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SUMMARY: The thyrohyoid muscle is one of the four infrahyoid muscles. Its role in vocalization and deglutition could be often overlooked, despite its crucial participation in these processes. Unlike other infrahyoid muscles, the thyrohyoid muscle receives innervation from the first cervical spinal nerves which contributes to its unique function. Its primary action involves hyolaryngeal elevation during swallowing, contributing to the opening of the upper esophageal sphincter. In conjunction with other muscles, it also protects the airway and facilitates the passage of food into the esophagus. Variations in the muscle's thickness may exist, and its function can be influenced by chewing habits. Weakened muscles involved in swallowing are often associated with dysphagia, a common complication in stroke and brain-injured patients. Advanced imaging techniques and sleep studies have provided insights into the dynamics and frequency of swallowing. This review explores the anatomic structures, function in action, diagnosis and clinical implications of this muscle. Overall, understanding the significance of the thyrohyoid muscle enhances our comprehension of the intricate interplay of laryngeal muscles during vocalization and deglutition.

El músculo tirohioideo es uno de los cuatro músculos infrahioideos. A menudo podría pasarse por alto su papel en la vocalización y la deglución, a pesar de su participación crucial en estos procesos. A diferencia de otros músculos infrahioideos, el músculo tirohioideo recibe inervación de los primeros nervios espinales cervicales, lo que contribuye a su función única. Su acción principal implica la elevación hiolaríngea durante la deglución, contribuyendo a la apertura del esfínter esofágico superior. Junto con otros músculos, también protege las vías respiratorias y facilita el paso de los alimentos al esófago. Pueden existir variaciones en el grosor del músculo y su función puede verse influenciada por los hábitos de masticación. Los músculos debilitados involucrados en la deglución a menudo se asocian con disfagia, una complicación común en pacientes con accidente cerebrovascular y lesión cerebral. Las técnicas de imagen avanzadas y los estudios del sueño han proporcionado información sobre la dinámica y la frecuencia de la deglución. Esta revisión explora las estructuras anatómicas, la función en acción, el diagnóstico y las implicaciones clínicas de este músculo. En general, comprender la importancia del músculo tirohioideo mejora nuestra comprensión de la intrincada interacción de los músculos laríngeos durante la vocalización y la deglución.

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El estudio de las fibras musculares permite comprender con mejor detalle la composición de los músculos y sus características funcionales. Además, facilita la aplicación de programas de entrenamiento y rehabilitación basados en las vías energéticas que regulan la contracción muscular. Su estudio generalmente va unido al análisis de las cadenas pesadas de miosina (MyHC), las que informan sobre las características y propiedades funcionales del músculo. El objetivo de este trabajo fue sintetizar la evidencia científica disponible sobre la distribución de fibras musculares y de isoformas de cadenas pesadas de miosina de los músculos intrínsecos de la laringe de seres humanos. Se realizó una revisión sistemática de la literatura mediante el análisis de artículos encontrados en las bases de datos PubMed, EBSCOHost y SciELO. Los hallazgos informan sobre la existencia de fibras tónicas lentas y tipo I, II, IIA y IIX/IIB. Además, se reconoce la presencia de las isoformas MyHC-I, MyHC-IIA, MyHC-IIX, MyHC-Fetal, MyHC-L y MyHC-IIB. En conclusión, los músculos intrínsecos de la laringe presentan una mezcla de fibras y de isoformas de MyHC lentas y rápidas,la que obedece a adaptaciones y cambios evolutivos que han permitido, por ejemplo, las características fonatorias que presenta la voz del ser humano.

The study of muscle fibers allows the composition of muscles and their functional characteristics to be understood in greaterdetail. In addition, it makes it possible to applytraining and rehabilitation programs based on the energypathways that regulatemuscle contraction. Studying muscle fibers is generally associated withthe analysis of myosin heavy chains (MHC) which provide information on the functional characteristics and properties of muscles. The objective of this study was to synthesize the available scientific evidence onthe distribution of muscle fibers and myosin heavy chain isoforms present in the intrinsic laryngeal muscles of human beings. A systematic reviewof the literature was carried outand articles found on PubMed, EBSCOHost,and SciELOwere analyzed.The findings showthe presenceof slow-tonic, type I, type II, type IIA, and type IIX/IIB fibers. Additionally,isoforms MHC-I, MHC-IIA, MHC-IIX, MHC-Fetal, MHC-L, and MHC-IIB canbe found. In conclusion, intrinsic laryngeal muscles are composed ofa combination of slow and fast fibers and MHC isoforms, derived from evolutionary adaptations and changes which have given way, among other things, to the phonetic characteristics ofthe human voice.

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Los primates actualmente se clasifican en "Estrepsirrinos" y "Haplorrinos". Los estrepsirrinos habitan principalmente Madagascar y el sudeste de Asia, en cambio, los Haplorrinos se subdividen en "monos del viejo mundo" y "monos del nuevo mundo", distribuyéndose los primeros en África y Asia principalmente, mientras que los últimos tienen en Centro y Sudamérica sus principales áreas de distribución. Son animales frecuentes en zoológicos y centros de rehabilitación, que presentan abundantes estudios en cuanto a su distribución, hábitat, comportamiento y medidas de conservación, pero escasos son los estudios en relación a su anatomía. Por esta razón, el objetivo de nuestro estudio fue realizar una descripción anatómica de la musculatura intrínseca y cavidad de la laringe en cuatro ejemplares de primates, los cuales fueron donados por el Zoológico del Parque Metropolitano de Santiago de Chile, correspondientes a las especies: mono araña (Ateles fusciceps), mono capuchino (Cebus albifrons), gibón de manos blancas (Hylobates lar) y lémur cola anillada (Lémur catta). La disección se realizó desde superficial a profundo en cada laringe aislada, describiendo y comparando los hallazgos anatómicos observados, utilizando como guía comparativa la literatura anatómica humana. El estudio demostró diferencias anatómicas entre los primates en estudio, así como también diferencias con lo descrito en la literatura para la anatomía de la laringe humana.

Primates are currently classified as "Strepsirrhini" and "Haplorrhini". The strepsirrhines inhabit mainly Madagascar and Southeast Asia. However, the Haplorrhini are subdivided into "old world monkeys" and "new world monkeys", the first being distributed in Africa and Asia mainly, while the main distribution areas for the latter are in Central and South America. They are frequent animals in zoos and rehabilitation centers, allowing abundant studies regarding their distribution, habitat, behavior and conservation measures, but few studies are related to their anatomy. For this reason, the aim of our study was to perform an anatomical description of the intrinsic muscles and cavity of the larynx in four specimens of primates, which were donated by the Metropolitan Park of Santiago, Chile, corresponding to species: spider monkey (Ateles fusciceps), capuchin monkey (Cebus albifrons), white-handed gibbon (Hylobates lar) and ring-tailed lemur (Lemur catta). The dissection was performed from superficial to deep in each isolated larynx, describing and comparing the observed anatomical findings, using as a comparative guide the human anatomical literature. The study showed anatomical differences between the primates under study, as well as differences for what is described in the literature for the anatomy of the human larynx.

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This study investigated the sexual dimorphism in the recurrent laryngeal nerve (RLN) and thyroarytenoid (TA) muscle, which control the vocal fold. The RLN and TA were bilaterally studied in human specimens obtained from necropsies (seven men and seven women). Analysis of the morphometric parameters showed that the RLN of the men were significantly larger, as shown by the intraperineural area (42.5%) (P=0.006), total number of fibers (38.0%) (P=0.0002), axonal area (34.3%) (P=0.0001), axonal diameter (19.0%) (P=0.0001), and the area of the nerve occupied by myelinated fibers (34.9%) (P=0.001). By contrast, in women, our results showed that the area of the RLN occupied by endoneurial connective tissue was larger (5.7%) (P=0.001). Estimation of the fiber area and shape coefficient showed that the histologic organization of TA is similar in men and women. These results may contribute toward enhancing our understanding about the voice neurobiology.

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The vocal muscle is a striated muscle with important functions in the emission of laryngeal sound and physiology of the voice. Therefore the knowledge of its constitution is the basis for the prevention and management of voice disorders. We used 10 samples from the middle third of vocal muscles obtained from autopsies of 6 male and 4 female subjects aged between 36 and 71 years. The samples were analyzed with BA-F8 monoclonal antibody to slow type I fibers, and antimyosin HC monoclonal antibody and antimyosin fast clone MY-32 antibody for types IIA, IIB, IIX, and neonatal fibers. We determined the distribution of the muscle fiber types and morphometric characteristics, evaluating the differences by sex and age group. The human vocal muscle presented a heterogeneous formation with a predominance of type II fibers at 51.99 percent, while type I fibers reached 48.01 percent; this difference was significant (p <0.05). Comparing fiber subtypes IIA and IIX, there is a slight predominance of type IIX fibers, although this is not statistically significant (p>0.05). In conclusion, the human vocal muscle the fibers were predominantly type II fast.

El músculo vocal es un músculo estriado con importantes funciones en la emisión del sonido laringeo y fisiología de la voz. Por ello el conocimiento de su constitución sirve de base para la prevención y manejo de los trastornos vocales. Se realizó un estudio morfométrico e inmunohistoquímico de músculo vocal humano. Se utilizaron 10 muestras del tercio medio del músculo vocal obtenidas de necropsias, 6 de individuos de sexo masculino y 4 femenino, con edades de entre 36 y 71 años. Las muestras fueron analizadas con anticuerpos monoclonales antimyosin skeletal slow BA-F8 para fibras tipo I y antimyosin skeletal fast HC y MY-32 para fibras tipo IIA, IIB, IIX y neonatal. Se determinó la distribución de los distintos tipos de fibras musculares y sus características morfométricas, evaluándose las diferencias por sexo y grupo etáreo. El músculo vocal humano presentó una constitución heterogénea con predominio de fibras tipo II con un 51,99 por ciento, mientras que las tipo I alcanzaron el 48,01 por ciento, estas diferencias resultaron significativas (p<0,05). Al comparar los subtipos de fibras IIA y IIX, se observa un leve predominio de las fibras IIX, aunque no significativo estadísticamente (p>0,05). No se encontraron diferencias en cuanto a los diámetros mayor y menor de las fibras ni en la constitución del músculo por sexo o grupo etáreo. Se concluye que en el músculo vocal humano predominan las fibras musculares rápidas tipo II.

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AIM: This prospective study investigated the anatomic relations between the external branch of the superior laryngeal nerve (EBSLN), the superior thyroid artery (STA) and the thyroid gland in human cadavers. MATERIAL AND METHODS: Twenty-two human cadavers aged over 18 years old, less than 24 hours after death. RESULTS: The mean distance between the EBSLN and the superior pole of the thyroid gland was 7.68 ±3.07 mm. A tangent to the inferior edge of the thyroid cartilage between the EBSLN and the STA measured 4.24 ±2.67 mm. A line from the intersection of the EBSLN - related to the STA - to the superior pole of the thyroid gland measured 9.53 ±4.65 mm. A line from the EBSLN to the midline of the most caudal point of the thyroid cartilage measured 19.70 ±2.82 mm. A line from the RENLS to the midline on the most cranial point of the cricoid cartilage was 18.35 ±3.66 mm. CONCLUSION: There is a variable proximity relation between the EBSLN and the superior pole of the thyroid gland; this distance ranges from 3.25 to 15.75 mm. There was no evidence of significant variation between the measures in the ethnic groups comprising the sample.

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AIM: This prospective study investigated the anatomic relations between the external branch of the superior laryngeal nerve (EBSLN), the superior thyroid artery (STA) and the thyroid gland in human cadavers. MATERIAL AND METHODS: Twenty-two human cadavers aged over 18 years old, less than 24 hours after death. RESULTS: The mean distance between the EBSLN and the superior pole of the thyroid gland was 7.68 ±3.07 mm. A tangent to the inferior edge of the thyroid cartilage between the EBSLN and the STA measured 4.24 ±2.67 mm. A line from the intersection of the EBSLN - related to the STA - to the superior pole of the thyroid gland measured 9.53 ±4.65 mm. A line from the EBSLN to the midline of the most caudal point of the thyroid cartilage measured 19.70 ±2.82 mm. A line from the RENLS to the midline on the most cranial point of the cricoid cartilage was 18.35 ±3.66 mm. CONCLUSION: There is a variable proximity relation between the EBSLN and the superior pole of the thyroid gland; this distance ranges from 3.25 to 15.75 mm. There was no evidence of significant variation between the measures in the ethnic groups comprising the sample.

OBJETIVO: Descrever, prospectivamente, a relação anatômica entre o ramo externo do nervo laríngeo superior (RENLS), a artéria tireoidea superior (ATS) e a glândula tireoide em cadáveres humanos. MATERIAL E MÉTODO: Foram dissecados 22 cadáveres humanos com idade superior a 18 anos, com menos de 24 horas de pós-morte. RESULTADOS: A medida entre o RENLS e o polo superior da glândula tireoide foi 7,68 +/- 3,07mm; entre o RENLS e a ATS foi de 4,24 +/- 2,67mm numa linha tangente ao bordo inferior da cartilagem tireoide; entre o cruzamento da ATS com o RENLS e o polo superior tireoidiano foi 9,53 +/- 4,65mm; entre o RENLS e a linha mediana do pescoço no ponto mais caudal da cartilagem tireoide foi 19,70 +/- 2,82mm; e entre o RENLS e a linha mediana do pescoço no ponto mais cranial da cartilagem cricoide foi 18,35 +/- 3,66mm. CONCLUSÕES: Há uma relação de proximidade variável entre o RENLS e o polo superior da glândula tireoide, variando de 3,25 a 15,75mm. Não constatou-se variações significativas entre as medidas para as diferentes etnias que compõem a amostra.

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The number and size of motor units in the intrinsic laryngeal muscles were estimated by morphometric methods. Laryngeal muscles with their respective nerve branches were obtained from 64 fresh cadavers (32 older than 60 years, mean age 74 +/- 9 years and 32 younger than 60 years, mean age 51 +/- 8 years). Myelinated nerve fibers and the total number of muscle fibers were counted. Motor unit size was estimated by dividing the total number of muscle fibers by the total number of motor units in each case. The mean number of motor units ranged from 268 +/- 1.3 (interarytenoid muscle) to 431 +/- 1.6 (cricothyroid muscle). Thyroarytenoid and cricothyroid muscle presented the smallest (9.8 +/- 0.2) and largest (20.5 +/- 0.9) motor unit size, respectively, suggesting that thyroarytenoid muscle has a greater capacity to fine-tune its total force compared with the other intrinsic laryngeal muscles. No differences in motor unit number or size were observed between the right and left sides or between younger and older subjects. It is suggested that synaptic rearrangements may occur at the level of the neuromuscular junction in the human larynx that may explain the age-related changes in motor units reported by clinical methods.

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OBJECTIVE: To establish the frequency and degree of postthyroidectomy injury of the external branch of the superior laryngeal nerve (EBSLN) by means of electromyography and to assess whether intraoperative identification of the nerve and the presence of malignancy influence morbidity. PATIENTS AND METHODS: Prospective, randomized, blind study. Comparison of 100 superior thyroid poles subjected to surgery because of benign and malignant disease, divided in three groups: G1, thyroidectomies, without searching for the EBSLN; G2, thyroidectomies, searching for the EBSLN; G3, Control, lobes, contralateral to the lobectomy, not surgically manipulated. The electromyographic function of the EBSLN was assessed in all cases, classifying the degree of injury and clinically assessing its function. Central tendency measures were used, as well as X (2) and multiple variance analysis. RESULTS: In G1, with 50 dissections of the superior pole, 25 injuries were found in 15 patients (10 bilateral and 5 unilateral). In G2, EBSLN injury was found after 13 explorations of the superior pole in 8 patients (5 bilateral and 3 unilateral). G3 patients did not present EBSLN injury. X (2) among groups and degree of injury revealed that intraoperative identification of the EBSLN decreases its injury. No evidence were found that injury frequency is increased by the presence of thyroid malignancy, extracapsular infiltration, or size of tumor. Clinical manifestations of hoarseness were present in 14% of G1 patients and 8% of G2 patients. DISCUSSION: The rate of EBSLN injury increased when not exploring and/or identifying it expressly. The presence of cancer, extracapsular extension, or size of the thyroid tumor exerted no influence on the frequency of injury; localization of the nerve was the only factor affecting injury. Hoarseness correlated with the degree of injury. CONCLUSION: EBSLN must be localized expressly to decrease the risk of injury.

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The present study was conducted on vocal muscles removed at autopsy from adult individuals (10 men and 8 women, ages ranging from 48 to 78 years) with no laryngeal disease. Histologic analysis was performed with hematoxylin and eosin staining, and histochemical analysis was performed by nicotinamide-adenine-dinucleotide tetrazolium reductase, succinate dehydrogenase, and acid and alkaline myofibrillar adenosine triphosphatase reactions. The histochemical reactions showed that the muscle consists of slow-twitch oxidative (SO), fast-twitch glycolytic (FG), and fast-twitch glycolytic oxidative (FOG) fibers distributed in mosaic form. The frequencies of SO, FOG, and FG fibers were 40.50%, 54.75%, and 4.75%, respectively. The higher frequency of SO and FOG oxidative fibers characterizes the muscle as having aerobic metabolism, resistance to fatigue, and fast contraction. The mean minimum diameters were 31.37 microm for SO fibers and 36.46 microm for FOG and FG fibers.

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