## Distinguishing True vs False Vocal Cords ### Structural Anatomy **Key Point:** The true vocal cords (vocal folds) contain the vocalis muscle and vocal ligament, which are absent in the false vocal cords. This is the single most reliable discriminator. ### Comparative Table | Feature | True Vocal Cords | False Vocal Cords | | --- | --- | --- | | **Vocalis muscle** | Present | Absent | | **Vocal ligament** | Present (elastic fibers) | Absent | | **Mucosa** | Stratified squamous (nonkeratinized) | Respiratory epithelium | | **Function** | Sound production | Protective; minimal phonatory role | | **Position** | Inferior fold; forms rima glottidis | Superior fold; forms rima vestibuli | | **Attachments** | Thyroid cartilage → arytenoid cartilage | Thyroid cartilage → arytenoid cartilage | ### Embryological Basis **High-Yield:** The vocalis muscle is derived from the thyroarytenoid muscle and is innervated by the recurrent laryngeal nerve. This muscularization is what enables active tension and pitch control during phonation—a function the false cords cannot perform. ### Clinical Pearl Damage to the recurrent laryngeal nerve affects the vocalis muscle and true cord mobility, causing hoarseness. False cord dysfunction alone does not typically cause voice changes, confirming their lesser role in phonation. ### Mnemonic **TRUE = Tension + Recurrent nerve + Unique muscle (vocalis)** The true cords have the muscular apparatus for active tension regulation; the false cords are passive protective structures. 
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