Larynx and hypopharynx
General
Anatomy

Author: Nat Pernick, M.D. (see Authors page)

Revised: 16 March 2018, last major update November 2013

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Larynx [title] anatomy [title]

Cite this page: Pernick, N. Anatomy. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/larynxanatomy.html. Accessed August 17th, 2018.
Definition / general
  • Tubular structure between pharynx / root of tongue and trachea at level of cervical vertebrae C4 - C6 in males, somewhat higher in females and during childhood
  • Composed of cartilaginous tissue that undergoes ossification and may completely replace cartilage by age 20
  • At puberty, increases in size in males due to enlargement of cartilages
  • Cartilages are connected by ligaments and moved by numerous muscles
Staging anatomy
  • Anterior limit is anterior or lingual surface of suprahyoid epiglottis, thyrohyoid membrane, anterior commissure and anterior wall of subglottic region (composed of thyroid cartilage, cricothyroid membrane and anterior arch of cricoid cartilage)
  • Posterior and lateral limits include laryngeal aspect of aryepiglottic folds, arytenoids region, interarytenoid space and posterior surface of subglottic space (mucous membrane covering surface of cricoid cartilage)
  • Superolateral limits are tip and lateral borders of epiglottis
  • Inferior limit is plane passing through inferior edge of cricoid cartilage
Structures
  • Supraglottic portion: epiglottis (lingual and laryngeal aspects), false vocal cords (ventricular bands), aryepiglottic folds (laryngeal aspect), arytenoid cartilages and ventricles; derived from third and fourth branchial pouches; inferior boundary is horizontal plane passing through lateral margin of ventricle at its junction with superior surface of vocal cord

  • Glottic portion: true vocal cords (superior and inferior surfaces) and anterior and posterior commissures; derived from sixth branchial pouch

  • Subglottic portion: between lower border of true vocal cords and first tracheal cartilage (or lower margin of cricoid cartilage); derived from sixth branchial pouch

  • Anterior commissure: convergence of thyroepiglottic, vestibular and vocal ligaments and conus elasticus; tendon provides anterior attachment for true vocal cords; tendon also separates glottic and supraglottic parts of larynx

  • Arytenoid cartilage: two hyaline cartilages at upper border of cricoid cartilage at back of larynx that support the vocal cords; each is pyramidal; apex is surmounted by small, conical, corniculate cartilage

  • Conus elasticus: extends from superior border of cricoid cartilage to free edge of vocal cord, then thickens to form vocal ligament, which runs length of true vocal cord close to mucosal surface, then continues along floor of ventricle as thyroglottic ligament

  • Cricoid cartilage: hyaline cartilage that is smaller but thicker and stronger than thyroid cartilage; upper edge is 1 cm below true vocal cords at mid larynx; forms the only complete trachiobronchial ring with posterior quadrate lamina (deep and broad, 2 - 3 cm high) and anterior arch that is narrow and convex; articulates with inferior horns of thyroid cartilage

  • Cuneiform cartilages: two small, elongated pieces of cartilage on either side of aryepiglottic fold

  • Epiglottis: thin, bicycle saddle-like and elastic fibrocartilage
    • Apex is attached to inner thyroid cartilage just above anterior commissure by thyroepiglottic ligament
    • Projects up behind tongue and body of hyoid bone, partly covers laryngeal entrance
    • Sides are attached to arytenoid cartilages by aryepiglottic folds
    • Upper and anterior surface is free, covered by mucous membrane reflected onto pharyngeal tongue and lateral wall of pharynx to form median and lateral glossoepiglottic folds
    • Median glossoepiglottic fold divides area between base of tongue and epiglottis into two valleculae
    • Not essential for respiration, phonation or deglutition

  • Hypopharynx: comprises posterolateral pharyngeal wall (from level of floor of valleculae to level of inferior border of cricoid cartilage), postcricoid esophagus (has anterior wall and extends from level of arytenoids cartilages superiorly to inferior border of cricoid cartilage) and pyriform sinuses (lie lateral to and below opening of larynx, each bounded laterally by medial aspect of thyroid lamina and medially by aryepiglottic fold)

  • Pre-epiglottic space: bounded posteriorly by epiglottic cartilage and thyroepiglottic ligament, anteriorly by thyroid cartilage and thyrohyoid membrane and superiorly by hypoepiglottic ligament; space communicates laterally with paraglottic space above ventricle

  • Pyriform sinus: not strictly part of larynx; inverted 3 sided pyramid with apex inferiorly at level of cricopharyngeus muscle, bounded superiorly by glossoepiglottic folds, medially by aryepiglottic folds, laterally by pharyngeal wall

  • Thyroid cartilage: largest cartilage of larynx; shield shaped forming anterior surface of larynx and acute angle in midline of neck (laryngeal prominence, Adam's apple); originally only hyaline cartilage, but ossifies at age 25 at sites of muscle origin or insertion; lower edge is 1 cm below anterior commissure

  • Lymphatics: separate systems exist above and below ventricle; are also subdivided as superficial (mucosal) and deep; few lymphatics are present in true vocal cord
  • Pyriform sinus drains laterally into deep cervical nodes, occasionally to paratracheal nodes
  • Supraglottic lymphatics drain through thyrohyoid membrane into upper cervical and anterosuperior nodes
  • Subglottic lymphatics drain into prelaryngeal (Delphian) node on cricothyroid membrane, then into pretracheal, paratracheal and supraclavicular nodes
Diagrams / tables

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Sagittal section

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Coronal section

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Entrance viewed from above

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Laryngoscopic view

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Laryngeal cartilages


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Vocal cords and muscles

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Muscles

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Ligaments

Gross images

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True and false vocal cords

Endoscopic images

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Larynx (fig 1)

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Larynx: labeled (fig 2)