Anatomical Study of Meandering and Functions of Human Intralaryngeal Artery

Abstract

Summary: In recent years, partial laryngectomy and partial reconstruction are increasingly intended for conservation of functions of phonation and swallowing. In partial reconstruction, it is important to comprehend morphological characteristics of the blood vessels distributed in the larynx, but there have been only few reports discussing detailed information about them. Previous reports on laryngeal blood vessels have shown that branches of some arteries show remarkable ''meandering''. In the present study, we devised a method for objectively determining the morphological nature, ''meandering'' and assessed functions of the arteries. Intralaryngeal arteries were excised from the larynx of cadavers prepared for practice in anatomy, and images of the ''meandering'' artery were analyzed with NIH Image. The extent of ''meandering'' was expressed mainly as the ratio of the total length of the blood vessel to the distance between the starting point and the end point of meandering. The results showed that there was a significant difference in the extent of meandering between superior posterior and medial posterior branches of superior laryngeal artery. These arteries, which were distributed in the arytenoid region, were found to be of primary importance in partial laryngectomy and partial reconstruction of the larynx.

Proposal of landmarks for clamping neurovascular elements during endoscopic surgery of the supraglottic region

“…One example of this is the exhaustively detailed study published by Dilworth 17. Other more modern studies described the course and distribution of the laryngeal nerves without any reference to the blood supply,16–29 whereas exhaustive studies of the vascular supply11, 12 and other previously published studies have failed to consider the relationships between vessels and nerves 5–15. In our opinion, to the best of our knowledge, there was a need to define the relationships between these structures, not only at their entrance to the larynx, but also from an endoluminal perspective.…”

“…For the above‐mentioned reasons, before CO 2 laser surgery is performed, a sound knowledge of the vascular anatomy of the region is required if the risk for development of complications is to be minimized. However, in the older classical studies and the more recently published reports describing the vascular5–15 and neural16–29 supply of the larynx, no references are made to the topographical relations of the neurovascular structures from an endoscopic approach, an essential aspect when undertaking microsurgery. Therefore, the aim of this study was to describe the topographic relations of the vascular elements within the supraglottic region that could be subjected to damage during endoscopic surgery and to suggest some constant, easily recognizable endoluminal landmarks that enable their reliable localization before surgery.…”

Surgical anatomy of the supraglottic larynx using the da Vinci robot

“…The SLA was identified in this dissection, in both the extralaryngeal and intralaryngeal positions, through the incision along the pharyngoepiglottic fold (Figure and 4). The course and branching pattern of the SLA has been discussed in multiple anatomic studies, but because there has not been standardized naming for the intralaryngeal branches, there is some variation to the findings . In a more recent cadaveric anatomic study, Rusu et al described 5 consistently appearing branches of the normal SLA: the superior branch, the anterior branch, the posteromedial branch, the anteromedial branch, and the posteroinferior branch.…”

Variations in the origin of superior laryngeal artery

“…As per conventional textbooks of anatomy, the superior laryngeal artery (SLA) is derived from the superior thyroid artery (STA). Though variations in the origin of SLA are not very common, the variations when present can acquire great importance in surgical procedures of the larynx like partial laryngectomy, reconstruction surgery and laryngeal transplantation [12]. Knowledge of SLA variations can also be helpful to clinicians for super-selective intra-arterial infusion chemotherapy for laryngeal and hypopharyngeal cancers, as well as in successful radical neck dissection for minimizing postoperative complications in a bloodless surgery [34].…”