Denervation of the cricothyroid occurs in up to 30% of thyroid dissections and causes monotone voice and impaired ability to produce pitched sounds. The cricothyroid is innervated by the superior laryngeal nerve. Sensory innervation ( Internal laryngeal nerve): above the vocal cordsĮxcept for the cricothyroid, all intrinsic muscles of the larynx are innervated by the recurrent laryngeal nerve.Motor innervation (external branch): cricothyroid muscle.Sensory innervation: below the vocal cords.Motor innervation: all intrinsic muscles except for cricothyroid muscle.Area below the vocal folds: lymphatic drainage along the inferior thyroid artery → subclavian nodes.Area above the vocal folds: lymphatic drainage along the superior laryngeal artery → deep cervical nodes at carotid bifurcation.Superior laryngeal veins and inferior laryngeal veins.Superior laryngeal artery (travels with the internal branch of superior laryngeal nerve ) and inferior laryngeal artery (travels with recurrent laryngeal nerve ).The extrinsic muscles connect the thyroid, cricoid, and arytenoid cartilage to other structures of the head and neck. The cricoarytenoid joint allows the vocal ligaments to be abducted and adducted. The cricothyroid ligament is where the incision is made for a cricothyrotomy. Cricoarytenoid: allows movement between the cricoid cartilage and the arytenoid cartilages ( abduction and adduction of the vocal ligaments).Cricothyroid: allows movement between the inferior horns of the thyroid cartilage and the cricoid cartilage.Quadrangular membrane: connects epiglottis and arytenoid and corniculate cartilages has free lower margin called the vestibular ligament.Cricothyroid ligament: connects cricoid cartilage to a free upper edge called the vocal ligament, which runs between the thyroid cartilage anteriorly and the arytenoid cartilages posteriorly (location of incision for cricothyrotomy ).Cricotracheal ligament: connects first tracheal cartilage and cricoid cartilage.Hyoepiglottic ligament: connects epiglottis and hyoid bone.Thyrohyoid membrane: fibroelastic, connects thyroid cartilage and hyoid bone.Arytenoid (regulate the width of the glottis).
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