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Cardiorespiratory system
Published in Helen Butler, Neel Sharma, Tiago Villanueva, Student Success in Anatomy - SBAs and EMQs, 2022
9 Which artery supplies the trachea? Inferior thyroid arteryCervical arteryInferior laryngeal arterySuperior thyroid arterySuperior laryngeal artery
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
At the level of the mouth, the facial artery gives rise to the inferior labial artery and the superior labial artery, and then becomes the angular artery at the level of the nose. The superior thyroid artery gives rise to the superior laryngeal artery, which pierces the thyrohyoid membrane together with the superior laryngeal vein and the internal laryngeal nerve to enter the larynx. Some students get confused about why the nerve and artery piercing the thyrohyoid membrane have different names, such as internal laryngeal nerve and superior laryngeal artery. However, keep in mind that the internal laryngeal nerve comes from the superior laryngeal nerve, so that the name is similar to that of the artery; the difference being that the superior laryngeal nerve also gives rise to the external laryngeal nerve, which innervates the inferior pharyngeal constrictor and cricothyroid muscles.
Anatomy of the Larynx and Tracheobronchial Tree
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The arterial supply of the larynx is derived from laryngeal branches of the superior and inferior thyroid arteries and the cricothyroid branch of the superior thyroid artery (see Figure 58.8). The superior laryngeal artery arises from the superior thyroid artery and passes deep to the thyrohyoid muscle. Together with the internal branch of the superior laryngeal nerve, it pierces the thyrohyoid membrane to supply the larynx. The superior laryngeal artery can be injured in endoscopic laryngeal laser surgery as it enters the paraglottic space at the anterior end of the aryepiglottic fold. Therefore, meticulous care to ensure haemostasis must be taken during supraglottic endoscopic surgical resections. The inferior laryngeal artery arises from the inferior thyroid artery at the level of the lower border of the thyroid gland and ascends on the trachea with the recurrent laryngeal nerve. It enters the larynx beneath the lower border of the inferior constrictor to supply the larynx. The cricothyroid artery is a branch of the superior thyroid artery and passes across the upper part of the cricothyroid ligament to supply the larynx. This ligament is penetrated by the branches (up to five) of the cricothyroid artery, which can be injured during cricothyroidotomy or endoscopic resection of anterior commissure cancers.
Transoral robotic surgery in patients with stage III/IV hypopharyngeal squamous cell carcinoma: treatment outcome and prognostic factor
Published in Acta Oto-Laryngologica, 2019
Young Min Park, Da Hee Kim, Min Seok Kang, Jae Yol Lim, Yoon Woo Koh, Se-Heon Kim
Treatment of cervical lymph nodes was performed simultaneously with that of primary site tumors. Ipsilateral selective neck dissection was performed for N0 cases, and ipsilateral modified radical neck dissection was performed for N + cases. The feeding artery (superior laryngeal artery) was prophylactically ligated in the neck to prevent severe bleeding during neck dissection or after surgery.
Is there a role for ultrasonic surgery in transoral laryngeal cancer resections?
Published in Expert Review of Medical Devices, 2019
Giancarlo Tirelli, Nicoletta Gardenal, Annalisa Gatto, Pierluigi Bonini, Margherita Tofanelli, Mario Marcos Fernández-Fernández
However, very few papers have examined its validity in the larynx. Salami et al. [26,27] investigated the efficacy and applicability of the US in open pharyngolaryngectomies and total laryngectomies, confirming the benefit of the tool in terms of reduced bleeding, shorter operative time, less seroma formation, and better wound healing also in this setting. Although they observed a lateral thermal spread limited to 1.5 mm in their series, they stated that high-power ultrasonic dissection may result in considerable heat production and collateral tissue damage, especially when the activation time exceeds 10 s. While well acknowledged in open surgery, the use of ultrasonic instruments has especially transformed endoscopic surgery. Saetti et al. [28] reported three cases of supraglottic laryngopharyngeal carcinoma treated transorally with ultrasonic forceps with good outcome. Compared to the CO2 laser, the US helped to reduce the cutting time and rapidly dissect the pre-epiglottic space up to the hyoid bone, coagulating at the same time the vessels at the base of the tongue; furthermore, it can dissect aryepiglottic and pharyngoepiglottic folds and simultaneously ensure hemostasis of the superior laryngeal artery branches. In 2015, Fernández-Fernández et al. [23] reported a series of pharyngolaryngeal cancer treated with the US transorally. They achieved a complete and safe transoral resection with US but had to stop in proximity to the vocal folds and switch to the laser because the US jaws were too bulky and not designed for such a fine resection. The same group described, in 2016, a minimally invasive transoral technique for total laryngectomy, with the benefit of lowering local morbidity and complications, in particular in irradiated patients [29]. In this instance, ultrasonic energy played a crucial role in managing bleeding in such a narrow space and the superior laryngeal pedicle. Mannelli et al. [30] investigated, in an ex-vivo model, the potential prognostic impact of different scalpels on laryngeal resection margin status. They confirmed that electrocautery causes the most widespread thermal damage with respect to the US and CO2 laser. However, when estimating mucosal shrinkage measured bidimensionally from a ‘probe’ margin, the US showed the highest loss of readable tissue. This can result in both false-positive and false-negative margins (for direct destruction of malignant cell clusters near the margin). The same authors interestingly found a higher number of positive and close margins in open supracricoid laryngectomies performed with the US with respect to the cold knife but the same local control of disease, suggesting that the choice of the device can alter the assessment of margins [31].