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Anatomy of the Larynx

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Anatomy of the Larynx Head & Neck Surgery Course Anatomy of the Larynx Dr Pierfrancesco PELLICCIA - Pr Benjamin LALLEMANT orl-nimes.frService ORL et CMF University Hospital of Nîmes Introduction • Anatomy – Cartilages + hyoid bone – Muscles – Membranes, ligaments – mucosa • Physiology orl-nimes.fr– Voice – Breathing – Swallowing – Airway protection Cartilages and bone of the Larynx orl-nimes.fr Cartilages and bone of the Larynx orl-nimes.fr Cartilages of the Larynx orl-nimes.fr Extrinsic membranes of the Larynx orl-nimes.fr Thyrohyoid membrane Cricotracheal membrane/ligament Intrinsic membranes of the Larynx Quadrangular membrane Conus elasticus: 2 parts= connects the epiglottis with the medial cricothyroid ligament: is a thickened arytenoid. anterior part of the membrane that connects the anterior apart of the arch of the cricoid cartilage The free superior margins form the with the inferior border of the thyroid membrane. aryepiglottic folds. lateral cricothyroid membranes : originate on the The free inferior borders form the superior surface of the cricoid arch and rise ventricular ligaments, also known as superiorly and medially to insert on the vocal the false vocal folds. process of the arytenoid cartilages posteriorly, and orl-nimes.frto the interior median part of the thyroid cartilage anteriorly. Its free borders form the VOCAL LIGAMENTS. Intrinsic membranes of the Larynx orl-nimes.fr Lateral aspect of larynx – right Coronal view of intrinsic thyroid lamina removed. Lateral membranes. view of intrinsic membranes Vocal ligaments orl-nimes.fr Muscles of the Larynx orl-nimes.fr Muscles of the Larynx orl-nimes.fr Anatomy of the endolarynx • Supraglottis • Glottis • Subglottisorl-nimes.fr Anatomy of the endolarynx orl-nimes.fr orl-nimes.fr orl-nimes.fr Anatomy of the endolarynx orl-nimes.fr Anatomy of the endolarynx orl-nimes.fr Spaces of the Larynx Preepiglottic space • Boundaries – Superior: hyoepiglottic ligament – Anterior: thyrohyoid membrane orl-nimes.fr – Inferior: thyroepiglottic ligament – Posterior: epiglottis Spaces of the Larynx Paraglottic Space • Boundaries – Superior and medial: quadrangular membrane – Inferior and medial: conus elasticus orl-nimes.fr – Lateral: thyroid cartilage – Posterior: piriform sinus wall Spaces of the Larynx orl-nimes.fr Spaces of the Larynx orl-nimes.fr Note the relationship between paraglottic space, preepiglottic space and piriform sinus Spaces of the Larynx orl-nimes.fr Blood supply of the Larynx orl-nimes.fr Blood supply of the Larynx orl-nimes.fr Neural supply of the Larynx orl-nimes.fr Neural supply of the Larynx orl-nimes.fr Neural supply of the Larynx orl-nimes.fr Neural supply of the Larynx orl-nimes.fr Lymphatic Drainage of the larynx • 1st echelon nodes: levels II-IV + level VI (subglottis) • Then levelsorl-nimes.fr Ib and V Lymphatic Drainage of the larynx NB: Two embryological separate parts of the larynx – The supraglottis develops from the buccopharyngeal origin • rich lymphatic pathways • LN metastases are more frequent – The glottis and the subglottis are derived from the tracheobronchialorl-nimes.fr buds: • fewer lymphatic pathways • LN metastases are rare Head & Neck Surgery Course Larynx: surgical options orl-nimes.fr Endoscopic cordectomy (ELS) orl-nimes.fr Frontolateral laryngectomy orl-nimes.fr Supraglottic laryngectomy (SGL) orl-nimes.fr Technique • Skin incision • Divide strap muscles orl-nimes.fr Technique • Elevate outer thyroid perichondrium orl-nimes.fr Technique • Planning Cartilage Cuts – Location of anterior commissure – Position of the ventricle – Posterior extent of true vocal cords orl-nimes.fr Technique • Entry through the vallecula orl-nimes.fr Technique • Entry through pyriform sinus orl-nimes.fr Technique • Entry through pyriform sinus orl-nimes.fr Technique • Mucosal cuts orl-nimes.fr Technique • Mucosal cuts orl-nimes.fr Technique • Mucosal cuts orl-nimes.fr Technique • Mucosal cuts orl-nimes.fr Technique • Close mucosa over exposed cartilage orl-nimes.fr Technique • Reapproximate outer thyroid perichondrium to tongue base orl-nimes.fr Technique • Reapproximate outer thyroid perichondrium to tongue base orl-nimes.fr Technique • Reinforce closure by reapproximating strap muscles orl-nimes.fr Supracricoid Laryngectomy: CHP and CHEP orl-nimes.fr CHP orl-nimes.fr CHP orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr CHEP orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Total Laryngectomy orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Technique orl-nimes.fr Head & Neck Surgery Course Anatomy of the hypopharynx Dr Pierfrancesco PELLICCIA - Pr Benjamin LALLEMANT orl-nimes.frService ORL et CMF University Hospital of Nîmes Introduction Anatomy •Mucosa •Pharingobasilar fascia •Inferior constrictor muscle •Buccopharyngeal fascia (Middle Layer of the Deep orl-nimes.frCervical Fascia) Physiology •swallowing Anatomy of the hypopharynx orl-nimes.fr Anatomy of the hypopharynx orl-nimes.fr Anatomy of the hypopharynx orl-nimes.fr Pharyngobasilar fascia orl-nimes.fr Inferior constrictor muscle orl-nimes.fr Blood supply of the hypopharynx orl-nimes.fr Blood supply of the hypopharynx orl-nimes.fr Lymphatics of the hypopharynx •1st echelon nodes : levels II,III,IV ± VI •Then : levels Ib, V, VII orl-nimes.fr Head & Neck Surgery Course Hypopharynx: surgical options orl-nimes.fr Alonso orl-nimes.fr Alonso orl-nimes.fr SGL extended to PS orl-nimes.fr TL + PP (known in Italy as PLT) orl-nimes.fr TL + TP (known in Italy as PLTC) orl-nimes.fr.
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