Larynx

Front 1

a. When does the larynx grow?

Back 1

i. From birth to early childhood
ii. Ossifies in advanced age

Front 2

a. What happens when the thyroid cartilage tilts anteriorly at the joint of the inferior thyroid horns and the lamina of the cricoid cartilage?

Back 2

i. Vocal folds are tensed

Front 3

b. What will posterior tilting of the joint of the inferior thyroid horns and the lamina of the cricoid cartilage lead to?

Back 3

i. Loosening of the vocal cords

Front 4

a. What allows for abduction or adduction of the vocal processes?

Back 4

i. Arytenoid cartilages slide transversely and pivot on cricoid cartilage

Front 5

a. What does the thyrohyoid membrane connect?

Back 5

i. Superior border of thyroid cartilage to body and greater horns of hyoid bone

Front 6

b. What is the median thyrohyoid ligament?

Back 6

i. Thickening of the thyrohyoid ligament

Front 7

c. What are the lateral thyrohyoid ligaments?

Back 7

i. Thickening at posterior edge of thyrohyoid ligament

Front 8

d. What structures pass through the thyrohyoid ligament?

Back 8

i. Superior laryngeal vessels
ii. Internal laryngeal nerve

Front 9

e. What does the cricotracheal ligament attach?

Back 9

i. Inferior surface of cricoid cartilage to upper border of 1st tracheal ring

Front 10

f. Where is the hyoepiglottic ligament?

Back 10

i. Passes from anterior midline of epiglottis to body of hyoid bone

Front 11

g. What is the function hyoepiglottic ligament?

Back 11

i. Limits epiglottic movement to posterior

Front 12

a. What is the function of the thyroepiglottic ligament?

Back 12

i. Attaches stalk of epiglottic cartilage to thyroid cartilage

Front 13

i. What is the conus elasticus?

Back 13

i. Elastic membrane that attaches to superior surface of cricoid cartilage and projects superomedially inside the thyroid cartilage

Front 14

j. What forms the vocal ligaments?

Back 14

i. Upper free edges of conus elasticus

Front 15

k. What are the attachments of the vocal ligaments?

Back 15

i. Posteriorly to vocal processes of arytenoid cartilage
ii. Anteriorly to thyroid laminae

Front 16

l. What is the media crycothyroid ligament?

Back 16

i. Thickened anterior portion of the conus elasticus

Front 17

m. What is the quadrangular ligament? What is its function?

Back 17

i. Thin submucosal connective tissue
ii. Supports the aryepiglottic fold

Front 18

n. What are the attachments of the quadrangular ligament?

Back 18

i. Between epiglottic and arytenoid/corniculate cartilages

Front 19

o. What forms the aryepiglottic ligament (fold)?

Back 19

i. Free superior margin of quadrangular ligament

Front 20

p. What forms the vestibular ligament?

Back 20

i. Free inferior margin of quadrangular ligament

Front 21

q. Where is the vestibular ligament located?

Back 21

i. Within the vestibular fold

Front 22

r. What are the attachments of the vestibular ligament?

Back 22

i. Below apex of arytenoid cartilage
ii. Thyroid cartilage above the vocal ligament

Front 23

a. What structures line the laryngeal inlet?

Back 23

i. Epiglottis
ii. Arytenoid cartilage
iii. Aryepiglottic folds

Front 24

b. What is the laryngeal vestibule? Where is it located?

Back 24

i. Space between the aryepiglottic folds
ii. Located superior to the inlet

Front 25

c. What is found below the vestibule?

Back 25

i. Vestibular folds→ false vocal cords

Front 26

d. What is the rima vestibule?

Back 26

i. Space between the vestibular folds

Front 27

e. What is the laryngeal ventricle?

Back 27

i. Narrow space between the vestibular and vocal folds

Front 28

f. What is the saccule?

Back 28

i. Anterosuperior extension of the laryngeal ventricle
ii. Blind pouch with numerous mucous glands

Front 29

g. What forms the vocal fold (true vocal cords)?

Back 29

i. Mucosa of the ventricle coming inferior to cover the vocal ligaments

Front 30

h. What is the infraglottic space?

Back 30

i. Space inferior to vocal folds and superior to trachea
ii. Also with mucosa covering the conus elasticus

Front 31

i. What are the contents of the vocal folds?

Back 31

i. Vocal ligament
ii. Vocalis muscle
iii. Overlying mucosa

Front 32

j. What is the rima glottidis?

Back 32

i. Opening between two vocal folds

Front 33

k. What is the glottis?

Back 33

i. Vocal folds + rima glottidis

Front 34

l. When is the glottis narrow?

Back 34

i. During normal respiration

Front 35

m. When is the glottis wide?

Back 35

i. Forced respiration

Front 36

n. When is the glottis slit-like?

Back 36

i. Phonation

Front 37

a. What are the attachments of the posterior cricoarytenoid muscle?

Back 37

i. Origin→ lamina of cricoid cartilage
ii. Insertion→ Muscular process of arytenoid cartilage

Front 38

b. What is the action of the posterior cricoarytenoid muscle?

Back 38

i. Adduction of muscular processes
ii. External rotation of arytenoid cartilages
iii. Abduction** of vocal folds→ opening of rima glottides

Front 39

c. What are the attachments of the lateral cricoarytenoid muscle?

Back 39

i. Origin→ lateral part of cricoid cartilage
ii. Insertion→ muscular process of arytenoids

Front 40

d. What is the action of the lateral cricoarytenoid muscle?

Back 40

i. Abduction of muscular processes
ii. Internal rotation of arytenoid cartilages
iii. Adducting the vocal folds

Front 41

e. What is the primary adductor of the rima glottis?

Back 41

i. Lateral cricoarytenoid muscle

Front 42

f. What are the attachments of the transverse arytenoid muscle?

Back 42

i. Attaches to each arytenoid cartilage and spans between the two posteriorly

Front 43

g. What is the action of the transverse arytenoid muscle?

Back 43

i. Assists in adduction of vocal folds

Front 44

h. What are the attachments of the oblique arytenoid muscle?

Back 44

i. Origin→ muscular processes of arytneoids
ii. Insertion→ apex of opposite arytenoid

Front 45

i. What is the action of the oblique arytenoid muscle?

Back 45

i. Assists in adduction of vocal folds

Front 46

j. What forms the aryepiglottic muscle?

Back 46

i. Oblique arytenoid continuation within the aryepiglottic folds

Front 47

k. What muscles form the sphincter for glottis closure?

Back 47

i. Lateral cricoarytenoid
ii. Transverse arytenoid
iii. Oblique arytenoid

Front 48

l. What are the attachments of the cricothyroid muscle?

Back 48

i. Origin→ arch of cricoid cartilage
ii. Insertion→Inferior edge of thyroid cartilage

Front 49

m. What is the action of the cricothyroid muscle?

Back 49

i. Cricoid arch moves up
ii. Arytenoids move posterior
iii. Stretches/tenses the vocal folds

Front 50

n. What are the attachments of the thyroarytenoid muscle?

Back 50

i. Origin→anterior part of thyroid cartilage
ii. Insertion→ Anterolateral surface of arytenoid cartilages

Front 51

o. What is the action of the thyroarytenoid muscle?

Back 51

i. Pulls arytenoid cartilages anteriorly
ii. Relaxes the vocal folds

Front 52

p. What are the attachments of the vocalis muscle?

Back 52

i. Origin→ Anterolateral side of arytenoid cartilage and its vocal process
ii. Insertion→ Vocal ligament

Front 53

q. What is the action of the vocalis muscle?

Back 53

i. Fine tunes the tension on vocal folds→ whispering

Front 54

r. What is the thyroepiglottic muscle?

Back 54

i. Extension from thyroarytenoid muscle into aryepiglottic fold

Front 55

s. What is the function of the thyroepiglottic muscle?

Back 55

i. Sphincter for the aditus

Front 56

a. What does the superior laryngeal artery supply?

Back 56

i. Upper part of larynx

Front 57

b. What is the artery of origin of the superior laryngeal artery?

Back 57

i. Superior thyroid artery

Front 58

c. What does the inferior laryngeal artery supply?

Back 58

i. Lower part of the larynx

Front 59

d. What is the artery of origin of the inferior laryngeal artery?

Back 59

i. Inferior thyroid artery

Front 60

e. What structure accompanies the inferior laryngeal artery?

Back 60

i. Recurrent laryngeal nerve

Front 61

f. Where does the inferior laryngeal artery enter the larynx?

Back 61

i. Deep near cricothyroid joint

Front 62

a. Into what does the superior laryngeal vein drain?

Back 62

i. Superior thyroid vein→ IJV

Front 63

b. Into what does the inferior laryngeal vein drain?

Back 63

i. Inferior thyroid vein→ left brachiocephalic vein

Front 64

a. What do the jugulodigastric nodes drain?

Back 64

i. Areas of larynx above vocal cords (supraglottic region)

Front 65

b. To where does the lymph from the infraglottic region of the larynx drain?

Back 65

i. Pretracheal or paratracheal nodes→ jugulo-omohyoid nodes

Front 66

a. What provides sensory superior to the vocal cords?

Back 66

i. Internal laryngeal nerve (from superior laryngeal nerve)

Front 67

b. What provides sensory inferior to the vocal cords?

Back 67

i. Recurrent laryngeal nerves

Front 68

c. What does the external laryngeal nerve provide motor innervation to?

Back 68

i. Cricothyroid muscle→ only tensor of vocal cords

Front 69

d. What innervates all of the muscles in the larynx? What is the exception to this?

Back 69

i. Recurrent laryngeal nerves
ii. Cricothyroid supplied by external laryngeal nerve

Front 70

e. Where are the cell bodies of sensory neurons to the larynx?

Back 70

i. Inferior vagal ganglion

Front 71

f. Where does the superior laryngeal nerve originate?

Back 71

i. Inferior ganglion of the vagus

Front 72

g. What is the course of the superior laryngeal nerve? What are its branches?

Back 72

i. Deep to and medial to carotid arteries on middle pharyngeal constrictor
ii. Internal laryngeal nerve and external laryngeal nerve

Front 73

h. What does the internal laryngeal nerve innervate?

Back 73

i. Sensation and parasympathetic input to larynx in area of vocal folds and above

Front 74

i. What does the external laryngeal nerve innervate? What is its preceding course?

Back 74

i. Cricothyroid muscle
ii. Descends on inferior pharyngeal constrictor

Front 75

j. What does the recurrent laryngeal nerve loop around?

Back 75

i. Left→ aortic arch
ii. Right→ subclavian artery

Front 76

k. Between what structures does the recurrent laryngeal nerve ascend?

Back 76

i. Groove between trachea and esophagus

Front 77

l. What is the inferior laryngeal nerve?

Back 77

i. Continuation of the recurrent laryngeal nerve

Front 78

m. What does the inferior laryngeal nerve innervate?

Back 78

i. All intrinsic muscles of larynx except cricothyroid
ii. Sensory and parasympathetic inferior to vocal cords

Front 79

a. What characterizes internal laryngeal nerve damage?

Back 79

i. Desensitization of superior larynx
ii. Difficulty swallowing→ foreign bodies and choking

Front 80

b. What characterizes external laryngeal nerve damage?

Back 80

i. Paralysis of cricothyroid muscle
ii. Weak voice, lowered pitch, and monotone voice

Front 81

c. What characterizes inferior laryngeal nerve damage?

Back 81

i. Vocal fold paralysis
ii. Unilateral damage→ Other cord can compensate
iii. Bilateral damage→ Usually yields no voice

Front 82

d. What characterizes recurrent laryngeal nerve bruising?

Back 82

i. Abductors being more affected that adductors→ Semon’s law
ii. Adducted position of affected cords.