Anatomy of the Larynx

Home , Pyriform sinus

Head & Neck Surgery Course

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 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 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 Technique

orl-nimes.fr CHEP

orl-nimes.fr Technique

orl-nimes.fr Total Laryngectomy

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 Pharyngobasilar fascia

orl-nimes.fr Inferior constrictor muscle

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