1. Phonation ANATOMY LARYNX Description: Location:
is musculocartilaginous structure
Location:
lies on top or/superior to trachea
located midline on anterior neck
Palpate thyroid notch which is anterior attachment of the vocal folds.
Thus larynx located between the hyoid bone (superiorly) and trachea (inferiorly)
located at about the level of the 3rd, 4th, 5th, & 6th cervical vertebrae
This position may vary according to:
sex, age, head position, laryngeal activity

2. Supraglottal Laryngeal Ps MEP Respiratory
Air from lungs is perturbed by the opening and closing of the approximated vocal folds.
Laryngeal
MEP Ps
Respiratory

3. From www.gbmc.org/voice/larynx/anatomyphysiologyofthelarynx.cfm

4. 1 = recurrent nerve
3 = thyroid gland

5. Function:
Biological
It is a component of respiratory system, thus functions as protective device for lower airway.
Acts to
(1) prevent foreign objects from entering lungs,
(2) prevents air from escaping the lungs,
(3) forcefully expels foreign substances which threaten to enter larynx or trachea.
Nonbiologic
sound production
only functions as sound generator when it is not fulfilling biological functions. It represents variable resistance to the flow of air.
What do I mean by variable resistance? Vocal fold adduct to provide varying/changing amounts of resistance to outward flowing air.

6. Sound Generation: A brief description
Vocal folds
Description: long bands of muscle tissue
May be lengthened, shortened, tensed, relaxed, abducted, or adducted
During quiet breathing, VFs are:
A quick, deep inhalation for speech occurs. Then exhalation (for speech) starts.

7. Generation of air pulses
Folds are either completely adducted (yet loosely) or slightly less than completely adducted.
Air flows out of lungs producing increasing pressure beneath folds.
When subglottic pressure is sufficient, folds are blown apart
A puff of air is released.
Release of air results in sudden drop in pressure beneath folds.
Elasticity of tissue, plus reduction of air press., causes folds to come together again.
This is one cycle of vocal fold vibration.
These air pulses excite the supralaryngeal air column so as to produce a complex tone.
Usual rate in males = 125 cps, females = 210 cps, higher in children.
cps =
Go to vocal pathology image library and normal anatomy (and voice)

9. Supportive Framework for Larynx 1. Hyoid bone:
U-shaped
Unique in that not attached directly to any other bone in skeleton, rather bound in place by network of muscles and ligaments
Muscles which attach to hyoid bone and suspend it comprise the hyoid sling muscles
Muscle from tongue* and mandible above, muscles & ligaments from temporal bone approach from behind and superiorly; while extrinsic laryngeal muscles from below attach to hyoid, as do muscles from sternum and clavicle.
Hyoid is a highly mobile structure
Larynx is somewhat suspended from it
Serves as superior attachment for some extrinsic laryngeal muscles (originating outside of part)

10. Anatomy: located in neck horizontally, at level of C3. Composed of:
Corpus: body, roughly quadrilateral in shape--convex anterior surface and concave posterior surface
Why does it have this form or structure?
Greater horns (cornua)--posteriorly (dorsally) directed limbs
diminish in size as go posteriorly
terminate as tubercles (sm. rounded projection), which articulate indirectly with superior horns of thyroid cartilage.
Lesser horns--at junction of corpus and greater horns
WHY? (structure minimizes wt. while not sacrificing strength)

11. www.getbodysmart.com Select skeletal system; skull bones

12. 1B. The picture is a superior view of the hyoid bone. Label 1, 2, and 3. State the plane.

13. CARTILAGENOUS FRAMEWORK of LARYNX
Comprised of 9 cartilages
3 are unpaired, rather lg.,
3 are paired, and smaller (3 X 2 = = 9)
Cartilages of made up of either:
(a) hyaline cartilage (ossifies as we turn older--means larynx rather soft, pliable, flexible, capable of growth during childhood/adolescence, later becomes bonelike and quite brittle) or
(b) elastic cartilage
Thyroid cartilage:
Largest of laryngeal cartilages--name means shieldlike
A. Thyroid laminae--two quadrilateral plates--fused at midline--form anterior and lateral walls of larynx
LANDMARKS
Angle of thyroid--pt. of juncture between 2 80 degrees in males, 90 degrees in females
Thyroid notch= V-shaped
Thyroid prominence (Adam's apple)--anterior projection

14. Pic from anatomy.med.umich.edu/home.html

15. Superior cornu--superior horns directed upward, backward, and medially--attached thru ligament to hyoid bone--Are extremely variable in size from pt. to pt., may even be missing
C. Inferior cornu--shorter and thicker than superior--directed downward and medially--articulate with cricoid cartilage by articular facets located on medial surface. 90% of people have oblique tendon that bridges the superior and inferior tubercles (It is place of origin for extrinsic m.= thyrohyoid & sternothyroid)
D. Foramen--found in 1/3 pop.--allows blood vessel access to interior of larynx

16. 2B. Name parts of the thyroid cartilage, numbers 1-5

18. 2. Cricoid cartilage: (Gr
2. Cricoid cartilage: (Gr. krikos = ring)--hyaline cartilage--located immediately above the uppermost tracheal ring. Smaller but stouter than thyroid
A. cricoid lamina--likened to signet ring--occupies space between posterior margins of thyroid; has articulatory facets for arytenoid cartilages.
anterior arch--has articular facets for articulating with inferior horns of thyroid. Joint formed by this articulation permits thyroid or cricoid to rotate about an axis. This movement is very important for pitch changing.
LABEL 1, 2A, 2B, 3 2A 2B

19. 3. Arytenoid cartilages: located on cricoid
3. Arytenoid cartilages: located on cricoid cartilage--hyaline cartilage--resemble 3- sided pyramid
A. muscular process--on posterolateral surface--is rounded facet that articulates with cricoid--pt. of attachment for some imp. laryngeal muscles.
b. vocal process--anterior angle, pointed projection--the vocal ligament, an important part of vocal fold, inserts on the vocal process. (see previous slide)
Muscular process
Locate muscular process on this slide.

21. 4. Corniculate cartilages: apexes of arytenoid cartilages are capped by this pair--name describes hornlike shape--quite large in animals; in humans are probably vestigial, once serving a protective function--sometimes are absent

22. Function: prevent food from entering the larynx during deglutition
5. Epiglottis: flexible, leaf-like structure made up of elastic cartilage.
Location:
Just behind hyoid bone and root of tongue. Attaches to thryoid cartilage at angle, just beneath thyroid notch by means of a ligament. Broadest portion connects to hyoid bone (hyoepiglottic ligament). Anterior surface is curved forward. Connects to tongue by median and lateral glossoepiglottic ligaments
Function: prevent food from entering the larynx during deglutition
Contributes very little to speech*
Name the view/plane

23. Valleculae (L. = sm. valleys)--pits formed between epiglottis and root of tongue, one on either side of median glossoepiglottic ligament. Food may fall into valleculae and remain before or after a swallow. See next slide

24. Laryngeal penetration (thick arrow) or tracheal aspiration (thin arrow) may occur as a result of post swallow stasis in the valleculae.

25. Cuneiform cartilages: (Cunie = wedge shaped) Are imbedded in aryepiglottic folds (fold of membrane which extends from sides of epiglottis to apexes of arytenoid cartilages= entrance to larynx)--anterior and lateral to corniculate cartilages--may be absent.
Function: lend support to aryepiglottic folds and stiffen them to help maintain the opening to the larynx
Cuneiform
Corniculate

26. Posterior Cricoarytenoid

27. Review: www.ncvs.org/index.html
Tutorials, Young Explorers
mywebpages.comcast.net/wnor/lesson11.htm
Select Respiratory System
Larynx
Take special notice of animations of intrinsic laryngeal muscles

28. LARYNGEAL JOINTS http://www.slpanimation.com/3dvoice/
A. cricoarytenoid joint: permits rocking motion and some gliding action
rocking motion causes an upward and outward motion of the vocal process during abduction and an inward and downward swing during adduction.
Medial and lateral sliding of the arytenoid cartilage toward or away from midline, which brings the arytenoids toward or away from each others.

30. B. cricothryoid joint: pivot joint--primary action is rotational.
In neutral position, ligaments surrounding joint are somewhat slack, so limited gliding action can take place.
Rotational and gliding action place v. folds under increased tension, increasing pitch.
Action decreases distance between thyroid and cricoid, and increases distance between vocal processes of arytenoids and angle of thyroid

31. MEMBRANES AND LIGAMENTS
A. Extrinsic: connect laryngeal cartilages with other adjacent structures
1. hyothyroid membrane and ligaments--larynx seems to be suspended from hyothyroid--located between hyoid and superior border of thyroid--portions are thickened and called ligaments.
Hyothyroid ligament

32. 2. hyoepiglottic ligament--unpaired, midline--extends from anterior surface of epiglottis to upper border of body of hyoid
3. cricotracheal membrane--connects lower border of cricoid with 1st tracheal ring A B

33. B. Intrinsic: interconnect various laryngeal cartilages, help to regulate extent and direction of movements--almost all originate from broad sheet of connective tissue called elastic membrane (lines almost entire larynx)
1. conus elasticus--lower portion of elastic membrane--cavity below vocal folds is cone-shaped (thus name)
continuous sheet of membrane connects thyroid, cricoid, and arytenoid cartilages with one another. Extends from superior border of arch and lamina of cricoid to true vocal folds.
Cuneiform
Corniculate

34. Cuneiform Corniculate Ventricular
2. quadrangular membrane (shape)--arise from lateral margins of epiglottis (i.e., superior margins of QM also called aryepiglottic folds) and thyroid cart. near angle--fibers course posteriorly downward, and attach to corniculate cartilages and arytenoids. Inferiorly, terminate as free, thickened borders called ventricular (or vestibular) ligaments.
Cuneiform
aryepiglottic folds: superior margins of quadrangular membrane--Rem. cuneiform cartilages embedded in aryepiglottic folds
Corniculate
Ventricular

35. Note the Aryepiglottic folds

36. C. Membrane: larynx lined with mucous membrane that is continuous with lining of oral cavity and trachea. It is rich in mucous glands in area between vocal and ventricular ligaments
INTERIOR OF LARYNX
A. Laryngeal cavity: goes from aditus laryngis (aditus = entrance) to inferior border of cricoid cartilage. Aditus = triangular in shape, bounded by epiglottis in front, aryepiglottic folds, and apexes of arytenoids posteriorly.

37. Posterior Cricoarytenoid

38. 1. pyriform sinus: bounded laterally by thyroid cartilages and membrane, medially by aryepiglottic folds (
2. rima glottidis or glottis: space between vocal folds. Some include the vocal folds and the space as the glottis.

39. Name the plane shown below.

40. vallecula
Pyriform sinus

41. mywebpages.comcast.net/wnor/lesson11.htm
Vestibule from Latin = entrance court

42. INTERIOR OF LARYNX CONT.
1. ventricular folds: are soft and flaccid, incapable of becoming tense.
Attach to angle of thyroid, just beneath attachment to epiglottis. Posteriorly attach to arytenoids. Move with arytenoids, but are further apart than vocal folds during phonation. They do not vibrate under normal conditions. Space between ventricular folds called ____________
Clinical note:

43. B. Supraglottic region: between ventricular folds & aditus is called vestibule. Sm. region between ventricular folds and vocal folds called ventricle.

44. C. Subglottal region: bounded above by v
C. Subglottal region: bounded above by v. folds and below by inferior margin of cricoid cartilage--lined with ciliated tissue, extending into trachea and bronchi. Cilia beat toward pharynx in L., helping to remove accumulations of mucus and foreign matter.
1. vocal folds: true lie parallel to and just beneath ventricular folds, separated by laryngeal ventricle.
Origin = thyroid cartilage, near angle, below notch--anterior commissure (anterior attachment) of folds is common, diverge as course posteriorly toward posterior commissure; Insert on arytenoid cartilages. Borders are free.
Membranous portion of vocal folds appear to be most active in vibration, altho cartilagenous portion also vibrates.
Appearance:

45. 2. glottis: variable opening between folds
2. glottis: variable opening between folds. Anterior portion bounded by vocal ligament called membranous glottis, posterior 2/5 is bounded by vocal process and medial arytenoid cartilage = cartilaginous glottis. At rest glottis 8mm in males, during forced inhalation this value may double.

46. Muscles of Larynx
Muscles are either intrinsic or extrinsic. We will only discuss intrinsic.
1. Thyroarytenoid (adductor, tensor, or relaxer):
Some texts list two separate muscles: Thyromuscularis and Vocalis.
Origin = inner surface of angle of thyroid.
* Superior fibers (vocalis) flank vocal ligament, course backward and insert into vocal process of arytenoids (lateral and inferior aspect).
*Inferior fibers (thyromuscularis) are twisted, course in lateroposterosuperior direction, insert along base of arytenoid cart.
Func = act as regulator of longitudinal tension.
Contracting alone = relax v. folds, and assist in closing glottis (by pulling forward on muscular process).
When contraction opposed by other intrinsic m., then =
Respiratory system
Larynx
Production of voiced sds

47. Label 1-6

48. 3B. Label 1-2, 4-9 Check movement on www.getbodysmart.com
For dissection pictures go to: zemlin.shs.uiuc.edu/
Select larynx 1 or larynx 2
3B. Label 1-2, 4-9

49. 2. Posterior Cricoarytenoid M. (abductor)
Just one abductor m.
Origin = posterior surface of cricoid
Insertion = muscular process of arytenoids.
Function:
Two m. act as antagonists to PCA: lateral cricoarytenoid, and arytenoid muscles.
Check movement on

50. 3. Lateral Cricoarytenoid M
3. Lateral Cricoarytenoid M. (adductor, increases medial compression)--slightly fan-shaped, located deep to thyroid cartilage.
Origin = upper border of anterolateral arch of cricoid, Course = upward, backward
Insertion = muscular process of arytenoid.
Func = rotates arytenoids to bring vocal processes toward midline. Also instrumental in regulating medial compression of v. folds. Acting unopposed, will shape glottis for whisper.
Check movement with

52. A. Oblique arytenoid = more superficial than other part.
4. Arytenoid M. (adductors)--located on posterior surface of arytenoids. Usually described as having 2 parts:
A. Oblique arytenoid = more superficial than other part.
Origin = m. process -- two m. cross ea. other like letter X, Insert = near apex of opposite arytenoid.
Func : approximate arytenoids and regulate medial compression.
B. Transverse arytenoid = stout m.
Origin = lateral margin and posterior surface of one arytenoid, course horizontally, Insert = lateral margin and post. surface of other arytenoid.
Func = approx. arytenoids by causing them to slide along axis toward midline.

53. 5. Cricothryoid (tensor)--only one other m. which tenses or elongates v. folds (thyroarytenoid)--Fan-shaped--Origin = anterolateral arch of cricoid--fibers diverge into two distinct parts.
A. Pars oblique--courses upward and back, Insertion = inferior horn of thyroid
B. Pars recta--fibers located anterior to pars oblique--courses nearly vertically, Insertion = inner aspect of lower margin of thyroid lamina
Func: contraction of anterior fibers = decrease distance between cricoid arch and thyroid cart.; If thyroid fixed, raises cricoid; If cricoid fixed, thyroid tilts downward. All result in increasing distance between thryoid and v. processes of arytenoids resulting in elongation of v. folds, placing them under increased tension, an action necessary for pitch changes.

54. Label 1-7 7

55.
Models of vocal fold oscillation
Videos of normal larynx and presents cases and videos of those with vocal pathologies
Videos of vocal pathologies

56. Structure of the Vocal Folds
3 layers
Cover: epithelium and superficial layers of the lamina propria
Epithelium is 8 layers thick to protect delicate underlying tissues from abrasion caused during phonation and flow of air into and out of lungs.
Superficial layer of lamina propria called ?
this layer vibrates the most during phonation
If it becomes stiffened due to pathologies, the result is dysphonia*

57. Transition: Intermediate (elastic fibers) and deep layers (likened to cotton fibers) of lamina propria; also called ?
Composed of elastic and collagenous fibers
Provides for resiliency and extensibility
Conclusion: Vocal ligament provides longitudinal stability to VFs and enables them to be responsive to the intrinsic laryngeal muscles, especially the TA
3. Body: vocalis portion of TA muscle (like bundle of stiff rubber bands)

58. Epithelium COVER Superficial TRANSITION Deep . Vocalis BODY Cover
Intermediate
Transition
Deep
Deep
Deep .
TRANSITION
Body
Vocalis
(Thyroarytenoid)
Vocalis
BODY
Lamina Propria= superficial, intermediate, and deep layers

59. It involves the entire length of one or both vfs.
Reinke’s edema
FYI
Reinke’s edema results from smoking—it is simply not found in persons who have never smoked. It may represent a specialized tissue reaction to thermal insult.
It involves the entire length of one or both vfs.

60. Innervation of the laryngeal muscles
Vagus nerve: Vagus originates from nucleus ambiguous of medulla; exits cranium thru jugular foramina; divides into 3 branches:
1. Pharyngeal nerve: supplies all muscles of the soft palate, except the tensor veli palatini (CV innervation for tensor)
2. Superior laryngeal nerve. Divides into internal and external branches.
a. Internal laryngeal nerve.
Enters thru hyothryoid membrane.
Sensory function = Sensory fibers to mucous membrane lining larynx above v. folds, epiglottis, vallecula, and vestibule of larynx, aryepiglottic folds.
b. External laryngeal nerve
Motor function =
3. Recurrent laryngeal nerve.
Motor function = it innervates all intrinsic m. of larynx except cricothyroid
Sensory = Innervates sensory receptors in mucous membrane below v. folds

62. Pharyngeal branch not shown in figure.
Internal superior
laryngeal branch
External superior laryngeal branch

64. Be able to name the nerves/muscle/membrane shown below.d c

65. Lesions to Vagus nerve and its branches:
Lesions above pharyngeal branch: Adductor paralysis with palatopharyngeal paralysis.
Unilateral: breathiness or whispered voice quality, hoarseness (due to asynchronous vibration), reduced loudness (inefficient glottal closure) and low pitch with possible pitch breaks, occassionally diplophonia; mild-to-moderate hypernasality and nasal emission (due to impaired VP function).
Bilateral = severe breathiness or aphonia (if bilateral paralysis is total); weak cough or glottal attack; hypernasality/nasal emission more severe; both folds fixed in abductor position; PROTECTION of airway is of primary concern. ASSOCIATED SYMPTOMS: Depend on extent of weakness and whether involvement is unilateral or bilateral
Difficulty swallowing—due to palatal and pharyngeal muscle involvement
Nasal regurgitation—VP incompetence
Aspiration of secretions—due to palatopharyngeal and laryngeal involvement. Tracheostomy may be necessary if aspiration becomes a problem.
MEDICOSURGICAL: Pts may need G-tube feeding and artificial larynx may be used.
VOICE TX: prognosis better for unilateral AD paralysis. Use txs listed for unilateral. Use of larger mouth opening and pushing may increase intensity of whispered speech. Alaryngeal or nonvocal comm aid can be used.
Unilateral: breathiness or whispered voice quality, hoarseness (due to asynchronous vibration), reduced loudness (inefficient glottal closure) and low pitch with possible pitch breaks, occassionally diplophonia; mild-to-moderate hypernasality and nasal emission (due to impaired VP function).
Bilateral = severe breathiness or aphonia (if bilateral paralysis is total); weak cough or glottal attack; hypernasality/nasal emission more severe; both folds fixed in abductor position; PROTECTION of airway is of primary concern. ASSOCIATED SYMPTOMS: Depend on extent of weakness and whether involvement is unilateral or bilateral
Difficulty swallowing—due to palatal and pharyngeal muscle involvement
Nasal regurgitation—VP incompetence
Aspiration of secretions—due to palatopharyngeal and laryngeal involvement. Tracheostomy may be necessary if aspiration becomes a problem.

66. 2. Lesions below pharyngeal branch involving SLN and RLN: Adductor paralysis.
Symptoms: Same voice symptoms as described above, but without ________. Fold usually in intermediate position. No VP incompetence.

67. 3. Lesion affecting SLN only Unilateral lesion: Voice =
Associated symptoms
Bilateral lesion:
Associated symptoms—same as above
ETIOLOGY: Surgical trauma, accidental trauma, benign thyroid disease.
UNILATERAL: Both folds adduct on phonation, but fold on affected side will appear shorter, and an asymmetric lateral shift of epiglottis and anterior larynx toward unaffected side is seen.
VOICE: mild breathiness and hoarseness, normal or mildly reduced loudness, and mild inability to alter pitch often only noticeable when pt attempts to sing. Pt may complain of vocal fatigue.
ASSOCIATED SYMPTOMS: laryngeal anesthesia can result in mild postdeglutition cough, choking, or aspiration, or a mild cough after swallowing; often symptoms aren’t constant or obvious thus may not be reported by pt.
NO surgical intervention
NO voice tx BI
Bilateral lesion = absence of tilt of thyroid cartilage on cricoid cart. during phonation, folds appear shorter than normal, epiglottis will overhang and obscure anterior portion of folds, will be bowing of folds. Voice = breathiness, hoarseness (mild to moderate), loudness will be reduced, ability to alter pitch will be moderately to severely impaired (serious prob. with singing). Pt may complain of vocal fatigue.
NO MEDICOSURGICAL MANAGEMENT; NO VOICE TX

68. SLN LESIONS ETIOLOGY: Surgical trauma, accidental trauma, benign thyroid disease. UNILATERAL: Both folds adduct on phonation, but fold on affected side will appear shorter, and an asymmetric lateral shift of epiglottis and anterior larynx toward unaffected side is seen. VOICE: mild breathiness and hoarseness, normal or mildly reduced loudness, and mild inability to alter pitch often only noticeable when pt attempts to sing. Pt may complain of vocal fatigue. ASSOCIATED SYMPTOMS: laryngeal anesthesia can result in mild postdeglutition cough, choking, or aspiration, or a mild cough after swallowing; often symptoms aren’t constant or obvious thus may not be reported by pt. NO surgical intervention NO voice tx Bilateral lesion = absence of tilt of thyroid cartilage on cricoid cart. during phonation, folds appear shorter than normal, epiglottis will overhang and obscure anterior portion of folds, will be bowing of folds. Voice = breathiness, hoarseness (mild to moderate), loudness will be reduced, ability to alter pitch will be moderately to severely impaired (serious prob. with singing). Pt may complain of vocal fatigue. NO MEDICOSURGICAL MANAGEMENT; NO VOICE TX

69. 4. Lesion affecting RLN only A. Unilateral RLN lesion Voice
Associated Symptoms
Unilateral Abductor paralysis—affected VF in paramedian position due to action of CT. CT exerts stretch on folds anteroposteriorly, acts as adductor, thus pulling v. folds closer to midline; abductor muscle nonfunctioning, so cannot pull VFs and widen glottis. May have weak cough or glottal attack.
ETIOLOGY: Intrathoracic malignant tumor, aneurysms, mital stenosis which causes left auricle to enlarge and impinge on Vagus, trauma to neck, idiopathic (80% resolve within 6 months to 1 year).
VOICE: voice usually not affected because both VFs can approximate at midline. If voice affected, will have mild breathy and mild hoarse quality, with slightly reduced loudness and occasional diplophonia.
ASSOCIATED SIGNS: May experience shortness of breath during physical activities due to narrowed airway (during periods of deep respiration).
MEDICOSURGICAL—delay for 6-12 months. Rarely is surgery indicated in unilateral abductor paralysis.
Voice TX: generally doesn’t require tx. Pts who use voice professionally may require instructions on increased breath control, how to increase intensity, and how to maintain a relaxed vocal tract.

70. Unilateral Abductor paralysis—affected VF in paramedian position due to action of CT. CT exerts stretch on folds anteroposteriorly, acts as adductor, thus pulling v. folds closer to midline; abductor muscle nonfunctioning, so cannot pull VFs and widen glottis. May have weak cough or glottal attack.
ETIOLOGY: Intrathoracic malignant tumor, aneurysms, mital stenosis which causes left auricle to enlarge and impinge on Vagus, trauma to neck, idiopathic (80% resolve within 6 months to 1 year).
VOICE: voice usually not affected because both VFs can approximate at midline. If voice affected, will have mild breathy and mild hoarse quality, with slightly reduced loudness and occasional diplophonia.
ASSOCIATED SIGNS: May experience shortness of breath during physical activities due to narrowed airway (during periods of deep respiration).
MEDICOSURGICAL—delay for 6-12 months. Rarely is surgery indicated in unilateral abductor paralysis.
Voice TX: generally doesn’t require tx. Pts who use voice professionally may require instructions on increased breath control, how to increase intensity, and how to maintain a relaxed vocal tract.

71. Unilateral VF paralysis video: http://www. youtube. com/watch

72. Muscles and actions Adduction (2 major muscles): Abduction
Raising fundamental frequency (pitch)
Lowers fundamental frequency (pitch)

73. a b c e d

74. a b d e c f

75. Do not use “vocal fold” as an answer below.1 6 2 7 3 4 8 5 9
10. Name the plane shown.