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Speech is a complex process that requires the coordination of multiple structures of the phonatory system that are regulated by the central nervous system. Specifically, the larynx is a fundamental structure in this whole process, since it is necessary for the vocal folds to come into contact to convert the air that comes out of our lungs (subglottic pressure) into sound.The starting point for voluntary vocal production is the laryngeal motor cortex. Although it is a common structure in mammals, the specific location within the cortical system differs in the case of humans with respect to other mammals. The laryngeal motor cortex projects to the periaqueductal gray matter (PAG), a key point structure, because it projects to pontomedullary structures where are located the generators of laryngeal-respiratory motor patterns, necessary for vocal emission. These pontomedullary generators control the pattern and intensity of activation of respiratory, laryngeal, oropharyngeal, and craniofacial motor neurons. Vocal emission involves the genesis of a precise and prolonged expiration that provides an adequate pressure / air flow component to generate a subglottic pressure compatible with vocalization. The nucleus ambiguus, the place where laryngeal motor neurons are concentrated, is mainly responsible for this. All these regions present a high expression of the FOXP2 factor, which is a transcription factor necessary for brain and lung development that is closely related to vocalization. It is kwnon that throughout the evolution of the human species, synaptic connectivity and plasticity in the circuits of the basal ganglia increased, improving motor control and human cognitive and linguistic abilities.In addition, all these central structures described have in common the fact that they convey cardiorespiratory responses to environmental stress and support vocalization. Recent studies show that the laryngeal microstructure and its innervation undergo the same changes during development in rodents and humans and that the central circuits responsible for vocalization present an overactivity in certain speech disorders of central origin such as spasmodic dysphonia due to laryngeal dystonia.

Central Control of the Larynx in Mammals