• The larynx is an inferior continuation of the oropharynx:It extends from the epiglottis (namely the glossoepiglottic and pharyngoepiglottic folds) to the inferior aspect / border of the cricoid cartilage. Inferiorly:It continues as the cervical trachea. 
• Gross anatomy:The larynx consists of a cartilage “skeleton”, as well as internal structures that are divided into three subsites, mainly for the purposes of laryngeal cancer staging:Supraglottis: Which extends from the tip of the epiglottis to the laryngeal ventricle
  • • • Subsites:Epiglottis:Divided into suprahyoid and infrahyoid portionsPre-epiglottic spaceArytenoid cartilagesAryepiglottic foldsVentriclesFalse vocal cords
        • Paraepiglottic space
    • GlottisTrue vocal cordsAnterior commissurePosterior commissure
    • Subglottis: Extends from the inferior surface of the true vocal cords / 5mm below the free margin of the true vocal cord to the inferior aspect / lower border of the cricoid cartilage
• Relations:Anterior: Strap muscles
  • • Anterior jugular vein
  • Posterior: EsophagusLaryngopharynx
  • Superior: Hyoid boneLaryngopharynx
  • inferior: Trachea
• Arterial supply:Above the vocal cords: Superior laryngeal artery:Branch of the superior thyroid arteryBelow the vocal cords:Inferior laryngeal artery:
  • • • Branch of the inferior thyroid artery
• Venous drainageAbove the vocal cords: Superior laryngeal vein accompanies its artery and drains into the superior thyroid vein:A tributary to the internal jugular veinBelow the vocal cords: Inferior laryngeal vein accompanies its artery and drains into the inferior thyroid vein:A direct tributary to the brachiocephalic vein
• Lymphatic drainage:Supraglottic: The supraglottic lymphatic network follows the superior laryngeal artery:Piercing the thyrohyoid membrane and then draining into the superior deep cervical nodes and the pre-epiglottic nodes. Subglottic: The infraglotttic lymphatic network drains to the inferior deep cervical nodes, following the inferior laryngeal artery, and/or the prelaryngeal (Delphian) nodes via the conus elasticus (aka the lateral cricothyroid ligaments). Both the superior and inferior deep cervical nodes then drain into the right and left jugular trunks:Which subsequently empty into the right lymphatic duct and the thoracic duct on the left. 
• Innervation:Motor: The recurrent laryngeal nerve supplies all the intrinsic muscles of the larynx apart from the cricothyroid muscle:Which is supplied by the external branch of the superior laryngeal nerve.Sensory: Above the vocal cords (supraglottic): Internal branch of the  superior laryngeal nerveBelow the vocal cords (infraglottic): Recurrent laryngeal nerve
• Development:The larynx is formed from the laryngotracheal groove:Which is related to the caudal aspect of the floor of the primordial pharynxThe cartilages of the larynx develop from:The 4^th and 6^th pharyngeal arches

Staging of Laryngeal Cancer

---

T Category	T Criteria
Reprinted with permission from AJCC: Larynx. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 149–61.
TX	Primary tumor cannot be assessed.
Tis	Carcinoma in situ.
Supraglottis
T1	Tumor limited to one subsite of supraglottis with normal vocal cord mobility.
T2	Tumor invades mucosa of more than one adjacent subsite of supraglottis or glottis or region outside the supraglottis (e.g., mucosa of the base of the tongue, vallecula, medial wall of pyriform sinus) without fixation of the larynx.
T3	Tumor limited to larynx with vocal cord fixation and/or invades any of the following: post-cricoid area, pre-epiglottic space, para-glottic space, and/or inner cortex of thyroid cartilage.
T4	Moderately advanced or very advanced.
T4a	Moderately advanced local disease.    Tumor invades through the outer cortex of the thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of the neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus).
T4b	Very advanced local disease.                Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures.
Glottis
T1	Tumor limited to the vocal cord(s) (may involve anterior or posterior commissure) with normal mobility.
T1a	Tumor limited to one vocal cord.
T1b	Tumor involves both vocal cords.
T2	Tumor extends to supraglottis and/or subglottis, and/or with impaired vocal cord mobility.
T3	Tumor limited to the larynx with vocal cord fixation and/or invasion of paraglottic space and/or inner cortex of the thyroid cartilage.
T4	Moderately advanced or very advanced.
T4a	Moderately advanced local disease.    Tumor invades through the outer cortex of the thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, cricoid cartilage, soft tissues of the neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus).
T4b	Very advanced local disease.               Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures.
Subglottis
T1	Tumor limited to the subglottis.
T2	Tumor extends to vocal cord(s) with normal or impaired mobility.
T3	Tumor limited to the larynx with vocal cord fixation and/or invasion of paraglottic space and/or inner cortex of the thyroid cartilage.
T4	Moderately advanced or very advanced.
T4a	Moderately advanced local disease.    Tumor invades cricoid or thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of the neck including deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus).
T4b	Very advanced local disease.                Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures.

 

• Rodrigo Arrangoiz MS, MD, FACS es especialista en Cirugía de Tumores de Cabeza y Cuello / Cirugía Endocrina y Cirugía Oncológica compleja:
• Fue egresado como Médico General de la Universidad Anahuac:

• Graduado Suma Cum Laude. Es miembro de Center for Advanced Surgical Oncology
• El Doctor Arrangoiz es experto en el manejo del: Cáncer de Tiroides:Cáncer papilar de tiroides

• • • • Cáncer folicular de tiroides
      • Cáncer medular de tiroides
      • Cáncer anaplásico de tiroides
    • Patología Quirúrgica de Tiroides:Bocio multi nodular no toxico sintomático  Bocio multi nodular toxicoHipertiroidismo
    • Hiperparatiroidismo:Hiperparatiroidismo primarioHiperparatiroidismo secundarioHiperparatiroidismo terciario
    • Tumores de Cabeza y Cuello:Cancer de la cavidad oral
      • Cáncer de faringe:
        • Nasofaringe
        • Orofaringe
        • Hipofaringe
      • Cáncer Laringeo:
        • Cáncer supraglótico
        • Cáncer glótico
        • Cancer subglótico
      • Cáncer de glándulas salivales:
        • Glándula Parótida
        • Glándula submandibular
        • Glándula sublingual
        • Glándulas salivales menores
      • Cáncer de piel de la cabeza y cuello:
        • Melanoma
        • Carcinoma basocelular
        • Carcinoma epidermoide
        • Carcinoma de Merkel
        • Dermatofibrosacroma Protuberans
      • Cáncer de Mama. 
      • Cáncer de piel:
        • Melanoma
        • Carcinoma basocelular
        • Carcinoma epidermoide
        • Carcinoma de Merkel
        • Dermatofibrosacroma Protuberans
  • Fue entrenado en las mejores instituciones académicas de los Estados Unidos.
  • Mantiene certificaciones por los Consejos de Cirugía General y Cirugía Oncológica en México y en los Estados Unidos de América. 
     
• Su entrenamiento incluyó:Cirugía General y Gastrointestinal:Michigan State University (2004 – 2010)

 

• Cirugía Oncológica / Tumores de Cabeza y Cuello / Cirugía Endocrina:Fox Chase Cancer Center en Filadelfia (2010 al 2012)

 

• Maestría en Ciencias (Clinical Research for Health Professionals):Drexel University (Filadelfia) (2010 – 2012)

 

• Cirugía de Tumores de Cabeza y Cuello / Cirugía Endocrina (2014 al 2016):IFHNOS / Memorial Sloan Kettering Cancer Center

• Ha participado en múltiples cursos y congresos como Conferencista y Profesor Invitado, así mismo ha realizado diversas publicaciones y artículos sobre temas relacionados con su especialidad.
• Fue pionero en México de la:
  • Cirugía minimamente invasive radioguida de paratiroides.
• Se encuentra certificado por el Consejo Mexicano de Cirugía General y el Consejo Mexicano de Oncología así como es de los pocos mexicanos certificado por, el AMERICAN BOARD OF SURGERY,  el cuál le faculta como cirujano con licencia en los EU.
• Es miembro de diversas asociaciones médicas como el:American College of Surgeons, American Thyroid Association, American Society of Endocrine Surgeons, American Medical Association, American Society of Clinical Oncology, Association of Academic Surgeons, Society of Surgical Oncology,  The Society of Surgery of the Alimentary Tract, Society of American Gastrointestinal Endoscopic Surgeons, y la American Society of Breast Surgeons, entre otras.
• Gracias a esto el Dr. Rodrigo Arrangoiz es reconocido como uno de los mejores especialistas en Cirugía de Tumores de Cabeza y Cuello / Cirugía Endocrina y Cirugía Oncológica en México, además de ser galardonado como uno de los 50 mejores médicos de México en los Top Doctors Awards 2018.

#Arrangoiz

#Teacher

#Surgeon

#Cirujano

#ThyroidExpert

#ThyroidSurgeon

#CirujanodeTiroides

#ExpertoenTiroides

#ExpertoenParatiroides

#Paratiroides

#Hiperparatiroidismo

#CancerdeTiroides

#ThyroidCancer

#PapillaryThyroidCancer

#SurgicalOncologist

#CirujanoOncologo

#CancerSurgeon

#CirujanodeCancer

#HeadandNeckSurgeon

#CirugiaEndocrina

#CirujanodeTumoresdeCabezayCuello

#OralCavityCancer

#Melanoma