The larynx is an intricate anatomical complex comprised of many different soft and hard tissues, that allow a human to articulate using sound and breathe through a well built filter. It connects the pharynx to the trachea and can be found in the midline of the human body at the level of the third to the sixth cervical vertebrae. Like the pharynx, the larynx is divided up into three regions:
- the vestibule
- the ventricle
- the infraglottic area
In this article, an overview of the laryngeal components including the cartilages, membranes and ligaments, muscles, blood supply, innervation and clinical pathology of the larynx will be discussed.
The larynx is composed of nine individual cartilages of which three are paired and three are unpaired. The thyroid cartilage, the cricoid cartilage and the arytenoid cartilage are all hyaline cartilages, but of those three only the arytenoid cartilage is paired. The epiglottis, the corniculate cartilage and the cuneiform cartilage are elastic cartilages and the two latter cartilages are paired. The thyroid cartilage is the largest of all the cartilages and it is linked to the hyoid bone via the thyrohyoid membrane, while the corniculate and the cuneiform cartilages are considered to be minor cartilages, due to their small size.
Membranes and Ligaments
The membranes and ligaments of the larynx are categorized according to their function.
The major extrinsic ligaments include the two lateral thyrohyoid ligaments, the single median thyrohyoid ligament, the thyrohyoid membrane, the median cricothyroid ligament and the cricotracheal ligament.
The major intrinsic ligaments of the larynx include the vocal ligament, the conus elasticus, the quadrangular membrane and the vestibular ligament.
The cricothyroid muscle is the only laryngeal muscle that is supplied by the external laryngeal nerve, whereas all the others are supplied by the recurrent laryngeal nerve. It increases the tension on the vocal ligaments because it stems from the arch of the cricoid cartilage and inserts into the lamina and inferior conu of the thyroid cartilage.
The thyroarytenoid muscle decreases the tension of the vocal ligaments because it originates in the angle of the thyroid cartilage and stretches across to the vocal process of the arytenoid cartilage.
The posterior cricoarytenoid muscle opens the rima glottidis, while the lateral cricoarytenoid muscle, the transverse arytenoid muscle and the oblique arytenoid muscle close it. It originates in the lamina of the cricoid cartilage and inserts into the muscular process of the arytenoid cartilage.
The lateral cricoarytenoid inserts itself just as the posterior cricoarytenoid muscle does. It stems from the lateral portion of the arch of the cricoid cartilage.
The transverse arytenoid muscle originates from the muscular process of the arytenoid cartilage and fastens itself to the muscular process of the opposing arytenoid cartilage.
The oblique arytenoid muscle seemingly has no origin as it stretches itself between the two arytenoid cartilages and inserts into both of their apices.
The aryepiglotticus and the thyroepiglotticus are two muscles that help close the laryngopharyngeal opening by inserting themselves into the epiglottis. The first arises from the apex of the arytenoid cartilage and the second from the lamina of the thyroid cartilage.
The arterial supply of the larynx is provided by the superior laryngeal artery and the inferior laryngeal artery. The venous drainage is managed by the superior laryngeal vein and the inferior laryngeal vein.
The motor and sensory innervation of the larynx in its entirety comes from the vagus nerve (CN X). The three branches which are contributed include the internal laryngeal nerve, the recurrent laryngeal nerve and the external laryngeal nerve.
Laryngitis is a very common ailment that occurs when the mucosa of the larynx and the vocal cords become inflamed. This results in the temporary partial or complete loss of the patients voice because the vocal cords become irritated. If the voice is still audible, it is usually hoarse. It can be acute, lasting less than three weeks, or it can become chronic. Its origin can be both infectious and noninfectious. Noxious stimulants include viral, bacterial and fungal infections while noninfectious causes include acid reflux, excessive coughing, allergies and overuse of the vocal cords. Treatment depends on the type of cause, but primarily include resting the vocal cords so that no long term damage occurs.