Larynx anatomy and laryngeal ca
-
Upload
anish-choudhary -
Category
Health & Medicine
-
view
205 -
download
3
Transcript of Larynx anatomy and laryngeal ca
![Page 1: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/1.jpg)
LEVELS OF THE LARYNX AND THEIR BOUNDARIES
The supraglottic division:From the superior-most tip of the epiglottis -to a
transverse plane through the laryngeal ventricle. The glottis:From this transverse plane to 1 cm inferiorly and
includes the true vocal cords. The subglottic regionFrom the inferior-most plane of the true cords -to the
inferior portion of the cricoid cartilage.
![Page 2: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/2.jpg)
![Page 3: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/3.jpg)
Supraglottis
• Extends from tip of epiglottis above to laryngeal ventricle below.
• Contains vestibule, epiglottis, pre-epiglottic fat, AE folds, FVC, paraglottic space, arytenoid cartilages
![Page 4: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/4.jpg)
• Pre-epiglottic space: Fat-filled space between hyoid bone anteriorly & epiglottis posteriorly
• AE folds: Projects from cephalad tip of arytenoid cartilages to inferolateral margin of epiglottis
• Represents superolateral margin of supraglottis, dividing it from pyriform sinus (hypopharynx)
![Page 5: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/5.jpg)
• False vocal cords: Mucosal surfaces of laryngeal vestibule of supraglottis.
• Beneath FVC are paired paraglottic spaces
• Paraglottic spaces: Paired fatty regions beneath false & true vocal cords
• Superiorly they merge into pre-epiglottic space
• Terminates inferiorly at under surface of TVC
![Page 6: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/6.jpg)
![Page 7: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/7.jpg)
![Page 8: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/8.jpg)
![Page 9: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/9.jpg)
Glottis
• TVC & anterior & posterior commissures
• Comprised of thyroarytenoid muscle (medial fibers are "vocalis muscle")
• Anterior commissure: Midline, anterior meeting point of TVC
![Page 10: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/10.jpg)
![Page 11: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/11.jpg)
![Page 12: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/12.jpg)
Subglottis
• Subglottis extends from under surface of TVC to inferior surface of cricoid cartilage
• Mucosal surface of subglottic area is closely applied to cricoid cartilage
• Conus elasticus: Fibroelastic membrane extends from medial margin of TVC above to cricoid below
![Page 13: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/13.jpg)
![Page 14: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/14.jpg)
![Page 15: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/15.jpg)
![Page 16: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/16.jpg)
![Page 17: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/17.jpg)
![Page 18: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/18.jpg)
![Page 19: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/19.jpg)
![Page 20: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/20.jpg)
![Page 21: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/21.jpg)
![Page 22: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/22.jpg)
![Page 23: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/23.jpg)
![Page 24: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/24.jpg)
![Page 25: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/25.jpg)
![Page 26: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/26.jpg)
![Page 27: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/27.jpg)
![Page 28: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/28.jpg)
![Page 29: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/29.jpg)
![Page 30: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/30.jpg)
![Page 31: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/31.jpg)
![Page 32: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/32.jpg)
CASE 1
Dr. Mohit GoelJR III
![Page 33: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/33.jpg)
NAME : Mr. Harnapallu Baburao Abbanna Req No : 330Patient Code : 140102135 CT No:330AGE/SEX : 74 Yr(s) / Male Date: 09/05/2014
MSCT NECK WITH CONTRASTHISTORY :
K/C/O CA hypopharynx.
Post radiotherapy status,
![Page 34: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/34.jpg)
soft tissue density mass involving hypopharynx, larynx & upper oesophagus which is occluding the laryngeal airway (supra-glottic space) as well as upper end of oesophagus.
![Page 35: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/35.jpg)
soft tissue density mass is showing heterogenous post-contrast enhancement.
![Page 36: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/36.jpg)
Valecula appears nomral.Thyroid cartilage appears normal.
![Page 37: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/37.jpg)
There is involvement of both thyro-arytenoid folds causing obliteration of both pyriformsinuses (L>R)
![Page 38: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/38.jpg)
Pre-epiglottic space appears normal.There is involvement of para-glottic space on both sides.
![Page 39: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/39.jpg)
Inferiroly the mass is extending upto the level of vocal cords.
![Page 40: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/40.jpg)
NAME : Mr. Khan Ibrahim Amir Req No : 339Patient Code : 140403479 / IPD CT No:339AGE/SEX : 72 Yr(s) / Male Date: 10/05/2014
MSCT NECK /LARYNX
Clinical Profile: H/o change in voice.
![Page 41: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/41.jpg)
Small mildly heterogeneously enhancing polypoidal mass lesion is noted involving right vocal cord and right para-glottic space, protruding into the laryngeal lumen
Plain Post-contrast
![Page 42: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/42.jpg)
There is small non enhancing hypodense area noted within the lesion s/o necrosis.
![Page 43: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/43.jpg)
Anteriorly the lesion is extending upto the anterior commissure with minimal extension to contralateral side. Thyroid cartilage appears normal.
![Page 44: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/44.jpg)
There is minimal extension of the enhancing soft tissue into the subglottic region noted at the anterior commissure. No obvious mass or thickening noted in posterior commissure.
![Page 45: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/45.jpg)
Mucosal thickening in ethmoid sinus and right maxillary sinus.
![Page 46: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/46.jpg)
Small lymph nodes noted in right level II
![Page 47: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/47.jpg)
Calcified atherosclerotic changes are noted.
![Page 48: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/48.jpg)
Supraglottic SCC
Approximately 30% of all laryngeal cancers arise in the supraglottis.
They often present in advanced stages, because symptoms (hoarseness, due to vocal cord involvement) do not occur until late.
Due to the rich lymphatic network of the supraglottis, nodal disease (level II and III) is a frequent finding in these patients.
Supraglottic SCC may arise in the • anterior compartment (epiglottis) or • the postero-lateral compartment (aryepiglottic fold and false
cords).
![Page 49: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/49.jpg)
a. Epiglottic SCCSpread:
PES (Pre-epiglottic space)Valleculabase of tongue PGS (Paraglottic space)PES glottis or subglottis
![Page 50: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/50.jpg)
![Page 51: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/51.jpg)
b. Aryepiglottic fold (AE fold) SCC
![Page 52: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/52.jpg)
c. False cord SCC
![Page 53: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/53.jpg)
Glottic SCC
Glottic SCCs represent about 65% of all laryngeal cancers.
Hoarseness of voice due to vocal cord involvement is the primary presenting symptom in these patients.
Metastatic nodal disease is rare in glottic carcinomas due to the sparse lymphatic drainage of the glottis.
Glottic SCCs commonly arise from the anterior half of the vocal cord and spread into the anterior commissure.
Anterior commissural disease is seen on CT or MRI as soft tissue thickening of more than 1-2 mm.
![Page 54: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/54.jpg)
Spread to :• contralateral cord • thyroid cartilage • posterior commissure• Arytenoids• cricoarytenoid joint and the cricoid cartilage
• superiorly to access the PES and the PGS• inferiorly to reach the subglottis
![Page 55: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/55.jpg)
![Page 56: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/56.jpg)
Subglottic SCC
These cancers are rare, accounting for only 5% of all laryngeal cancers, clinically silent and present late in the course.
Subglottic cancer is diagnosed if any tissue thickening is noted between the airway and the cricoid ring.
![Page 57: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/57.jpg)
![Page 58: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/58.jpg)
Transglottic SCC
Laryngeal SCC encroaching on both, the glottis and supraglottis, with or without subglottic component and when the site of origin is unclear, is termed as transglottic tumor.
![Page 59: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/59.jpg)
CORONAL
![Page 60: Larynx anatomy and laryngeal ca](https://reader030.fdocuments.us/reader030/viewer/2022020101/55abbf451a28ab297f8b45f7/html5/thumbnails/60.jpg)
THANK YOU