The anterior commissure of the larynx

Abstract

This study is based on a very large series of histological sections of non-tumour-bearing larynges, most of them in the horizontal plane. Six hundred sections in one larynx were performed to show the constitution of the anterior region of the larynx at all levels. Although the same tissues are present (fibres, glands and vessels) in almost the entire extent of the anterior segment of the larynx, there is a small zone immediately above the vocal cords with neither glands nor vessels. The authors designate this zone as 'plane O' which separates the anterior commissure from the thyro-epiglottic ligament. It is not possible to separate the anterior commissure from the most anterior portion of the subglottis, because the glands and vessels are in continuity. There are 2 regions of the anterior part of the larynx: a supraglottic (vestibulo-epiglottic) and a glottic-subglottic to which the anterior commissure belongs.

Frontoanterior supracricoid laryngectomy with epiglottoplasty

“…Clinical appearance of T1a cancer is often in Stage T3 due to its silent infiltration into the thyroid lamina of TC via the Broyles ligament, as the Broyles ligament directly inserts to the intermediate lamina of the TC and the lack of cancer-resistant inner perichondrium facilitates tumor invasion in the AC. [3][4][5] This region is the junction of three levels of the larynx. The AC is a pathway of invasion of the cancer cells into the TC and the three levels of the larynx.…”

“…[4] The AC is anatomically non-separable unit from the glottis and subglottis. Based on the anatomic and histological studies of the larynx, Andreas and Guerrier [3] reported a small zone in the AC which they called O plan. This zone is deficient in vessels and glands, thereby, facilitating the oncological separation of the AC from the petiole of the supraglottis.…”

“…The anatomic histological and embryonal structure and pathways of dissemination of the tumor cells from the AC have been the subject of many studies with serial section of the larynx. [1][2][3][4][5] According to these studies, AC can be defined as an independent and vulnerable unit and, consequently, the AC plays a key role in decision making for the treatment modality. [4] Current Tumor, Node, Metastasis (TNM) system is inadequate for the AC involvement of Citation: Başerer glottic cancer.…”

Traditional transcutaneous approaches in head and neck surgery

“…This tendinous insertion at first provides a barrier to tumor invasion anteriorly [8], but if the tendon is invaded by tumor, it provides a route for tumor extension anteriorly [8]. Below the anterior commissure, Guerrier’s “plane zero” is devoid of perichondrium and allows direct tumor infiltration of the cartilage [9]. Hence, the anterior commissure is a key structure for tumor spread, it enables tumor spread to different spaces: preepiglottic, paraglottic and subglottic spaces or externally via the vascularized ossification centers of the thyroid cartilage.…”

Comparision of Transoral Laser and Open Partial Laryngectomy for T1 and T2 Glottic Cancer: A Review of literature.

“…20,21,22 Majority of the studies focus on the weak points through which tumours affecting the anterior comissure can extend into other levels of the larynx (supraglottis, subglottis), cartilage or extralaryngeal structures. 23,24,25,26 Clinical evaluation of the lesion depending on whether it has an infiltrating or non-infiltrating morphology implies different behaviour. In case of non infiltrating morphology, the tumour is usually limited to the glottic plane, and in tumours with infiltrating morphology the tumour is often deeply invasive, reaching other planes of the larynx and behaving as a true anterior transglottic tumour.…”