Larynx

Passing through the nasopharyngeal opening, air enters the top of the snorkel, which is called the mountain-Tanya (larynx) and is located in front of the neck, under the hyoid bone at the level of IV-VII of the cervical vertebrae. The larynx is partly concealed by the front subhyoid muscles on the sides and front part of it adjacent thyroid gland, and the rear - laryngeal part of pharynx. The larynx is connected to the hyoid bone through schitopodyazychnoy membrane (membrana thyrohyoidea)  and moves together with the membrane while reducing nadi subhyoid muscles.

Laryngeal cartilage skeleton form, which are divided into paired and unpaired. By unpaired cartilages are:

1) cricoid (cartilago cricoideae), which is the basis of the larynx and the lower edge is connected to the first cartilaginous tracheal ring by means of ligaments;

2) the thyroid cartilage (cartilago thyroidea), which is located over an arc of the thyroid cartilage and consists of two large plates that connect to an angle, open posteriorly. This angle is called guttural protuberance (prominentia laryngea), or Adam's apple, Adam's apple and freely palpated through the skin;

3) The epiglottic cartilage (cartilago epiglottis), or the epiglottis, it covers the entrance to the larynx during swallowing, speaking of the thyroid cartilage, being attached to the back of his corner with his ligaments the lower end, and has a shape of a leaf. Its upper part is located behind and below by the tongue.

In Fig. 195.
The cavity of the larynx
1 - the tongue;
2 - the root of the tongue;
3 - genioglossal muscle;
4 - epiglottic cartilage;
5 - mentohyoid muscle;
6 - hyoepiglottic ligament;
7 - cherpalonadgortannaya ligament;
8 - preddverno fold;
9 - ventricle of larynx;
10 - Voice fold;
11 - thyroid cartilage;
12 - perstneschitovidnaya ligament;
13 - cricoid;
14 - trachea;
15 - arched tracheal cartilage;
16 - esophagus

By paired cartilages are:

1) The arytenoid cartilages (cartilagines arytenoideae), which take the form of irregular triangular pyramid and through the joints are connected to the cricoid cartilage plate. They are located mounting position of the larynx, vocal muscle and vocal cords;

2) rozhkovidnye cartilage (cartilagines corniculatae) having a conical shape and located at the top of arytenoid cartilages in the thick folds cherpalonadgortannoy (plica aryepiglottica);

3) The wedge-shaped cartilage (cartilagines cuneiformes), which are located anteriorly and over rozhkovidnymi cartilage and have a wedge-shaped, sometimes absent.

All cartilages are connected to each other by means of joints and ligaments of the larynx. The space between is filled with cartilage connecting membranes. In the motion of the joints changes the tension of the vocal cords. Schitopodyazychnaya membrane, which connects the larynx with hyoid bone, is a broad plate of connective tissue, lying between the hyoid bone and the upper edge of thyroid cartilage. Thickened edge on each side, stretched between the upper horn of the thyroid cartilage and hyoid bone, called schitopodyazychnoy ligament (lig. thyrohyoideum). In it lies a small sesamoid cartilage, which in form is called triticeum (cartilago triticea). In the middle of the membrane is thickened and forms the medial ligament schitopodyazychnuyu (lig. thyrohyoideum medianum).

In Fig. 196.
Ligaments and cartilages of the larynx, front view
1 - schitopodyazychnaya ligament;
2 - triticeum;
3 - median schitopodyazychnaya ligament;
4 - schitopodyazychnaya membrane;
5 - thyroid cartilage;
6 - perstneschitovidnaya ligament;
7 - cricoid;
8 - perstnetrahealnaya ligament;
9 - annular ligament of the trachea;
10 - arched tracheal cartilages

Cricoid is connected to the thyroid through perstneschitovidnoy ligament (lig. cricothyroideum) and perstneschitovidnogo joint (articulatio cricothyroidea). During the rotation of the joint around the transverse axis is the tension of the vocal cords (ligg. vocalia), situated between the arytenoid cartilage appendage voice and the inner surface of the thyroid cartilage. Vocal cords are composed of elastic tissue and participate in the formation of the glottis. On the arytenoid cartilages connected with annular perstnecherpalovidnogo joint (articulatio cricoarytenoidea), in which the arytenoid cartilage movement, allowing the vocal cords come together and move apart. On the upper ring of trachea (windpipe) is connected perstnetrahealnoy cricoid ligament (lig. cricotracheale). Epiglottic cartilage is connected to the thyroid cartilage schitonadgortannoy ligament (lig. thyroepiglotticum), with the body of the hyoid bone - hyoepiglottic ligament (lig. hyoepiglotticum), and with the surface of the tongue - glossoepiglottidean median and lateral folds of mucous membrane (plicae glosssoepiglotticae mediana et laterales). Rozhkovidnye cartilage connected to the cricoid cartilage, arytenoid cartilages and the mucous membrane of the pharynx with perstneglotochnoy ligament (lig. cricopharyngeum). In addition to voice, to the inner cords are preddverno ligament (ligg. vestibularia), consisting of fibrous and partly elastic fibers.

In Fig. 197.
Ligaments and cartilages of the larynx, rear view
1 - epiglottic cartilage;
2 - triticeum;
3 - schitopodyazychnaya ligament;
4 - schitopodyazychnaya membrane;
5 - schitonadgortannaya ligament;
6 - rozhkovidny cartilage;
7 - thyroid cartilage;
8 - arytenoid cartilage;
9 - perstneschitovidny joint;
10 - cricoid;
11 - membranous wall of the trachea;
12 - arched tracheal cartilages
In Fig. 198.
Ligaments and cartilages of the larynx side view
1 - epiglottic cartilage;
2 - schitopodyazychnaya ligament;
3 - triticeum;
4 - hyoepiglottic ligament;
5 - schitopodyazychnaya median ligament;
6 - thyroid cartilage;
7 - guttural boss (Adam's apple);
8 - perstneschitovidnaya ligament;
9 - cricoid;
10 - perstnetrahealnaya ligament;
11 - arched tracheal cartilage;
12 - annular ligament of the trachea

The motion of the larynx as a whole and its individual cartilage is caused by the larynx. During the movement of the entire larynx muscles respond front of the neck. Muscles engaged in the movement of individual cartilage, muscles are divided into valvular, shifting the location of epiglottic cartilage acts of breathing and swallowing, and voice box muscles that change the position of the thyroid and arytenoid cartilages, thereby changing the degree of tension of the vocal cords.

To the muscle valve apparatus includes:

1) cherpalonadgortannaya muscle (m. aryepiglotticus), which narrows the entrance to the larynx and pulls back and down epiglottic cartilage, thereby closing the entrance to the larynx in the act of swallowing. Point of beginning is on the muscular process of arytenoid cartilage, and the mounting position - on top of the arytenoid cartilage on the opposite side from where it is directed anteriorly and is woven into the lateral edge of the epiglottic cartilage. The back of the arytenoid cartilage muscles on both sides overlap. The entrance to the larynx limit cherpalonadgortannye folds formed by the muscle and its overlying mucous membrane;

2) schitonadgortannaya muscle (m. thyroepiglotticus), which raises the epiglottic cartilage, and opens the entrance to the larynx during respiration and speech acts. Muscle starts on the inside of the angle of the thyroid cartilage and attached to the front surface of the epiglottic cartilage.

For the muscles of vocal apparatus are:

1) muscles, relaxing the vocal cords:

- Voice muscle (m. vocalis), which, in addition to relaxing the vocal cords, is involved in the narrowing of the glottis and is located in the interior of the vocal cords, starting from the inner surface of the thyroid cartilage and attaching to the voice appendage and arytenoid cartilage;

- Schitocherpalovidnaya muscle (m. thyroarytenoideus), it starts on the inner surface of the thyroid cartilage and attached to the anterolateral surface of the arytenoid cartilage;

In Fig. 199.
Laryngeal muscles, rear view
1 - the tongue;
2 - of the tonsils;
3 - the root of the tongue;
4 - epiglottic cartilage;
5 - lateral fold of mucous membrane;
6 - cherpalonadgortannaya muscle;
7 - Transverse arytenoideus;
8 - thyroid cartilage;
9 - cricoid;
10 - Rear perstnecherpalovidnaya muscle;
11 - membranous tracheal wall

2) The muscles that bend the vocal cords:

- Perstneschitovidnaya muscle (m. crirothyroideus), which tilts the thyroid cartilage anteriorly, distancing him from the arytenoid cartilage. Located on the anterolateral surface of the larynx, beginning from the arc of cricoid cartilage and attached to the bottom edge of the thyroid cartilage;

3) muscle, narrowing the glottis:

- Side perstnecherpalovidnaya muscle (m. cricoarytenoideus lateralis), which pulls the arytenoid cartilage to the side, bringing together voice processes arytenoid cartilage. The muscle begins at the lateral surface of cricoid cartilage, and attached to a muscular appendage arytenoid cartilage;

- Transverse arytenoideus (m. arytenoideus transversus) Bringing arytenoid cartilages, stretching between their rear surfaces;

4) muscles that extend the glottis:

- Back perstnecherpalovidnaya muscle (m. cricoarytenoideus posterior), which rotates the arytenoid cartilage, removing from each other vocal processes of arytenoid cartilage. Start point of the muscle on the back surface of the cricoid cartilage, and the mounting position - on the muscular process of arytenoid cartilage.

Laryngeal mucosa (tunica mucosa laryngis) is connected to the cartilage through the fibrous elastic membrane of larynx (membrana fibroelastica laryngis). Mucosa (except for the vocal cords) is lined with ciliated epithelium of prismatic multi-row. The folds of the mucous folds form the top pair threshold (plicae vestibulares) and a pair of vocal folds (plicae vocalis). The deepening of the voice between the crease and preddverno called laryngeal ventricle (ventriculus laryngis), and the space between the vocal folds voice-slit (rima glottidis). With the reduction of the larynx the gap changes, which, in turn, changes the pitch of the sound conductivity of the air through the larynx. The area of  the vocal cords, the posterior surface of the epiglottic cartilage and the inner surface of the arytenoid cartilage is lined with stratified squamous epithelium neorogovevayuschy. In the mucosa, except for the edges of the vocal folds, contains a large number of ducts laryngeal glands (glandulae laryngeae).

In Fig. 200.
The cavity of the larynx, rear view
1 - triticeum;
2 - schitopodyazychnaya ligament;
3 - schitopodyazychnaya membrane;
4 - the threshold of the larynx;
5 - fold threshold;
6 - arytenoid cartilage;
7 - vocal fold;
8 - perstneschitovidny joint;
9 - Side perstnecherpalovidnaya muscle;
10 - cricoid;
11 - trachea

Fibro-cartilaginous laryngeal membrane is formed by hyaline and elastic cartilage, which are surrounded by dense fibrous connective tissue and are the reference frame of the larynx.





List of Abbreviations

a., aa. — arteria, arteriae (artery, the artery)

lig., ligg. — ligamentum, ligamenta (ligament, the ligaments)

m., mm. — musculus, musculi (muscle, the muscle)

n., nn. — nervus, nervi (nerve, the nerve)

r., rr. — ramus, rami (branch)

s. — seu (or)

v., vv. — vena, venae (vienna)