Larynx

The larynx or organ of voice is placed at the upper part of the air passage.

It is situated between the trachea and the root of the tongue, at the upper and forepart of the neck, where it presents a considerable projection in the middle line.

It forms the lower part of the anterior wall of the pharynx, and is covered behind by the mucous lining of that cavity; on either side of it lie the great vessels of the neck. Its vertical extent corresponds to the fourth, fifth, and sixth cervical vertebræ, but it is placed somewhat higher in the female and also during childhood.

Until puberty the larynx of the male differs little in size from that of the female. In the female its increase after puberty is only slight; in the male it undergoes considerable increase; all the cartilages are enlarged and the thyroid cartilage becomes prominent in the middle line of the neck, while the length of the rima glottidis is nearly doubled.

The larynx is broad above, where it presents the form of a triangular box flattened behind and at the sides, and bounded in front by a prominent vertical ridge. Below, it is narrow and cylindrical. It is composed of cartilages, which are connected together by ligaments and moved by numerous muscles. It is lined by mucous membrane continuous above with that of the pharynx and below with that of the trachea.

The Cartilages of the Larynx (cartilagines laryngis) are nine in number, three single and three paired, as follows:

• Thyroid.
• Two Corniculate.
• Cricoid.
• Two Cuneiform.
• Two Arytenoid.
• Epiglottis

Intrinsic Ligaments.—Beneath the mucous membrane of the larynx is a broad sheet of fibrous tissue containing many elastic fibers, and termed the elastic membrane of the larynx. It is subdivided on either side by the interval between the ventricular and vocal ligaments, the upper portion extends between the arytenoid cartilage and the epiglottis and is often poorly defined; the lower part is a well-marked membrane forming, with its fellow of the opposite side, the conus elasticus which connects the thyroid, cricoid, and arytenoid cartilages to one another. In addition the joints between the individual cartilages are provided with ligaments.

Movements.—The articulation between the inferior cornu of the thyroid cartilage and the cricoid cartilage on either side is a diarthrodial one, and permits of rotatory and gliding movements. The rotatory movement is one in which the cricoid cartilage rotates upon the inferior cornua of the thyroid cartilage around an axis passing transversely through both joints. The gliding movement consists in a limited shifting of the cricoid on the thyroid in different directions.

The articulation between the arytenoid cartilages and the cricoid is also a diarthrodial one, and permits of two varieties of movement: one is a rotation of the arytenoid on a vertical axis, whereby the vocal process is moved lateralward or medialward, and the rima glottidis increased or diminished; the other is a gliding movement, and allows the arytenoid cartilages to approach or recede from each other; from the direction and slope of the articular surfaces lateral gliding is accompanied by a forward and downward movement. The two movements of gliding and rotation are associated, the medial gliding being connected with medialward rotation, and the lateral gliding with lateralward rotation. The posterior cricoarytenoid ligaments limit the forward movement of the arytenoid cartilages on the cricoid.

Interior of the Larynx : The cavity of the larynx (cavum laryngis) extends from the laryngeal entrance to the lower border of the cricoid cartilage where it is continuous with that of the trachea. It is divided into two parts by the projection of the vocal folds, between which is a narrow triangular fissure or chink, the rima glottidis. The portion of the cavity of the larynx above the vocal folds is called the vestibule; it is wide and triangular in shape, its base or anterior wall presenting, however, about its center the backward projection of the tubercle of the epiglottis. It contains the ventricular folds, and between these and the vocal folds are the ventricles of the larynx. The portion below the vocal folds is at first of an elliptical form, but lower down it widens out, assumes a circular form, and is continuous with the tube of the trachea.

Muscles.—The muscles of the larynx are extrinsic, passing between the larynx and parts around and intrinsic, confined entirely to the larynx.

The intrinsic muscles are:

• Cricothyreoideus.
• Cricoarytænoideus lateralis.
• Cricoarytænoideus posterior.
• Arytænoideus.
• Thyroarytænoideus.

Mucous Membrane.—The mucous membrane of the larynx is continuous above with that lining the mouth and pharynx, and is prolonged through the trachea and bronchi into the lungs. It lines the posterior surface and the upper part of the anterior surface of the epiglottis, to which it is closely adherent, and forms the aryepiglottic folds which bound the entrance of the larynx. It lines the whole of the cavity of the larynx; forms, by its reduplication, the chief part of the ventricular fold, and, from the ventricle, is continued into the ventricular appendix. It is then reflected over the vocal ligament, where it is thin, and very intimately adherent; covers the inner surface of the conus elasticus and cricoid cartilage; and is ultimately continuous with the lining membrane of the trachea. The anterior surface and the upper half of the posterior surface of the epiglottis, the upper part of the aryepiglottic folds and the vocal folds are covered by stratified squamous epithelium; all the rest of the laryngeal mucous membrane is covered by columnar ciliated cells, but patches of stratified squamous epithelium are found in the mucous membrane above the glottis.

Glands.—The mucous membrane of the larynx is furnished with numerous mucous secreting glands, the orifices of which are found in nearly every part; they are very plentiful upon the epiglottis, being lodged in little pits in its substance; they are also found in large numbers along the margin of the aryepiglottic fold, in front of the arytenoid cartilages, where they are termed the arytenoid glands. They exist also in large numbers in the ventricular appendages. None are found on the free edges of the vocal folds.

Vessels and Nerves.—

• The chief arteries of the larynx are the laryngeal branches derived from the superior and inferior thyroid.
• The veins accompany the arteries; those accompanying the superior laryngeal artery join the superior thyroid vein which opens into the internal jugular vein; while those accompanying the inferior laryngeal artery join the inferior thyroid vein which opens into the innominate vein.
• The lymphatic vessels consist of two sets, superior and inferior. The former accompany the superior laryngeal artery and pierce the hyothyroid membrane, to end in the glands situated near the bifurcation of the common carotid artery. Of the latter, some pass through the middle cricothyroid ligament and open into a gland lying in front of that ligament or in front of the upper part of the trachea, while others pass to the deep cervical glands and to the glands accompanying the inferior thyroid artery.
• The nerves are derived from the internal and external branches of the superior laryngeal nerve, from the recurrent nerve, and from the sympathetic. The internal laryngeal branch is almost entirely sensory, but some motor filaments are said to be carried by it to the Arytænoideus. It enters the larynx by piercing the posterior part of the hyothyroid membrane above the superior laryngeal vessels, and divides into a branch which is distributed to both surfaces of the epiglottis, a second to the aryepiglottic fold, and a third, the largest, which supplies the mucous membrane over the back of the larynx and communicates with the recurrent nerve. The external laryngeal branch supplies the Cricothyreoideus. The recurrent nerve passes upward beneath the lower border of the Constrictor pharyngis inferior immediately behind the cricothyroid joint. It supplies all the muscles of the larynx except the Cricothyreoideus, and perhaps a part of the Arytænoideus. The sensory branches of the laryngeal nerves form subepithelial plexuses, from which fibers pass to end between the cells covering the mucous membrane.