Anatomy of the Larynx and Tracheobronchial Tree
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in 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.
Head and Neck
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
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.
Complications of Thyroidectomy and Parathyroidectomy
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
The best way to prevent this serious complication is to develop a good understanding of the normal anatomic position of these nerves, including variations that are either natural or caused by a slowly growing goiter. In approximately 20% of cases, the external branch of the superior laryngeal nerve extends inferiorly with the superior thyroid artery to a position at which damage is likely to occur when the blood supply to the superior pole of the thyroid is ligated. During resection of a large goiter, meticulous dissection as close as possible to the capsule of the thyroid, followed by clamping and ligation of individual vessels, will help prevent injury to this nerve, which is often not visualized. The right recurrent laryngeal nerve arises from the vagus in the inferior portion of the neck, passes around the innominate artery, and ascends obliquely in the tracheoesophageal groove until it penetrates the larynx at the level of the inferior horn of the thyroid cartilage lateral to Berry’s ligament. In 1% of patients, this nerve is non-recurrent, traversing directly from the vagus.11 The left recurrent laryngeal nerve arises from the vagus, passes behind the aorta at the level of the ligamentum arteriosum, and then ascends, assuming the same trajectory as the right nerve.
Ultrasound-guided thermal ablation for hyperparathyroidism: current status and prospects
Published in International Journal of Hyperthermia, 2022
Zhiguang Chen, Linggang Cheng, Wei Zhang, Wen He
The average dimensions of each gland are 5 mm × 3 mm × 1 mm (length × width × thickness), and each gland weighs approximately 60 mg [18,19]. The superior gland is relatively fixed and is located in the middle third of the posterior thyroid gland. The final position of the inferior gland changes considerably because of the relatively long descending process, with >50% located at the lower pole of the thyroid gland [20–22]. There are abundant vascular network anastomoses between the parathyroid gland and the pharynx, larynx, trachea, and esophagus. The blood supply to the parathyroid gland mainly comes from the inferior thyroid artery and, in a few cases, from the superior thyroid artery. The venous system of the parathyroid gland is accompanied by the corresponding artery, which flows into the internal jugular vein. Furthermore, the lymphatic drainage of the parathyroid gland is similar to that of the thyroid gland, leading to the deep neck and anterior trachea [23].
Intra-operative vagal neuromonitoring predicts non-recurrent laryngeal nerves: technical notes and review of the recent literature
Published in Acta Chirurgica Belgica, 2021
S. Van Slycke, K. Van Den Heede, K. Magamadov, J.-P. Gillardin, H. Vermeersch, N. Brusselaers
The intra-operative identification of the nerve is optimally performed in the same classic surgical way with attention to certain anatomical reference points such as the ligation of the medial thyroid vein. After retracting the lobe medially, a blunt and careful dissection of the superior thyroid artery of the superior lobe is designated. At that point, we individualise all arterial side branches and ligate them close to the thyroid capsule. Some mild traction on the arterial trunk of the inferior thyroid lobe can obtain us an idea of the course of the RLN. After identification of all these different structures, continuous monitoring of the vagal nerve and intermittent monitoring of the RLN or the NRLN in this particular case can prevent mindless manipulation and iatrogenic damage. In 2004, a study of 6000 thyroidectomies, described 31 cases with a NRLN course (0.5%), and iatrogenic nerve damage was reported in 12.9% of the patients with a NRLN compared to only 1.8% of the patients with a normal anatomical course [5].
An early complication in the donor site of the medial sural artery perforator flap: necrosis of the medial head of gastrocnemius
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Hui-Ju Tsou, Chih-Peng Tu, Yu-Fan Chen, Wen-Teng Yao
A 45-year-old man with a medical history of coronary artery disease, hypertension, and type II diabetes mellitus was diagnosed with right buccal squamous cell carcinoma (cT3N1Mb, stage III). After wide excision, a 12 × 9 cm2 MSAP flap (number of perforators: 2, 8 cm & 12 cm to popliteal crease; length of pedicle: 13 cm) was harvested for reconstruction. The medial sural artery was anastomosed to the right superior thyroid artery in an end-to-end manner, and the concomitant vein was anastomosed to the right internal jugular vein by end-to-side anastomosis. The donor site was covered with STSG, approximately 150 cm2, from his ipsilateral thigh.
Related Knowledge Centers
- External Carotid Artery
- Fascia
- Hyoid Bone
- Omohyoid Muscle
- Platysma Muscle
- Sternocleidomastoid Muscle
- Sternohyoid Muscle
- Sternothyroid Muscle
- Thyroid
- Carotid Triangle