335 8.3 Tongue and Vocal Tract

• prime mover of the tongue
• makes uo deep bulk
• 0 - inner mandibular surface at symphysis
• c - fans up and back
• i - tip and dorsum of tongue and body of hyoid bone
• inn - XII Hypoglossus nerve
• f - anterior fibers retract tongue, posterior fibers protrude tongue, collectively they depress the tongue
• paired

• o - styloid process of the temporal bone
• c - forward and down
• ins - inferior sides of the tongue
• inn - XII hypoglossus nerve
• f - draws the tongue back and up
• paired

• o - greater horn and lateral body of the hyoid bone
• c - upward
• ins - sides of the tongue
• inn - XII hypoglossus nerve
• f - pulls sides of tongue down
• paired

• 3 divisions
• 12 cm in length
• extends from vocal folds up to the region posterior to the nasal caivty
• tube lined with muscles that aid in deglutition (swallowing) and velopharyngeal closure

• nasopharynx
• oropharynx
• laryngopharynx

• space above soft palate
• upper most portion of the vocal tract

• lateral wall contains orifice to Eustachian tube - actively opened through contraction of tensor veli palatini muscle
• pharyngeal tonsils (adenoids) - can help close off nasal cavity

• portion posterior to the faucial arches
• superior boundary is velum
• lower boundary is hyoid bone

• anterior boundary is epiglottis
• inferior boundary is esophagus
• superior boundary is hyoid bone

reconstruction of the larynx

• trachea sutured to bse of neck
• creation of a stoma (hole) for breathing
• pharyngeal wall sutured together
• inferior portion of the pharynx joined to upper esophagus
• superior portion of pharynx sutured to base of tongue

• creation of a stoma for breathing
• separates the eating/drinking tract from te breathing tract
• loss of normal speech
• need to learn an artificial way of talking
• reduced sense of smell and taste
• loss of ability to swim
• increased risk for respiratory disease

without a larynx

• artificial larynx (AL)
• esophageal speech (ES)
• tracheoesophageal speech (TES)

• synonymous with electrolarynx
• battery powered devices
• 2 types : intra-oral and neck

• useful immediately after surgery
• gets in way of articulation
• not really sanitary

• cannot use immediately after surgery due to discomfort and swelling
• many types : Servox, Neovox, NewVois

• immediate use after surgery with intra-oral device
• relatively easy to learn

• not very sanitary
• voice is not natural sounding
• occupies one hand
• very obvious to others

• works by injecting air into esophagus, expelling it to vibrate PE segment
• oral cavity then forms vibation into speech sounds

• cricopharyngeus muscle / upper esophageal sphincter (UES)
• aka neoglottis or pseudo-glottis

• hands free
• no need to worry about atteries
• no extra cost associated with device

• very hard to learn
• difficult to talk after meals
• only short sentences as you have to keep swallowing air
• if cricopharyngeus muscle it too tight or too lose then you are not a good candidate

• fistula surgically created at time of laryngectomy or afterwards
• voice prosthesis fitted into fistula
• air from trachea is occluded from exiting stoma
• now redirected through the tracheoesophageal punctures (TEP) vibrating the PE segment and creating voise
• articulated out the mouth

• used in TES
• blocks stoma to divert air to esophagus
• come in varying resistances
• need to be tested
• typically glued around stoma

sounds very natural air coming from lungs so you can speak for a longer period of time

• not everyone can do TES - if walls of esophagus are too tight, air will not pass through
• the voice prosthesis must be removed and cleaned periodically