Useful landmarks in arytenoid adduction and laryngeal reinnervation surgery.
OBJECTIVE
Knowledge of the location of the muscular process of the arytenoid cartilage and the recurrent laryngeal nerve is essential to performing a successful arytenoid adduction and laryngeal reinnervation surgery. We describe external landmarks useful in locating these structures.


METHODS
Cadaveric laryngeal dissection.


METHODS
Posterior laryngeal dissection was performed in 16 human larynges. The position of the muscular process of the arytenoid was measured bilaterally relative to the inferior and superior borders of the thyroid lamina. The recurrent laryngeal nerve was followed distally from slightly below the level of the cricothyroid joint to its genu where its vertical course changes to an oblique intralaryngeal course.


RESULTS
The muscular process of the arytenoid was usually found halfway between the roots of the superior and inferior cornu of the thyroid lamina. The recurrent laryngeal nerve was found just deep to the cricothyroid joint and lateral to the posterior cricoarytenoid muscle. There were no other nerves in this area.


CONCLUSIONS
This study finds that the superior and inferior borders of the thyroid lamina are useful intraoperative landmarks to locate the muscular process of the arytenoid. The cricothyroid joint provides a good starting point to locate the recurrent laryngeal nerve, which can be identified slightly deeper between it and the posterior cricoarytenoid muscle.
Armin
Bob B
BB
Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. barmin@ucla.edu
Head
Christian
C
Berke
Gerald S
GS
Chhetri
Dinesh K
DK
D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D001193:Arytenoid Cartilage / Q000033:anatomy & histology* / Q000294:innervation / Q000502:physiology; D002102:Cadaver; D003413:Cricoid Cartilage / Q000033:anatomy & histology / Q000294:innervation; D005260:Female; D006801:Humans; D007821:Laryngeal Muscles / Q000033:anatomy & histology / Q000294:innervation / Q000502:physiology; D007830:Larynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012009:Recurrent Laryngeal Nerve / Q000033:anatomy & histology* / Q000502:physiology; D013957:Thyroid Cartilage / Q000033:anatomy & histology / Q000294:innervation