What is an Epiglottis?

Epiglottis: a leaf-like structure on the anterior part of the larynx composed of epiglottis cartilage and mucous membranes. When talking or breathing, the epiglottis is upwards, so that the larynx is opened; when you swallow, the epiglottis is downwards, covering the trachea, so that food or water does not get inside the intake pipe. The leaf-like skin of the cartilage at the back of the tongue prevents food and fluids from entering the trachea when swallowed. When swallowing, the epiglottis descends, covering the throat (the top of the trachea), and the throat simultaneously produces an upward reflective movement, thereby effectively closing the entrance of the trachea.

Epiglottis: a leaf-like structure on the anterior part of the larynx composed of epiglottis cartilage and mucous membranes. When talking or breathing, the epiglottis is upwards, so that the larynx is opened; when you swallow, the epiglottis is downwards, covering the trachea, so that food or water does not get inside the intake pipe. The leaf-like skin of the cartilage at the back of the tongue prevents food and fluids from entering the trachea when swallowed. When swallowing, the epiglottis descends, covering the throat (the top of the trachea), and the throat simultaneously produces an upward reflective movement, thereby effectively closing the entrance of the trachea.

Chinese name

Epiglottis

Nature

Medical

Location

Base of tongue

Location

One of the seven punches

Also known as

Suction door

Provenance

Difficulties

Epiglottic anatomy

The epiglottis is formed by the epithelial cartilage covering the mucous membrane, which is a valve for the throat. Mucosa is covered with epiglottic cartilage. It is located at the base of the tongue and the base of the tongue, and has elasticity and toughness. The upper edge is arc-shaped free, and the lower end is called the epiglottic cartilage stem, which is attached to the inner surface of the thyroid cartilage keratin by the thyroid epiglottis ligament. The epiglottis is innervated by the laryngeal nerve. It is a flap of the larynx. When swallowing, the larynx moves up with the pharynx and moves forward slightly. The pressure of the tongue root downward and downward will close the throat and prevent food from invading the trachea. Children's epiglottis resembles a leaf, and the elasticity of the free edge of the elderly decreases, so it turns inward.

Partial glottic resection of epiglottis cancer

Epiglottic cancer is limited to those with epiglottis or invasion, and can be treated with partial glottic resection. During surgery, the upper 1/3 of the thyroid cartilage, the epiglottis, the anterior space of the epiglottis, and the anterior part of the ventricular zone, such as the removal of one side of the condylar cartilage, can basically restore the full function of the larynx. Methods: 40 patients with epiglottic cancer were treated by supraglottic laryngectomy, and the cases were organized and followed up. According to the UICC 1987 standard, 17 cases were T1, 17 cases were T2, and 6 cases were T4. Results: Twelve patients underwent unilateral cervical lymph node dissection, 1 patient underwent bilateral cervical lymph node dissection, and 7 patients had lymph node metastasis, accounting for 58%. There were no deaths during the perioperative period; 8 patients had mild choking during early feeding, and all patients had their cannulas removed. Postoperative radiotherapy and chemotherapy were performed in 29 patients, accounting for 73%, and the 3-year survival rate was 74%. CONCLUSIONS: Selecting patients with appropriate T grade for superior glottic laryngectomy can achieve satisfactory laryngeal function and prognosis.

Subglottic laryngectomy was first widely reported by Alouso (1947). This operation removes the ventricle, the vestibule of the larynx, the epicondyle, the epiglottis, the anterior space of the epiglottis, and the hyoid bone along the base of the laryngeal ventricle, which is also called horizontal upper laryngectomy. Choosing the right one can remove the condylar cartilage on one side at the same time, and still get satisfactory results.

Indications: Upper glottic cancer T1 and 2 lesions are confined to epiglottis, laryngeal vestibular or epiglottis, without involving the laryngeal ventricle and anterior union; epiglottic cancer invades part of the anterior medial wall of the piriform fossa; cancer of the epiglottis Involving epiglottis on the tongue surface or early cancer of the epiglottis tongue; epiglottic cancer involving one side of the epiglottis and approaching or involving the mucosa of the sacral region and normal sacral cartilage activity.

Contraindications: Tumors involving the larynx, piriform fossa, intercondylar area, posterior annulus, anterior union, thyroid cartilage, and root of tongue.

Surgical steps: Perform a conventional tracheotomy under local anesthesia, insert an anesthesia cannula with a balloon, cut the skin above the flat ring nail to the bilateral sternocleidomastoid muscle, and flip the flap upward along the deep side of the broad cervical muscle. Above the hyoid surface. Patients with or suspected of cervical lymph node metastasis should undergo cervical lymph node dissection first. Enter the pharyngeal cavity, cut off the upper and lower hyoid muscles at the upper and lower edges of the hyoid bone, separate the band muscles downward to expose the thyroid cartilage, cut the cartilage adventitia at the upper edge of the thyroid cartilage, and peel off to the middle of the cartilage to form a base under Perichondrial flap. The large horn of one side of the hyoid bone and the small angle of the hyoid bone are excised, the pharyngeal mucosa is cut into the pharyngeal cavity, and the incision will be pulled forward and outward. Observe the location and extent of the tumor. Cut the hypoglossal membrane down to the upper edge of the thyroid cartilage on the healthy side, and cut forward to the upper middle 1/3 of the front of the thyroid cartilage with a micro chainsaw or scissors. From this point, turn to the outside and cut off the affected thyroid cartilage horizontally. . On the affected side, an incision is made from the upper incision down the posterior edge of the thyroid cartilage and intersects the horizontal incision of the thyroid cartilage. Remove the tumor, cut the epigastric epithelium forward and downward on the healthy side of the condyle cartilage, deep down to the bottom of the laryngeal chamber, and join forward along the undercut of the laryngeal chamber. To prevent injury to the vocal cords, use a small hook to pull up the ventricular band. If the tumor does not involve the iliac cartilage, the contralateral ventricular band can be cut off in the same way, and the anterior joint can be removed to remove the tumor while retaining bilateral iliac cartilage. If the tumor invades the mucosa of the affected iliac region, the lateral iliac cartilage should be excised, and the iliac cartilage and mucous membranes should be cut with a small knife at the posterior, external and internal sides of the affected iliac cartilage. The other leaf is cut forward along the laryngeal at the thyroid cartilage cut, intersecting the anterior incision with the contralateral incision, and the tumor is removed. After sacral cartilage resection, the vocal cords should be moved inward and fixed at the midline of the ring-shaped cartilage plate. The needle should be inserted at the center line of the upper edge of the ring-shaped cartilage plate and passed through the back of the remaining sacral cartilage or the vocal cords. Move to the midline to reduce or avoid postoperative aspiration. Close the pharynx, cut off the pharynx and stop bleeding. The laryngeal chamber mucosa can be sutured with the piriformis marginal mucosa for several stitches. Intermittent suture from the center of the tongue root cuticle to the center of the thyroid cartilage adventitia, and then suture the pharyngeal wall mucosa to the corresponding pharyngeal wall mucosa, pharyngeal wall and tongue base mucosa, middle tongue base mucosa and thyroid cartilage Suture and close the pharyngeal cavity. The band muscles and tongue base muscles are reinforced and sutured, and the skin is sutured. Replace the tracheal tube and bandage the incision.

discuss:

The key to successful glottic resection is to select appropriate patients. Before surgery, indirect laryngoscope, fiber laryngoscope, and CT should be used to determine the location of the tumor and the extent of invasion. If the tumor invades the larynx and vocal cords, the glottis area of the affected side should be removed at the same time; patients with bilateral zygomatic cartilage involvement should be treated with ring-pharyngeal anastomosis; the cancer on the tongue surface of the epiglottis should be removed at the same time. The surgical approach can adopt the hyoid approach, from the hyoid bone into the pharyngeal cavity, pull out the epiglottis, the epiglottis tumor is well exposed, and the tumor is completely removed outside its safety margin. In order to prevent aspiration, those who remove one side of the sacral cartilage should fix the affected vocal cord to the midline so that the contralateral vocal cord is brought into contact with it when swallowing, and the glottis is closed to reduce aspiration. At the same time, a circumpharyngeal muscle incision is helpful to prevent aspiration, cut off the epicondylitis, and pull the ventricular zone to see the laryngeal chamber when the ventricular zone is pulled to reduce the damage to the vocal cords.

Epiglottis related diseases

Epiglottic cysts: also known as laryngeal mucinous cysts, which are more common in the laryngeal mucinous cysts on the tongue surface of the epiglottis. Larger cysts may have a feeling of throat obstruction, hoarseness and difficulty breathing. Laryngoscopy showed a pale red, smooth cyst, and a tan or milky white liquid was aspirated. Treatment can remove most of the capsule wall under laryngoscope.