1、Anatomy and Physiology of the Larynx,Tube occupying middle third of the neckOpposite 3rd,4th,5th,6th cervical vertebraeFramework of cartilages, not to allow for collapse with inspirationCartilages are connected by ligaments & membranes,Larynx Cartilage,Cartilaginous Framework,Unpaired 1- Epiglottis
2、Cartilage 2- Thyroid Cartilage 3- Cricoid Cartilage,Paired 1- Arytenoid Cartilage 2- Corniculate Cartilage 3- Cuniform Cartilage 4- triticeal Cartilage,Epiglottic cartilage A thin lamina of elastic cartilage forming the central portion of the epiglottis. attached to the thyroid cartilage of the lary
3、nx by the thyroepiglottic ligament; it is the structural basis of the epiglottis.,Larynx Cartilage,Thyroid cartilage The largest cartilage of the larynx consisting of two laminae fusing anteriorly at an acute angle in the midline of the neck. The point of fusion forms a subcutaneous projection known
4、 as the adams apple.,Larynx Cartilage,Carcoid cartilageIt sits just inferior to the thyroid cartilage in the neck, and is joined to it medially by the median cricothyroid ligament and postero-laterally by the cricothyroid joints. Inferior to it are the rings of cartilage around the trachea (which ar
5、e not continuous - rather they are C-shaped with a gap posteriorly). The cricoid is joined to the first tracheal ring by the cricotracheal ligament, and this can be felt as a more yielding area between the firm thyroid cartilage and firmer cricoid. The posterior part of the cricoid is slightly broad
6、er than the anterior and lateral parts, and is called the lamina, while the anterior part is the band; this may be the reason for the common comparison made between the cricoid and a signet ring.,Larynx Cartilage,Arytenoids CartilageOne of a pair of small pyramidal cartilages that articulate with th
7、e lamina of the cricoid cartilage. The corresponding vocal ligament and several muscles are attached to it.,喉软骨 ( larynx cartilage),喉韧带及膜,喉软骨之所以能构成喉的支架结构是因为喉体各软骨之间有纤维状韧带组织连接之故，称喉韧带和膜。 主要的韧带：甲状会厌韧带舌会厌正中襞杓状会厌襞环杓后韧带环气管韧带,Muscles of the Larynx,Extrinsic1- Thyrohyoid Muscles2- Sternothyroid MusclesRaise
8、and lower the larynx during deglutition,According to the functions:1- Raise the larynx : Thyrohyoid Muscles, Mylohyoid muscle, Digastric muscle, Stylohyoid muscle2- Lower the larynx :Sternothyroid Muscles,Sternohyoid M, supraomohyoid M, pharyngeal constrictor muscle,Muscles of the Larynx,IntrinsicAl
9、l paired except the transverse arytenoidAbductor: Post. Crico-arytenoidAdductors: Lat. Crico-arytenoid, interarytenoid & thyroarytenoidTensors: Internal part of thyroarytenoidCricothyroid, adductor & tensor,Muscles of the Larynx,Muscles of the Larynx,按其功能分为5组： 声带外展肌：环杓后肌 功能：声带外展、声门变大。 声带内收肌：环杓侧肌、杓肌
10、功能：声带内收、声门闭合。 声带紧张肌：环甲肌 功能：声带紧张度增加，并略使声带内收。 声带松弛肌；甲杓肌 功能：声带内收、关闭声门。使会厌活动肌：杓会厌肌、甲状会厌肌，前者使喉入口关闭，后者使喉入口开放。,Cavity of the Larynx,Laryngeal Cavity: 3 portions Supraglottic portion ; Glottic portion; Infraglottic portion Supraglottic portion:EpiglottisAritenoepiglottic FoldArytenoid areaFalse Vocal Cord,G
11、lottic portion:Vocal Cord Fissure of GlottisAnterior Commisure,Cavity of the Larynx,Cavity of the Larynx,Infraglottic portion,喉腔粘膜,向上与咽粘膜连接，向下与气管粘膜相接。组成： 喉腔粘膜由上皮层和固有膜层组成，上皮层主要是假复层柱状纤毛上皮，但在声带、杓状软骨间切迹、会厌舌面及部分喉面、部分的杓会厌襞以及室襞游离缘等处为复层鳞状上皮。结构特点： 会厌喉面、声带表面等处的粘膜附着甚紧。 会厌舌面、声门下区、杓会厌壁处的粘膜则疏松，有疏松的粘膜下层。临床：易发生肿胀或水
12、肿。,Mucosa of the larynx,there are 5 layers of the vocal cord under the microscope：Stratified squamous epithelium ，Reink layer，elastic fibre layer，Collagen fiber layer and muscle layer 。,声门旁间隙前外界：甲状软骨翼板前部内膜内界：喉弹性膜上部、喉室、甲杓肌内下界：弹性圆锥后界：梨状窝内壁粘膜转折处向上通会厌前间隙，肿瘤可以互相侵犯。,Space of the larynx,Reink space 是潜在的微小间
13、隙，位于声带上皮下层和声韧带之间，占声带的全长。该层为疏松结缔组织，炎症水肿多积于此层。声带息肉形成于该间隙。,Space of the larynx,Blood Supply & Lymphatics,Blood Supply: - Superior thyroid artery Ext. Carotid - Inferior Thyrocervical trunk SubclavianLymphatics: - Glottis No lymphatics - Supraglottic Pre-epiglottic & UDC - Subglottic Pre-laryngeal & pre
14、-tracheal to the LDC,喉的淋巴,喉的淋巴引流与喉癌的局部扩散以及向颈部转移密切相关。 喉的淋巴分为两个高度分隔的系统，浅层淋巴系统和深层淋巴系统：、浅层淋巴系统：为喉的粘膜内系统，左右互相相通。、深层淋巴系统：为喉的粘膜下系统，左右互不相通。 以声门区为界，分为声门上区组、声门下区组。声门上区：淋巴管丰富，汇入颈内静脉周围的颈深上淋巴结，颈深下淋巴结或副神经链。声门区：淋巴管甚少，几乎无粘膜下淋巴系统。声门下区：喉前淋巴结，气管前和气管旁淋巴结。,Never of the Larynx,支配喉的神经：喉上神经和喉返神经喉上神经在舌骨大角平面分为内、外两支。 外支：运动神经支
15、配环甲肌。 内支：感觉神经分布声门以上区域的粘膜。Superior Laryngeal: Sensory above vocal folds, motor to Cricothyroid muscle,Never of the Larynx,Superior Laryngeal: Sensory above vocal folds, motor to Cricothyroid muscleInferior (Recurrent) Laryngeal: Sensory below folds, motor to all muscles except cricothyroid,Never of t
16、he Larynx 喉的神经,喉返神经：喉的主要运动神经 迷走神经进入胸腔后分出，右侧路径短，左侧路径长，麻痹多见。 支配除环甲肌以外各肌的运动。右侧：锁骨下动脉前离开迷走神经，绕该动脉的下后方再折上向行，沿气管与食管沟，环甲关节后方入喉内。左侧：绕过主动脉弓，继而上行，在环甲关节后方入喉内。,SmallerFunnel shaped with the narrowest area in the sub-glottisLoss submucosa, allow accumulation of exudates Cartilages more softLies high up under ton
17、gueAxis of air entry is more straight, more possibility of F.B. inhalation,The Infantile Larynx,Physiology of the Larynx,Protection of the lower respiratory passages: (The primitive, embryonic & most imp.) 1- Sphicteric Mechanisms (epiglottic-aryepiglottic, V.B. and V.F.) 2- Elevation of the larynx during swallowing 3- Cessation of respiration during swallowing 4- Cough reflex PhonationRespirationFixation of the chest,
