M.

Hedesiu 1

1.

Iuliu HatieganuUniversity of Medicine and Pharmacy, Cluj Napoca, Romania

Laryngeal tumors

squamous cell carcinoma - over 90% of

laryngeal tumors
non-squamous cell tumors
adenocarcinoma
adenosquamous carcinoma

Imaging investigation
Endoscopy

MRI

CT

The role of CT
examination
1.

To establish the origin of the tumors

2.

To assess the neoplastic invasion

3.

To provide the useful information for

surgery

The origin of laryngeal tumors and

the patterns of tumors spread
1.

Supraglottic tumors
originating from the epiglottis
primarily invade the preepiglottic space

The origin of laryngeal tumors and

the patterns of tumors spread
1.

Supraglottic tumors
originating from the false cord, laryngeal

ventricle, or aryepiglottic fold

primarily infiltrate the paraglottic space

The origin of laryngeal tumors and

the patterns of tumors spread
1.

Supraglottic tumors
Tumors arising in the arytenoid region
typically infiltrate towards the postcricoid portion of
the hypopharynx.

The origin of laryngeal tumors and

the patterns of tumors spread
1.

Supraglottic tumors
The primary lymphatic spread is directed

toward the superior jugular lymph nodes.

Lymph node metastases are common and
often bilateral.

The origin of laryngeal tumors and

the patterns of tumors spread
1.

Glottic carcinoma
typically arises from the anterior half of the

vocal cord
primarily spreads into the anterior commissure.
Then, easily spread into the supraglottis or

subglottis.

The origin of laryngeal tumors and

the patterns of tumors spread
1.

Glottic carcinoma

Tumor spreads laterally with invasion of the the

thyroarytenoid muscle.
Further spread occurs mainly in a cephalad or caudad
direction
spread via the cricothyroid membrane, into the perilaryngeal
tissue.
Perilaryngeal invasion is often accompanied by destruction
of the lower margin of the thyroid ala and the upper edge of
the cricoid cartilage.

P Som, 2002

The origin of laryngeal tumors and

the patterns of tumors spread
1.

Glottic carcinoma

Subglottic spread is relatively common and may either

occur superficial or deep to the elastic cone.

The origin of laryngeal tumors and

the patterns of tumors spread
1.

Glottic carcinoma

Lymphatic metastases - uncommon as long as the tumor is

confined to the endolarynx.
It the tumor spreads into the soft tissues of the neck the
frequency of lymph node metastases increases significantly.

The origin of laryngeal tumors and

the patterns of tumors spread
1.

Subglottic carcinoma

are uncommon
and tend to spread to the trachea or invade the thyroid
gland and the cervical esophagus.

The origin of laryngeal tumors and

the patterns of tumors spread
1.

Subglottic carcinoma
Lymph node metastases are much more common than in
glottic carcinoma

the paratracheal and pretracheal nodes. These nodes drain

to the lower jugular or upper mediastinal nodes.

What the surgeon should

know?

Supraglottic carcinoma

No supraglottic
Supra or infra-hyoidian extention
laryngectomy
Cricoid cartilage invasion
Bilateral arytenoid invasion
Pair/impair vocal cord fixation
tyroid cartilage fixation
Tumoral extansion into the post-cricoidian region

or into the apex of the pyriphorm sinus

Tumoral invasion of the tongue base more than
1 cm posterior to the cicumvalate papillae
Invasion into de anterior commissure

What the surgeon should

know?

The lower extention of the tumor

Glottic carcinoma
Crico-arytenoidian space invasion
Degree of extension into the tyroid

cartilage
Deep invasion and vocal cord fixation

No vertical
hemilaryngectomy

Message to take home

The radiological report should describe

the key region for tumoral staging and
also, for surgery