Lecture 17

24 minute
larynx and trachea 2
done by : azam,najwa aiman,nur liyana

slide 2
Today I want to finish talking about the
larynx and talk about the trachea in the
neck. Ok, so there are two groups of
muscles acting on the larynx. The first
group consists of the extrinsic muscles
that elevate or depress the larynx as a
whole. Where as the second group
consists of the intrinsic muscles that
act on the laryngeal inlet and the vocal
cords. So, you can divide the extrinsic
muscles into elevators and depressor
according to their action on the larynx.
So elevators of the larynx are (slides 2)
Slides 3,4
you can see digastric muscle here. In
fact this is the posterior belly. Ok, so,
again here you can see the posterior
belly of the digastric muscle , the
stylohyoid muscle and then you can see
here the most posterior is call the
salpingopharyngeus muscle. Then, here
if you remember,this is the soft palate,
more anterior is the uvula, and here is
the pharynx. (The doctor then stop
lecturing for 5 minutes because the
students were making noise. Please do
have respect for the dukturah and other
students who willingly came to class . dr
quoted : if you do not care about
yourself,care about others (“,)V )
ok so if you remember this the soft
palate, this is the larynx.we can see the
epiglottis and then this is the
pharynx,posterior to the larynx.
So here you can see the muscle from
the soft palate to the pharynx called
palatopharyngeus muscle and then this
is the stylopharyngeus muscle. So, all of
these pharynx muscle are some of the
elevators of the larynx which means
they are some of the muscles that
elevate the larynx as a whole.
Now if you remember, this the anterior
belly of the digastric and this is the
mylohyoid muscles . the two mylohyoid
muscles form the muscular floor of the
mouth or the oral cavity and the
mylohyoid muscles as well as the
geniohyoid muscle which is located deep
to the mylohyoid muscles also act as the
elevators of the larynx. Now the muscles
of the larynx are, you can see the
sternohyoid here, sternothyroid, as well
as the omohyoid. If you remember this is
the superior belly and this the inferior
belly of the omohyoid muscle. Well,
there are many intrinsic muscles of the
larynx and whenever you say intrinsic,
means that they present within the
larynx. So they insert from parts of
cartilages of the larynx and they arise
from other parts of those cartilages.

Slide 6
So the intrinsics muscle can be divided
into two groups. There is the first group
consist of those muscles that act on the
laryngeal inlet whereas the other group
consist of muscles act on the vocal
cords. So the first group consist of two
muscles which are the oblique arytenoid
muscle and the thyro-epiglottic muscle.
And the oblique arytenoid muscle arises
from the muscular process of the
arytenoid cartilage and insert on the
apex of the opposite arytenoid cartilage.
The thyro-epiglottic as the name
indicates arises from the medial surface
of the thyroid cartilage and inserts on
lateral margin of the epiglottis and ary-
epiglottic fold.
Thyroepiglottic as the name indicates, it
arises from the medial surface of the
thyroid cartilage and inserts at the
lateral margin of the epiglottis and
aryepiglottic fold. So, as its mention
here, oblique arytenoids narrows
laryngeal inlet while thyroepiglottic
muscle widens the inlet. (refer table 11-
12,slide 6)
Then,the muscles that are controlling
the movement of vocal cords/true vocal
cords are cricothyroid, thyroarytenoid,
lateral cricoarytenoid, posterior
cricoarytenoid and the transverse
arytenoid. Now, remember that the
vocalis is consider as heart of
thyroarytenoid muscle and its medial to
it. Now, cricothyroid arises from side of
cricoid cartilage and inserts to the lower
border and inferior cornu/horn of thyroid
cartilage and it tenses the vocal cords.
Thyroarytenoid as well as the vocalis
inserts from the inner surface of thyroid
cartilage specifically the vocalis muscle
impact arises from the angle between
two laminae of the thyroid cartilage and
then this two muscles insert on the
arytenoids cartilage and they relaxes
the vocal cords. The lateral
cricoarytenoid arises from the upper
border of cricoid cartilage and inserts on
the muscular process of arytenoid
cartilages and it adducts the vocal
cords. The posterior cricoarytenoid
arises from back of the cricoid cartilage
and inserts on the muscular process of
arytenoid cartilage and it abducts the
vocal cords and finally the transverse
arytenoid arises from the back of medial
surface of arytenoid cartilage and it
inserts on back and medial surface of
opposite arytenoid cartilage, and it
closes posterior part of the rima
glottidis.
Q : Now, what is the rima glottidis?
A (answered by herself) : I told you
about it last lecture. This is space
between the two vocal folds/vocal cords.
Q : What is the difference between
abduction and adduction?
A : The adduction is moving the
structure towards the midline whereas
the abduction, is moving the structure
away from midline.
So, to view those muscles, here you
have posterior view of ,this is the hyoid
bone, this is the epiglottis, this is thyroid
cartilage,the lamina of thyroid cartilage,
superior horn,inferior horn and then
here is the lamina of the cricoid
cartilage. Here is the aryepiglottic fold.
You can see the corniculate cartilage
which sits on the apex of the arytenoid
cartilage and here is the inferior horn
cartilage anterior to it in the
aryepiglottic fold.
So, here you have muscle that is
transversely. this is the transverse
arytenoids muscle (horizontally) and this
muscle here is the oblique arytenoid
muscle. This is one and this is another
one. Here, this is the cricoarytenoid
muscle and since you can see it
posteriorly, just to remember, so, this is
the posterior cricoarytenoid muscle. A
student ask about blood supply and dr
said will explain it later.
Here, this is just the thyroid cartilage,
the lamina, inferior horn, superior horn,
and this is the cricoid cartilage, anterior
arch and the posterior lamina. (Doc was
mad at those who were sitting and
talking at the back. I think we shouldn’t
make the doctor mad and make things
(giving lecture) hard for her as she
always try her best (including the
exam’s date,material, labs) for us. Just
try to give her a respect during the
lecture.For the sake of us too)
So, this cricothyroid cartilage can be
divided into a posterior oblique part or
superior part, anterior and inferior
vertical part. Then, here is the epiglottis,
here is the cricoid cartilage that has
been cut.This lamina, the right lamina of
the thyroid cartilage has been cut and
removed.And then this is the cricoid
cartilage arch and lamina and this is
trachea and this is the cricotracheal
ligament.so, the cricothyroid muscle has
already been cut, you can see the lateral
cricoarytenoid muscle on its lateral view,
and then between the arytenoid
cartilage and thyroid cartilage, you can
see the thyroarytenoid muscle. Finally
you can see the thyroepiglottic muscle
between the thyroid cartilage and the
epiglottis.
 SUPERIOR VIEW
If you look at the larynx superiorly,the
intrinsic muscle that can be seen are
first, this is thyroid cartilage and here is
the arytenoid cartilage and so this is the
thyroarytenoid muscle. Medial to it is the
vocalis muscle.Now, again this is the
lateral cricoarytenoid muscle and this is
the posterior one. Here, you can see the
transverse and then the oblique
arytenoid muscle. Okay, so I’ve already
told you about the sensory innervations
of the larynx in the last lecture but
here,you have,this is the superior
laryngeal nerve which is the branch of
the vagus. So,here you have common
carotid artery, the vagus nerve and
there is internal jugular vein that has
been removed. All of these are within
the carotid sheath which has been
removed.

Slide 10,12 next page…

Now, the branch of vagus nerve is
superior laryngeal nerve which divide to
internal branch that pass together with
superior laryngeal artery. superior
laryngeal artery is a branch of superior
thyroid artery which is branch of
external carotid artery.
Now remember that the internal branch
of superior laryngeal nerve is sensory to
the larynx to down as far as vocal folds
or the true vocal cords. Then, here you
have the Recurrent laryngeal nerve. This
is the vagus. Recurrent laryngeal nerve
is for sensory innervations to that part of
the larynx below the vocal cords.
Now, the Recurrent laryngeal nerve also
provide nerve supply to the muscles,
intrinsic muscle of the larynx. All the
intrinsic muscle of the larynx except
cricothyroid muscle which receives its
motor innervations from external
branch of the superior laryngeal nerve.
Slide 11,12
Now, regarding to blood supply, this is
the right side, this is the left side. So,
this should be the brachiocephalic trunk,
this is arch of aorta. The brachiocephalic
trunk divides into the common carotid
artery and subclavian artery. Now the
common carotid artery divides into the
internal carotid artery and the external
carotid artery. The external carotid
artery gives off the superior thyroid
artery which gives off the superior
laryngeal artery. Now, the superior
laryngeal artery provides blood supply
to the upper half of the larynx. While the
lower half of the larynx is supplied by
inferior laryngeal artery which is branch
of inferior thyroid artery. So here is the
inferior thyroid artery which is branch of
thyrocervical trunk which is branch of
subclavian artery.
Slide 13,14

THE TRACHEA
The trachea. You know that the larynx
continues as trachea. So, here is the first
tracheal ring and of course the tracheal
begins at level of CV6. So now, if you
remember from histology, the trachea is
lined by pseudostratified columnar
epithelium and its wall consist of U
shaped hyaline cartilages that is
connected superiorly by smooth muscle
called trachealis. The trachea divides
(bifurcate) at the level of sternal angle
into two main bronchi (right and left).
Now, this cartilaginous ridge that ends
anterior posteriorly at lower end of
trachea (at its birfurcation) is called the
carina.
So, this is the thyroid cartilage.it consist
of an isthmus and two lateral lobes.
Now remember that the thyroid cartilage
especially the isthmus of it, covers the
anterior part of the trachea. we also
have the inferior thyroid vein located in
front of the trachea. Now, of course
there are sternohyoid and sternothyroid
muscles which are overlapping the
trachea that has been removed.
Laterally, you can see this lateral lobe of
the thyroid gland and the carotid sheath
and its contents which are the cartilage
itself, vagus nerve and internal jugular
vein. Posteriorly, you will see the
esophagus (It is the continuation of the
pharynx) and recurrent laryngeal nerve.
Now remember that the lymph drains
from the pharynx into the deep cervical
node and remember that the trachea
receive its sensory innervations from
recurrent laryngeal nerve which is
branch of the vagus nerve, and the
vagus nerve itself.
The trachea receives its blood supply
the inferior thyroid artery and from the
bronchial artery. This here one and the
other one. Those are the branches of the
arch of aorta. Finally, the lymph drains
from the trachea into paratracheal
lymph nodes (para means they are to
the sides of trachea) and they also have
pretracheal (pre is anterior or before)
lymph nodes which located anterior. So
the pretracheal lymph nodes is at the
anterior surface of trachea and finally
into the deep cervical lymph nodes.
 “ONE OF THE HOW TO RESPECT
OURSELVES IS TO RESPECT OTHERS
WHETHER KIDS, FRIENDS, OLD
PEOPLE, ESPECIALLY OUR
TEACHERS, IF YOU ARE BEING RUDE
TO THEM MEANING THAT YOU ARE
RUDE TO YOURSELVES.”

RESPECT YOURSELF,RESPECT
OTHERS.YOSH!