The Larynx: Revision Sheet

The larynx is the modified upper part of the ____________ tract. It lies in the __________ triangle of the neck, and is continuous with the ______ superiorly and the _______ inferiorly. Its three main functions are: 1. Protection of the _________ 2. _________ closure 3. _________ Its skeleton consists of 4 main cartilages: 1. ____________ (foundation of the larynx, a ___________ ring) 2. ____________ (paired, with ________ and _____________ processes) 3. ____________ (forms the laryngeal ______________) 4. ____________ (____________ cartilage, never calcifies) Its intrinsic membranes are the: 1. ______________ membrane, whose upper borders form the _________________ folds and the lower borders form the _____________ folds ( _______ cords). 2. ____________ membrane, whose upper borders form the ______ folds ( ______ cords). The _____________ membrane connects the _______ bone and ____________ cartilage, and is pierced by the superior laryngeal vessels, nerves and lymphatics. Its intrinsic muscles can be divided into three groups: 1. Action on the laryngeal inlet: ______________ (closing) and _____________ (widening). 2. __________-___________ of the vocal folds Abduction ____________ _______-arytenoid Adduction ____________ _______-arytenoid _______-arytenoid ( ________ and ___________ ) 3. Changes in ______ and _______ (of _________vocal folds in phonation) Tenses and lengthens ______________ Relaxes and shortens ______________ Extrinsic muscles ________ or __________ the larynx. The former include the ___________ and -____________ muscles; the latter are the _____________ muscles. The interior of the larynx: The vocal folds together form the ________, with the space between them being known as the _____ _________. The superior part is the v__________, with the mucous membrane herniating between the vestibular and vocal folds through an opening into the __________. Histologically, the epithelium of the vocal folds and epiglottis is _________ _________, while the rest of the larynx is _____________ ___________ _________ epithelium. Neurovascular supply of the larynx: Blood supply above and below the vocal folds are via the __________ and _________ laryngeal vessels respectively. Sensation above the vocal folds is supplied by the __________ branch of the ___________ laryngeal nerve; below the vocal folds by the ____________ laryngeal nerve. All the intrinsic muscles of the larynx are supplied by the ____________ laryngeal nerve except for ___________ which is supplied by the ____________ branch of the ____________ laryngeal nerve. Both these nerves may be damaged during ___________ surgery. Bilateral damage to the ___________ laryngeal nerve may require emergency __________________ or _______________. Swallowing consists of a sequence of events involving: __________ of vestibular and vocal folds; closure of laryngeal inlet by _______________; __________ of the larynx and swinging downwards of the _____________. Powerful adduction of the cords is used to ___________ intrathoracic and/or intra-abdominal pressure in activities such as c_________, s___________ or a_____________ s_____________.

The Larynx: Revision MCQs

Choose True or False for each statement. 1. A. B. C. D. E. 2. A. B. C. D. E. 3. A. B. C. D. E. 4. A. B. C. D. E. 5. A. B. C. D. E. In the larynx: The mucosal lining below the cords is innervated by the glossopharyngeal nerve. Cricothyroid lengthens the vocal cords. The arytenoid cartilages articulate with the thyroid cartilage. The cricoid cartilage is a derivative of the third pharyngeal pouch. Posterior cricoarytenoid abducts the true vocal cords. Concerning the laryngeal cartilages: The cricoid cartilage forms a complete ring. The arytenoid cartilages are composed of elastic cartilage. The epiglottis is covered by ciliated columnar epithelium. The superior horn of the thyroid cartilage articulates with the hyoid bone. The inferior horn of the thyroid cartilage articulates with the cricoid cartilage. Concerning the larynx, it is important to remember that: Sensation above the vocal folds is mediated by the recurrent laryngeal nerve. Cricothyroid is supplied by the internal branch of the superior laryngeal nerve. The epiglottis is composed of elastic cartilage. The vocal cord is the thickened upper edge of the cricothyroid membrane. Lateral cricoarytenoid abducts the vocal cords. The intrinsic muscles of the larynx are supplied by: The recurrent laryngeal nerve. The internal branch of the superior laryngeal nerve. The external branch of the superior laryngeal nerve. The pharyngeal plexus. The hypoglossal nerve. Concerning the larynx, a clinician must bear in mind that: Hoarseness of the voice of several weeks duration must be investigated. Most cases of carcinoma of the larynx are adenocarcinomas. Emergency cricothyroidotomy is performed above the vocal cords. Unilateral recurrent laryngeal nerve palsy is always fatal. A laryngocele is an enlargement of the saccule of the larynx.

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Essays
1. The larynx is an essential organ. Discuss. (2004) 2. A 32-year-old professional opera singer is about to undergo total thyroidectomy, and has attended the outpatient clinic for pre-operative assessment. Based on your knowledge of anatomy, discuss any local complications that may occur and their possible short-term and long-term consequences. (2011)