Surgical Anatomy of Larynx(1).pdf by dr arfa

Details of anatomy of larynx

1. Surgical Anatomy of Larynx
Dr. ArfaAslam
Senior House Officer ENT

2. Introduction:
Larynxisacomplexfunnelshaped
fibromuscularorganwhich
•Protectsthelowerairway
•Providesacontrolledairway
•Allowsphonation
•Keepsthehighintrathoracic
pressurewhilecoughingandlifting

3. Larynx
Exterior
Bone
Hyoid
Cartilages
Thyroid Cartilage
Strap Muscles
Sternohyoid
Omohyoid
Thyrohyoid
Sternothyroid
Spaces of Larynx
Neuroasculature
Interior

4. Larynx
Exterior
Interior
Cartilages
Arytenoids
Corniculate
Cuneiform
Epiglottis
Internal Laryngeal
Muscles
Cricothyroid
Thyroarytenoid
Post.
Cricoarytenoid
Lat.
Cricoarytenoid
Trans. & Obl.
arytenoids
Ventricular &
Vocal folds

5. Hyoid bone
•Horseshoeshapedbone
•LocatedatthelevelofC3
•Comprises
•Body
•Greaterhorn
•Lesserhorn
Thetipofgreaterhornofhyoidboneissignificantlandmark
inneck/cervicalsurgeryasBifurcationofcarotidarteries,
Superficialthyroidarteryandlingualarteryareclosely
relatedtotipofgreaterhornofhyoidbone.

6. Thyroid Cartilage
•Formed by 2 Quadrilateral Lamina
•Fused anteriorly to form Laryngeal
prominence (Adam’s Apple)
•Posterolateral edge makes
•Superior horn
•Inferior horn

7. Thyroid Cartilage
1.Lookinganteriorly:Atmidpointbetweensuperiorandinferior
thyroidnotchliesAnteriorcommissure
2.Lookingfromsides:Atmidpointbetweenanteriorandsuperior
borderofthyroidcartilageliesVocalprocessofarytenoidcartilages
➢VocalLigamentextendsfrom1to2
➢TheselandmarksareimportantinExtralaryngealapproachforlaryngeal
frameworkprocedureslikethyroplasty.

9. Cricoid Cartilage
✓Signetringshapedcartilage
✓Onlycompletecartilaginousringin
airway
✓Connectedto
•Thyroidsuperiorly(mediancricothyroid
ligament)
•TracheaInferiorly(cricotrachealligament)

10. Cricoid Cartilage
•Lookingposteriorlyatthelarynx:
Upperborderofcricoidlamina,
CricoarytenoidjointsandMuscular
processofarytenoidcartilagealllies
atLevelofVocalfold(i.e.atcrossing
pointof1and2.
•Thesepointareusefulinprocedure
likeadductionofvocalcords.

11. Strap Muscles
•Sternohyoid
oMostmedial,fromhyoidto
manubrium
•Omohyoid
oLateraltosternohyoid,runsdowninto
neck
•Thyrohyoid
oDeeptoomohyoid,thyroidtohyoid
•Sternothyroid
oDeeptosternohyoid,Attachesthyroid
tosternum

12. Spaces of Larynx
Pre-epiglottic space
•Midline space anterior to epiglottis
❑Anteriorly: Hyo epiglottic ligament,
Hyoid bone, Thyrohyoid membrane,
Thyroid Cartilage
❑Superiorly: Hyoepiglotticligament
❑Posteroinferiorly: Epiglottis
❑Laterally: By lateral edge of epiglottis

13. Pre epiglottic space
•Preepiglotticspacegets
lymphaticsfromSupraglotticarea
(byperforationsinepiglottis).
HencesupraglotticLaryngealCA
spread.
•TNMClassification:labelledT3
whenPESininvaded.
•SupraglotticTumorsinvadedtoPES
arecompletelyresectablewith
supraglotticLaryngectomy

14. Para GlotticSpace
•Medial to Thyroid Lamina
❑Laterally: Thyroid Lamina
❑Posteriorly: Mucosa of Hypopharynx
❑Medially: Thyroepiglotticligament,
thyroarytenoid muscle aryepiglottic folds
❑Inferiorly: Criothyroid
•In para glottic space runs the superior
laryngeal artery

15. Para glottic space
•Itprovidesspaceforcontractionand
relaxationofintralaryngealmuscles
•SupraglotticandsubglotticCA
spreadtothisspaceviablood
vessels(TMNClassification:T3)
•PathwayofPrelaryngealMetastasis
ofHypopharyngealandLaryngealCA
•Pathwayofsurgicalapproachfor
HypopharyngealCA.

17. Cricoid Area
•Loose connective tissue in subglottic
area
❑Laterally: Pericardium of cricoid
cartilage
❑Superiorly: Subglottic area
❑Inferiorly: First Tracheal Ring
❑Postero-Superiorly: Cricoarytenoid
Joint

18. Cricoid Area
•SiteofAcuteSubglotticLaryngitis
•RouteforPrelaryngeal,Pretrachealand
paratrachealmetastasis(intravascular
tumorinvasion)
•Glotticandsupraglotticcarcinomas,
withoutsubglotticextensionbutwith
cricoidareainvasioncanmetastasizeto
theprelaryngeal,pretracheal,and/or
paratracheallymphnodes.Thiscancer
developstomalrecurrences.

20. Blood Supply of Larynx
•SuperiorLaryngealArtery
Supplyinternalsurfaceoflarynx
Cricothyroidmuscle
•InferiorLaryngealArtery
Mucusmembranesandmusclesof
interiorpartoflarynx
Superiorandinferiorlaryngealartery
formanastomosisintheparaglottis
space.

21. Nerve Supply of larynx
•Internal Laryngeal Nerve
Only sensory supply above Vocal Cord
•External Laryngeal Nerve
Only motor to Cricothyroid
•Recurrent Laryngeal Nerve
Sensory supply below Vocal Cord
Motor supply to All muscles

22. ENDOLARYNX

23. Arytenoid Cartilages
•Articulates over cricoid lamina
•Apex: Aryepiglottic Folds
•Vocal process: Vocal Ligament
•Muscular Process: Posterior and
Lateral cricoarytenoid

24. Corniculate Cartilages
Articulate over the summit of
arytenoids
Cuneiform Cartilages
•Reside within the aryepiglottic
fold
•Anterior to the corniculate
cartilages

25. Epiglottis
•Thin,leaflikecartilage
•Projectsupwardsbehindthe
tongueandbodyofhyoidbone
•Attachesinferiorlytothyroid
cartilage,bythyroepiglottic
ligament
•Attachesanteriorlytohyoid
bonebyhyoepiglotticligament.

28. Ventricular folds
•Thickenedinferioredgeofthe
quadrangularmembrane
•Stretchedsuperiorandparalleltothe
vocalfold
•Attachments
•Anteriorly:Lateralborderofthe
thyroepiglotticligament
•Posteriorly:arytenoidcartilage.
Resectionofventricularfoldsincaseoflow
exposureofvocalcordlesionshasnoeffect
onlaryngealfunction

29. Vocal Folds
•Vibratinganteriorportion:attachedto
thyroidcartilagesatanteriormacula
flavaandanteriorcommissure
•Posteriorprocess:Attachedtovocal
processofarytenoidandposterior
maculaflava
•Vocalligamentisthethickenedfree
medialendoffold.

30. Reinke’s Space
•Potentialspacebeneaththe
epitheliumofvocalcords;Lamina
propriaofvocalcords
•WhilemicrosurgeryofReinke's
edema
Mucosaoffreeedgeispreservedand
incisedalongvocalfoldsforminimal
disturbanceofvocalquality

31. References:
•Friedrich G, LichteneggerR. Surgical anatomy of the larynx. J Voice. 1997
Sep;11(3):345-55. doi: 10.1016/s0892-1997(97)80014-8. PMID: 9297680.
•Kumar, R., Sagar, P. (2019). Surgical Anatomy and TumourSpread in the Larynx and
Hypopharynx. In: Bahadur, S., Thakar, A., Mohanti, B. (eds) Carcinoma of the Larynx
and Hypopharynx . Springer, Singapore. https://doi.org/10.1007/978-981-13-3110-
7_1
•Sato K . Functional Histoanatomyof the Human Larynx. Singa-poreSingapore:
Springer, 2018
•Scott-Brown's Otorhinolaryngology and Head and Neck Surgery, Eighth Edition
•Clinically Oriented Anatomy, 7e Keith L. Moore,Arthur F. Dalley, II;Anne M. R. Agur
•Diseases of Ear, Nose and Throat & Head and Neck Surgery, Seventh Edition, PL
Dhingra; Shruti Dhingra

32. THANK YOU