0:01

This was a case of a laryngeal carcinoma.

0:05

And what was interesting here was that it was a big, uh,

0:09

big laryngeal carcinoma. So it's probably involving the true vocal cords.

0:13

And when we looked at the bone algorithms, let me magnify this up for you.

0:19

This tumor had eroded through anteriorly through the thyroid

0:24

cartilage and into the soft tissues of the neck.

0:27

So normally when we look at the thyroid cartilage, we should see an inverted,

0:32

uh, U-shaped structure right here.

0:34

But instead we see discontinuity of the anterior portion of the thyroid

0:39

cartilage and the sclerosis.

0:40

And we can see that tumor extending into the soft tissue of the neck.

0:44

So this was an example of a T four laryngeal carcinoma.

0:50

We also see involvement here extending into the posterior commissure.

0:53

And there's erosion here of the cricoid cartilage inferiorly The tumor,

0:58

uh, extended to below the true vocal cord.

1:01

So it's involving the subglottic larynx.

1:03

So this is an example of subglottic spread and then the tumor's actually growing

1:09

superiorly extending to the, uh, supraglottic larynx.

1:14

So it has a spread that we refer to as trans glottic spread.

1:18

And I think we can see that on the coronal images as well too. Yes.

1:22

So if I magnify this up,

1:27

so the normal anatomy is going to be,

1:31

this is gonna be the level of the true vocal cords. The false focal cord is,

1:34

excuse me, the laryngeal ventricle is gonna be here,

1:36

and the false focal port is here.

1:38

And we can see how the tumor extends from the subglottic larynx crosses the

1:43

laryngeal ventricle and then extends to the right side of the supraglottic

1:47

larynx. So this is an example of a advanced laryngeal carcinoma.

1:52

There's, uh, evidence of, uh, cartilage invasion,

1:55

both the inner and the outer cortex,

1:57

and there's extension into the soft tissue of the neck.

2:00

So we would characterize this as a T four lesion.

2:04

So let me stop there and take any questions you may have. Oh,

2:08

broils ligament. Yeah, sure. Yeah, sure. Let me show you that real quick.

2:12

So broils ligament is a combination of

2:17

structures that's located at the most anterior portion

2:22

at the level of the true vocal cords.

2:24

So broil LIG broils ligament is a combination of this

2:29

ligament, which runs from the tip of the epiglottis of the thyroid caratess,

2:33

that's referred to as a thyroid epiglottic ligament.

2:36

The next component is this ligament,

2:38

which runs along the medial portion of the true VCA cord,

2:42

which is referred to as the vocalist ligament,

2:46

and the inner perichondrium here of the thyroid cartilage.

2:49

So broils ligament is actually a combination of thetic ligament. The

2:56

ligament ligament

2:58

Is, um, in a, not, I don't wanna say it's controversial,

3:02

but some people feel that broils ligament is a natural extension of tumors to

3:07

erode the inner cortex of the thyroid cartilage.

3:10

But other people feel that broils cartilage is, uh, excuse me,

3:13

broils ligament is a protective structure that prevents tumors

3:18

from actually extending to the most anterior portion of the thyroid cartilage.

3:22

And in fact, some people say it actually redirects it superiorly.

3:26

So if you have cartilage erosion,

3:27

it won't necessarily be along the undersurface of the thyroid cartilage,

3:31

but it's redirected superiorly along the thyroid epiglottic ligaments.

3:36

So if you do have cartilage erosion, it's gonna be more superior to it.

3:41

So does that make sense to you on, on broils ligaments?

3:44

So here's an example here. True voc cord carcinoma.

3:47

These tumors can grow anteriorly,

3:50

this ex anterior spread with theoretically be along broils ligaments.

3:54

So here's a tumor involving the most anterior portion of the true VCAL cord.

3:58

This is what we refer to as the anterior commissure.

4:01

And then you can see this another tumor here that's involving the true VCAL

4:06

cord. But this is would be erosion, expected. Erosion along burrows ligament.

4:10

'cause there's erosion, the inner and the outer cortex.