The Larynx R. Shane Tubbs, MS, PA-C, PhD. 9 Cartilages 3 unpaired: epiglottis, thyroid, cricoid 3...
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Transcript of The Larynx R. Shane Tubbs, MS, PA-C, PhD. 9 Cartilages 3 unpaired: epiglottis, thyroid, cricoid 3...
The Larynx The Larynx
R. Shane Tubbs, MS, PA-C, PhDR. Shane Tubbs, MS, PA-C, PhD
9 Cartilages9 Cartilages
3 unpaired: epiglottis, thyroid, cricoid3 unpaired: epiglottis, thyroid, cricoid3 paired: arytenoid, corniculate, 3 paired: arytenoid, corniculate,
cuneiformcuneiform
CartilagesCartilagesThyroid: (shield), C4-C5 hyaline, 90Thyroid: (shield), C4-C5 hyaline, 90oo male; male;
120120oo female (subpubic) female (subpubic)Cricoid: C6, hyaline, only complete ring Cricoid: C6, hyaline, only complete ring
therefore can compress the esophagustherefore can compress the esophagusTriticealTriticealEpiglottis: extends to C3, elastic Epiglottis: extends to C3, elastic Cuneiform: elastic, does not contact other Cuneiform: elastic, does not contact other
cartilagescartilagesCorniculate: limited function in man, elastic Corniculate: limited function in man, elastic Arytenoid: ½ elastic ½ hyalineArytenoid: ½ elastic ½ hyalineBy ~age 65 thyroid, cricoid and ½ By ~age 65 thyroid, cricoid and ½
arytenoid are ossifiedarytenoid are ossified
Quadrangular Quadrangular membrane: membrane: submucosal sheet of submucosal sheet of connective tissueconnective tissue
Its free inferior margin Its free inferior margin = vestibular fold= vestibular fold
Its free superior Its free superior margin = aryepiglottic margin = aryepiglottic foldfold
Conus elasticus: Conus elasticus:
(cricothyroid (cricothyroid membrane and membrane and vocal ligament)vocal ligament)
Three Three regions: regions: vestibule vestibule (superior to (superior to false folds), false folds), ventricle ventricle (between (between false above false above true), true), infraglottic infraglottic (folds to (folds to cricoid)cricoid)
Rima (slit) Rima (slit) glottidis glottidis between true between true foldsfolds
Saccule Saccule (appendix)(appendix)
Larynx InnervationLarynx Innervation
MusclesMuscles
Extrinsic: suprahyoid and infrahyoidExtrinsic: suprahyoid and infrahyoid Intrinsic:Intrinsic:
Most Most ImportantImportant Muscle in the Muscle in the Body?Body?
The EarThe Ear
Auricle (Pinna)Auricle (Pinna)
EAM InnervationEAM Innervation
Anterior: auriculotemporal nerveAnterior: auriculotemporal nerve
Posterior: CN X with some CN IX/CN Posterior: CN X with some CN IX/CN VIIVII
Reflexes: bradycardic, cough, emesisReflexes: bradycardic, cough, emesis
Dentally referred otalgia Dentally referred otalgia
EAMEAMLength: adults 2-3 cm, children ~1 cmLength: adults 2-3 cm, children ~1 cm
Medial 2/3 bony; lateral part elastic Medial 2/3 bony; lateral part elastic cartilagecartilage
Lined with skin, Meibomian glandsLined with skin, Meibomian glands
Superficial parotid lymph node just Superficial parotid lymph node just anterior to opening of EAManterior to opening of EAM
External: auriculotemporal, X, ?VII, ?External: auriculotemporal, X, ?VII, ?IXIX
Internal: tympanic plexus, VII (chorda Internal: tympanic plexus, VII (chorda tympani)tympani)
Middle Ear FeaturesMiddle Ear Features
Ossicles (covered with mucous Ossicles (covered with mucous membrane not periosteum)membrane not periosteum)
Stapedius and tensor tympaniStapedius and tensor tympani
Chorda tympaniChorda tympani
Tympanic plexusTympanic plexus
Middle EarMiddle Ear
Roof: Roof: tegmen tegmen tympanitympani
Lateral: Lateral: tympanic tympanic membranemembrane
Medial: Medial: inner ear inner ear (promontor(promontory of y of cochlea; cochlea; aka aka labyrinthine labyrinthine wall), facial wall), facial nervenerve
Posterior Posterior wall = wall = aditusaditus
Anterior Anterior wall = ET, wall = ET, canal of canal of tensor tensor tympani, tympani, ICAICA
IJ (superior IJ (superior bulb) in floor bulb) in floor of middle of middle earear
ICA in ICA in anterior wall anterior wall of middle of middle earear
StapediusStapedius
Inserts into the Inserts into the neck of stapesneck of stapes
FunctionFunction
Tensor TympaniTensor Tympani
Chorda TympaniChorda Tympani
5 mm superior to 5 mm superior to SM foramen enters SM foramen enters posterior iterposterior iter
From posterior iter From posterior iter into middle earinto middle ear
Enters anterior iter Enters anterior iter then leaves via then leaves via petrotympanic petrotympanic fissure fissure
Eustachian TubeEustachian TubePosterolateral 1/3 is bonyPosterolateral 1/3 is bony
Innervation: tympanic plexus and Innervation: tympanic plexus and fibers from pterygopalatine ganglionfibers from pterygopalatine ganglion
Inner EarInner Ear
Bony LabyrinthBony Labyrinth
CochleaCochlea
Semicircular Semicircular canalscanals
Membranous LabyrinthMembranous Labyrinth
Cochlear ductCochlear duct
Semicircular ductsSemicircular ducts
Utricle and saccule (within vestibule)Utricle and saccule (within vestibule)