Prades Jean-Michel, Faye Mamadou Birame, Timoshenko Andrei P, Dubois Marie-Dominique, Dupuis-Cuny Arnaud, Martin Christian
Department of Anatomy, Jacques Lisfranc Faculty of Medicine, Jean Monnet University, 15 rue Ambroise Paré, 42023, Saint-Etienne cedex 2, France.
Surg Radiol Anat. 2006 Jun;28(3):271-6. doi: 10.1007/s00276-006-0083-2. Epub 2006 Apr 13.
The functional results of a partial laryngeal surgery or a laryngeal reinnervation depend on the precise knowledge of the intra laryngeal anatomy of the inferior laryngeal nerve (ILN). Ten human larynges without known laryngeal disorders were obtained from human cadavers for ILN microdissection. Intra laryngeal ILN branching patterns were determined bilaterally. The lengths of the vertical, genu and oblique segments of the anterior division of ILN and the distance between the nerve within the paraglottic space and the cricothyroid articulation (CTA) were measured with a digital microcaliper. The mean lengths of the vertical, genu and oblique segments were 10.82, 5.89 and 9.29 mm, respectively. The mean distance between the nerve in the paraglottic space and the CTA was 11.20 mm. Key anatomical landmarks of the abductor division (vertical and genu segments of ILN) were the lateral border of posterior cricoarytenoid (PCA) muscle and the superior ligament of the CTA. The two-branch pattern for the lateral border of the PCA muscle has been the most frequent (50%). A branch of interarytenoid muscle (IA) originated from the genu segment. One or two branches for the PCA muscle has been identified in 75% of cases from the IA neural plexus on the front side of PCA muscle. The adductor division for the thyroarytenoid muscle and the lateral cricoarytenoid muscle was the oblique segment of the nerve. We conclude that abductor and adductor divisions of intra laryngeal ILN can be readily identified and the knowledge of key landmarks allows preservation of the ILN during partial surgery of the larynx and possibly selective muscle reinnervation.
部分喉手术或喉再支配的功能结果取决于对喉下神经（ILN）喉内解剖结构的确切了解。从人体尸体获取了10个无已知喉部疾病的人喉进行ILN显微解剖。双侧确定喉内ILN分支模式。用数字微量卡尺测量ILN前支垂直段、膝段和斜段的长度以及声门旁间隙内神经与环甲关节（CTA）之间的距离。垂直段、膝段和斜段的平均长度分别为10.82、5.89和9.29毫米。声门旁间隙内神经与CTA之间的平均距离为11.20毫米。外展支（ILN的垂直段和膝段）的关键解剖标志是环杓后肌（PCA）的外侧缘和CTA的上韧带。PCA肌外侧缘的双分支模式最为常见（50%）。杓间肌（IA）的一个分支起源于膝段。在75%的病例中，从PCA肌前侧的IA神经丛中可识别出PCA肌的一个或两个分支。环甲肌和外侧环杓肌的内收支为神经的斜段。我们得出结论，喉内ILN的外展支和内收支易于识别，关键标志的知识有助于在喉部部分手术期间保留ILN，并可能进行选择性肌肉再支配。
