Anatomy Exam 2 Study Guide

Hyoid Bone: Structure

- "U" shaped and located in the neck and level C3, limbs of the "U" directed backward and slightly upward. Structure: 1) Corpus: Main body 2) Greater Cornu (horns): Posteriorly directed limbs 3) Lesser Cornu (horns): Cone-Shaped prominences

Laryngeal Vestibule

- A cavity inferior to the Aditus Laryngis - Just superior to the false vocal folds

What is termination?

- Abduction of vocal folds. - Phonation is terminated several times during running speech. - Muscles controlling adduction and abduction occur rapidly.

Glottal Attack

- Adduction prior to airflow. - Similar to a cough. - Use with words starting with a stressed vowel.

What is the prephonatory phase?

- Adjustment phase prior to onset of phonation. - The vocal folds move from abducted to fully or partially adducted. 1) Interarytenoids (oblique and transverse): - Slide arytenoids together. 2) Lateral Cricoarytenoids: - Rock the arytenoids forwards and rotate. - Vocal processes move medially.

Ventricular Folds

- Also known as false vocal folds or vestibular folds. - Small paired bulges of tissue inferior to the vestibule. - Incapable of becoming tense. - Composed of mucous membrane surrounding a narrow band of tissue called the ventricular ligament.

Subglottal Space

- Also known as infraglottal space. - Extends inferiorly from the true vocal folds to the inferior border of the cricoid cartilage.

Glottis

- Also known as the rima glottis. - The variable opening between the true vocal folds. - It varies from wide open to completely closed. - The glottis is open during breathing. - The glottis is closed during swallowing. - The glottis is closed or mostly closed during phonation.

What is an attack?

- Begins with vocal fold adduction. - Subglottic pressure increases until it overcomes glottal resistance. - Puff of air is released. - Followed by the closure of the glottal chink. - Occurs frequently in running speech

What is ventricular phonation?

- False folds technically cannot vibrate for voice. - Clients using ventricular phonation as adaptive response to serve vocal fold dysfunction. - Client force lateral superior walls close together (vibrates ventricular folds).

Hyothyroid (or thyrohyoid) Membrane: Structure/Function

- Fibroelastic sheet. - Connects the superior border of the thyroid cartilage with the body and greater horns of the hyoid. - Middle Hyothyroid ligament - Lateral Hyothyroid ligament

True Vocal Folds

- Inferior to the ventricles. - Parallel to the ventricular folds. - Larger than the false vocal folds. - Both left and right vocal fold have a common anterior attachment at the angle of the thyroid. - The vocal folds course posteriorly and have separate posterior attachments on the anterolateral surface of the arytenoid cartilages.

Conus Elasticus (Cricovocal Membrane)

- Lower portion of the elastic membrane. - Most extensive portion - Extends from the superior border of the cricoid arch and Lamina to the medial portion of the true vocal folds.

Chest Register

- Middle range (speaking) register. - The natural manner of action for the vocal folds. - The entire vocal fold (all 5 tissue layers) are vibrating.

Aditus Laryngis

- Opening to the larynx - Superior limit of the supraglottal space - Triangular opening - Slopes obliquely (at and angle) down and back - The boundaries for the Aditus Laryngis are: • Anteriorly: The epiglottis • Laterally: The aryepiglottic folds • Posteriorly: The apex of the arytenoids

Breathy Vocal Attack

- Start of airflow before the adduction of the vocal folds. - Common during running speech, air is continually flowing.

What are the intrinsic Laryngeal membranes?

- They interconnect the various laryngeal cartilages. - Regulate the movements of laryngeal cartilages. - Both attachments are within the larynx. - Arise from a broad sheet of connective tissue called the elastic membrane of the larynx. 1) Conus Elasticus (Cricovocal Membrane) 2) Quadrangular Membranes

Pyriform Sinuses

- Two deep depressions located outside of the larynx in the laryngopharynx or hypopharynx. - They are lateral and inferior to the Aditus Laryngis and the quadrangualr membranes.

Ventricles

- Two small cavities located inferior to the false vocal folds and superior to the true vocal folds. - Perpendicular to airway.

Quadrangualr Membranes

- Upper portion of the elastic membrane (paired). Origin: lateral margins of the epiglottis and the thyroid cartilage near the angle. Course: curve posteriorly downward. Insertion: corniculate cartilages and the medial surface of the arytenoids. Inferiorly: - Free thickened borders called the ventricular ligaments of the false vocal folds. - lie parallel and superior to the true vocal folds. Superiorly: - Free borders called the aryepiglottic folds - Extends from the sides of the epiglottis to the apexes of the arytenoid cartilages. - Cuneiform cartilage embedded within.

What are the parts and functions of the Hyoid bone? (Definition/Function)

-A supportive structure for the root of the tongue. -The larynx is somewhat suspended form the hyoid bone. -Provides the origin and insertion for 22 muscles. -Is the only bone in the body that is not directly attached to any other bone in the skeleton.

Hypoglossal Nerve: Structure/Function

-Descending Branch follows the course taken by the vagus. -Unites with branches of spinal nerve C1 and C2. -Motor innervation of most extrinsic laryngeal muscles.

Cuneiform Cartilages: Structure pt. 2

-Embedded with aryepoglottic folds (covered by connective tissue and fat). -Lend support to the aryepiglottic folds and stiffen them to help maintain the opening of the larynx.

Aryepiglottic Folds: Structure

-Folds of mucous membrane which extend from the sides of the epiglottis to the apexes of the arytenoid cartilages. -Aryepiglottic folds form the entrance of the larynx.

Hyoid Bone: Location

-Superior and Anterior: From the muscles from the tongue and chin. -Superior and Posterior: From the muscles and ligaments form the temporal bone. -Inferior: From Extrinsic laryngeal muscles, and muscles from the sternum and clavicle.

Classification of Intrinsic Muscles

1) Adductors: - Approximate the arytenoids. - Bring vocal folds closer together. 2) Abductors: - Separate the arytenoids. - Vocal folds pulled apart to open the glottis. 3) Tensors: - Elongate and/or tighten the vocal folds. 4) Relaxers: - Shorten or relax the vocal folds.

What are the laryngeal cavities? (7)

1) Aditus Laryngis (Opening) 2) Vestibule (Cavity) 3) False Vocal Folds (Tissue) 4) Ventricles (Cavities) 5) True Vocal Folds (Tissue) 6) Glottis (Opening) 7) Subglottal Space (Cavity)

Cricoid Cartilage: Structure

1) Anterior Arch: -The lateral portion of the arch. -Articulation point for the cricothyroid joint. 2) Posterior Quadrate Lamina: -The superior portion. -Articulation for the cricoarytenoid joint.

Digastric Muscle

1) Anterior Belly: - Origin: Inner surface of mandible near the mental symphysis. - Course: Inferior and posterior. 2) Posterior Belly: - Origin: Mastoid process of the temporal bone (behind and beneath the ear). - Course: Inferior and anterior. - Insertion: The two bellies meet and are joined by an intermediate tendon (loop) which attaches to the hyoid at the junction of the body and greater horn of hyoid.

What is sustained phonation?

1) Attacks and termination require muscular action. 2) Sustained phonation required maintenance of laryngeal posture. - Tonic/Sustained contraction of a muscle. 3) Clinically: - Evaluate maximum potential.

Arytenoid Cartilage: Structure

1) Base 2) Apex: -Superior portion of each arytenoid 3) Three surfaces: -Posterior -Anterolateral -Medial (inner)

What are the types of voice registers?

1) Chest Register 2) Glottal Fry 3) Falsetto 4) Whisper

What are the Non-Speech Laryngeal Functions?

1) Coughing: - Response to irritant/foreign object. 2) Throat Clearing: - Not as violent, but still stressful. 3) Abdominal Fixation: - Effortful closure (valsalva maneuver) 4) Abduction: - Dilates the larynx. 5) Reflexes are involuntary: - Some can be controlled but you must eventually breathe. 6) Swallow Reflex: - Bolus triggers a reflex as it passes behind the tongue and above the larynx. - Larynx elevates. - Epiglottis drops down. - Aryepiglottic folds tense by action of aryepiglottic muscle. - Vocal fold adduct.

Flasetto

1) Highest Register: - Breathy - Flute like 2) Frequency is 300-600 Hz 3) Characterized by: - VFs lengthen - VFs extremely thin "reedlike"

Omohyoid Muscle

1) Inferior Belly: Origin: Upper border of scapula. Course: Medial and anterior. Insertion: Intermediate tendon just above the sternum (different than intermediate tendon of hyoid) 2) Superior Belly: Origin: Intermediate tendon. Course: Superior, slightly medially. Insertion: Greater horn of hyoid. Action: (for both bellies): Depressed hyoid (pull hyoid inferiorly).

Placement

1) Intrinsic muscles of the larynx: - Both attachments within the larynx on a laryngeal cartilage. - Make fine adjustments to the vocal folds. 2) Extrinsic muscles of the larynx: - One attachment inside the larynx and one attachment outside the larynx. - Support of the larynx. 3) Non-Laryngeal muscles: - One attachment to the hyoid. - One attachment to another structure. - Responsible for elevating and depressing the larynx. - Due to attachments to the hyoid, work together with motions of the tongue.

Function

1) Intrinsic: - Adductor - Abductor - Tensor - Relaxer 2) Extrinsic: - Laryngeal Elevators - Laryngeal Depressors

Thyroid Cartilage: Structure

1) Lamiane: -Composed of two shield-like quadrilateral plates. -The plates are fused at the midline. -The "V" shaped is called the superior thyroid notch. 2) Superior Cornu: -Paired horns directed superiorly, posteriorly, and medially. -Shorter and thicker. -Attached to greater horns of joyous by a ligament. 3) Inferior Cornu: -Paired horns directed inferiorly and slightly medially. -Articulate directly with cricoid cartilage at cricothyroid joint.

How do we visualize laryngeal function?

1) Light Source 2) Transillumination 3) Early Photography 4) Stroboscopy 5) High Speed Cinematography 6) Radiography 7) Flexible Fiberoptic Laryngoscopy

Glottal Fry

1) Lowest Register: - aka Pulse Register - Crackly "popcorn" quality 2) Frequency is roughly 30-90 Hz, average is 60 Hz. 3) Characterized by: - Low subglottilc pressure to sustain. - Tight adduction. - Vocal tension reduced. - Lateral tension on VFs for strong medial compression.

Arytenoid Cartilage: Processes

1) Muscular Process: -Located on the posterolateral corner of each arytenoid. -Provides attachment point for important laryngeal muscles. 2) Vocal Process: -Located on the anteromedial corner of each arytenoid. -Provides the posterior attachment point for vocal ligament of each vocal fold.

Vagus Nerve: Structure/Function

1) Pharyngeal Branch: - Sensory: Mucous membrane of the pharynx and the soft plate. - Motor: Muscles of the pharynx and soft palate except tensor veli palatini muscle. 2) Superior Laryngeal Nerve Branch: - Internal laryngeal nerve: sensory, supraglottic larynx mucous membrane. - External Laryngeal Nerve: motor, Cricothyroid muscle. 3) Recurrent Laryngeal Nerve Branch: - Branches off the Vagus inside the thoracic cavity. - Sensory: Subglottal laryngeal mucosa - Motor: All intrinsic laryngeal muscles except Cricothyroid muscle. - Left RLN is longer than the right RLN: Loops under the aorta from front to back and then ascends to the larynx. - Longer than the SLN therefore more opportunity for damage.

What are the classifications for laryngeal muscles?

1) Placement 2) Function

What are the biological functions of the larynx?

1) Prevent foreign substances from entering the larynx. 2) Forcefully expels foreign substances in danger of entering the larynx or trachea (coughing). 3) Prevents air from escaping from the lungs when the valve is closed.

What are the locations, parts, and functions of the 9 cartilages?

1) Thyroid Cartilage 2) Cricoid Cartilage 3) Epiglottis 4) Aryteniod Cartilages (Paired) 5) Corniculate Cartilages (Paired) 6) Cuneiform Cartilages (Paired)

Epiglottis: Structure

1) Valleculae: -Two pit-like depressions located between the epiglottis and the root of the tongue.

What is the larynx composed of?

A framework of muscles and cartilages bound by elastic tissue.

Cricoid Cartilage: Definition/Location

A hyaline structure shaped like a class ring with the larger part facing posteriorly. It is located immediately above the first tracheal ring and is attached to the first tracheal ring by means of the cricotracheal membrane or ligament.

Epiglottis: Definition/Location/Function

A leaf-shaped flap in the throat that keeps food from entering the windpipe and lungs.

What is the Bernoulli effect?

Air passing through the glottis increases in flow, and pulls the vocal folds back together due to the negative air pressure caused by the airflow (similar to large truck passing a car on the freeway and the force pulls car toward truck).

Cricoarytenoid Joint: Structure

CA joint is a saddle joint that permits rocking and a limited amount of gliding motion. Vocal Fold abduction: Upward and outward swinging motion. Vocal Fold Adduction: Inward and downward swinging motion.

Cricothyroid Joint: Structure

CT joint is a pivot joint which: 1) Allows either the thyroid or the cricoid to rotate/pivot about an axis through the joint. 2) Allows a limited amount of gliding or sliding action which is also called translation.

Corniculate Cartilage: Structure

Cap the apex of the arytenoid.

Hyoepiglottic Ligament

Connects the anterior portion of the epiglottis at the midline with the posterior body of the hyoid.

What are the extrinsic laryngeal membranes? (3)

Connects the laryngeal cartilages with adjacent structures. - One attachment to structures inside the larynx. - One attachment to structures outside the larynx. 1) Hyothyroid (or thyrohyoid) Membrane 2) Hyoepiglottic Ligament 3) Cricotracheal Membrane/Ligament

Cricotracheal Membrane/Ligament

Connects the lower border of the cricoid cartilage with the upper border of the first tracheal ring.

Simultaneous Vocal Attack

Coordination of adduction and onset of expiration.

Corniculate Cartilage: Definition/Location

Function of the cuneiform cartilages is to support the vocal folds and lateral aspects of the epiglottis. They also provide a degree of solidity to the folds in which they are embedded. They are located at the top or apex of the arytenoid cartilages.

Cuneiform Cartilages: Definition/Location

In the human larynx, the cuneiform cartilages are two small, elongated pieces of yellow elastic cartilage, placed one on either side, in the aryepiglottic fold. The cuneiforms are paired cartilages that sit on top of and move with the arytenoids.

What is a cycle of vocal fold vibration?

Long, smooth, rounded bands of muscle Lengthened or shortened Tensed or relaxed Abducted or Adducted

Cricothyroid Pars Recta

Origin: Anterior surface of the cricoid cartilage beneath the arch. Course: Superior lateral. Insertion: Lower margin of thyroid Lamina. Function: - Depresses the thyroid. - Tenses the vocal fold (Pitch change)

Cricothyroid Pars Oblique

Origin: Cricoid cartilage, lateral to the pars recta. Course: Obliquely superior and posterior. Insertion: Thyroid cartilage between the laminae and inferior horns. Function: - Depressed the thyroid. - Tenses the vocal fold (Pitch change).

Mylohyoid Muscle

Origin: Inner surface of mandible from mental symphysis to last molar. Course: Medial and inferior. Insertion: Meets with fibers from other side at a tendinous midline raphe which extends from the mental symphysis to the hyoid bone. Posterior fibers of mylohyoid insert directly onto body of hyoid. Action: Elevates the hyoid, the floor of mouth and the tongue, depresses the mandible.

Transverse Arytenoid Muscle

Origin: Lateral margin and posterior surface of one arytenoid. Course: Laterally. Insertion: Lateral margin and posterior surface of opposite arytenoid. Function: -Adducts the vocal folds. -Medial compression.

Sternohyoid Muscle

Origin: Manubrium of sternum and first costal cartilage. Course: Superior and slightly lateral. Insertion: Oblique line of the thyroid cartilage. Action: Depresses the thyroid cartilage, active in swallowing, brings the larynx downwards after its elevation in the pharyngeal phase.

Sternohyoid Muscle

Origin: Manubrium of sternum and the medial end of clavicle. Course: Superior. Insertion: Body of hyoid. Action: Depresses the hyoid bone or fixes the hyoid and larynx.

Geniohyoid Muscle

Origin: Mental spine, inner surface of mandible. Course: Posterior and inferior. Insertion: Body of hyoid. Action: With mandible fixed, elevates hyoid superior and anterior, depresses the tongue.

Thyrohyoid Muscle

Origin: Oblique line of the thyroid cartilage. Course: Superior. Insertion: Greater horn of hyoid. Action: Either depress the hyoid or raise the larynx.

Posterior Cricoarytenoid Muscle

Origin: Posterior aspect of quadrate lamina of cricoid. Course: Superior and lateral. Insertion: Posterior surface of muscular process of arytenoid cartilage. Function: - Vocal fold abduction.

Thyrovocalis Muscle

Origin: Posterior surface near the angle of the thyroid cartilage. Course: Posterior. Insertion: Lateral surface vocal process of the arytenoids. Function: Tensor - Especially when contracting with the Cricothyroid.

Thyromuscularis Muscle

Origin: Posterior surface of thyroid lamina just lateral to vocalis origin. Course: Parallel to vocalis. Insertion: Base and muscular process of arytenoids. Function: - Relaxes vocal folds.

Stylohyoid Muscle

Origin: Styloid process of the temporal bone. Course: Inferior and anterior, roughly parallel to the course of posterior belly of digastric. Insertion: On the body of hyoid at junction with greater horn. Action: Draw hyoid bone superior and posterior.

Lateral Cricoarytenoid Muscle

Origin: Superior lateral surface of the cricoid. Course: Superior and posterior. Insertion: Muscular process of the arytenoid. Function: - Adduct vocal folds. - Increases medial compression of vocal folds.

Oblique Arytenoid Muscle

Origin: The posterior surface of the muscular process of one arytenoid. Course: Obliquely (diagonally) superior. Insertion: Near the apex of the opposite arytenoid. Function: -Pull the apex medially. - Medial Compression. - Works with the aryepiglottic to pull the epiglottis down.

Thyropharyngeous Muscle

Origin: Thyroid Lamina and inferior cornu. Course: Superiorly and medially. Insertion: Posterior pharyngeal raphe. Action: Constrict the pharynx, elevate the larynx.

voicing

Rapid series of air pulses One cycle of VF vibration VF adduction restricts air flow Pressure increases beneath the VFs VFs are blown apart releasing a puff of air into the vocal tract Pressure decrease beneath the VFs and elasticity of muscles allows return to adduction

Thyroid Cartilage: Definition/Location

Surrounds the laryngeal organ on three sides and is made up of hyaline cartilage.

Aryepiglottic Folds: Definition/Location

The Aryepiglottic folds are triangular folds of mucous membrane enclosing ligamentous and muscular fibres. They are located at the entrance of the larynx, extending from the lateral borders of the epiglottis to the arytenoid cartilages, hence the name 'aryepiglottic'.

Cricoarytenoid Joint: Definition/Location

The cricoarytenoid (CA) joint is a diarthrodial joint that includes a synovial lining and a fluid-filled bursa. The joint capsule and the ligamentous attachments, including the cricoarytenoid (CA) ligament, vocal ligament, and false vocal folds, limit normal motion of the joint.

Cricothyroid Joint: Definition/Location

The cricothyroid articulation (or joint) is a joint connecting the cricoid cartilage and the thyroid cartilage. It plays a key role in adjusting human voice pitch by changing the tension of the vocal cords.

Hypoglossal Nerve: Definition/Location

The hypoglossal nerve is the twelfth cranial nerve, and innervates all the extrinsic and intrinsic muscles of the tongue, except for the palatoglossus which is innervated by the vagus nerve. It is a nerve with a solely motor function.

Hyothyroid (or thyrohyoid) Membrane: Defintion/Location

The thyrohyoid membrane is a wide and fibrous layer of tissue that connects the thyroid cartilage to the hyoid bone. The thyroid cartilage is the largest cartilage — a type of strong, flexible tissue — in the neck, part of which forms the Adam's apple.

Vagus Nerve: Definition/Location

The vagus nerve is the tenth cranial nerve or CN X, and interfaces with the parasympathetic control of the heart, lungs, and digestive tract. The vagus nerves are paired but are normally referred to in the singular.

Arytenoid Cartilage: Definition/Location/Function

They allow the vocal folds to be tensed, relaxed, or approximated. The arytenoids articulate with the supero-lateral parts of the cricoid cartilage lamina, forming the cricoarytenoid joints at which they can come together, move apart, tilt anteriorly or posteriorly, and rotate.

What are the locations and actions of laryngeal Joints?

Two pairs of joints in the larynx —Functional articulators between bones or between cartilages Both laryngeal joints are diarthrodial or moveable -Cricothyroid joint (pivot joint) -Cricoarytenoid (saddle joint) Control all internal adjustments of the vocal folds.

What are the parts and functions of vagus and hypoglossal nerves?

Vagus Nerve: (Branches) 1) Pharyngeal 2) Superior Laryngeal Nerve 3) Recurrent Laryngeal Nerve Hypoglossal Nerve: -Follows the course taken by the vagus nerve.

Normal Cycles

Vowel production: 125 cycles per second Males: 110 cps (low pitch) Women: 180-220 cps (medium pitch) Children: 300 cps (high pitch)