Anatomical Cadaver Study of Endolaryngeal Vascularization: Focus on the Glottis, Supraglottis, and Subglottis From the Transoral Microsurgical Point of View
IntroductionCarbon dioxide laser coagulation during transoral laser microsurgery (TLM) for laryngeal cancer allows control of bleeding from vessels smaller than 0.5 mm. Therefore, larger arteries and veins must be carefully managed by clipping and/or monopolar cautery. The aim of this paper is to de...
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Frontiers Media S.A.
2018-04-01
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Online Access: | http://journal.frontiersin.org/article/10.3389/fonc.2018.00138/full |
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language |
English |
format |
Article |
sources |
DOAJ |
author |
Pietro Perotti Marco Ferrari Nausica Montalto Davide Lancini Alberto Paderno Alberto Paderno Fabiola Incandela Fabiola Incandela Barbara Buffoli Luigi Fabrizio Rodella Cesare Piazza |
spellingShingle |
Pietro Perotti Marco Ferrari Nausica Montalto Davide Lancini Alberto Paderno Alberto Paderno Fabiola Incandela Fabiola Incandela Barbara Buffoli Luigi Fabrizio Rodella Cesare Piazza Anatomical Cadaver Study of Endolaryngeal Vascularization: Focus on the Glottis, Supraglottis, and Subglottis From the Transoral Microsurgical Point of View Frontiers in Oncology larynx anatomy vascularization transoral laser microsurgery bleeding |
author_facet |
Pietro Perotti Marco Ferrari Nausica Montalto Davide Lancini Alberto Paderno Alberto Paderno Fabiola Incandela Fabiola Incandela Barbara Buffoli Luigi Fabrizio Rodella Cesare Piazza |
author_sort |
Pietro Perotti |
title |
Anatomical Cadaver Study of Endolaryngeal Vascularization: Focus on the Glottis, Supraglottis, and Subglottis From the Transoral Microsurgical Point of View |
title_short |
Anatomical Cadaver Study of Endolaryngeal Vascularization: Focus on the Glottis, Supraglottis, and Subglottis From the Transoral Microsurgical Point of View |
title_full |
Anatomical Cadaver Study of Endolaryngeal Vascularization: Focus on the Glottis, Supraglottis, and Subglottis From the Transoral Microsurgical Point of View |
title_fullStr |
Anatomical Cadaver Study of Endolaryngeal Vascularization: Focus on the Glottis, Supraglottis, and Subglottis From the Transoral Microsurgical Point of View |
title_full_unstemmed |
Anatomical Cadaver Study of Endolaryngeal Vascularization: Focus on the Glottis, Supraglottis, and Subglottis From the Transoral Microsurgical Point of View |
title_sort |
anatomical cadaver study of endolaryngeal vascularization: focus on the glottis, supraglottis, and subglottis from the transoral microsurgical point of view |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Oncology |
issn |
2234-943X |
publishDate |
2018-04-01 |
description |
IntroductionCarbon dioxide laser coagulation during transoral laser microsurgery (TLM) for laryngeal cancer allows control of bleeding from vessels smaller than 0.5 mm. Therefore, larger arteries and veins must be carefully managed by clipping and/or monopolar cautery. The aim of this paper is to detail endolaryngeal vascular anatomy and identify areas of possible bleeding during TLM.MethodsWe performed an anatomical study on a series of 11 fresh-frozen human cadavers. After injection of a bicomponent red silicone into the innominate, left common carotid, and left subclavian arteries, 22 hemilarynges were dissected, the course of the supraglottic, glottic, and subglottic vessels were traced after microdissection of the intervening structures, and their size measured at specific landmark points where such vessels are more frequently encountered during TLM.ResultsThree vessels arising from the superior laryngeal artery were identified after its entry point at the level of the thyro-hyoid membrane: (1) the epiglottic artery (EA), documented in 100% of cases, a common trunk dividing into two main vessels (2) the postero-inferior artery (PIA), present in 100% of the specimens, running downward and dividing in a posterior (pPIA), and anterior (aPIA) branches (3) the antero-inferior artery (AIA), present in 95% of our specimens, running downward to the anterior commissure (AC). Two transverse anastomotic networks (TANs) connected the AIA and PIA, both parallel to the vocal muscle, one lateral (present in 100% of cases), and another medial (91% of specimens). Finally, a fourth vessel supplying the glottic plane was found to be the endolaryngeal paracommissural branch of the crico–thyroid artery (PCA), arising from the inferior laryngeal artery and emerging just below the AC, through the crico–thyroid membrane (reported in 100% of the specimens). This vessel anastomosed in 91% of cases with the AIA, through one or both of the TANs.ConclusionThe course of the endolaryngeal arteries, their relationships with adjacent structures, and size at specific landmark points have been herein described in order to provide surgeons with a map to guide them during the steep learning curve of transoral surgery of the larynx, with special emphasis given to TLM. |
topic |
larynx anatomy vascularization transoral laser microsurgery bleeding |
url |
http://journal.frontiersin.org/article/10.3389/fonc.2018.00138/full |
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doaj-ff13c3fb1739421e93ef99ba252a055f2020-11-25T00:17:56ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2018-04-01810.3389/fonc.2018.00138362560Anatomical Cadaver Study of Endolaryngeal Vascularization: Focus on the Glottis, Supraglottis, and Subglottis From the Transoral Microsurgical Point of ViewPietro Perotti0Marco Ferrari1Nausica Montalto2Davide Lancini3Alberto Paderno4Alberto Paderno5Fabiola Incandela6Fabiola Incandela7Barbara Buffoli8Luigi Fabrizio Rodella9Cesare Piazza10Department of Otorhinolaryngology – Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, ItalyDepartment of Otorhinolaryngology – Head and Neck Surgery, University of Brescia, Brescia, ItalyDepartment of Otorhinolaryngology – Head and Neck Surgery, University of Brescia, Brescia, ItalyDepartment of Otorhinolaryngology – Head and Neck Surgery, University of Brescia, Brescia, ItalyDepartment of Otorhinolaryngology – Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, ItalyDepartment of Otorhinolaryngology – Head and Neck Surgery, University of Brescia, Brescia, ItalyDepartment of Otorhinolaryngology – Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, ItalyDepartment of Otorhinolaryngology – Head and Neck Surgery, University of Genoa, Genoa, ItalyDepartment of Clinical and Experimental Sciences, Section of Anatomy and Physiopathology, University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, Section of Anatomy and Physiopathology, University of Brescia, Brescia, ItalyDepartment of Otorhinolaryngology – Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, ItalyIntroductionCarbon dioxide laser coagulation during transoral laser microsurgery (TLM) for laryngeal cancer allows control of bleeding from vessels smaller than 0.5 mm. Therefore, larger arteries and veins must be carefully managed by clipping and/or monopolar cautery. The aim of this paper is to detail endolaryngeal vascular anatomy and identify areas of possible bleeding during TLM.MethodsWe performed an anatomical study on a series of 11 fresh-frozen human cadavers. After injection of a bicomponent red silicone into the innominate, left common carotid, and left subclavian arteries, 22 hemilarynges were dissected, the course of the supraglottic, glottic, and subglottic vessels were traced after microdissection of the intervening structures, and their size measured at specific landmark points where such vessels are more frequently encountered during TLM.ResultsThree vessels arising from the superior laryngeal artery were identified after its entry point at the level of the thyro-hyoid membrane: (1) the epiglottic artery (EA), documented in 100% of cases, a common trunk dividing into two main vessels (2) the postero-inferior artery (PIA), present in 100% of the specimens, running downward and dividing in a posterior (pPIA), and anterior (aPIA) branches (3) the antero-inferior artery (AIA), present in 95% of our specimens, running downward to the anterior commissure (AC). Two transverse anastomotic networks (TANs) connected the AIA and PIA, both parallel to the vocal muscle, one lateral (present in 100% of cases), and another medial (91% of specimens). Finally, a fourth vessel supplying the glottic plane was found to be the endolaryngeal paracommissural branch of the crico–thyroid artery (PCA), arising from the inferior laryngeal artery and emerging just below the AC, through the crico–thyroid membrane (reported in 100% of the specimens). This vessel anastomosed in 91% of cases with the AIA, through one or both of the TANs.ConclusionThe course of the endolaryngeal arteries, their relationships with adjacent structures, and size at specific landmark points have been herein described in order to provide surgeons with a map to guide them during the steep learning curve of transoral surgery of the larynx, with special emphasis given to TLM.http://journal.frontiersin.org/article/10.3389/fonc.2018.00138/fulllarynxanatomyvascularizationtransoral laser microsurgerybleeding |