Chapter 106: Malignant Tumors of the Larynx Flashcards
The pattern of spread of tumors within the larynx is guided by:
- Ligaments
- Connective tissue membrane
- Major cartilages
- Soft tissue spaces
Supraglottic larynx is derived from the:
Buccopharyngeal primordium (3rd and 4th branchial arches)
Glottis and subglottis are derived from the:
Tracheobronchial primordium (6th branchial arch—>union of lateral furrows that develop on each side of the tracheobronchial primordium)
Blood supply and drainage
Supraglottis
Blood supply and drainage
Superior laryngeal arteries
Deep cervical chain nodes (levels II, III)
Blood supply and drainage
Glottis and subglottis
Inferior laryngeal arteries
Prelaryngeal and pretracheal nodes (level VI), before it reaches the deep cervical chain nodes in level IV
Metastasis
Glottis
Midline, unilateral, lower metastasis
Metastasis
Supraglottis
without midline, bilateral, higher metastasis
Laryngeal framework
3 unpaired cartilages (epiglottis, thyroid, cricoid)
Paired arytenoid cartilages
Superior boundary of the larynx
Tip and lateral margin of the epiglottis
Superior edge of the aryepiglottic folds
Anterior boundary of the larynx
Thyrohyoid membrane Thyroid cartilage in the supraglottis Thyroid cartilage in the glottis Cricothyroid membrane Anterior arch of the cricoid cartilage in the subglottis
Posterior and lateral boundaries of larynx
Laryngeal surface of the aryepiglottic folds
Arytenoid cartilages
Interarytenoid space
Posterioe surface of the subglottic space
Posterior and lateral boundaries of larynx
Laryngeal surface of the aryepiglottic folds
Arytenoid cartilages
Interarytenoid space
Posterioe surface of the subglottic space
Supraglottis is composed of:
- Suprahyoid and infrahyoid epiglottis (lingual and laryngeal surface)
- Laryngeal surfaces of the aryepiglottic folds
- Arytenoids
- False vocalcords
Glottis is composed of:
- True vocal cords (superior and inferior surfaces)
2. Commisure (anterior and posterior)
Subglottis is composed of:
- Extends from the inferior limit of the glottis to the inferior edge of the cricoid cartilage
Mucosal lining
Supraglottis
Pseudostratified columnar type
Stratified squamous epithelium (edges of the aryepiglottic folds and the lateral borders of the epiglottis)
Mucosal lining
True vocal cords
Stratified squamous epithelium covers a three-layered lamina propia composed of superficial, intermediate and deep layers
Mucosal lining
Subglottis
Pseudostratified columnar epithelium
Natural barriers to the spread of tumor
Laryngeal cartilages
Hypoepiglottic ligament (provides barrier to spread of tumor to the tongue)
Thyrohyoid membrane
Quadrangular membrane
Conus elasticus
Anterior commisure
Cricothyroid membrane
Within the larynx, provide pathways for spread of laryngeal tumors:
Preepiglottic space
Paraglottic space
Boundaries of PES
Anterior
thyroid cartilage, thyrohyoid membrane
Boundaries of PES
Superior
hyoid bone, hyoepiglottic ligament, valleculae
Boundaries of PES
Posterior
anterior surface of the epiglottic cartilage, thyroepiglottic ligament
Boundaries of PES
Lateral
PES is open and continuous with each of the two paraglottic spaces
The lymphatics of the PES drain through the:
thyrohyoid membrane and spread to lymph nodes on both sides of the neck, primarily in level II and III
Boundaries of PGS
Medial (superior to inferior)
quadrangular membrane, laryngeal ventricle, conus elasticus
Boundaries of PGS
Lateral
thyroid cartilage (anterior), mucosa of the medial wall of the piriform sinus (posterior)
Boundaries of PGS
Inferolateral
cricothyroid membrane
Tumor that crosses the ventricle in a vertical direction
Transglottic cancer
Tumors can become transglottic in 4ways:
Crossing the ventricle directly
Crossing at the anterior commisure
Spreading through the paraglottic space
Spreading along the arytenoid cartilage posterior to the ventricle
