Using CT to Localize Side and Level of Vocal Cord ... Conus elasticus is a fibroelastic membrane which extends from vocal ligament of true vocal cord to cricoid. The left true and false vocal cords were normal and both vocal cords moved normally. Department of Diagnostic Radiology, College of Medicine, Pusan National University, Korea. Vocal cord is laterally displaced in recurrent laryngeal nerve palsy. The thyroarytenoid (vocalis) muscles attaches to the lower anterior surface of the arytenoid, forming the bulk of the true vocal cord. of vocal cord impairment, including adduction or medial deviation of the vocal cord and aryepiglottic fold, rotation of the arytenoid cartilage, atrophy of the true vocal cord, or enlargement of the piriforna sinus, vallecula, or laryn- geal ventricle. the true vocal cord, and does not impair cord mobility, endoscopic surgery with the use of a carbon dioxide laser for excision is preferred over open surgical approaches such as midline thyrotomy with cordectomy (26). There is no perichondrium at that point, so the fibers extend directly from the vocal ligament into the cartilage. Ortner's syndrome, also known as cardio vocal syndrome [1], is a rare entity characterized by left recurrent laryngeal nerve palsy resulting from cardiovascular pathologies. 9. It is rarely caused by intralaryngeal lesions. Reports were further reviewed for the pres- It arises in one or both of the vocal cords and may extend into the ventricle of Morgagni, false cords, and the adjacent structures; that is, cancer of the endolarynx. The more superiorly placed false vocal fold has a more blunted medial surface. The move- The anterior commissure is an important anatomic landmark where the fibers of the vocal ligament directly pierce the thyroid cartilage. Vocal cord paralysis (VCP) occurs when there is impaired function of either CN X or the RLN. The true vocal cords appeared as 2-paired triangular hypoechoic structures . Vocal cord lesions, also known as vocal fold lesions, are benign (noncancerous) growths that include nodules, polyps, and cysts. Vocal cord cancer is very closely linked with a history of smoking, though nonsmokers may get vocal cord cancer as well. BACKGROUND AND PURPOSE: With a 64-channel multidetector row CT, imaging acquisition during speech, swallowing, or phonation has become feasible. The glottis includes the true vocal cords, the anterior commissure and the posterior commissure. The glottis includes exclusively the true vocal cords, paraglotic space and anterior and posterior commissures.. The residual true vocal cord and the surgically Radiology #{149} 685 invasion by tumor, which was manifest on CT as an asymmetric soft-tissue mass adjacent to the trachea (Fig. Carcinoma in situ within the vocal cords often is treated surgically . The narrowing of the subglottic lumen alters the radiographic appearance of the tracheal air column, which resembles a steeply pitched roof or a church steeple. true vocal cords on computed tomography. Since the 1920's, radiation therapy, as well as surgery has been accepted as a useful means of dealing with this disease (1). Volume rendering technique provide us with radiologic images that resemble an homogeneneous double contrast static pharyngolaryngogram in which we can depict important anatomic landmarks for diagnosis of laterocervical diverticula (true vocal cord, false vocal cord, laryngeal ventricle, thyroid cartilage, hyoid bone) (Fig 2, Fig 3). On cross-sectional imaging, the false vocal folds are easily discriminated from the true cords by submucosal presence of fat in the former. A key component of the imaging assessment is to define the three anatomical sites of supraglottis, glottis and subglottis. PURPOSE: To analyze the causes of vocal cord fixation in laryngeal cancer and to demonstrate its spiral CT findings. Left true vocal cord Results of 1 and 2 specimens: invasive epidermoid carcinoma of the Malpighian . The base of the arytenoids projects the vocal processes anteriorly, that attach the vocal ligament running along the inner margin of true vocal cords. This procedure is often complicated by laryngeal stenosis and aspiration. After surgery the cord re- Many articles have been written describing tomographic exploration of the physiology of the larynx during . Group Ill: Four patients had CT findings that mimicked tumor recur- rence. Incisional biopsy specimens from within the 1. carcinomaofthevocal cord. 1c). 2 , Jorge Ceballos , M.D. These are the true and false vocal cords or folds. It may be a first sign of extensive and severe pathology. Tomographic Aspect of Paralysis of the Vocal Cords 1 Roberto Calderon , M.D. Answer choices: 1. Isolated EMP of the true vocal cord is a very rare lesion, and only 9 cases were reported in the English medical literature, but none of them had regional lymph node . The false vocal cords are not involved. Together they form part of the glottis, the V-shaped aperture through which air passes. Vocal cord nodule. Vats et al. - During phonation, the arytenoid cartilages slide medially allowing the true vocal cords to oppose each other. It manifests early due to hoarseness of voice and rarely metastasizes due to the poor lymphatic drainage of the glottis. 8).Anteriorly both vocal cords meet close to the medial part of the posterior surface of the thyroid . Complicating the use of these findings is the observation that axial CT scans often are not properly aligned in the plane of the true vocal cords; as a result, partial visualization of por-tions of the ventricles, true vocal cords, and the subglottic larynx may be encountered on spe-cific images. cords and ventricles. 5). Indirect laryngoscopy, flexible fibrooptic laryngoscopy, CT, and MRI are all modalities used for diagnosis. Vocal cord paralysis (VCP) may be caused by a variety of mediastinal disease entities, including various neoplastic, inflammatory, and vascular conditions, and may be the presenting symptom of an otherwise clinically occult disease. Fifth sign is a thickening and medial position of the aryepiglottic fold compared to the normal side (fig 2c). If there had been vocal cord impaired mobility and PGS invasion at CT scan more advanced disease with T2 extension and stage II would result. Although plain-film radiography, fluoroscopy, and CT can evaluate vocal cord mobility, abnormal vocal cord motion is generally diagnosed by laryngoscopy (Fig. 1a). Clinically, vocal cord mobility is impaired but not fixed. reported on the use of ultrasound in the frequency of 10-30 MHz in the diagnosis of vocal cord disorders. Vocal cord paralysis is a relatively common entity, usually resulting from a pathologic process of the vagus nerve or its recurrent laryngeal branch. However, a fullness of the paralyzed vocal cord was seen in only 45% of our patients. 1 True-positive result on positron emission tomography (PET)-computed tomography: patient with tongue base cancer, with marked differential vocal fold uptake greater on right than left on (a) fused and (b) PET-only image . The true vocal cords are formed by the thyroarytenoid muscles, whose medial fibers are named "vocalis muscle" and are located slightly lateral to the vocal ligament (Fig. . 4 M. D. Anderson Hospital for Cancer Research, Houston 6, Texas Excerpt Tomographic study of laryngeal paralysis has received little mention in the literature. Sagittal graphic of midline larynx shows laryngeal ventricle, air-space which separates false vocal cords above with true vocal cords . Case Discussion This case shows a laryngoscopic view of vocal fold polyp. Start studying Figure 36.2 - Larynx. Until now there was no injectable material strong enough for the job," said Guangyu Bao, one of the lead developers of the new material, in a McGill announcement. If the lesion extends off of the true vocal cords, then the fields are accordingly enlarged. A polypoidal lesion is seen arising from anterior aspect of left vocal fold close to the anterior commissure. The glottis itself is composed solely of the true vocal cords and is the narrowest point of the airway. Contrast-enhanced computed tomography (CT) of the neck was performed with a shield protecting the abdomen and pelvis. Because the typical paralyzed vocal cord fails to completely abduct during quiet breathing, one might expect that the most common imaging finding would be asymmetry in the appearance of the true vocal cords. Histopathological diagnosis. The supraglottic larynx… Anatomy: Three levels of Larynx (from base of Tongue, down to trachea) Supraglottis ( Tongue base to above true Vocal Cords) Protected by Hyoid Bone, Thyroid cartilage. Such diseases include mitral valve disease, septal defects, thoracic aortic aneurysm, aneurysm of the ductus arteriosus or patent ductus arteriosus and pulmonary artery . In this study, we reviewed the CT and/or MR images of 20 patients with vocal cord paralysis, 4. The true vocal cords, which is made up the vocal cord ligament and vocalis muscle attach to the TC anteriorly and the arytenoid cartilage posteriorly. MRI was first performed to assess the origin and extent of the lesion and it revealed a T1-weighted hypointense and T2-weighted hyperintense contrast enhancing lesion within the lamina of the right thyroid . bulk of the true vocal cord. Arytenoid dislocation is common cause for vocal cord palsy. Unilateral vocal fold paralysis results in complete glottic incompetence. 2 C). DURHAM, NORTH CAROLINA EARLY squamous cell carcinoma ofthe vocal cords isaradiocurable disease and, inmost cases, radiation therapy isthe A patient presenting with what was believed to be true vocal cord paralysis. (Fig.2). Glottis (true Vocal Cords to 1 cm below) Protected by Thyroid cartilage. of true vocal cord show no change in the location of vocal cord, indicating the fixed vocal cord. It did, however, show an infiltrating tumor of the larynx that was entirely submucosal. the true vocal cord, and does not impair cord mobility, endoscopic surgery with the use of a carbon dioxide laser for excision is preferred over open surgical approaches such as midline thyrotomy with cordectomy (26). The Normal Width of the Anterior Commissure of the True Vocal Cord in Korean Adults Measured by Helical CT Woo Young Lim, Dong Hoon Lim, Jang Il Moon, Yong Seok Ko, Joo Nam Byeon and Jae Hee Oh Department of Diagnostic Radiology, College of Medicine, Chosun University, Korea. Fig 6. Normal laryngeal anatomy. Vertical Hemilaryngectomy. SCC arises from the true vocal fold. Larynx Edward B. Stelow ANATOMY AND HISTOLOGY The larynx lies between the hypopharynx and the trachea. This is staged as T3 for pre-epiglottic extension. - Anteriorly projecting vocal processes extend from the base of the arytenoids to the origin of the true vocal cord. The vagus nerve (CN X) originates from the nucleus ambiguous, located in the medulla oblongata between the medullary pyramid and the inferior cerebellar peduncle (Fig. The true vocal cords are hypoechoic due to their muscular nature (inferior thyroarytenoid muscle and inferior thyroarytenoid ligament). Subglottic carcinoma SCC arises from anywhere below the true vocal fold to the inferior edge of the cricoid cartilage. The availability, affordability, and usability of portable ultrasound units have undergone dramatic improvements. Its inferior tip (apex) is located at the level of the true vocal cords. The arytenoid cartilages articulate superolaterally with the cricoid posteriorly. Biopsy of this nodule showed chondrometaplasia. In the evaluation of the paramedian cord, CT was limited in its . Vocal cord assumes cadaveric position in arytenoid dislocation. ited to the true vocal cords, the top of the field is the midthyroid notch, the bottom is the inferior aspect of the cricoid cartilage, the posterior aspect is 1 cm be - hind the thyroid ala, and the anterior border is 1 to 1.5 cm anterior to the skin. This form of cancer is confined within the cells and has not spread beyond them. Fourteen patients with recurrent laryngeal nerve paralysis (RLNP) were evaluated by laryngography, computed tomography (CT), or both. dicting the presence of vocal cord paralysis. 1996 Mar;34 (3):359-365. AJNR Am J Neuroradiol 31:251-56 Feb 2010 253 Vocal cord paralysis (VCP) can be caused by any process that interferes with the normal function of the vagal nerves or recurrent laryngeal nerves. The level of the true vocal cords is determined by identifying the cricoarytenoid joints on an axial image ( Fig 2a ). CT image at the level of the true vocal cords shows a mass, which is clearly located in the posterior cervical space. The atrophy of the true vocal cord is responsible for the second, seventh and eighth signs. Korean. The detection of atro-phy of the PCA muscle on CT and MR examina-tions in a patient with a history of vocal cord pa-ralysis may be helpful when other imaging features of vocal cord paralysis are absent or equivocal. Fig 5. Axial, reformatted coronal and sagittal images were obtained using 64-channel CT (Brilliance 64; Philips Medical Systems, Cleveland, Ohio). The true cord is inferior to the false cord, with the glottis defined as the horizontal space between the true and false vocal cords. Stephen E. Rubesin MD, in Textbook of Gastrointestinal Radiology (Third Edition), 2008. Trauma is the commonest cause for vocal cord palsy. , In 2007, Huang et al. Although there are a number of VCP mimics and imaging pitfalls, they can generally be avoided by carefully assessing the scan plane and level and evaluating for additional findings. The pre-epiglottic space is filled with fat tissue ( Fig. 106-11). By understand- sonographic landmarks 10 are the true vocal folds, false vocal folds, and arytenoid cartilages the true vocal folds are hyperechoic and the more superficial of the structures the presence and symmetry of vocal fold motion is assessed through eliciting quiet inspiration, an apneic pause, and phonation Only the true vocal cord and the vocalis muscle and tendon are excised (Fig 4). Robust lymphatic drainage to the high deep . It comprises of the anterior cord, the anterior junction of the two vocal cords, the thyroid cartilage and the Broyle's ligament, a fibrous structure connecting the vocal ligaments to the cartilage. There is an irregular tan/white mass with central ulceration (2.5 × 1.5 × 0.9 cm) located in the glottis completely involving the left true vocal cord.