larynx imaging 1st part laryngeal anatomy ct mri dr ahmed esawy
TRANSCRIPT
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Dr. Ahmed Esawy
MBBS M.Sc MD
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ANATOMY OF THE LARYNX
• Position:
• The larynx projects forwards in the median part of the front of the neck. It extends from the root of the tongue to the trachea,
• lying opposite the third, fourth, fifth and sixth cervical vertebrae.
• Its upper end opens into the laryngopharynx by the laryngeal inlet, while its lower part is continuous with the trachea at the level of the sixth cervical vertebra.
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• Lateral digital radiograph of neck. Superior and inferior limits of laryngeal examination Indicated by dashed lines. These limits include hyold bone (H) and epiglottis (arrows) superiorly and tracheal rings (arrowheads) inferionly. T - thyroid cartilage.
• hyperextended neck
• centralized
• 3MM
• IV contrast
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Anatomic landmarks Hyiod bone
Laryngeal skeleton
the paired
1- arytenoid,
2- corniculate
3- cuneiform cartilage
the unpaired
4- thyroid
5- cricoid
6- epiglottic cartilages
supraglottic
7- Valleculae
8- Aryepiglottic fold
9- Glossoepiglottic fold
10- Laryngeal vestibule
11- False cord
12- Ventricle
13- Preepiglottic space
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Anatomic landmarks
glottic
14-True cord
15-Thyroaryteniod muscle TAM
16-Anterior commissure
17-Posterior commissure
allthrough
18-Mucosal surface
19-Submucosal surface
20-Paraepiglottic space
21-Pyriform sinuses
22-Recurrent laryngeal nerve
23-Lymphatic drainage
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Laryngeal skeleton
Consists of
the paired – arytenoid,
– corniculate
– cuneiform cartilage
the unpaired – thyroid
– cricoid
– epiglottic cartilages
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Laryngeal
Cartilages
Anterior view
Posterior view
Epiglottis
Hyoid bone
Thyroid C.
Arytenoid C.
Cricoid C.
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Laryngeal
Cartilages
Lateral view Sagittal
section
Epiglottis
Hyoid bone
Thyroid C.
Arytenoid C.
Cricoid C.
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• Lateral radiograph of the neck showing the different structures of the larynx:
• a, vallecula;
• b, hyoid bone;
• c, epiglottis;
• d, pre-epiglottic space;
• e, ventricle (air-space between false and true cords);
• f, arytenoid;
• g, cricoid; and
• h, thyroid cartilage.
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Osification of laryngeal
cartilage • Thyriod criciod most aryteniod hyaline
cartilage
• ossification begins 25 years
• Epiglottis ,apex aryteniod ,corniculate
,cuniform elastic cartilage
• little tendence to calcifiy
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Hyoid bone:
• The hyoid bone is considered a
lingual bone
• The hyoid bone consists of a central
body and paired lateral greater and
lesser horns
• The line of fusion of the body and
greater horns of the hyoid bone
should not be mistaken for a fracture
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• : The valleculae (v) are smaller.
• Normal lucency (white arrowhead) between the body and greater cornus of the hyoid bone is seen. Large arrow, omohyoid muscle; small arrow platysma muscle.
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Thyriod cartilage
• Largest cartilage
• Bilateral cartilage plate (lamina)
• Superior cornua (horns)
• Inferior cornua (horna)
• Notch
• Laryngeal prominence
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Variation in thyroid (large arrows) an cricoid
(small arrows) cartilage mineralization
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Section of the Larynx
Epiglottis
Ventricular bands
Vocal folds
(Glottic area)
Supraglottic
area
Subglottic
area
Sagittal section
Ventricular bands
Ventricle
Vocal folds (Glottic
area)
Coronal section
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• Coronal T1-weighted MR images of larynx. A, B: Successive dorsal images. large black arrow, cricoid cartilage; small black arrow, thyroid cartilage; small black arrowheads, laryngeal ventricle; small white arrowhead, arytenoid cartilage; small white arrow, aryepiglottic fold; P, pyriform sinus; PLS, paralaryngeal space; V, vestibule; S, strap muscles.
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• Sagittal T1-weighted MR image of larynx.
• White arrow, epiglottis;
• white arrowhead, cricoid cartilage;
• black arrowhead, vallecula;
• H, hyoid bone;
• M, mylohyoid and geniohyoid muscles;
• PES, preepiglottic space.
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Supraglottis boundaries
• tip of the epiglottis,
• inferiorly to the laryngeal ventricle
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The supraglottis contents
• the epiglottis
• Glossoepiglottic folds
• valleculae
• aryepiglottic folds
• false vocal cords,
• arytenoid cartilage.
• Pyriform fossap
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epiglottis
Thin leaf-shaped cartilage
Anterior border supraglottic larynx
Lingual and laryngeal surfaces
Free portion and base
Preepiglottic space
filled with loose areolar tissue
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epiglottis
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The supraglottic larynx
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• A: The suprahyoid portion of the epiglottis (white arrow) is
seen posterior to the valleculae and anterior to the laryngeal
vestibule.
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Just above the thyroid notch, the epiglottis (large arrow) has tapered and is not nearly as broad as its suprahyoid portion. A small amount of air (arrowhead) is seen within a minimally dilated left saccule of the laryngeal ventricle. S, infrahyoid strap muscles.
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• Calcification in epiglottic cartilage, an unusual
finding in this elastic cartilage (arrow).
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The supraglottic larynx
FVC
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FALSE FOCAL CORDS
• Above and parallel to true vocal cord
• Attaches to thyriod cartilage and
aryteniod cartilage apex
• Fat density
• Laryngeal ventricle
• (invagination of mucosa between TVC and FVC)
• Laryngeal saccule appendix (2-4) mm
• Projects posteriorly from ventricle
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The supraglottic larynx
FVC
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The supraglottic larynx
FVC
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• The false vocal cord (small arrows),
• level of the base (arrowhead) of the arytenoid cartilage
• thyroid notch (large arrow).
• C, common carotid artery; J, internal jugular vein; S, infrahyoid strap muscle; SCM, sternocleidomastoid muscle.
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Ventricle
True cord=1
False cord=2
E=epiglottis
H=hyiod bone
ventricle (arrowhead)
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Ventricle
True cord=1
False cord=2
T =thyriod cartilage
ventricle (arrowhead)
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ventricle
• Arrows, laryngeal
ventricle; A, arytenoid
cartilages; CR, cricoid
cartilage.
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cuneiform cartilage
• White arrowhead,
cuneiform
cartilage. Faintly
visible corniculate
cartilage (black
arrowhead) just
cephalad to
arytenoid cartilage.
Arrow, aryepiglottic
fold; P, pyriform
sinus.
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Arytenoid cartilages
• Pyramidal shape
• Vocal process - anteriorly
• Apex
• corniculate cartilage in AE folds
• Muscular process laterally
• Articular base inferiorly
• concave
• site on superior border of posterior criciod ring
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Cricoid & Arytenoids
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Arytenoid cartilages
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Glottis فتحة الحنجرة
• The glottis is made up of the
• true vocal cords
• anterior
• posterior commissures
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True focal cord
• Composed of
• Vocal ligament
• Vocalis muscle
• Mucous memberane
• 9-10 mm thickness
• Muscular density
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True focal cord
• Anterior comissure
• Immovable anterior junction
• Attches to inner perichondrium
of thyriod cartilage
• posterior comissure
• Midline mucosal noth between
aryteniods
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Landmarks for true focal
cords • Anterior aryteniod cartilage
• Posterior ring criciod
• Anterior and posterior comissure
• True focal cord muscle density ,
false focal cord fat density
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• Other land mark is change of air
cavity from multiple to single cavity
• True vocal cord should be
symmetrical in centralized patient
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• True focal cord attach to base of
aryteniod cartilage
• False focal cord attach to apex of
aryteniod cartilage
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Larynx true focal cords
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•
• vocal process (small arrowhead)
• the arytenoid cartilage (A), cricoid cartilage (Cr), true vocal cord (small arrows).
• The thyroid lamina have fused anteriorly to form the laryngeal prominence (P).
• The soft tissues at the anterior commissure just posterior to the prominence should normally be less than 1 mm in thickness.
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Larynx true focal cords
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• Enhanced axial T1-weighted MR scan of the neck at the level of the glottis. The glottis is
made up of the true vocal cords (arrows) and the anterior (arrowhead) and posterior
commissures. Also, note the arytenoid cartilages (A), thyroid cartilage (T), and cricoid
cartilage (C).
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subglottis
• Where is the subglottis?
• extends from the undersurface of
the true vocal cords through the
inferior surface of the cricoid
cartilage
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Subglottic larynx
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Cricoid cartilage
• Foundation of the larynx
• Complete signet ring
• broader posteriorly than anteriorly
• Articulates with inferior horn of
thyriod cartilage
• Articulates with base aryteniod
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Cricoid & Arytenoids
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Cricoid cartilage
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Subglottic larynx
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spaces
• Paraglottic
• preglottic
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• The fat-containing preepiglottic space (PES) is seen anterior to the soft-tissue density epiglottis (small white arrowhead) and extends laterally into the paralaryngeal space (PLS) and then posteriorly into the aryepiglottic folds (arrows).
• P, pyriform sinus;
• black arrowhead, superior cornu of thyroid cartilage;
• large white arrowhead, normal spinal accessory lymph node;.
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hypopharynx
• Posterior pharyngeal wall
• Pyriform sinuses
• Post criciod region
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hypopharynx
• Two region of have important relation to larynx ‘ the pyriform sinuses and postcriciod region
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pyriform sinus
• The indent the posterior wall of the
larynx.
• the anterior wall of the pyriform sinus
represent the anterior wall of the
paraglottic space
• the pyriform sinus makes up the
lateral aspect of the AEF
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post cricoid
region
• The post cricoid region is that lower area
of the hypo pharynx that covers the
posterior aspect of the criciod cartilage