Anatomy as Applied to Transoral Surgery
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The thyroid cartilage attaches anteriorly to the cricoid cartilage through the cricothyroid membrane and posteriorly through the cartilaginous cricothyroid joints. Inferiorly the lower border of the cricoid cartilage is attached to the trachea by the cricotracheal ligament. The medial and lateral thyrohyoid membranes along with the cricotracheal membrane are termed extrinsic ligaments of the larynx. Within the thyroid cartilage, the endolarynx is supported by intrinsic ligaments which lie beneath the laryngeal mucosal membrane forming an internal framework and connecting the internal laryngeal cartilages together.2 There are two intrinsic fibro-elastic membranes divided by the laryngeal ventricle; the quadrangular membrane, stretching from the arytenoid cartilage to the epiglottis, the free superior border being named the aryepiglottic fold, and the inferior free border forming the ventricular or false vocal fold. The inferior membrane, called conus elasticus, has attachments below to the upper border of the cricoid cartilage, to the mid-point of the thyroid prominence of the thyroid cartilage anteriorly and the vocal process of the arytenoid posteriorly. The free superior edge of the conus elasticus forms the true vocal ligament.
Obstruction of the Respiratory Orifices, Larynx, Trachea and Bronchia
Burkhard Madea in Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
As with the other strangulation mechanisms, the proportion of fractures detected depends on the dissection technique. Haarhoff [70] was unable to verify fractures to the larynx or to the hyoid bone in 40 autopsies of fatal ligature strangulation. Koops et al. [72] identified fractures to the larynx or the hyoid bone in 66 per cent of cases of homicidal ligature strangulation. In his autopsies, Maxeiner [73] established fractures in around 43 per cent of cases following fine dissection of the larynx. Bilateral fractures to the superior cornua of thyroid cartilage were by far the most frequent finding. Cricoid cartilage fractures are extremely uncommon. In rare cases, the hyoid bone is also fractured. Due to the intensive congestion syndrome, the fractures are generally a great deal more perfused than in death by hanging. By contrast, haemorrhaging in the joints of the larynx was determined in less than 10 per cent of cases [74].
Pediatrics
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Manual of Neuroanesthesia, 2017
Anatomically, the pediatric airway is different than adults, which can make airway management challenging. The following is a quick review of the main pediatric airway anatomical differences: Large occiput compared to the rest of the body, large tongue and short mandible.Larynx funnel shaped and elongated.Cricoid cartilage is the narrowest portion of the airway—leading to subglottic stenosis after prolonged intubation due to mucosal swelling from a tight cuffed tube.Short trachea—changes in head position with extension/flexion risk migration of the tube causing inadvertent extubation or endobronchial intubation.
Clinical outcome and comparison between squamous and non-squamous cell carcinoma of the larynx
Published in Acta Oto-Laryngologica, 2020
Le Chen, Weiye Deng, Cai Li, Huiching Lau, Lei Tao, Shuyi Wang, Liang Zhou, Ming Zhang
Chondrosarcoma is the most common type of sarcoma occurring in the larynx, although it reportedly only accounts for ∼0.2% of all laryngeal malignancies [18]. The cricoid cartilage represents the most frequent laryngeal cartilage harboring this tumor (72–75%), followed by the thyroid and arytenoid cartilages and the epiglottis [19]. Chondrosarcoma presents as a submucosal lesion with an intact overlying mucosa on laryngoscopy, and a variably dense, expansile lesion with characteristic calcification is usually seen on imaging examinations, particularly on computed tomography (CT) or magnetic resonance imaging (MRI). The majority of chondrosarcomas of the larynx are low-grade histologically, and grade 1 chondrosarcomas are composed of bi- or multinucleated chondrocytes and include areas of calcification, but characteristically lack mitotic activity (Supplemental Figure 11). Due to the frequent occurrence of laryngeal chondrosarcoma on the cricoid cartilage, specifically the posterior lamina, total laryngectomy is the main treatment approach, whereas the role of radiotherapy is controversial. The OS outcome for this malignancy is favorable and significantly better than that for other laryngeal malignancies [19].
Vocal tract discomfort and voice handicap index in patients undergoing thyroidectomy
Published in Logopedics Phoniatrics Vocology, 2022
Masoumeh Saeedi, Meysam Yadegari, Samira Aghadoost, Maryam Naderi
The thyroid gland is a vital hormonal gland and one of the largest endocrine organs, which plays a major role in the growth, development, and metabolism of the human body [1]. This organ is located in the neck, anterior to the trachea, between the suprasternal notch and the cricoid cartilage. It is made of two lobes that are connected by an isthmus [2]. In thyroid problems, thyroidectomy is a commonly used surgical procedure [3] and vocal dysfunction is a known complication following thyroid surgery [4]. The prevalence of voice alterations in the thyroidectomy varies from 0.77% to 13.3% and is mainly due to recurrent laryngeal nerve injury during the surgery [5,6]. However, alterations in voice quality and vocal symptoms can be observed in the absence of laryngeal nerve injuries [7,8]. Considering the voice complaints, pre- and post-thyroidectomy pre- and post-operatively, it is important to evaluate the voice and vocal symptoms.
A case of dedifferentiated chondrosarcoma arising in the cricoid cartilage that mimicked an aneurysmal bone cyst
Published in Postgraduate Medicine, 2018
Lixiao Chen, Ziwei Yu, Rui Jiang, Pin Dong, Bin Shen, Yu Li
As the patient had originally undergone partial removal of his cricoid cartilage and the tumor during the initial surgery in 2014, we performed a total laryngectomy and partial tracheotomy under general anesthesia during the second admission because of the recurrence of tumor. Direct observation revealed a mass in the lower edge of the cricoid cartilage and that the cricoid cartilage had prolapsed into the lower trachea. The tumor had also infiltrated the laryngeal mucosa and the adjacent skeletal muscle. Histopathological examination of the surgical specimen revealed that the mass in the thyroid and cricoid cartilage was dedifferentiated chondrosarcoma with a giant-cell component (Figure 2), although some parts appeared to be an ABC. Malignant osteoids were not observed in the specimen. Excision of the larynx revealed an irregular gray and red lump (approximately 5 cm × 4.5 cm × 2 cm), which had a medium texture and had invaded the cartilage and bone tissue. The patient did not receive any additional treatment during the follow-up and was free from disease at the 9-month follow-up after the second surgery. Although the patient was unable to speak, he had been able to return to work and live his normal life.
Related Knowledge Centers
- Cartilage
- Trachea
- Larynx
- Thyroid Cartilage
- Arytenoid Cartilage
- Cervical Vertebrae
- Adam'S Apple
- Cricothyroid Ligament
- Thyroid
- Cricotracheal Ligament