Proposal of landmarks for clamping neurovascular elements during endoscopic surgery of the supraglottic region.
BACKGROUND
Bleeding within the supraglottic region can be a lethal complication after CO(2) laser microsurgery. Our aim was to propose endoluminal anatomical landmarks to locate the superior laryngeal vessels resulting in a safer microsurgery.


METHODS
Endoluminal dissections were made in 22 larynges without laryngeal disease.


RESULTS
The neurovascular structures were in the superior third of a triangle defined by the vocal process, the anterior commissure, and the epiglottic attachment of the aryepiglottic fold. They overlapped in 4 different ways: pattern I (70.4%): superior laryngeal vein (SLV), superior laryngeal artery (SLA), and internal laryngeal nerve (ILN); pattern II (13.6%): SLA, SLV, ILN; pattern III (4.6%): SLV, ILN, and SLA; pattern IV (4.6%): SLA, ILN, and SLV.


CONCLUSIONS
Microsurgery in the supraglottic region may be safer if surgeons are aware of the superior third of the above-defined triangle, "danger area", where the vascular elements of this region are located.
ENT Department. Hospital Ramón y Cajal, Madrid, Spain.
R
R
Souvirón
E
E
Maranillo
T
T
Vázquez
N
N
Patel
S
S
McHanwell
I
I
Cobeta
B
B
Scola
J
J
Sañudo
D059925:Anatomic Landmarks / Q000098:blood supply* / Q000294:innervation; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D004825:Epiglottis / Q000601:surgery*; D005260:Female; D006801:Humans; D007830:Larynx / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D013525:Surgical Instruments / Q000009:adverse effects*