Larynx II - vocal cord position,cartilages, joints

Question 1

identify the numbered positions

Answer 1

1. MIDLINE
   Median position
   Phonation, effort closure (have pt. say “ee”)
2. PARAMEDIAN
   Cadaveric position
   Rest; end-expiration (i.e. after propofol, NMB)
3. INTERMEDIATE
   Positions between paramedian and lateral
   Inspiration
4. LATERAL
   Against inner wall of larynx (thyroid cartilage)
   Maximum inspiration (have pt take a deep as breath as possible)

Question 2

what actions of the vocal cords are responsible for change in pitch of voice

Answer 2

shortening and tensing via intrinsic laryngeal m.m.

Question 3

What are the cartilage types in the larynx?

Answer 3

1. Hyaline
   
   • Calcifies - beginning in middle life
   • Ossifies - as age advances
   1. • Cricoid
   2. • Arytenoid
   3. • Thyroid
2. Elastic
   
   • Neither calcifies nor ossifies
   • Maintains functional form throughout life
   1. • Epiglottic
   2. • Corniculate
   3. • Cuneiform

Question 4

What is true of the thyroid cartilage?

Answer 4

1. made of hyaline cartilage
2. shield shaped
3. largets laryngeal cartilage
4. structure (on PE)
   
   1. (2) alae - a.k.a. wings.
   2. superior cornu (greater horns)
   3. inferior cornu (lesser horns)
      
      1. will not feel on PE
   4. Prominentia laryngis (adam’s apple)
   5. thyroid notch
5. Attachments
   
   1. thyrohyoid membrane (cephalad)
   2. cricothyroid membrane (caudad)
   3. vocal cords (midline,interior)

Question 5

what is the function of the thyroid cartilage?

Answer 5

protects the larynx

suspends 7 (of 8) laryngeal folds

Question 6

what is true of the cricoid cartilage?

Answer 6

1. made of hyaline cartilage
2. signet ring shape
3. the only circumferential laryngeal structure
4. Thinner on the anterior side
5. Has 2 articulations (joints) -true joints that slide and glide
   
   1. inferior cornu (lesser horns) of thyroid cartilage
   2. base of the arytenoid cartilages
6. attachements
   
   1. cephalad - cricothyroid membrane
   2. caudad - trachea

Question 7

what are the functions of the cricoid cartilage

Answer 7

supports arytenoid cartilages

tilts for tensing vocal cords

Question 8

what is true of the Arytenoid cartilages

Answer 8

1. TYPE
   
   1. Hyaline cartilage
2. GENERAL SHAPE
   
   1. Pyramid
3. UNIQUE ASPECT
   
   1. Action center of larynx
4. STRUCTURE – PHYSICAL EXAM
   
   1. See Laryngoscopic Examination
5. ARTICULATIONS
   
   1. Cricoid cartilage
   2. (Corniculate cartilages)
6. ATTACHMENTS
   
   1. Muscular process – cricoarytenoid muscles
   2. Vocal process – vocal cords

Question 9

what is the function of the Arytenoid cartilages

Answer 9

provides movements for vocal cords by gliding/rotating on base at the cricoarytenoid joint

rotates on vertical axis

Question 10

What is true of the Epiglottic cartilage?

Answer 10

1. TYPE
   
   • Elastic cartilage
2. GENERAL SHAPE
   
   • Leaf shape
3. UNIQUE ASPECT
   
   • Landmark DL structure

Question 11

what are the functions of epiglottic cartilage ?

Answer 11

folds to help protect laryngeal aditus (opening to interior space or cavity)

Question 12

Identify the number structures

Answer 12

Attachements of the epiglottis cartilage via

hyoepiglotic ligament

thyroepiglottic ligament

Question 13

what is true of the Corniculate cartilages?

Answer 13

1. TYPE
   
   1. Elastic cartilage
2. GENERAL SHAPE
   
   1. Conical nodules
3. UNIQUE ASPECT
   
   1. Cartilages of Santorini (Italian anatomist, 1700s)
4. STRUCTURE – PHYSICAL EXAM
   
   1. Tubercles appear beside interarytenoid incisure
   2. Located in aryepiglottic folds
5. ATTACHMENTS
   
   1. Arytenoid cartilages (sometimes fused)

Question 14

what is the function of corniculate cartilages ?

Answer 14

spring-like action (stressed by aDduction of arytenoid cartilateges) produces recoil assistance with mediolateral separation of arytenoids and reopening of glottis

Question 15

What is the functions of Cuneiform cartilages?

Answer 15

Stiffens aryepiglottic folds

spring-like action facilitates reopening of glottis

Question 16

What is true of the Cuneiform Cartilages?

Answer 16

1. TYPE
   
   1. Elastic cartilage
2. GENERAL SHAPE
   
   1. Small, elongated
3. STRUCTURE – PHYSICAL EXAM
   
   1. Tubercles appear lateral to corniculate tubercles
   2. Located in aryepiglottic folds
4. ATTACHMENTS
   
   1. Arytenoid cartilage
5. Unique Aspect
   
   1. Cartilages of Wrisberg

Question 17

How many joint pairs are in the larynx?

Answer 17

2 pairs of joints,

cricothyriod joints

Cricoarytenoid joints (the more important of the pairs)

Question 18

intrinsic muscles of the larynx

Answer 18

Question 19

Which joint is marked with a red dot?

Answer 19

Cricothyroid joint

Cricothyroid muscles helps move this joint, the muscle opposes the action of the vocalis muscle and thyroarytenoid muscle.

allows rotation and gliding movements

composed of inferior cornu of thyroid cartilage and lateral exterior surface of cricoid carilage

Question 20

anatomy of larynx cartilages

Answer 20

Question 21

Which larynx joints are marked with a red dot

Answer 21

cricoarytenoid joints

allows for lateral and medial gliding and rotation

Question 22

Identify the numbered structural components of the vocal cords

Answer 22

1. vocal ligaments (elastic tissue) - the actual white of the cords that we see
2. vocalis muscle
3. thyroarytenoid muscle
4. cricothyroid muscle

NOTE: stratified squamous epithelium covers the muscles