LARYNX AND THE MECHANISM OF VOICE

PRODUCTION

Rommel B. Gonzalez, M.D.

ENT- Head and Neck Surgeon
Voice Specialist- Laryngology
EMBRYOLOGY
• At 20 days' gestation, ventral laryngotracheal groove.

• Trachea becomes separated from the esophagus by the

tracheoesophageal septum

• 7th week AOG: obliteration of lumen

• 9th week AOG: recanalization
EMBRYOLOGY
• endodermal lining and the adjacent mesenchyme

• fourth and sixth branchial arches

• 4th branchial arch: Cricothyroid

• 6th Branchial arch: all other intrinsic muscles

ANATOMY
• Infants: C1-C2
• Children: C3- C4
• Adults: C6-C7
ANATOMY
• Infants: C1-C2
• Obligate nasal
breathers
(4-6 months)
THE FUNCTIONS OF THE LARYNX
1. Airway protection : Gateway
2. Respiration
3. Voice production: Phonation
I. PROTECTIVE
• Epiglottis serves to direct swallowed food laterally
into the pyriform sinuses, away from the midline
laryngeal aperture.
• Elevation of the larynx toward the nasal cavity during
the height of deglutition
• Glottic Closure
II. RESPIRATION
• Provides the energy for sound
• Breathing is an aerodynamic process
• a continuous difference in air pressure is created
between the thoracic cavity and the atmospheric
pressure outside the body
III. PHONATION
• Vocal folds: main structures responsible for
phonation
Anteriorly - Thyroid cartilage
Posteriorly - Arytenoid cartilage
• Adducted vocal folds: vibration: phonation
ANATOMY
1. Supraglottis: Epiglottis – False Vocal Folds: Vestibule
2. Glottis: level of true vocal folds
3. Subglottis : 5 mm below the inferior margin of the vocal
folds – cricoid cartilage

Transition
Respiratory epithelium (supraglottis)
Stratified squamous epithelium (glottis)
Respiratory Epithelium (subglottis)
ANATOMY
1. Supraglottis: Dysphagia
2. Glottis: Dysphonia
3. Subglottis : Dyspnea
ANATOMY
1. Supraglottis: Dysphagia
2. Glottis: Dysphonia
3. Subglottis : Dyspnea
ANATOMY
CARTILAGES
1.Unpaired
Epiglottis, Thyroid and Cricoid

2.Paired
Arytenoids
Corniculate
Cuneiform
ANATOMY
CARTILAGES
ANATOMY
ARYTENOID CARTILAGES: rest on the cricoid at the
cricoarytenoid joint and move in two distinct ways:
1.) Rocking: to pivot the arytenoids away from each other
abducting the vocal folds or the reverse
2.) Sliding the arytenoids on an anterior-posterior direction

TVC are attached to the anterior ends of these cartilages any

movement in them will change the folds’ shape, tension and
relationship to each other thereby affecting phonation.
ANATOMY
ARYTENOID CARTILAGES:
ANATOMY
Laryngeal Muscles
• Extrinsic muscles: divided into two groups
• Elevators of the larynx ( Geniohyoid, Stylohyoid, Mylohyoid,
Digastrics)
• Depressors of the larynx (Sternohyoid, Thyrohyoid,
Omohyoid)
• Intrinsic muscles: divided into two groups
• Muscles controlling the laryngeal cavity
• Muscles controlling the movements of the vocal cords
ANATOMY
Laryngeal Muscles
• Extrinsic muscles:
 muscle origin Insertion Action
Sterno hyoid posterir surface of the lower edge of the draws the larynx
manubrium sterni and body of the hyoid downwards .
the 1st costal cartilage

Thyrohyoid oblique line on the lower border of the rises the larynx if the
thyroid ala greater horn of the hyoid is fixed .
hyoid bone Depress the hyoid if
the larynx is fixed .

Sternothyroid posterir surface of the oblique line on the Depresses the larynx
manubrium and the thyroid lamina .
1st costal cartilage
omohyoid superior border of intermediate tendon Depresses the larynx
scapula
(inferior belly )

omohyoid intermediate tendon Lateral surface of Depresses the larynx

hyoid bone
(superior belly )
 muscle origin Insertion Action inervation
Mylohyoid Mylohyoid line on Midline raphe and Raises and pulls Nerve to mylohyoid
the inner aspect of body of hyoid . the hyoid . (inferior alveolar
Mndible . branch of v3 )

Geniohyoid Genial tubercle on Upper border of the Raises and pulls Hypoglossal (C1
Mndible . body of hyoid . the hyoid forward . root)

Stylohyoid Back of the styloid Base of greater Retractor and Facial nerve .
(split around cornu of thyroid . elevator of hyoid for
digastric process ) swallowing .

Digastric notch on Lower border of the Anterior belly pulls the Posterior belly – facial
Digastric nerve .
the medial surface Mandible .fibrous sling Hyoid anterior and up .
holds the tendon to posterior belly pulls Anterior belly - nerve to
Mastoid process .
lesser cornu of hyoid . Hyoid post. and up. mylohyoid .

Medial aspect of post. Border of lamina Elevates the larynx Glossopharyngeal

Stylopharyng of th. Cart.( side wall
the styloid process . nerve
eous Of pharynx )

Palatine aponeurosis post . Border of thyroid Helps tilts the Accessory nerve
Palatopharyn alar and cornu.
And post. Margin of larynx forward . )pharyngeal plexus)
geus palat .

Eustachian tube post . Border of thyroid Elevates the larynx Pharyngeal plexus
Salpingophar cart. .( side wall of
yngeus pharynx )
ANATOMY
Intrinsic muscles:
Muscles controlling the laryngeal cavity
Adductors
Lateral Cricoarytenoids
Interarytenoids (Transverse, Oblique)
Thyroarytenoids
Cricothyroid
Abductor
Posterior Cricoarytenoids : synchronous with inspiration
ANATOMY
Intrinsic muscles:
Muscles controlling the laryngeal cavity
Adductors
Lateral Cricoarytenoids
Interarytenoids (Transverse, Oblique)
Thyroarytenoid
Cricothyroid
ANATOMY
Intrinsic muscles:
Muscles controlling the laryngeal cavity
Abductor
Posterior Cricoarytenoids
ANATOMY
Intrinsic muscles:
Muscles controlling the movements of the vocal cords

Lengthens and tenses:

Cricothyroid (Frequency: Pitch)

Shortens and Relaxes:

Thyroarytenoid (Amplitude: Loudness)
ANATOMY
Intrinsic muscles:
Muscles controlling the movements of the vocal cords

Lengthens and tenses:

Cricothyroid (Frequency)
ANATOMY
Intrinsic muscles:
Muscles controlling the movements of the vocal cords

Shortens and Relaxes:

Thyroarytenoid (Amplitude)
ANATOMY
Blood Supply
Arterial
 Above the vocal folds: Laryngeal branch of the Superior
Thyroid Artery- External Carotid Artery
 Below the vocal folds: Laryngeal branch of the Inferior
Thyroid Artery- Thyrocervical Trunk
Venous
 Superior Thyroid Vein- Internal Jugular Vein
 Inferior Thyroid Vein- Brachiocephalic Vein
ANATOMY
Nerve Innervation
Vagus Nerve
Sensory
 Above the vocal folds: Internal branch of the Superior
laryngeal nerve
 Below the vocal folds: Recurrent laryngeal nerve
Motor
 External branch of the Superior laryngeal nerve:
Cricothyroid
 Recurrent Laryngeal Nerve (The rest)
ANATOMY
Nerve supply
ANATOMY
ANATOMY
GLOTTIS
•Consists of TVF, anterior commissure and posterior commissure
•TVF: Anterior 2/3 is membranous : responsible for voice
production
•Posterior third consists of vocal processes of arytenoids and
posterior commissure
ANATOMY
True vocal folds
•12- 24 mm in length, 3-5 mm in width
•Avascular with scarce lymphatics
ANATOMY
True vocal folds
Layers:
• Cover: Non- keratinized stratified squamous epithelium
Superficial Lamina propria (amorphous)
Transitional Zone:
Intermediate and Deep Lamina propria
(elastic and collagenous)
Body: Vocalis muscle
ANATOMY
True vocal folds
Layers:
PHONATION (COMPONENTS)

•The generation of sound: Sound production originates from the

larynx as a fundamental tone by the intermittent release of
expired air between the adducted vocal cords resulting in
their vibration.
•The resonance of sound: This tone is modified by various
resonating chambers (resonators) i.e. pharynx, mouth and
paranasal sinuses.
•The articulation of sound (speech production) : coordinated action
of the tongue, palate, cheek and lips
REQUIREMENTS FOR PHONATION

1.Adequate breath support

2.Approximation of vocal folds
3.Favorable vibratory properties
4.Favorable vocal fold shape
5.Control of length and tension
MECHANISM OF PHONATION
Inhalation of air
Glottic closure: in various degrees of adduction and
place them under the appropriate longitudinal tension
MECHANISM OF PHONATION
Exhalation increases subglottic pressure until it
exceeds muscular opposition opening the glottic chink
MECHANISM OF PHONATION
Vocal folds return to midline
•Decrease in subglottic pressure
•Elastic forces in vocal fold (Myoelastic theory)
•Negative pressure (Bernoulli therory: effect of airflow)
GLOTTIC CYCLE

•Cycle of vibration
•110 cycles per second for males
•200 cycles per second for females

•Males (80-150 Hz)

•Females (180-250 Hz)
•Children (250-300)
GLOTTIC CYCLE

Open in a posterior to anterior direction and inferior to superior

direction recontacting each other at the end of the vibratory cycle.
MYOELASTIC-AERODYNAMIC THEORY
Model describing voice production
(phonation) as a combination of:
• Muscle force (myo)
• Tissue TVF elasticity (elastic)
• Pressures and flows
(aerodynamic)

• Bernoulli principle
GLOTTIC CYCLE

•Closure patterns
•Mucosal wave
•Amplitude
•Symmetry
•Periodicity
Thank you…..