anatomy

1. Clinical Anatomy Of Laryngeal
Cancer.
Presented by: Dr Aadil Najeed
Moderator : Dr Asifa Andleeb

3. • The larynx is an air passage, a sphincter and an organ of phonation.
• it opens into laryngopharynx above and continues into trachea.
• It lies opposite 3rd to 6th cervical vertebra in adults and in infants it
starts just above the junction of body and dens of axis vertebra.
• The male and female larynges are similar in size till puberty, however
after puberty male larynx increases considerably in size.
• Mobile on deglutition.

5. Development
• All the laryngeal cartilages and muscles develop from 6th pharyngeal arch
and are supplied by recurrent laryngeal nerve
• Exceptions are thyroid cartilage and cricothyroid muscle which develop
from 5th pharyngeal arch and are supplied by superior laryngeal nerve.
• Note: The most common developmental anomaly seen in larynx is
laryngomalacia characterised by noisy respiration and inspiratory stridor.
• Needs no management as it resolves spontaneously except in rare cases
where epiglotoplasty may be needed.

6. Skeleton of larynx
• 3 Unpaired :
Thyroid, Cricoid and epiglottis.
• 3 Paired:
Arytenoid, cuneiform and
corniculate.
• Hyaline:
Thyroid, cricoid and greater part
of arytenoid.
• Elastic:
Epiglottis, Corniculate and
cuneiform.

8. Soft Tissues
Extrinsic Ligaments and Membranes:
Connect:
Thyroid cartilage with epiglottis and hyoid bone
Cricoid cartilage with trachea.
• Thyrohyoid membrane.
• Hyo and thyroepiglottic ligaments.
• Cricotracheal ligament.

10. Intrinsic Ligaments:
Connect cartilages of larynx to each other.
• Quadrangular membrane.
• Cricothyroid membrane.
• Conus elasticus.

12. Muscles of Larynx
• A) Extrinsic muscles: Connect larynx to surrounding structures and
are responsible for moving it vertically during swallowing and also
during phonation affecting the pitch and quality of voice , these
include
1. Infrahyoid strap muscle
2. Thyrohyoid
3. Sternothyroid
4. Sternohyoid.

13. • B) Intrinsic muscles and their functions:
1. Abductors: Posterior Cricoarytenoid
2. Adductors: Lateral Cricoarytenoid, interarytenoid, thyroarytenoid
cricothyroid
3. Tensors: Vocalis, cricothyroid, thyro arytenoid.
4. Opener of laryngeal inlet: thyroepiglottic
5. Closer of laryngeal inlet: interarytenoid and aryepiglottic.

15. Laryngeal Cavity

17. Supraglottic Larynx
• From tip of epiglottis to superior surface of true vocal cords.
• Composed of: Epiglottis, arytenoid, aryepiglottic fold and false vocal
cords.
• Majority of supraglottics tumors arise from epiglottis .

19. • Subglottic larynx
• It extends from the lower border of glottis to lower border of cricoid
cartilage and consists of mobile upper and fixed lower part

20. Glottis
• From superior surface of true vocal
cords to 0.5 cms below free edge of
true vocal cords.
• True vocal cords are mucosal folds
formed by vocal ligaments composed
of elastic fibres running from
arytenoid to thyroid cartilage.
• True vocal cords are most common
site of laryngeal cancers.
• False vocal cords are made of
vestibular folds.

22. Mucosa
• Stratified squamous epithelium is seen in Supraglottic larynx and
Glottis.
• Sub glottic larynx and Ventricles are lined by pseudo stratified ciliated
epithelium.
• Supra and sub glottic larynx are particularly rich in submuscosal
mucous or minor salivary glands.

24. Blood supply
Superior laryngeal artery supplies the greater
part of tissues from epiglottis down to level of
vocal cords including majority of laryngeal
musculature.
Inferior laryngeal artery supplies areas of larynx
around cricothyroid.

25. Lymphatic Drainage
• Supraglottis :
It is rich in lymphatics with high propensity for bilateral mets due to
midline location and often nodal metastasis is seen at the time of
presentation.
the primary drainage pattern is jugular lymph chain, Level 2 is most
commonly involved followed by level 3 and 4.
• Glottis:
True vocal cords are almost devoid of lymphatics, therefore glottis
cancers have better prognosis despite being the most common site.

26. • Subglottis:
The lymphatics in subglottis are less developed, the first echelon being
delphian node.
The sub glottic lymphatics form 3 pedicles, one anterior and two
posterior

27. Nerve Supply
• Motor Supply:
All muscles are supplied by Recurrent laryngeal nerve except
Cricothyroid muscle which is supplied by superior laryngeal nerve
• Sensory supply:
Above Vocal cords :- Superior laryngeal nerve
Below Vocal cords:- Recurrent laryngeal nerve

29. Nerve injuries
• Recurrent Laryngeal Nerve
Unilateral:- Hoarseness
Bilateral:- Stridor, Respiratory distress, Aphonia
• Superior Laryngeal Nerve
Unilateral:- minimal effects
Bilateral:- hoarseness, tiring of voice

30. Laryngeal Spaces
A) Pre epiglottic or Boyer’s Space:
Anteriorly; Thyroid membrane and thyroid
cartilage.
Posteriorly: Epiglottis
Inferiorly: Petiole attachment to thyroid.
Importance: direct extension of subglottic
cancer into this facia bound space and is
Often invaded by advanced cancers

31. B) Paraglottic space:
Inferiorly: Quadrangular space
Anterio medially: Conus elasticus
Laterally: Thyroid cartilage

32. C) Reinkes’s Space
• Mucosa over the vocal ligament is loosely attached to ligaments.
• Under the epithelium of vocal cords is a potential space.
• Edema in reinke’s space is bilateral and also
known as smokers edema.

33. Radiological Anatomy

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