Imaging larynx 1st part laryngeal anatomy ct mri dr ahmed esawy Laryngomalacia Ductal retention cyst Cystic hygroma Bifid epiglottis Vocal cord paralysis Web and atresia Interarytenoid web Posterior laryngeal cleft Cri-du-chat syndrome Cong. Subglottic stenosis Subglottic hemangioma Web & atresia Cysts Croup Epiglottic Enlargement Epiglottitis Squamous cell carcinoma is mucosal disease Glottic carcinoma subglottic carcinoma supraglottic carcinoma virtual laryngoscopy vocal cord paralysis 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

2. Dr. Ahmed Esawy
MBBS M.Sc MD

4. 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.

5. • 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

8. 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

9. 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

10. Laryngeal skeleton
Consists of
the paired
– arytenoid,
– corniculate
– cuneiform cartilage
the unpaired
– thyroid
– cricoid
– epiglottic cartilages

12. Laryngeal
Cartilages
Anterior view
Posterior view
Epiglottis
Hyoid bone
Thyroid C.
Arytenoid C.
Cricoid C.

13. Laryngeal
Cartilages
Lateral view
Sagittal
section
Epiglottis
Hyoid bone
Thyroid C.
Arytenoid C.
Cricoid C.

14. • 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.

15. 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

16. 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

17. • : 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.

18. Thyriod cartilage
• Largest cartilage
• Bilateral cartilage plate (lamina)
• Superior cornua (horns)
• Inferior cornua (horna)
• Notch
• Laryngeal prominence

19. Variation in thyroid (large arrows) an cricoid
(small arrows) cartilage mineralization

20. 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

21. • 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.

22. • 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.

25. Supraglottis boundaries
• tip of the epiglottis,
• inferiorly to the laryngeal ventricle

26. The supraglottis contents
• the epiglottis
• Glossoepiglottic folds
• valleculae
• aryepiglottic folds
• false vocal cords,
• arytenoid cartilage.
• Pyriform fossap

27. epiglottis
Thin leaf-shaped cartilage
Anterior border supraglottic larynx
Lingual and laryngeal surfaces
Free portion and base
Preepiglottic space
filled with loose areolar tissue

28. epiglottis

29. The supraglottic larynx

30. • A: The suprahyoid portion of the epiglottis (white arrow) is
seen posterior to the valleculae and anterior to the laryngeal
vestibule.

31. 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.

32. • Calcification in epiglottic cartilage, an unusual
finding in this elastic cartilage (arrow).

33. The supraglottic larynx
FVC

34. 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

35. The supraglottic larynx
FVC

36. The supraglottic larynx
FVC

37. • 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.

38. Ventricle
True cord=1
False cord=2
E=epiglottis
H=hyiod bone
ventricle (arrowhead)

39. Ventricle
True cord=1
False cord=2
T =thyriod cartilage
ventricle (arrowhead)

40. ventricle
Arrows, laryngeal
ventricle; A, arytenoid
cartilages; CR, cricoid
cartilage.

41. cuneiform cartilage
• White arrowhead,
cuneiform
cartilage. Faintly
visible corniculate
cartilage (black
arrowhead) just
cephalad to
arytenoid cartilage.
Arrow, aryepiglottic
fold; P, pyriform
sinus.

42. 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

43. Cricoid & Arytenoids

44. Arytenoid cartilages

45. Glottis ‫الحنجرة‬ ‫فتحة‬
• The glottis is made up of the
• true vocal cords
• anterior
• posterior commissures

46. True focal cord
• Composed of
• Vocal ligament
• Vocalis muscle
• Mucous memberane
• 9-10 mm thickness
• Muscular density

47. True focal cord
• Anterior comissure
• Immovable anterior junction
• Attches to inner perichondrium
of thyriod cartilage
• posterior comissure
• Midline mucosal noth between
aryteniods

48. 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

49. • Other land mark is change of air
cavity from multiple to single cavity
• True vocal cord should be
symmetrical in centralized patient

50. • True focal cord attach to base of
aryteniod cartilage
• False focal cord attach to apex of
aryteniod cartilage

51. Larynx true focal cords

52. •
• 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.

53. Larynx true focal cords

54. • 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).

55. subglottis
• Where is the subglottis?
• extends from the undersurface of
the true vocal cords through the
inferior surface of the cricoid
cartilage

56. Subglottic larynx

57. Cricoid cartilage
• Foundation of the larynx
• Complete signet ring
• broader posteriorly than anteriorly
• Articulates with inferior horn of
thyriod cartilage
• Articulates with base aryteniod

58. Cricoid & Arytenoids

59. Cricoid cartilage

60. Subglottic larynx

61. spaces
• Paraglottic
• preglottic

62. • 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;.

63. hypopharynx
• Posterior pharyngeal wall
• Pyriform sinuses
• Post criciod region

64. hypopharynx
• Two region of have important relation to larynx
‘ the pyriform sinuses and postcriciod region

65. 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

66. post cricoid
region
• The post cricoid region is that lower area
of the hypo pharynx that covers the
posterior aspect of the criciod cartilage