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Neck
Published in Swati Goyal, Neuroradiology, 2020
The epiglottis is the leaf-shaped cartilage in the midline with a free margin (attachment for the hyoepiglottic ligament, which is near the base of the tongue) and a fixed portion called the stem (attachment for the thyroepiglottic ligament).
Anatomy as Applied to Transoral Surgery
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Mark Puvanendran, Andrew Harris
The fusion of the two vocal cords anteriorly produces the anterior commissure tendon. The anterior commissure is an important area for transoral surgery as the epithelium reaches within 1 to 2 mm of the cartilage, there is no perichondrium at this site, and it is a difficult area to expose during surgery. Superior to the anterior commissure the thyroepiglottic ligament attaches the epiglottis to the thyroid cartilage. The epiglottic cartilage extends superiorly and posteriorly forming an important anatomical space within the larynx, the pre-epiglottic space. The pre-epiglottic space is bounded anteriorly by the thyrohyoid ligament, the hyoid bone, and posteriorly by the epiglottis, and superiorly by the hyoepiglottic ligament, connecting the epiglottis to the hyoid bone (Figure 23.9).
Acquired Laryngotracheal Stenosis
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Michael J. Rutter, Alessandro de Alarcón, Catherine K. Hart
This presents as a compromised laryngeal inlet owing to the base of the epiglottis (the ‘petiole’, from the term used to describe the footstalk of a leaf, i.e. the part which connects the blade to the stem) obscuring the anterior true vocal folds and foreshortening the anterior/posterior diameter of the laryngeal inlet. This problem is most commonly seen in children who have had repeated previous laryngofissure and is a consequence of damage to the thyroepiglottic ligament, where it inserts into the thyroid cartilage just above the anterior commissure. Epiglottic petiole prolapse is rare, and challenging to treat. Injudicious use of a laser in the endolarynx tends to exacerbate the problem, with further scarring narrowing the laryngeal inlet. Suspension of the epiglottic base to the hyoid bone provides some benefit, but is technically challenging and causes the patient significant pain on swallowing for several weeks post-operatively.
Chondrolaryngoplasty in transgender women: Prospective analysis of voice and aesthetic satisfaction
Published in International Journal of Transgender Health, 2021
Mateus Morais Aires, Daniela de Vasconcelos, Bruno Teixeira de Moraes
The two techniques described in the literature demonstrate different strategies in order to avoid disinsertion of the anterior commissure of the vocal folds. Wolfort and Parry (1975) recommended detachment of the internal perichondrium from the upper portion of the thyroid cartilage only up to the insertion level of the thyroepiglottic ligament. As the insertion of the vocal ligament is inferior to the thyroepiglottic ligament, a safe limit is established. Later, Spiegel and Rodriguez (2008) described a surgical approach using a laryngeal mask airway combined with intra-operative fiberoptic laryngoscopy examination to mark the implantation height of the anterior commissure in the thyroid cartilage with a 22-gauge needle, and consequently at the safe limit of the resection of the thyroid cartilage.