Ch 4 Study Guide

Valleculae and swallowing

-"little valleys" formed by the membrane between the tongue and the epiglottis -during a normal swallow, the larynx elevates and the epiglottis folds down to protect the airway from food and liquid -when swallowing is compromised, the larynx may not elevate properly, or the tongue movement may be inadequate, and food can accumulate in the valleculae -bad breath may be an indicator of swallowing dysfunction; if the epiglottis is not covering the airway there is a good chance the vocal folds are not protecting the lungs and the lungs are being exposed to food/drink

Voiced sounds

produced by the action of the vocal folds, as in /z/ and /v/

Cuneiform cartilages

reside in the aryepiglottic folds, providing a degree of rigidity to the folds

Corniculate cartilages

ride on the superior surface of each arytenoid and are prominent landmarks in the aryepiglottic folds

Cover of the vocal folds

superficial epithelium, primary and secondary layers of lamina propria

Quadrangular membranes

the undergirding layer of connective tissue running from the arytenoids to the epiglottis and thyroid cartilage, and forming the false vocal folds -they originate at the inner thyroid angle and sides of the epiglottis and form an upper cone that narrows as it terminates in the free margin of the arytenoid and corniculate cartilages

Body of the vocal folds

third layer of lamina propria and thyroarytenoid muscle

Cricothyroid joint

where the cricoid and thyroid cartilages articulate

Epiglottis & aryepiglottic folds in relation to aditus

-Epiglottis comprises the anterior boundary of the frame of the aditus -Aryepiglottic folds (the folds of membrane and muscle slung between the epiglottis and arytenoids) comprises the lateral margins of aditus

Reinke's Edema

-Larynx is lined with mucous membrane, designed to retain moisture and provide a low-resistance surface for airway -Reasonably loose except at vocal ligament, where mucous membrane is fixed -When tissue is irritated, extracellular fluid accumulates, causing swelling (edema) -In the larynx, that fluid can't go anywhere because lining is bound to vocal ligament -Result is that inner lining of larynx expands, particularly the vocal folds become swollen -Swelling is maintained because of the poor lymphatic swelling of the space -The space deep to the superficial lamina is called Reinke's space -Condition can arise from vocal abuse, smoking that irritates tissue

Biological functions of the larynx

-protective; designed to stop intrusion by foreign matter and to rapidly expel it from the opening of the airway -the vocal folds are wired to close immediately on stimulation by outside agents, such as food or liquids, a response that is followed quickly by the rapid and forceful exhalation of a cough -permit you to hold your breath, capturing a significant respiratory charge for activity and for fixing your thorax

Laryngectomy

-surgical removal of the larynx: larynx is removed and the oral cavity is sealed off from the trachea and lower respiratory passageway as a safeguard -laryngectomees: individuals who have undergone laryngectomy -tracheostoma: an opening placed in the trachea through which they must breathe -tracheostomy: surgical procedure to create tracheostoma -expectoration: elimination of phlegm from the respiratory passageway stoma: would be exposed to water or pollutants; filter must be kept over it to prevent introduction of foreign objects xerostoma: extreme dryness of oral tissues arising from damage to the salivary glands from radiation therapy dysphagia: swallowing dysfunction risk of aspiration: trachea has been completely separated from esophagus so greater risk

Aryepiglottic folds

Run from the side of the epiglottis to the arytenoid apex-forms upper margin of quadrangular membrane -the ridges marking the highest elevation of these membranes and muscles slung from the epiglottis to the arytenoids

Aryepiglottic folds

Run from the side of the epiglottis to the arytenoid apex-forms upper margin of quadrangular membrane.

cavity of the larynx

a constricted tube with a smooth and reasonably aerodynamic surface; created by developing a deep structure of cartilages, connecting those cartilages through sheets and cords of ligaments and membrane, and lining the entire structure with a wet, smooth mucous membrane

Epiglottis

a leaflike cartilage; medial to the hyoid bone and thyroid cartilage; protective structure in that it drops to cover the orifice of the larynx during swallowing

Larynx

a musculo-cartilaginous structure located at the superior (upper) end of the trachea; composed of three unpaired and three paired cartilages bound by ligaments and lined with mucous membrane

Laryngeal saccule

anterior extension of the laryngeal ventricle space (also known as the appendix of the ventricle); endowed with more than 60 mucous glands that secrete lubricating mucus into the laryngeal cavity

Anterior commissure

anterior-most opening of glottis, posterior to the angle of the thyroid cartilage

Hyoid bone

articulates with the thyroid cartilage by means of superior processes

Hyoepiglottic ligament

attaches the epiglottis to the corpus hyoid

Thyroepiglottic ligament

attaches the epiglottis to the inner thyroid cartilage, just below the notch

Cricotracheal ligament

attaches the trachea to the larynx

Vocal folds (2)

bands of mucous membrane, connective tissue, and thyrovocalis muscle that are slung between the arytenoid cartilages and the thyroid cartilage so that they may be moved into and out of the airstream

Vocal folds

bands of tissue that can be set into vibration

Function of mucus secretions

important for maintaining the health of the vocal folds and reducing airway resistance also assists in eliminating errant food particles that enter the airway by encapsulating them, thereby enabling them to be eliminated through coughing

Median thyrohyoid ligament

in front, running from the corpus hyoid to the upper border of the anterior thyroid

Laryngoscopic examination

use of a laryngoscope

Phonation

voicing; the product of vibrating vocal folds which occurs within the larynx

Arytenoid cartilages

paired; ride on the high-backed upper surface of the cricoid cartilage, forming the posterior point of attachment for the vocal folds

Lateral thyrohyoid ligament

posterior to the thyrohyoid membrane; runs from the superior cornu of the thyroid to the posterior tip of the greater cornu hyoid

Cartilaginous glottis

posterior two fifths of the vocal folds, comprised of the cartilage of the arytenoids aka respiratory glottis

Voiceless phonemes

produced without the use of the vocal folds, such as /s/ or /f/

extrinsic ligaments

provide attachment between the hyoid or trachea and the cartilage of the larynx

Vocal ligament

within the vocal folds; formed by the upper edge of the conus elasticus between the vocal process and the angle of the thyroid cartilage

Function of muscles attached to the arytenoids

provide both adductory and abductory functions, with which we control the degree of airflow by muscular contraction

Vocal ligament (2)

second and third layers (elastin and collagen) of lamina propria; a structure giving a degree of stiffness and support to the vocal folds

Triticeal cartilage

small cartilage that may or may not be found by the lateral thyrohyoid ligament (present in 33% of population)

Rima vestibule

space between the false vocal folds

Glottis

space between the vocal folds

Glottis (2)

space between the vocal folds, inferior to the ventricle and superior to the conus elasticus; most important laryngeal space for speech because it is defined by the variable sphincter that permits voicing -area is variable, depending upon the moment-by-moment configuration of the vocal folds -lateral margins are the vocal folds and the arytenoid cartilage

Thyrohyoid membrane

stretches across the space between the greater cornu of the hyoid and the lateral thyroid

Thyroid cartilage

the largest of the laryngeal cartilages, articulating with the cricoid cartilage below by means of paired processes that let it rock forward and backward at that joint

Relationship between trachea and larynx

the larynx sits as an oddly shaped box atop the last ring of the trachea; adjacent to cervical vertebrae 4 through 6 in adults

Pyriform sinus

the space between the aryepiglottic folds and the thyroid cartilage, marking an important point of transit for food and liquid during a swallow

Mucous glands

throughout the larynx, including surface of the epiglottis and aryepiglottic folds; secrete mucus periodically to lubricate the vocal folds because the folds themselves do not have mucous glands

Valleculae

"little valleys" between the tongue and the epiglottis, produced by the overlay of the mucous membranes on the lateral and median glossoepiglottic ligaments

Mucosal lining of the vocal folds

a combination of the epithelial lining and the disorganized first lamina propria layer

Ventricular (vestibular) folds

also known as false vocal folds because they are not used for phonation except in rare & clinically significant cases -made up of a mucous membrane and a fibrous vestibular ligament, but not muscular tissue

Conus elasticus

also referred to as the cricovocal membrane or cricothyroid ligament; the dominant membranous lining that is situated below the vocal folds and that attaches to the lower thyroid cartilage and upper surface of the cricoid cartilage and tip of the vocal process of the arytenoid -has the shape and form of a vortex and is believed to reduce resistance to airflow

Subglottal region

area below the vocal folds

Fibroelastic membrane

composed of the upper quadrangular membranes and aryepiglottic folds, the lower conus elasticus, and the vocal ligament, which is actually the upward free extension of the conus elasticus

Intrinsic ligaments

connect the cartilages of the larynx and form the support structure for the cavity of the larynx, as well as that of the vocal folds

Laryngoscope

device used by laryngologists or SLPs to view the larynx

Vestibule

first cavity of the larynx; space between the aditus and the ventricular (or vestibular folds) -wide at the aditus but narrows at the ventricular folds -lateral walls are comprised of the aryepiglottic folds and the posterior walls are made up of the membrane covering the arytenoid cartilages, which project superiorly to the false folds

Laryngeal ventricle (laryngeal sinus)

middle space of the larynx; lies between the margins of the false vocal folds and the true vocal folds below

Posterior commissure

posterior opening of glottis, between the arytenoid cartilages

Membranous glottis

the anterior three fifths of the vocal margin- made up of soft tissue of the vocal folds aka phonatory glottis -this free margin of the vocal folds is the vibrating element that provides voice

Aditus larynges (aditus)

entry to the larynx from the pharynx above

Lateral and median glossoepiglottic ligaments

epiglottic attachment to the tongue

Vestibular ligament

gibrous component of the false/ventricular vocal folds

Secular Cysts and Laryngoceles

-Saccule of the laryngeal ventricle is a fibrous pouch that encapsulates the mucus to be secreted into the airway for lubrication and to entrap foreign particules -the fibrous wall can break down and weaken, allowing a herniation of the saccus - laryngocele - saccule will enlarge, expanding beyond its location in the ventricle -can interfere with the airway, causing hoarseness, swallowing problems (dysphagia), and laryngeal stridor (noisy inhalations and exhalations because of airway obstruction) -saccular cysts are growths that can occur if the opening of the saccule is obstructed, as result of growth of a tumor - saccule will enlarge and often become inflamed/infected -can be health-threatening as they can expand to obstruct airway and become infected

To Summarize (2)

-The cavity of the larynx is a constricted tube with s smooth surface -Sheets and cords of ligaments connect the cartilages, while a smooth mucous membrane covers the medial-most surface of the larynx -The thyrohyoid membrane, lateral thyrohyoid ligament, and median thyrohyoid ligament cover the space between the hyoid bone and the thyroid -The hyoepiglottic and thyroepiglottic ligaments attach the epiglottis to the corpus hyoid and the inner thyroid cartilage, respectively -The valleculae are found between the tongue and the epiglottis, within folds arising from the lateral and median glossoepiglottic ligaments -The cricotacheal ligament attaches the trachea to the larynx -The fibroelastic membrane is composed of the upper quadrangular membranes and aryepiglottic folds, the lower conus elasticus, and the vocal ligament, which is actually the upward free extension of the conus elasticus. The pyriform sinus is the space between the fold of the aryepiglottic membrane and the thyroid cartilage laterally -The aryepiglottic folds course from the side of the epiglottis to the arytenoid apex -The conus elasticus is the membranous cover beneath the level of the vocal folds. It is continuous with the vocal ligament and is thought to reduce airway resistance leading to the glottis

To summarize

-The larynx is a musculo-cartilaginous structure located at the upper end of the trachea. It is composed of the cricoid, thyroid, and epiglottis cartilages, as well as the paired arytenoid, corniculate, and cuneiform cartilages -The thyroid and cricoid cartilages articulate by means of the cricothyroid joint that lets the two cartilages come closer together in front -The arytenoid and cricoid cartilages also articulate with a joint that permits a wide range of arytenoid motion -The corniculate cartilages rest on the upper surface of the arytenoids, while the cuneiform cartilages reside within the aryepiglottic folds -The epiglottis protects the airway during swallowing

To Summarize

-The vocal folds consist of five layers of tissue -Deep to the thin epithelial layer is the lamina propria, made up of two layers of elastin and one layer of collagen fibers. The thyroarytenoid muscle is the deepest of the layers -The vocal ligament is made of elastin. The aditus is the entryway of the larynx, marking the entry to the vestibule -The ventricular and vocal folds are separated by the laryngeal ventricle -The glottis is the variable space between the vocal folds

Vocal Fold Hydration

-Vocal folds are sensitive to internal/external environments -When vocal folds are subject to abuse, problems may arise like contact ulcers and vocal nodules -Hydration therapy is frequent prescription to counteract the problems of irritated tissue -Dry tissue does not heal as well as moist tissue, so client will be told to increase environmental humidity, drink fluids, or take meds to increase fluid retention -Effort of phonation increased as individuals became dehydrated and decreased when they were hydrated -Airflow required to produce same phonation is greatly increased by poorly lubricated larynx -When lubricated, the vocal folds vibrate much more periodically (they have greatly reduced perturbation, or cycle-by-cycle variation) -When relative periodicity of the vocal folds decreases, the voice sounds hoarse, as with laryngitis

Cricoid cartilage

-a complete ring resting atop the trachea; the most inferior of the laryngeal cartilages -shape of a signet ring, with its back arching up relative to the front

Composition of the vocal folds

composed of five layers of tissue -layer 1 (most superficial): protective layer of squamous epithelium with an underlaying of basement membrane to bind it to the next layer; gives vocal folds the glistening white appearance seen during laryngoscopic examination; this layer aids in keeping the delicate tissues of the vocal folds moist by assisting in fluid retention -layer 2: superficial lamina propria (SLP) made up of elastin fibers that can be extensively stretched; fibrous and elastic elements of SLP cushion the vocal folds -layer 3: intermediate lamina propria (ILP) made up of elastin fibers; cross-layered with SLP -layer 4: deep lamina propria (DLP): primarily supportive, made up of collagen fibers that prohibit extension; ILP and DLP combine to make up vocal ligament -layer 5 (deepest): thryoarytenoid muscle (thyrovocalis and thyromuscularis): makes up bulk of vocal fold; muscle course is anterior-posterior; active element of vocal folds -layers of lamina propria: passive element of vocal folds, providing strength, cushioning, and elasticity

Aryepiglottic muscles

course from the side of the epiglottis to the arytenoid apex, forming the upper margin of the quadrangular membranes and laterally, the aryepiglottic folds