Larynx - Learning Objectives and Review Questions

True/False

1. Raising intraabdominal pressure requires effective closure of the vocal cords.
2. The isthmus of the thyroid gland lies posterior to the cricoid cartilage.
3. The rigidity of the larynx assures patency of the airway.
4. The cricoid cartilage has its posterior superior margin superior to the anterior superior margin.
5. The vocal process of the arytenoid cartilage provides attachment for the lateral cricoarytenoidus muscle
6. A transgender migration of the male is especially challenged by the pitch of the voice fixed by laryngeal anatomy.
7. The cricoid membrane has its inferior margin at the true vocal cord.
8. The quadrangular membrane has the false vocal cord at its inferior margin.
9. Emergency tracheostomy is usually performed inferior to the cricoid cartilage.
10. The cricothyroid muscle is especially important for an effective cough reflex.
11. The posterior cricoarytenoid muscle is the only muscle that abducts the false vocal cord.
12. The lateral cricoarytenoid muscle closes the true vocal cord.
13. The thyroarytenoid muscle resides within the mucosa of the true vocal cord.
14. Tensing the thyroarytenoid muscle raises the pitch of the voice.
15. The stylohyoid muscle is unique in that it is digastric and innervated by two cranial nerves.
16. Inferior to the false vocal fold and superior to the true vocal cord is the ventricle.
17. The ventricles are not lined by mucosa and, thus, do not provide an effective barrier against cancerous spread.
18. The aryepiglottic fold is at the superior margin of the quadrangular membrane.
19. The piriform sinuses received a bolus of food after crossing the lateral glossepiglottic fold.
20. The primary source of vibration during phonation is the laryngeal mucosa of the conus elasticus (triangular membrane).
21. Aspiration is more likely if there is weakness in raising the larynx during swallowing.
22. Aspiration is more likely if the internal branch of the superior laryngeal is perturbed.
23. The inferior thyroid artery crosses the recurrent laryngeal nerve.
24. The recurrent laryngeal nerve ascends posterior the cricothyroid joint.
25. We truly need to have more lecture time devoted to the pancoast tumor.

1. The larynx rests higher in the child than in the adult.
2. The cricoid cartilage gives way to a fibrous posterior wall.
3. The arytenoid cartilage provides mobility to the true vocal folds.
4. The vocal process is a characteristic of the arytenoid cartilage.
5. The articulation between the arytenoid cartilage and the cricoid cartilage is synovial.
6. The arytenoid cartilages have similar extents for either male of female but the true vocal cord is longer in the male.
7. The quadrangular membrane transmits the axillary nerve into the laryngeal additus.
8. The superior free edge of the cricothyroid membrane is at the true vocal fold and the inferior free edge of the quadrangular membrane has the false vocal cord at its inferior free edge.
9. The median surface of the cricothyroid membrane is often the site of tracheostomy in the case of emergency airway restoration.
10. The cricothyroideus controls the length/tension of the true cord and the interarytenoideus controls the spacing (but not abduction) of the true cords.
11. The posterior cricoarytenoideus is the only abductor of the true vocal fold.
12. The lateral cricoarytenoideus is a adductor of the true vocal fold.
13. The extrinsic muscles of the larynx are also known as the strap muscles.
14. The infrahyoid muscles depress the larynx and the suprahyoid muscles elevate the larynx.
15. The suprahyoid muscles have a substantial role on swallowing.
16. The superior constrictor has anterior attachment to the pterygomandibular raphe and the inferior constrictor has attachment to the cricoid cartilage.
17. The middle constrictor has attachment to the stylohyoid ligament.
18. The superior free edge of the quadrangular membrane forms, in part, the aryeppiglottic fold.
19. The thyroarytenoid muscle forms, in part, the true vocal cord.
20. The superior free edge of the conus elasticus forms, in part, the true vocal cord.
21. The piriform recess becomes the cricopharyngeus and then the esophagus at its distal extent.
22. The vallecula divert food into the bilateral piriform sinuses.
23. The false vocal fold, true vocal cord, and epiglottis coordinate closing the glottis during swallowing.
24. The muscles of the larynx are innervated by the vagus nerve.
25. The inferior thyroid artery crosses the recurrent laryngeal nerve at the tracheoesophageal groove.

1. The cricoid cartilage is compared to a signet ring.
2. The thyroid cartilage sits on the first tracheal ring.
3. The cricoid cartilage extends inferior to the 3rd tracheal ring.
4. The arytenoid cartilages have vocal and muscular processes.
5. The cricoarytenoid joint is a synovial joint.
6. The laryngeal prominence is unique to the male.
7. The female vocal fold is 60% longer than in the male.
8. The superior free edge of the quadrangular membrane is the thyroepiglottic fold.
9. The superior border of the conus elasticus is continuous with the true vocal fold.
10. The vestibular fold is at the inferior margin of the quadrangular membrane.
11. The lateral cricoarytenoid muscle abducts the true vocal cord and the posterior cricoarytenoid abducts the false vocal cord.
12. The thyroarytenoid muscle is immediately related to the vestibular fold.
13. The cricoarytenoid muscle shortens the vocal cord to achieve a raise in the pitch of the voice.
14. A lesion of the external laryngeal nerves is expected to cause adduction of the vocal cords.
15. The strap muscles are innervated by the ansa subclavia.
16. The larynx moves inferior during a swallow.
17. The saccule is a diverticulum of the ventricle.
18. The aryepiglottic fold contributes a medial border of the piriform recess.
19. The aryepiglottic fold is continuous with the thyroarytenoid fold.
20. Vibration of the vocal fold is mostly by the mucosa.
21. Closure of the glottis occurs by action of both the true and false focal cords.
22. The epiglottis moves anterior during swallowing.
23. Relaxation of the cricopharyngeus lowers the pitch of the voice.
24. The recurrent laryngeal nerve innervates the intrinsic muscles of the larynx with the exception of the geniohyoid muscle.
25. The recurrent laryngeal nerve continues superior the first tracheal ring as the internal laryngeal nerve.
26. The recurrent nerve is at risk in the tracheoesophageal groove during thyroid surgery.
27. The inferior thyroid artery passes into the larynx through the thyrohyoid membrane.
28. A Pancoast tumor may eventually erode the vagus, phrenic, and recurrent laryngeal nerves as well as the sympathetic trunk.
29. The false vocal fold is superior to the true vocal fold.
30. The interarytenoid muscle and the lateral cricoarytenoid muscle are synergistic in closing the larynx.
31. Lesions of both recurrent laryngeal nerves cause the vocal folds to be abducted.
32. The cough reflex is mediated by GVA fibers within the cervical plexus.
33. The external laryngeal nerve carries SVE fibers to cricothyroideus and possibly to cricopharyngeus.
34. The piriform recesses extend inferior to the region of the upper esophageal sphincter.
35. The recurrent laryngeal nerves lie in the tracheoesophageal groove and passes the anterior surface of the thyroid gland.
36. The thyroid hyoid membrane is "pierced" by the internal laryngeal artery and the superior laryngeal nerve.
37. The muscular process of the arytenoid cartilage is anterior and lateral to the posterior cricoarytenoideus.
38. The vocal process of the arytenoid cartilage is at the superior edge of the conus elasticus.
39. The false vocal fold is at the inferior edge of the conus elasticus.
40. The vestibule and saccule are apt to enlarge if you are a professional tuba player.

Essay

1. Discuss the larynx. Include contents, relationships, foramina, nerve distributions, and nerve embarrassment. Briefly discuss aspiration.
2. Discuss the recurrent laryngeal nerves. Include pathways, relationships, foramina, nerve distributions, functional components, and nerve embarrassment. Briefly discuss thyoid surgery in relation to these nerves.

Short Answer

1. Posterior Cricoarytenoideus
2. Lateral cricoarytenoideus
3. Cricothyroid membrane
4. Aryepiglottic fold

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