Larynx

The voice box (larynx) - the initial division of the respiratory tract; at the top of the throat is opened in the throat, below goes into the trachea (Fig).

the structure of larynx image
Sagittal section through the nasal cavity, pharynx and larynx: 1 - soft heaven; 2 - the hyoid bone; 3 - epiglottis; 4 - thyroid cartilage; 5 - voice fold; 6 - the trachea.

The level of the larynx corresponds III-VI (sometimes VII) of the cervical vertebrae. In children it is somewhat higher. The skeleton of the larynx formed cartilages (unpaired - thyroid, thyroid, epiglottis and steam rooms - decalomainia, roscovitine, V)connected to each other by joints and ligaments. Using sublingual-thyroid membrane of the larynx connects to the hyoid bone. Between thyroid cricoid cartilage is the ring-thyroid link. To cut its use sometimes when an emergency tracheotomy (see). In the cavity of the larynx are vocal fold (true vocal cords still nomenclature), which are based on paired voice link and voice muscle, and above them - preddverii folds (false vocal cords). Between them there is a recess - guttural the ventricles. The space between the vocal folds is called voice crack. The muscles of the larynx are divided into convergent voice crack and extend it. The larynx cavity is divided into three sections: upper, or threshold, over preddverii folds, the bottom below the vocal folds and average, the narrowest in the vocal folds.
The mucous membrane of the larynx covered cylindrical ciliary epithelium. On the vocal folds and the upper parts of the epiglottis he multilayered flat. In the lower part of the larynx have loose submucosa, prone to the formation of edema, especially in childhood (see Cereals, Laryngitis), submucosal tissues are clumps of lymphoid tissue, inflammation which may develop "guttural angina".
Larynx carries respiratory protective (spasm throat and cough when the ingress of foreign bodies or harmful air impurities) and golosovaniya functions.
In diseases of the larynx patients complain of voice changing, cough, pain when swallowing, difficulty breathing, shortness of breath. Getting food to the larynx may be in disorders of innervation and when pronounced infiltrative processes. When interviewing patients should be aware of their profession, the nature and conditions of work, past illnesses. At external examination and palpation of the larynx for diagnosis are set to change the colour of the skin in this area, induration, violation of the integrity them, swelling, change, configuration, etc. Laryngoscope (see) is made after careful examination of the nose and throat. In addition, the evidence used, other methods of research of the larynx - x-rays, a biopsy.

anatomy of the larynx
Fig. 1. The ligaments and the joints of the larynx front: 1-cornu sup. cartilaginis thyreoideae; 2 - tuberculum thyreoideum sup.; 3 - tuberculum thyreoideum inf.; 4 - cornu inf. cartilaginis thyreoideae; 5 - lig. ceratocricoideum lat.; in - lig. cricotracheale; 7 - cartilagines tracheales; 8-cartilago cricoidea (arcus); 9 - lig. cricothyreoideum (s. conicum); 10 - incisura tliyreoidea slip.; 11-membrana thyreohyoidea; 12 - lig. thyreohyoideum medianum; 13 - lig. thyreohyoideum; 14 - os hyoideum. Fig. 2. The muscles and ligaments of the larynx on the right: 1 - epiglottis; 2 - m. cricothyreoidcus (pars recta); 3 - m. cricothyreoidcus (pars obliqua); 4 - cartilage thyreoidea.
Fig. 3. Elastic cone and rectangular membrane right (right-hand plate of the thyroid cartilage removed): 1 - lig. hyoepigl otticum; 2 - lig. thyreohyoideum medianum; 3 - membrana quadrangularis; 4 - cartilago thyreoidea; 5 - lig. ventriculare; 6 - lig. vocale; 7 - conus elasticus; 8 - cartilago cricoidea; 9 - membrana thyreohyoidea; 10 - lig. thyreohyoideum.
Fig. 4. The muscles and ligaments of the larynx; the right side from the inside (sagittal-the middle section): 1 - lig. thyreohyoideum lat.; 2 - lig. cricothyreoideum; 3 - m. cricothyreoidcus; 4 - m. thyreoarytenoideus; 5 - lig. vocale; 6 - lig. ventriculare; 7 - lig. thyreoepiglotticum; 8 - lig. thyreohyoideum med.
Fig. 5. The ligaments and the joints of the larynx on the right: 1 - lig. liyoepiglotticum; 2 - lig. thyreohyoideum; 3 - lig. cricothyreoideum; 4 - lig. Ceratocricoideum lat.; 5 - lig. thyreohyoideum; 6 - cartilago triticea.
Fig. 6. The muscles of the larynx rear: 1-uvula; 2 - tonsilla palatina; 3 - radix linguae; 4-epiglottis; 5 - m. aryepiglotticus; 6-m. arytenoidcus obliquus; 7-m. cricothyreoidcus; 8-m. cricoarytenoideus post.; 9 - lamina cartilaginis cricoideae; 10-m. arytenoideus transversus; 11-plica glossoepiglottica lat.
Fig. 7. Arteries and nerves of the larynx: 1 - ramus int. n. laryngei sup.; 2 - ramus ext. n. laryngei sup.; 3 - n. vagus sin.; 4 - trachea; 5 - n. laryngeus reccurens; 6 - arcus aortae; 7 - a. anonyma; 8 - a. subclavia; 9 - a. thyreoidea inf.; 10 - a. carotis communis; 11 - a. thyreoidea sup.; 12 - a. laryngea sup.; 13 - a. carotis ext.; 14 - a. carotis int.; 15 - a. lingualis; 16 - ramus suprahyoideus a. lingualis.
Fig. 8. The larynx cavity behind: 1 - tuberculum epiglotticum; 2 - plica ventricularis; 3 - plica vocalis; 1 - m. thyreoarytenoideus ext.; 5 - cartilago cricoidea; 6 - glandula thyreoidea; 7 - m. cricothyreoidcus; 8 - m. vocalis (s. thyreoarytenoideus int.); 9 - vcntriculus laryngis; 10 - cartilago thyreoidea.

Trauma to the larynx relatively rare. When external injuries (bruises, compression, broken cartilage breaks larynx from the trachea) may be a shock. Appear hemoptysis, pain when swallowing and coughing, difficulty breathing, skin neck hemorrhage, with the feeling - the feeling of characteristic crunch in the subcutaneous tissue (subcutaneous emphysema), crackle broken cartilage. The victim may threaten choking from offset and swelling of the larynx and emphysema mediastinum. Burn the larynx may occur from exposure to flame, hot smoke, steam and hot water, as well as by inhalation of fumes or ingestion of strong acids and alkalis. In these cases, the victims are observed pronounced pain, shortness of breath, possible shock. The forecast at the trauma to the larynx is always serious. Every injured larynx, must be urgently hospitalized. Cm. also Foreign body larynx.
Tuberculosis throat is a severe complication of lung tuberculosis. Complaints sick (sore, hoarseness, dysphagia, and others) depend on the location, distribution, and shape the process. In the diagnosis should be considered a medical history, and complaints, the General condition of patients, the data of laboratory researches (sticks Koch, a positive test Pirke or test. Patients with suspected tuberculosis larynx should be urgently directed to the doctor.
Syphilis throat is relatively rare. Defeat occurs, as a rule, at secondary and tertiary forms of syphilis. Complaints of patients are the same as at a tuberculosis of the larynx. Suspected syphilis throat patients should be referred to a specialist.
Tumors of the larynx are divided into benign and malignant. Among benign tumors are more common fibroids and papillomas, localized on voice and Predgorny folds. Their main symptom is hoarseness; rare angiomas, lymphangioma. For diagnosis in all cases a histological examination of the removed piece of the tumor.
The main type of treatment of benign tumors of the larynx is surgical removal.
Cancer of the larynx is observed more often at the age older than 40 years, mainly in men. Precancerous diseases of the larynx are pachydermia, hyperkeratosis, papillomas, chronic laryngitis with symptoms of leukoplakia (see), keloid scars after injuries. Larynx cancer most often squamous cell carcinoma. Localization distinguish cancer of the vestibular Department (vestibule), the true and the false vocal cords and podvysotskogo Department.
When cancer true vocal cords most typical initial symptoms are hoarseness. Cancer of the vestibule there are scratchy, sensation of foreign body, and pain when swallowing, often radiating to the ear. When cancer podvysotskogo Department larynx more typical is slowly increasing shortness of breath and wheezing. As the tumor spread to surrounding tissues, and organs intensify the above symptoms, developing gradually narrowing of larynx, requiring urgent overlay tracheostomy, there are metastases in the lymph nodes of the neck, worsens the General condition of patients.
Diagnosis of laryngeal cancer is installed indirect laringoscopiei, and sometimes (in podvenechnom Department and guttural ventricle) direct laringoscopiei. Before treatment should histological examination of a piece of the tumor.
Treatment of laryngeal cancer is radiation, surgical or combined method in the cancer establishment.
All patients suffering from prolonged hoarseness and pain when swallowing, subject to the direction of the ENT specialist.




diseases of the larynx
Fig. 1. Normal throat when breathing. Fig. 2. Normal larynx in phonation. Fig. 3. Tuberculosis larynx (pitting the vocal cords). Fig. 4. Tuberculosis larynx (unilateral redness vocal cords). Fig. 5. Tuberculosis larynx (sores on his vocal cords; perihodit; ulcers of the epiglottis, scooped-eminent cartilage and scooped-nadgorny ligaments). Fig. 6. Syphilis larynx (II stage). Fig. 7. Syphilis larynx (late stage). Fig. 8. Fibroma vocal cords. Fig. 9. Papilloma vocal cords. Fig. 10. Cancer of the left half of the epiglottis and scooped-nadgorny ligaments. Fig. 11. Polyp vocal cords. Fig. 12. Cavernous hemangioma of the larynx.