard palate is a thin horizontal bony plate of thel, located in the roof of
the mouth.
It composes two-third of the total palate area.
The hard palate is covered by a moist , durable layer of mucousmembrane tissue , which secrete small amounts of mucous. This layer
forms several ridges that help grip food while the tongue agitates it during
chewing.

 The hard palate provides space for the tongue to move freely and supplies a
rigid floor to the nasal cavity .
In many lower vertebrates , the hard palate bears teeth. It is formed by the
palatine process of the maxilla and horizontal plate of the palatine bone. It forms
a partition between the nasal passages and the mouth.

Function of hard palate :

Separating the mouth and nose.
Strengthening the skull and transmitting mechanical forces during chewing.
Helping to hold food during transport.
Play a great role during suckling period.
The posterior third tightens during swallowing to keep food from moving back
into the nasal passage.

Soft palate :
The soft palate ( velum, or muscular palate) is the soft tissue
constituting the back of the roof of mouth.
The soft palate is distinguished from the hard palate in that it
does not contain bone.
The soft palate is composed of muscle and connective tissue ,
which give it both mobility and support.
This palate is very flexible. When elevated for swallowing and
sucking , it completely blocks and separates the nasal cavity and
nasal portion of the pharynx from the mouth and the oral part of
the pharynx.

Functions :

It is movable and responsible for closing off the nasal passages during the
act of swallowing.

The soft palate's motion during breathing is responsible for the sound of
snoring.

Separate the oral cavity (mouth) from the nose, in order to produce the oral
speech sounds.

 Attached to the posterior border of the hard palate

Covered on its upper and lower surfaces by mucous membrane
Composed of:
Muscle fibers
An aponeurosis
Lymphoid tissue
Glands
Blood vessels
Nerves

Palatine Aponeurosis
Fibrous sheath
Attached to posterior border of
Is expanded tendon of
tensor velli palatini
Splits to enclose musculus uvulae
Gives origin & insertion to palatine
muscles

Muscles
Tensor veli palatini
Origin: spine of sphenoid; auditory
tube
Insertion: forms palatine
aponeurosis
Action: Tenses soft palate

Levator veli palatini

Origin:petrous temporal bone,
auditory tube, palatine aponeurosis
Insertion: palatine aponeurosis
Action: Raises soft palate

Musculus uvulae
Origin: posterior border of hard
palate
Insertion: mucosa of uvula
Action: Elevates uvula

Palatoglossus
Origin: palatine aponeurosis
Insertion: side of tongue
Action: pulls root of tongue
upward,
narrowing
oropharyngeal isthmus

Palatopharyngeus
Origin: palatine aponeurosis
Insertion: posterior border of
thyroid cartilage
Action: Elevates wall of the
pharynx

Sensory nerve supply

-

Mostly by the
maxillary nerve
through its branches:
->Greater palatine
nerve
-> Lesser palatine nerve
-> Nasopalatine nerve

Glossopharyngeal
nerve supplies the
region of the soft
palate

Motor nerve supply

- All the muscles, except tensor veli
palatini, are supplied by the:
-> Pharyngeal plexus

Tensor veli palatini supplied by the:

-> Nerve to medial pterygoid, a branch of the
division of the trigeminal nerve

mandibular

Blood supply
Branches of the maxillary artery
- Greater palatine
- Lesser palatine
- Spheno palatine
Ascending palatine branch of the facial artery
Ascending pharyngeal branch of the external carotid
artery

Clinical note
Cleft palate:
Unilateral
Bilateral
Median

Paralysis of the soft

palate
The pharyngeal isthmus can
not be closed during
swallowing and speech

Thank You . . .