Head & Neck Surgery Course

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Anatomy of the Larynx

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Dr Pierfrancesco PELLICCIA - Pr Benjamin LALLEMANT
Service ORL et CMF
University Hospital of Nîmes
Introduction

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• Anatomy

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–
Cartilages + hyoid bone
Muscles

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– Membranes, ligaments

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– mucosa

orl • Physiology
– Voice
– Breathing
– Swallowing
– Airway protection
Cartilages and bone of the Larynx

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Cartilages and bone of the Larynx

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Cartilages of the Larynx

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Extrinsic membranes of the Larynx

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Thyrohyoid membrane Cricotracheal membrane/ligament
Intrinsic membranes of the Larynx

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Quadrangular membrane Conus elasticus: 2 parts=
 connects the epiglottis with the

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 medial cricothyroid ligament: is a thickened

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arytenoid. anterior part of the membrane that connects the

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anterior apart of the arch of the cricoid cartilage
 The free superior margins form the
with the inferior border of the thyroid membrane.

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aryepiglottic folds.

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 lateral cricothyroid membranes : originate on the
 The free inferior borders form the
superior surface of the cricoid arch and rise

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ventricular ligaments, also known as
superiorly and medially to insert on the vocal
the false vocal folds.
process of the arytenoid cartilages posteriorly, and
to the interior median part of the thyroid cartilage
anteriorly. Its free borders form the VOCAL
LIGAMENTS.
Intrinsic membranes of the Larynx

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o Lateral aspect of larynx – right
Coronal view of intrinsic thyroid lamina removed. Lateral
membranes. view of intrinsic membranes
Vocal ligaments

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Muscles of the Larynx

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Muscles of the Larynx

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Anatomy of the endolarynx

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• Supraglottis

• Glottis
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• Subglottis
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Anatomy of the endolarynx

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Anatomy of the endolarynx

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Anatomy of the endolarynx

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 Spaces of the Larynx

Preepiglottic space

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• Boundaries

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– Superior: hyoepiglottic
ligament

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– Anterior: thyrohyoid

– Inferior: thyroepiglottic
ligament

– Posterior: epiglottis
 Spaces of the Larynx

Paraglottic Space

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• Boundaries

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– Superior and medial:

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quadrangular membrane

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– Inferior and medial: conus

– Lateral: thyroid cartilage

– Posterior: piriform sinus wall

Spaces of the Larynx

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 Spaces of the Larynx

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Note the relationship between paraglottic space, preepiglottic
space and piriform sinus
Spaces of the Larynx

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Blood supply of the Larynx

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Blood supply of the Larynx

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Neural supply of the Larynx

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Neural supply of the Larynx

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Neural supply of the Larynx

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Neural supply of the Larynx

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Lymphatic Drainage of the larynx

• 1st echelon nodes:

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levels II-IV + level VI

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(subglottis)

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• Then levels Ib and V
Lymphatic Drainage of the larynx

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NB: Two embryological separate parts of the larynx

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– The supraglottis develops from the buccopharyngeal origin

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• rich lymphatic pathways

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• LN metastases are more frequent

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– The glottis and the subglottis are derived from the
tracheobronchial buds:
• fewer lymphatic pathways

• LN metastases are rare

 Head & Neck Surgery Course

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Larynx: surgical options

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Endoscopic cordectomy (ELS)

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Frontolateral laryngectomy

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Supraglottic laryngectomy (SGL)

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 Technique
• Skin incision • Divide strap muscles

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 Technique
• Elevate outer thyroid perichondrium

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 Technique
• Planning Cartilage Cuts

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– Location of anterior
commissure
– Position of the ventricle

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– Posterior extent of true vocal

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cords

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 Technique

• Entry through the vallecula

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 Technique

• Entry through pyriform sinus

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 Technique

• Entry through pyriform sinus

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 Technique

• Mucosal cuts
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 Technique

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• Mucosal cuts

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 Technique

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• Mucosal cuts

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 Technique

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• Mucosal cuts

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 Technique
• Close mucosa over exposed cartilage

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 Technique
• Reapproximate outer thyroid perichondrium to
tongue base

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 Technique
• Reapproximate outer thyroid perichondrium to
tongue base

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 Technique
• Reinforce closure by reapproximating strap muscles

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Supracricoid Laryngectomy: CHP and
CHEP

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 CHP

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 CHP

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 CHEP

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 Technique

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 Technique

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 Technique

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 Technique

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Total Laryngectomy

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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 Technique

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Head & Neck Surgery Course

Anatomy of the
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hypopharynx
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Dr Pierfrancesco PELLICCIA - Pr Benjamin LALLEMANT
Service ORL et CMF
University Hospital of Nîmes
 Introduction

f r
Anatomy

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•Mucosa

im
•Pharingobasilar fascia

n
•Inferior constrictor muscle

rl - •Buccopharyngeal fascia

o
(Middle Layer of the Deep
Cervical Fascia)

Physiology
•swallowing
Anatomy of the hypopharynx

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Anatomy of the hypopharynx

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Anatomy of the hypopharynx

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Pharyngobasilar fascia

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Inferior constrictor muscle

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Blood supply of the hypopharynx

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Blood supply of the hypopharynx

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Lymphatics of the hypopharynx

•1st echelon nodes : levels II,III,IV ± VI

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•Then : levels Ib, V, VII

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Head & Neck Surgery Course

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Hypopharynx: surgical

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options

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 Alonso

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 Alonso

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SGL extended to PS

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TL + PP (known in Italy as PLT)

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TL + TP (known in Italy as PLTC)

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