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A rich lymphatic network exists in the inferior surface of the vocal cord

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Abstract

Conservation laryngeal surgery is an increasingly available alternative for the treatment of laryngeal cancer. Understanding anatomy of laryngeal lymph drainage is essential for clinicians to diagnose, grade and surgically manage the laryngeal cancer. Although the lymphatic drainage of the larynx has been extensively studied, few studies revealed the relationship of the lymphatic drainage between various parts of the larynx. The distribution of lymphatic vessels in the inferior surface of the vocal cord also remains unclear. The aim of this study was to investigate the communication of the lymphatic networks between the vocal cord, the supraglottic and subglottic parts of the larynx, paying special attention to the lymphatic drainage of the inferior surface of the vocal cord. Eighteen larynx specimens from 18 fresh fetal cadavers were manually injected with prassion blue solution into the mucosal or submucosal layer of the larynx in order to reveal the lymphatic vessels in the inner larynx. We found that a rich lymphatic network is present in the inferior surface of the vocal cord, and the lymphatic networks in the superior and inferior surfaces of the vocal cord appear as two different patterns. These findings provide an anatomical basis for the design of a partial or conservation laryngeal surgery, particularly when considering the precise resection margin.

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References

  1. Beck C, Mann W (1980) The inner laryngeal lymphatics. Acta Otolaryngol 89:265–270

    Article  PubMed  CAS  Google Scholar 

  2. Bryce DP (1975) The laryngeal subglottis. J Laryng Oto 89:667–685

    CAS  Google Scholar 

  3. Buckley JG, MacLennan K (2000) Cancer spread in the larynx; a pathologic basis for conservation surgery. Head Neck 22:265–274

    Article  PubMed  CAS  Google Scholar 

  4. Dahm JD, Sessions DG, Paniell RC et al (1998) Primary subglottic cancer. Laryngoscope 108:741–746

    Article  PubMed  CAS  Google Scholar 

  5. Freeland AP, Nostrand AW (1975) The applied anatomy of the anterior commissure and subglottis. Can J Otolaryngol 4:644–659

    PubMed  CAS  Google Scholar 

  6. Johner CH (1970) The lymphatics of the larynx. Otolaryngol Clin North Am 3:439–450

    PubMed  CAS  Google Scholar 

  7. Laramore GE, Coltrera MD (2003) Organ preservation strategires in the treatment of laryngeal cancer. Curr Treat Options Oncol 4:15–25

    Article  PubMed  Google Scholar 

  8. Lederman M (1970) Radiotherapy of cancer of the larynx. J Laryngol 84:867–896

    CAS  Google Scholar 

  9. Lin ZH, Cai YE, Wang HE (1990) Lymphatic distribution and ultrastructures of human larynx. Zhonghau Er Bi Yan Hou Ke Za Zhi 1990:275–276

    Google Scholar 

  10. Pressman JJ (1956) Submucosal compartmentation of the larynx. Ann Otol Rhinol Laryngol 65:766–771

    PubMed  CAS  Google Scholar 

  11. Pressman JJ, Dowdy A, Libby R et al (1956) Further studies upon the submucosal compartments and lymphatics of the larynx by the injection of dyes and radioisotopes. Ann Otol Rhinol Laryngol 65:963–980

    PubMed  CAS  Google Scholar 

  12. Saleh EM, Mancuso AA, Alhussaini AA (1992) Computed tomography of primary subglottic cancer: clinical importance of typical spread pattern. Head Neck 14:125–132

    Article  PubMed  CAS  Google Scholar 

  13. Sessions DG, Ogura JH, Fried MP (1975) Carcinoma of the subglottic area. Laryngoscope 85:1417–1423

    Article  PubMed  CAS  Google Scholar 

  14. Skarzynski H, Skarzynska B, Deszezynska H (1990) Now outlook on the problem of an anatomic barrier in the lymphatics of the laryngeal mucous membrane. Otolaryngol Pol 44:57–61

    PubMed  CAS  Google Scholar 

  15. Thekdi AA, Ferris RL (2002) Diagnostic assessment of laryngeal cancer. Otolaryngol Clin N Am 35:953–969

    Article  Google Scholar 

  16. Tufano RP (2002) Organ preservation surgery for laryngeal cancer. Otolaryngol Clin North Am 35:1067–1080

    Article  PubMed  Google Scholar 

  17. Welsh JJ, Welsh LW, Rizzo TA (1983) Laryngeal spaces and lymphatics: current anatomic concepts. Ann Otol Rhinol Laryngol 92(Suppl):19–31

    Google Scholar 

  18. Welsh L (1964) The normal human laryngeal lymphatics. Ann Otol 73:569–582

    CAS  Google Scholar 

  19. Werner JA, Schunke M, Rudert H et al (1990) Description and clinical importance of the lymphatics of the vocal fold. Otolaryngol Head Neck Surg 102:13–19

    PubMed  CAS  Google Scholar 

  20. Werner JA, Schunke M, Lippert BM et al (1995) The laryngeal lymph vessel system of the human. A morphologic and lymphography study with clinical viewpoints. HNO 43:525–531

    PubMed  CAS  Google Scholar 

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Acknowledgements

The generosity of the Department of Anatomy, Anhui Medical University, for providing access to the fetal cadavers and technical assistance is acknowledged. The laryneal specimens used in this study were collected from the fetal cadavers that were bequeathed for the medical education and research purposes and approved by the Medical Ethic Committee of Anhui Medical University, Hefei, China.

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Correspondence to M. Zhang.

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Liu, YH., Xu, SC., Tu, LL. et al. A rich lymphatic network exists in the inferior surface of the vocal cord. Surg Radiol Anat 28, 125–128 (2006). https://doi.org/10.1007/s00276-006-0075-2

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  • DOI: https://doi.org/10.1007/s00276-006-0075-2

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