Superior laryngeal nerve

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Superior laryngeal nerve
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Plan of upper portions of glossopharyngeal nerve, vagus nerve, and accessory nerve. ("Laryngeal" labeled at lower right.)
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Course and distribution of the glossopharyngeal, vagus, and accessory nerves. (Branches visible in upper right.)
Details
FromVagus nerve
Innervates larynx
Identifiers
Latin nervus laryngeus superior
TA98 A14.2.01.160
TA2 6339
FMA 6239
Anatomical terms of neuroanatomy

The superior laryngeal nerve is a branch of the vagus nerve. It arises from the middle of the inferior ganglion of vagus nerve and additionally also receives a sympathetic branch from the superior cervical ganglion.

Contents

The superior laryngeal nerve produces of two branches: the internal laryngeal nerve (its sensory branch) which supplies sensory fibers to the laryngeal mucosa, and the external laryngeal nerve (its motor branch) which innervates the cricothyroid muscle.

Structure

Origin

The superior laryngeal nerve arises from the middle of the inferior ganglion of vagus nerve.

Course

The superior laryngeal nerve descends by the side of the pharynx deep to the internal carotid artery before dividing into two branches —the external laryngeal nerve and the internal laryngeal nerve. [1]

Branches

External laryngeal nerve

The external laryngeal nerve is the smaller, external branch. It descends on the larynx, beneath the sternothyroid muscle, to supply the cricothyroid muscle. The external branch functions to tense the vocal cords by activating the cricothyroid muscle, increasing pitch. The external laryngeal nerve gives branches to pharyngeal plexus and the superior portion of the inferior pharyngeal constrictor, and communicates with the superior cardiac nerve behind the common carotid artery.

Internal laryngeal nerve

The internal laryngeal nerve is the internal branch. It descends to the thyrohyoid membrane, piercing it in company with the superior laryngeal artery, and is distributed to the mucous membrane of the larynx. Of these sensory branches, some are distributed to the epiglottis, the base of the tongue, and the epiglottic glands; others pass posteriorly, in the aryepiglottic fold, to supply the mucous membrane surrounding the entrance of the larynx, and the mucous lining of the larynx as far down as the vocal folds.

A filament descends beneath the mucous membrane on the inner surface of the thyroid cartilage and joins the recurrent laryngeal nerve. Above the vocal folds the sensory innervation of the larynx is via the internal laryngeal nerve. Below the vocal folds it is by way of branches of the recurrent laryngeal nerve. The vocal fold itself receives dual innervation from both nerves.

Function

The superior laryngeal nerve innervates the cricothyroid muscle. [2]

Clinical significance

A superior laryngeal nerve palsy changes the pitch of the voice and causes an inability to make explosive sounds due to paralysis of the cricothyroid muscle. If no recovery is evident three months after the palsy initially presents, the damage is most likely to be permanent. A bilateral palsy presents as a tiring and hoarse voice. It can be injured in surgery involving the removal of the thyroid gland (thyroidectomy). [3] [4] Understanding the most common anatomic variations of the distal portion of the external laryngeal nerve and its relation to the inferior constrictor muscle is critical and allows identifying and preserving the integrity of this nerve in most cases. [5] [6] The external branch is susceptible to damage during thyroidectomy or cricothyrotomy, as it lies immediately deep to the superior thyroid artery. The ability to produce pitched sounds is then impaired along with easy voice fatigability, (usually mono-toned voice).

Irritation of the internal laryngeal nerve results in uncontrolled coughing - usually as a result of food or water in the laryngopharynx. The lesion of this branch (for example, during surgery) that seeks an anterior approach to the cervix, is associated with a loss of the laryngeal reflex of cough and an elevated risk of aspiration pneumonia. [7]

Additional images

Related Research Articles

<span class="mw-page-title-main">Vagus nerve</span> Cranial nerve X, for visceral innervation

The vagus nerve, also known as the tenth cranial nerve, cranial nerve X, or simply CN X, is a cranial nerve that carries sensory fibers that create a pathway that interfaces with the parasympathetic control of the heart, lungs, and digestive tract. It comprises two nerves—the left and right vagus nerves—but they are typically referred to collectively as a single subsystem. The vagus is the longest nerve of the autonomic nervous system in the human body and comprises both sensory and motor fibers. The sensory fibers originate from neurons of the nodose ganglion, whereas the motor fibers come from neurons of the dorsal motor nucleus of the vagus and the nucleus ambiguus. The vagus was also historically called the pneumogastric nerve.

<span class="mw-page-title-main">Larynx</span> Voice box, an organ in the neck of amphibians, reptiles, and mammals

The larynx, commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about 4–5 centimeters in diameter. The larynx houses the vocal cords, and manipulates pitch and volume, which is essential for phonation. It is situated just below where the tract of the pharynx splits into the trachea and the esophagus. The word 'larynx' comes from the Ancient Greek word lárunx ʻlarynx, gullet, throat.ʼ

Articles related to anatomy include:

<span class="mw-page-title-main">Glossopharyngeal nerve</span> Cranial nerve IX, for the tongue and pharynx

The glossopharyngeal nerve, also known as the ninth cranial nerve, cranial nerve IX, or simply CN IX, is a cranial nerve that exits the brainstem from the sides of the upper medulla, just anterior to the vagus nerve. Being a mixed nerve (sensorimotor), it carries afferent sensory and efferent motor information. The motor division of the glossopharyngeal nerve is derived from the basal plate of the embryonic medulla oblongata, whereas the sensory division originates from the cranial neural crest.

<span class="mw-page-title-main">External carotid artery</span> Major artery of the head and neck

The external carotid artery is a major artery of the head and neck. It arises from the common carotid artery when it splits into the external and internal carotid artery. The external carotid artery supplies blood to the face and neck.

<span class="mw-page-title-main">Internal carotid artery</span> Artery of the human brain

The internal carotid artery is an artery in the neck which supplies the anterior circulation of the brain.

<span class="mw-page-title-main">Recurrent laryngeal nerve</span> Nerve in the human body

The recurrent laryngeal nerve (RLN) is a branch of the vagus nerve that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. There are two recurrent laryngeal nerves, right and left. The right and left nerves are not symmetrical, with the left nerve looping under the aortic arch, and the right nerve looping under the right subclavian artery then traveling upwards. They both travel alongside the trachea. Additionally, the nerves are among the few nerves that follow a recurrent course, moving in the opposite direction to the nerve they branch from, a fact from which they gain their name.

<span class="mw-page-title-main">Posterior cricoarytenoid muscle</span> Muscle of the larynx

The posterior cricoarytenoid muscle is a intrinsic muscle of the larynx. It arises from the cricoid cartilage; it inserts onto the arytenoid cartilage of the same side. It is innervated by the recurrent laryngeal nerve. Each acts to open the vocal folds by pulling the vocal fold of the same side laterally. It participates in the production of sounds.

<span class="mw-page-title-main">Cricothyroid muscle</span>

The cricothyroid muscle is the only tensor muscle of the larynx aiding with phonation. It is innervated by the superior laryngeal nerve. Its action tilts the thyroid forward to help tense the vocal cords.

<span class="mw-page-title-main">Common carotid artery</span> One of the two arteries that supply the head and neck with blood

In anatomy, the left and right common carotid arteries (carotids) are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries.

<span class="mw-page-title-main">Inferior pharyngeal constrictor muscle</span> Skeletal muscle of the pharynx

The inferior pharyngeal constrictor muscle is a skeletal muscle of the neck. It is the thickest of the three outer pharyngeal muscles. It arises from the sides of the cricoid cartilage and the thyroid cartilage. It is supplied by the vagus nerve. It is active during swallowing, and partially during breathing and speech. It may be affected by Zenker's diverticulum.

<span class="mw-page-title-main">Stylopharyngeus muscle</span> Muscle

The stylopharyngeus muscle is a muscle in the head. It originates from the temporal styloid process. Some of its fibres insert onto the thyroid cartilage, while others end by intermingling with proximal structures. It is innervated by the glossopharyngeal nerve. It acts to elevate the larynx and pharynx, and dilate the pharynx, thus facilitating swallowing.

<span class="mw-page-title-main">Thyrohyoid membrane</span> Elastic membrane in the larynx

The thyrohyoid membrane is a broad, fibro-elastic sheet of the larynx. It connects the upper border of the thyroid cartilage to the hyoid bone.

<span class="mw-page-title-main">Superior thyroid artery</span>

The superior thyroid artery arises from the external carotid artery just below the level of the greater cornu of the hyoid bone and ends in the thyroid gland.

<span class="mw-page-title-main">Oblique arytenoid</span>

The oblique arytenoid is bilaterally paired intrinsic muscle of the larynx. It is superficial to the transverse arytenoid; the oblique and transverse arytenoids are often considered two parts of a single muscle - the interarytenoid muscle.

<span class="mw-page-title-main">Inferior thyroid artery</span> Artery of the neck

The inferior thyroid artery is an artery in the neck. It arises from the thyrocervical trunk and passes upward, in front of the vertebral artery and longus colli muscle. It then turns medially behind the carotid sheath and its contents, and also behind the sympathetic trunk, the middle cervical ganglion resting upon the vessel.

<span class="mw-page-title-main">Carotid triangle</span>

The carotid triangle is a portion of the anterior triangle of the neck.

<span class="mw-page-title-main">Superior cardiac nerve</span>

The superior cardiac nerve arises by two or more branches from the superior cervical ganglion, and occasionally receives a filament from the trunk between the first and second cervical ganglia. It runs down the neck behind the common carotid artery, and in front of the Longus colli muscle; and crosses in front of the inferior thyroid artery, and recurrent nerve. The course of the nerves on the two sides then differs.

<span class="mw-page-title-main">Pharyngeal plexus of vagus nerve</span> Nerve fibers innervating most of the palate and pharynx

The pharyngeal plexus is a nerve plexus located upon the outer surface of the pharynx. It contains a motor component, a sensory component, and sympathetic component.

<span class="mw-page-title-main">Outline of human anatomy</span> Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

References

PD-icon.svgThis article incorporates text in the public domain from page 912 of the 20th edition of Gray's Anatomy (1918)

  1. Sinnatamby, Chummy S. (2011). Last's Anatomy (12th ed.). Elsevier Australia. p. 367. ISBN   978-0-7295-3752-0.
  2. Duarte, Robert A.; Argoff, Charles E. (2009-01-01), Argoff, Charles E.; McCleane, Gary (eds.), "Chapter 19 - Glossopharyngeal and other Facial Neuralgias", Pain Management Secrets (Third Edition), Philadelphia: Mosby, pp. 116–118, ISBN   978-0-323-04019-8 , retrieved 2021-01-12
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  7. Kiray A, Naderi S, Ergur I, Korman E (2006). "Surgical anatomy of the internal branch of the superior laryngeal nerve". Eur Spine J. 15 (9): 1320–5. doi:10.1007/s00586-005-0006-7. PMC   2438561 . PMID   16402208.