Paediatric Larynx

Paediatric Larynx: Anatomical and Functional Differences

The paediatric larynx differs significantly from the adult larynx, with important clinical implications:

1. Position:
   • The infant’s larynx is positioned high in the neck, with the glottis at the level of C3–C4 at rest and rising to C1–C2 during swallowing.
   • This high position allows the epiglottis to meet the soft palate, creating a nasopharyngeal channel for breathing during feeding. This enables simultaneous breathing and suckling.
2. Cartilages:
   • Laryngeal cartilages are soft and prone to collapse.
   • The epiglottis is omega-shaped, and the arytenoids are relatively large, covering a significant portion of the posterior glottis.
3. Thyroid Cartilage:
   • In infants, the thyroid cartilage is flat, overlapping the cricoid cartilage and being overlapped by the hyoid bone.
   • This arrangement makes the cricothyroid and thyrohyoid spaces narrow and less discernible, complicating procedures like tracheostomy.
4. Size and Shape:
   • The infant’s larynx is small and conical, with the cricoid cartilage being narrower than the glottis, making the subglottis the narrowest part. This influences the selection of paediatric endotracheal tubes.
   • In adults, the larynx is cylindrical, with the subglottic and glottic dimensions being approximately equal.
5. Submucosal Tissues:
   • The submucosal tissues in infants are loose and prone to oedema from trauma or inflammation, leading to airway obstruction.

Growth and Development of the Larynx

The paediatric larynx undergoes two significant growth spurts:

1. First Growth Spurt (0–3 years):
   • The larynx grows in width and length, which can resolve certain congenital airway anomalies without surgical intervention.
2. Second Growth Spurt (Adolescence):
   • The thyroid angle develops, and the vocal cords lengthen, leading to voice changes during puberty (e.g., puberphonia).
   • The larynx gradually descends to its adult position, with the vocal cords lying opposite C5.

Vocal Cord Dimensions:

• In childhood, vocal cords measure 6 mm in females and 8 mm in males.
• In adulthood, they increase to 15–19 mm in females and 17–23 mm in males.

Clinical Significance

Understanding the anatomical and developmental differences between the paediatric and adult larynx is crucial for:

• Airway management (e.g., endotracheal intubation, tracheostomy).
• Diagnosing and treating congenital anomalies.
• Managing airway obstruction caused by inflammation or trauma.
• Addressing voice changes during puberty.

This knowledge ensures safe and effective clinical interventions in paediatric otolaryngology.

———— End of the chapter ————

Download the full PDF Link:

Paediatric Larynx Best Lecture Notes Dr Rahul Bagla ENT Textbook

Reference Textbooks.

• Scott-Brown, Textbook of Otorhinolaryngology-Head and Neck Surgery.
• Cummings, Otolaryngology-Head and Neck Surgery.
• Stell and Maran’s, Textbook of Head and Neck Surgery and Oncology.
• Ballenger’s, Otorhinolaryngology Head And Neck Surgery
• Susan Standring, Gray’s Anatomy.
• Frank H. Netter, Atlas of Human Anatomy.
• B.D. Chaurasiya, Human Anatomy.
• P L Dhingra, Textbook of Diseases of Ear, Nose and Throat.
• Hazarika P, Textbook of Ear Nose Throat And Head Neck Surgery Clinical Practical.
• Mohan Bansal, Textbook of Diseases of Ear, Nose and Throat Head and Neck Surgery.
• Hans Behrbohm, Textbook of Ear, Nose, and Throat Diseases With Head and Neck Surgery.
• Logan Turner, Textbook of Diseases of The Nose, Throat and Ear Head And Neck Surgery.
• Arnold, U. Ganzer, Textbook of  Otorhinolaryngology, Head and Neck Surgery.
• Ganong’s Review of Medical Physiology.
• Guyton & Hall Textbook of Medical Physiology.

Author:

Dr. Rahul Bagla
MBBS (MAMC, Delhi) MS ENT (UCMS, Delhi)
Fellow Rhinoplasty & Facial Plastic Surgery.
Renowned Teaching Faculty
Mail: msrahulbagla@gmail.com
India

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