Surgical Anatomy 2 Vol Set: The Embryologic & Anatomic Basis of Modern Surgery (Skandalakis, Surgical Anatomy 2 vol set)

129 Pages·2004·2.49 MB·English

by  John E. Skandalakis

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Skandalakis' Surgical Anatomy > Chapter 5. Larynx >
HISTORY
The anatomic and surgical history of the larynx is shown in Table 5-1.
Table 5-1. Anatomic and Surgical History of the Larynx
Aretaeus ca. 100The earliest reference to laryngeal cancer
A.D.
Galen ca. 200Described malignant ulceration of the throat. Stated that
A.D. larynx has three cartilages: shield (thyroid), ladle
(arytenoid), and ring (cricoid). Described strap muscles.
Leonardo Sketched and described larynx
Da Vinci
(1451-1519)
Fabricius of 1600 Discussed actions of intrinsic and extrinsic muscles of
Padua human and animal larynx
Casserius 1601 Wrote that the posterior cricoarytenoid muscles are
considered to open the glottis
Boerhaave 1688 Described "cancerous angina"
Morgagni 1732 Reported two autopsy cases of laryngeal carcinoma
Dodart 1709- Compared action of glottis to playing of oboe
1719
Santorini 1724 Discovered corniculate cartilages (of Santorini)
Winslow 1732 Discussed action of laryngeal muscles
Ferrein 1741 First use of term "vocal cords"
Leverett 1743 Examined throat using bent mirror; used snare to remove
polyps
Bertin 1745 Disagreed with Ferrein, naming structures "folds"
Camper 1767 Discovered cuneiform cartilages
Pelletan 1778 Split larynx to remove piece of meat
Wrisberg 1780 Claimed discovery of cuneiform cartilages (of Wrisberg)
Astley early Removed large tumor of the epiglottis (supraglottic partial
Cooper 19th laryngectomy)
century
Bozzini 1807 Claimed to visualize the larynx with a double cannula
using an angled mirror, wax candle, and reflector
Caron 1808 Performed first successful tracheostomy in a child
Desault 1810 Performed or suggested a thyrotomy by transecting the
midline of the larynx from within outward
midline of the larynx from within outward
Magendie 1822 Studied physiology of larynx
Babington 1829 Presented the first effective laryngoscope
Albers 1829 Experimented with total laryngectomy
Lauth 1835 Identified conus elasticus and several ligamentous bands
Trousseau 1837 Described 4 types of laryngeal phthisis (chronic laryngeal
& Belloc alterations)
Trousseau 1837 First to use tracheostomy for laryngeal cancer
Green 1846 Wrote A Treatise on Diseases of the Air Passages.
Advocated application of silver nitrate solution for
treatment of laryngeal diseases.
Pratt mid Successful resection of an epiglottic tumor
19th
century
Kronlein mid Promoted lateral subhyoid or suprahyoid pharyngotomy
19th
century
Buck 1851 Performed first laryngofissure in the United States
Garcia 1855 Visualized his own glottis; called "Father of Laryngology"
Krackowizer 1858 Introduced laryngoscopy to North America
Van Türck, 1860 Introduced mirror laryngology
Czermak
Lewin 1861- Reported removal of laryngeal tumor by indirect
1862 laryngoscopy
Avery 1862 Used a type of laryngoscope for 18 years
deSilva 1867 Reported permanent cure of carcinoma by laryngofissure
Solis-Cohen
Czerny 1870 Tested laryngectomies on dogs
Luschka 1871 Accurately described laryngeal anatomy
Mackenzie 1871 Developed surgical manipulation of the larynx with curved
laryngeal forceps guided visually by mirror laryngoscopy
Billroth 1873 Performed first human laryngectomy for cancer
Bottini 1875 Performed first completely successful laryngectomy
Isambert 1876 Suggested classification into intrinsic, extrinsic, and
subglottic varieties of laryngeal carcinoma
Cornil, 1876 Described laryngeal cancer as an extremely rare disease
Ranvier
Billroth 1878 Reported first vertical hemilaryngectomy
Krishaber 1879 Classified laryngeal tumors as intrinsic and extrinsic;
Krishaber 1879 Classified laryngeal tumors as intrinsic and extrinsic;
recognized intrinsic are slow growing and extrinsic have a
more malignant course and early lymphatic invasion
Störk 1880 "[C]arcinoma is rarely found limited to the larynx and
most frequently invades it from the mucous folds between
the epiglottis and the tongue, or the epiglottis and the
esophagus."
Butlin 1883 Noticed that intrinsic carcinoma was more frequent than
extrinsic and the most common origin was the true vocal
cords. Preponderance of intrinsic cancer was
subsequently verified by Semon (136 of 212 cases),
Chevalier Jackson (98 of 141), Tucker (144 of 200),
Schmiegelow (36 of 48).
Kobler 1884 Used cocaine as local anesthetic
Elsberg 1886 First to describe endoscopic removal of vocal cord
carcinoma
Kirstein 1895 Used direct laryngoscopy
Föderl 1899 Performed first tracheohyoidoepiglottopexy
Semon 1903 Reported partial extirpation of the larynx
Crile 1906 Described radical surgical removal of neck lymphatic
tissue
Gluck and 1911 Adopted Crile's technique.
Sorenson 1922 Performed 160 total laryngectomies.
Trotter 1913 Described partial practical pharyngolaryngectomy
Jackson 1915- Created instrument that permitted examination of the
1939 larynx in toto. Stated that children do not outgrow chronic
laryngeal stenosis.
Masson and 1924 First description of mucoepidermoid tumors
Berger
Suchanek 1925 First description of laryngeal Schwannoma
Abrikossoff 1926 First description of granular cell tumor of larynx
Lynch 1929 First description of pleomorphic adenoma
Colledge 1930 First description of laryngeal neurofibroma
Mackenty 1934 First description of malignant lymphoma of the larynx
Looper 1938 Described use of hyoid bone in cricoid framework
expansion to treat subglottic stenosis
Watson 1942 Performed mediastinal dissection
Alonso 1947 Performed two-stage supraglottic laryngectomy
Hofmann 1950 Described intravestibular horizontal partial laryngectomy
Saguez
Saguez
Lapido et al. 1968 Described successful animal use of thyrochondroplasty
flap
Goldman et 1969 Reported first carcinoid of larynx
al.
Laitman and 1971- Studied comparative upper respiratory anatomy of apes,
Lieberman 1982 hominids, and modern humans
Grahne 1971 Described Réthi procedure (vertical division of posterior
lamina of cricoid cartilage)
Jako 1972 Described laser surgery on vocal cords of dogs
Fearon and 1972 Used pedicled and free grafts of thyroid cartilage to
Cotton expand arch of anterior lumen
Mozolewski 1975 Created arytenoid vocal shunt
Montgomery1975 Sutured vocal cords to prevent aspiration (glottic closure
procedure)
Singer and 1980, Developed tracheoesophageal puncture to restore voice
Blom 1981 after laryngectomy
Hirano 1981, Studied intrinsic laryngeal muscles
1991
Holinger et 1987, Studied congenital subglottic stenosis and
al. 1989 laryngomalacia
Quiney et 1989 Studied laryngeal papillomatosis
al.
Kantor et al. 1991 Proposed videomicrolaryngoscopy
Andrea and 1994 Introduced microendoscopy
Dias
History table compiled by David A. McClusky III and John E. Skandalakis.
References for History Table
Andrea M, Dias O. Atlas of Rigid and Contact Endoscopy in Microlaryngeal
Surgery. Philadelphia: Lippincott-Raven, 1995.
Fink BR. A brief history of ideas about the larynx. In: Fink BR. The Human
Larynx: A Functional Study. New York: Raven, 1975, pp. 1-15.
Kleinsasser O. Tumors of the Larynx and Hypopharynx. New York: Thieme,
1988.
Myer CM III, Cotton RT. Historical development of surgery for pediatric
laryngeal stenosis. ENT Ear Nose Throat J 1995;74:560-562.
Silver CE. Historical aspects. In: Silver CE, Ferlito A. Surgery for Cancer of the
Silver CE. Historical aspects. In: Silver CE, Ferlito A. Surgery for Cancer of the
Larynx and Related Structures (2nd ed). New York: Churchill Livingstone, 1996,
pp. 3-12.
Whicker JH, Devine KD. The commemoration of great men in laryngology. Arch
Otolaryngol 1972;95:522-525.
Yanagisawa E, D'Agostino. The larynx. In: Lee KJ (ed). Essential
Otolaryngology (7th ed). Stamford CT: Appleton & Lange, 1999, pp. 791-858.
EMBRYOGENESIS
Normal Development
The respiratory primordium appears in the floor of the foregut in the fourth week
of gestational life. The larynx begins as a slitlike diverticulum of the primitive
pharynx (Fig. 5-1A).
Fig. 5-1.
Development of the larynx. A, In the 4-week-old fetus, the larynx develops on
the proximal end of the laryngotracheal groove. B, In the 5-week-old fetus,
paired arytenoid swellings are found lateral to the laryngeal aditus. The anterior
midline swelling (the future epiglottis) is a derivative of the hypobranchial
eminence. C, In the 6-week-old fetus, the arytenoid swellings have migrated
medially and toward the tongue, and the laryngeal aditus has become T-
shaped. The laryngeal lumen is only a slit. D, In the 10-week-old fetus, the
laryngeal cartilaginous and muscular structures have formed from the fourth and
sixth branchial arches. (From Moore KL, Persaud TVN. The Developing Human,
6th ed. Philadelphia: WB Saunders, 1998; with permission.)
Between the fifth and sixth weeks three swellings appear at the laryngeal aditus.
An anterior swelling, which is probably a derivative of the hypobranchial
eminence from the fourth arch, forms the future epiglottis. Then two lateral
arytenoid swellings appear (Fig. 5-1B). The arytenoid swellings, which are
derived from the sixth branchial arch, move medially and form a T-shaped
2,3
aperture (Fig. 5-1C).
The laryngeal lumen becomes occluded at 8 weeks gestational age as a result of
epithelial proliferation. Recanalization occurs during the tenth week (Fig. 5-1D).
The formation of the vocal and vestibular folds is related to condensation of
mesenchyme. The laryngeal cartilages develop from the mesenchyme of the
branchial arches. The thyroid cartilage develops from the fourth arch as two
lateral plates meet in the midline. The intrinsic laryngeal muscles develop from
2,4
the mesoderm of the fourth and sixth arches.
5
We agree with O'Rahilly and Müller that possible relationships between the
developing larynx and the pharyngeal arches and pouches are obscure.
For more information on the embryology of the larynx, please consult Embryology
6
for Surgeons by Skandalakis and Gray.
Congenital Anomalies
Certain congenital laryngotracheal anomalies occur because of problems during
embryogenesis. These include laryngeal atresia, laryngeal webs, subglottic stenosis,
and laryngotracheal clefts.
Laryngeal atresia occurs if the endolarynx fails to recanalize. Immediate tracheotomy
is required for survival.

Laryngeal webs occur when the epithelium partially fails to resorb. A weblike mass
may appear at the glottic level, often with significant subglottic extension.

Subglottic stenosis is a deformity in the development of the normal cricoid cartilage
(sixth branchial arch).

Laryngotracheal cleft results from a failure to form the tracheoesophageal septum.

Immature teratomas of the larynx are very rare. They are composed of multiple
tissues foreign to the part of the body in which they arise. Complete surgical excision
of the teratoma is advised because of the possibility of malignant degeneration.7

8
We quote from Sichel et al. :
Congenital malformations of the larynx are relatively rare but may be life-
threatening. The most common causes include laryngomalacia, vocal cord
paralysis, and subglottic stenosis. ...[S]urgical procedures...include
supraglottoplasty for cases of severe laryngomalacia, in which relief of respiratory
symptoms has been shown to occur in excess of 80% of cases. Complication rate
is low, although postoperative death has been reported. Failure usually occurs in
patients with concomitant airway abnormalities including pharyngomalacia. Vocal
cord lateralization for vocal cord paralysis with airway compromise is achieved by
means of arytenoidopexy or arytenoidectomy, using the lateral approach.
Arytenoidectomy also can be performed using laryngofissure or endoscopic laser
excision. Subglottic stenosis is the 3rd most common congenital anomaly. Anterior
or multiple cricoid splitting with cartilage graft interpositioning is usually performed.
The success rates for these procedures has been shown to be approximately