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Type:
Educational Exhibit
Keywords:
Education and training, eLearning, Education, MR, CT, Head and neck, Anatomy
Authors:
A. I. Fernández Martín1, N. Delgado Ronda2, E. Dominguez Franjo3, M. Martínez Martínez-Losa4, N. Alegre Borge5, J. Martínez Salazar3; 1Arganda del Rey, MADRID/ES, 2Ávila/ES, 3Arganda del Rey/ES, 4Madrid/ES, 5San Sebastián de los Reyes/ES
DOI:
10.1594/ecr2016/C-0786
Findings and procedure details
HYPOPHARYNX
The hypopharynx extends from the vallecula to the inferior cricoid carilage (cricopharyngeal muscle).
It consists of three regions: pyriform sinus,
postcricoid area or prharygoesophageal junction and posterior hypopharyngeal wall.
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The pyriform sinus consists of an invaginaion of the aryepiglottic folds and the thyroid cartilage.
Its inferior tip (apex) is located at the level of the true vocal cords.
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The postcricoid area or pharygoesophageal junction is the anterior wall of the hypopharynx at the level of the cricoid and extends from the level of cricoarytenoid joints to the lower border of the cricoid cartilage.
It is an area difficult to evaluate with CT or MRI.
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The posterior hypopharyngeal wall continuates the posterior oropharynx wall; it is composed of mucosa and the constrictor muscle.
LARYNX
The larynx is divided into three subsites: supraglottis,
glottis and subglottis.
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The supraglottis extends from the tip of the epiglottis to the laryngeal ventricles.
It contais the vestibule,
epiglottis,
pre-epiglottic fat,
aryepiglottic folds,
false vocal cords,
paraglottic space,
arytenoids cartilages and ventricles.
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The epiglottis is a leaf-shaped flexible cartilage situated into the anterosuperior part of the laryx.
It is seldom calcified.
The epiglottis acts as a lid,
protecting the airway during swallowing and is divided into the free margin (suprahyoid) and the fixed portion (infrahyoid).
The petiole or “stem of a leaf” attaches the epiglottis to the thyroid lamina in conjunction with the thyroepiglottic ligament.
Other connecting structures are the glossoepiglottic fold,
the hyoepiglottic ligament and the pharyngoepiglottic folds that attacht the epiglottis to the tongue in the midline,
the hyoid bone and the oropharynx respendolectively.
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The pre-epiglottic space represents the fat tissue situated anterior to the epiglottis and posterior to the hyoid bone.
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The aryepiglottic folds separate the epiglottis (supraglottis) from the piriform sinuses (hypopharynx).
They project from the superior tip of arytenoid cartilages to inferolateral edge of epiglottis.
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The false vocal cords consist of mucosa lining the laryngeal vestibule.
The aryepiglottic folds are continuated inferiorly by the false vocal cords,
and these by the the paraglottic spaces.
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The paraglottic spaces contain the fat situated beneath false and vocal cords.
Superiorly,
they blend with the pre-epiglotic space.
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The glottis includes exclusively the true vocal cords and anterior and posterior commissures.
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The true vocal cords are formed by the thyroarytenoid muscles,
whose medial fibers are named “vocalis muscle”.
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The point in which both vocal cords meet anteriorly is the anterior commissure.
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The subglottis extends from the undersurface of the true vocal cords to inferior surfaces of cricoid cartilage.
This site comprises the mucosal surface at the level of cricoid cartilage,
which includes the conus elasticus and the quadrangular membrane.
The cricoid,
thyroid and arytenoids cartilages serve as a framework for the soft tissue structures of the larynx.
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The thyroid cartilage is composed of two laminae that meet anteriorly at an acute angle with a notch in the anterior superior aspect.
It acts as a protective shield.
The superior and inferior horns strecht out from the posterior part of the laminae to articulate with the hyoid and cricoid cartilages respectively.
The thyrohyoid ligaments attacht to the superior horns.
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The cricoid cartilage has a ring shape,
only completed at the level of endolarynx.
It consists of a posterior lamina and an anterior arch and its lower border separates the larynx above and the trachea below.
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The paired pyramidal arytenoid cartilages sit on top of the posterior cricoid cartilage (lamina) and move the vocal cords during phonation.
Their vocal processes serve for the attachement of the posterior part of vocal cords.
Their ossification begins by the age of 20.
And as a "picture is worth a thousand words"...let´s convert into images the theoretical knowkedge!
- The CT and plain radiograph images: Fig. 1 ,
Fig. 2 ,
Fig. 3 ,
Fig. 4 ,
Fig. 5 , Fig. 6 ,
Fig. 7 & Fig. 8
- The laryngoscopy images: Fig. 9,
Fig. 10,
Fig. 11,
Fig. 12,
Fig. 13 & Fig. 14
- And MR-laryngoscopy images correlation: Fig. 15,
Fig. 16