The vocal folds, or true vocal cords, are two pearly white folds stretched from the back of the thyroid cartilage to the vocal processes of the arytenoid cartilages. Each contains the vocal ligament and the vocalis muscle, covered by a thin layer of stratified squamous epithelium over a loose layer known as Reinke's space. Their vibration in the airstream produces the voice.
| Location | Middle part of the larynx, below the laryngeal ventricles, at about the level of the middle of the thyroid cartilage. |
|---|---|
| Parts |
|
| Nerve Supply | Recurrent laryngeal nerve (motor to vocalis and other muscles moving the folds); External laryngeal nerve (cricothyroid, tenses the folds); Internal laryngeal and recurrent laryngeal nerves (sensory) |
| Blood Supply | Superior laryngeal artery (from the superior thyroid artery); Inferior laryngeal artery (from the inferior thyroid artery) |
| Lymphatic drainage |
|
Produce sound when air from the lungs sets them vibrating; pitch rises as they are stretched and tensed, and loudness rises with air pressure. They also close tightly to protect the airway and to build pressure for coughing and lifting.
Hoarseness for more than about three weeks warrants examination of the vocal folds. Damage to a recurrent laryngeal nerve, for example during thyroid surgery, paralyses the fold on that side, while damage to both can obstruct the airway. Heavy voice users such as teachers, singers and fitness instructors are prone to nodules and polyps, and good vocal hygiene and amplification help prevent them.
Paired benign thickenings at the junction of the front and middle thirds of the folds, caused by voice overuse. They cause a breathy, hoarse voice and usually respond to voice therapy.
Loss of movement of one or both folds, most often from recurrent laryngeal nerve injury. Unilateral paralysis causes a weak, breathy voice and aspiration risk; bilateral paralysis can cause stridor.
Swelling of the loose layer beneath the fold surface, closely linked to smoking. It lowers the voice and can enlarge enough to narrow the airway.
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