Imaging anatomy of larynx and pharynx

1. By
Dr.Muhammad Sherwani

3. Knowledge
is
Power
Reda Kamel
Professor of Rhinology

16. The Cartilages
• The cartilaginous
skeleton is
comprised of :
 Single Cartilages:
Thyroid
Cricoid
Epiglottis
 Paired Cartilages:
Arytenoid
Corniculate
Cuneiform

17. All the cartilages,
except the epiglottis,
are of hyaline type.
Epiglottis is formed of
elastic cartilage
The cartilages are:
 Connected by
joints, membranes
& ligaments
 Moved by muscles

18. Thyroid Cartilage
Shield shaped, open posteriorly, angulated
anteriorly
Angulation more acute in males
Its function is to shield larynx from injury
and provide an attachment to vocal cords

19. Epiglottis
 Thin leaf shaped fibro-cartilage,
situated in midline
 Upper free end broad & rounded,
projects up behind base of tongue
 Narrow base called pitiole
 This attachment forms lower limit of
pre-epiglottis space
 Half of epiglottis projects above
hyoid
 This part has a laryngeal and
lingual surfaces

20. Cricoid Cartilage
Signet ring shaped
Stronger than thyroid
cartilage.
Lamina – 2 to 3 cm
from above
downwards,
considerably broader
than anterior arch.

21. Arytenoids
 Paired cartilages, pyramidal
in shape
 Base articulated with cricoid
 PCA & LCA muscles attach
on muscular process
 Anterior angle elongated into
vocal process which receives
insertion of vocal ligament

22. Corniculate & Cuneiform Cartilages
Corniculate Cartilages
 Small nodules
 Articulate with the apices of
arytenoid cartilages
Cuneiform Cartilages
 Small rod shaped, placed in
each aryepiglottic fold,
producing a small elevation
 Do not articulate with any other
cartilage
Serve as support for the ary-
epiglottic fold
E
CU
CO
V
F

23. Thyrohoid membrane,
median & lateral
thyrohoid ligaments
Hyoepiglottic ligament
Thyroepiglottic ligament
Median cricothyroid
ligament
Cricotracheal membrane

24. Two Para- Laryngeal
spaces
Pre-epiglottic space(PES)
Paraglottic space (PGS)

25.  The goal of any organ preservation surgery is
to preserve function without compromising
cure rate
 Functions of the larynx:
- Phonation
- Respiration
- Deglutition (swallowing)
- Airway protection
 The functions of the larynx must be
maintained without the need for tracheostomy
or feeding tube.

26. Laryngeal cancer is the Elenventh most
common cancer in men worldwide
SCC comprising 90%of all laryngeal
malignancies
1. Surprglottic 19% LAP 32-70%
2. Glottic 76% LAP 5%
3. Subglottic 5% LAP 6%
4. Transglottic :spread superfacially and into
the PGS to span all three sub sites.

27. Subsites within the larynx
 Supraglottis:
Suprahyoid epiglottis (including tip, lingual and
laryngeal surfaces)
Infrahyoid epiglottis
Aryepiglottic fold, laryngeal aspect
Arytenoid
Ventricular bands (false vocal cords)
 Glottis:
True vocal cords
Anterior commissure
Posterior commissure
 Subglottis:

28. What we need to know???
1. The site of Tumer
2. The volume of Tumer
3. Extention of Tumer
 Pre-Epiglottic space (PES)
 Para-glottic space (PGS)
 Anterior commisure invasion
 Laryngeal cartilage invasion .
 Extention to other structure(thyroid,trachea,
cervical oseophagus, base of tounge )
4. Neck Metastasis

29. Endoscopic Surgical Excision
Endoscopic LASER Excision
Vertical partial laryngectomy
Horizontal partial laryngectomy
Supracriocoid laryngectomy

30. Supraglottis
 Consists of ventricles, false
cords, laryngeal surface of
epiglottis, aryepiglottic
folds and the mucosal
expanse.
 Posterior tapering shape
reduces area of mucosa in
posterior region.

31. Supraglottic

63. Glottis
 Consists of true cords,
anterior commissure and
posterior commissure
 Narrow triangular space
between the true cords is
called rima glottis
 Anterior 2/3 is membranous
 Posterior third consists of
vocal processes of
arytenoids
 Posterior 1/3 of cords and
covering mucosa are called
posterior commissure

70. Sub-glottis
 Begins about 5mm below free
margins of VC
 Consists of a mobile upper
and fixed lower part

71. Subglottic Larynx

86. Supraglottis
T1- Tumor limited to one subsite of supraglottis
or glottis with normal vocal cord mobility
T2- Tumor invades more than one subsite of supraglottis with
normal vocal cord mobility
T3- Tumor limited to larynx with vocal cord fixation or invades
postcricoid area, medial wall of piriform sinus, or preepiglottic
tissues
T4a- Tumor invades through thyroid cartilage or extends to other
tissues beyond the larynx (e.g., to oropharynx, soft tissues of
neck)
T4b- Tumor invades prevertebral space, encases the carotid artery,
or invades the medistinal structures

87. Glottis
T1- Tumor limited to vocal cord(s) (may involve anterior or
posterior commissures) with normal mobility
T2- Tumor extends to supraglottis or subglottis, or with
impaired vocal cord mobility
T3- Tumor limited to the larynx with vocal cord fixation
and/or paraglottic space involvement or minor thyroid
cartilage invasion (inner cortex)
T4a- Tumor invades through thyroid cartilage or extends to
other tissues beyond the larynx, (e.g., to oropharynx, soft
tissues of neck)
T4b- Tumor invades prevertebral space, encases the carotid
artery, or invades the mediastinal structures

88. Subglottis
T1- Tumor limited to the subglottis
T2- Tumor extends to vocal cord(s) with normal or impaired
mobility
T3- Tumor limited to the larynx with vocal cord fixation
T4a- Tumor invades through cricoid or thyroid cartilage or
extends to other tissues beyond the larynx (e.g., to
oropharynx, soft tissues of neck)
T4b- Tumor invades prevertebral space, encases the carotid
artery, or invades the medistinal structures