Clinical Anatomy Of Congenital Pyriform Sinus Fistula Associated With Intralaryngeal Surgery

The first part The patial stereoscopic relationship between congenital pyriform sinus fistula and its surrounding structures Objective:To further determine the diagnosis of congenital pyriform sinus fistula(CPSF)by thin-slice CT plain scan after dilution of barium sulfate with esophageal swallowing.To explore the three-dimensional reconstructed image of CPSF and its surrounding structures by Mimics 17.0 interactive medical image processing software.To more intuitive understanding of fistula and its surrounding structures of the three-dimensional relationship between the space.Methods:24 patients with suspected CPSF were treated with thin slice CT scan immediately after slowly swallowing dilution of barium sulfate.Scanning range from the upper edge of epiglottic cartilage,down to the level of sternoclavicular joints,thickness 0.625 mm.After scanning,the captured tomographic image data is imported into Mimics 17.0 software for image segmentation and 3D reconstruction,and the CPSF and its surrounding structures 3D model images are obtained.Results:23 of the 24 cases of thin CT images were seen in the fistula with barium retention,which can determine the presence of fistula.CT images of the fistula is characterized by: from the left pear-shaped fossa,down through the lower left corner of the thyroid cartilage after the medial or lateral to the thyroid on the left lobe of the pole on the continuous or intermittent white barium shadow,There is a shadow.We obtained a clear fistula and its surrounding structures of the 3D images by Mimics 17.0 software treatment.We found: fistula originated from the tip of the pyriform sinus,along with the lateral and posterior side of the thyroid cartilage,ending at the posterior side of the inferior cornu of the thyroid cartilage(ICTC);and the thyroid cartilage forms the anterior and lateral wall.The intralaryngeal muscle is the medial wall and the hypopharynge is the posterior wall.Conclusion:Thin slice CT plain scan can improve the diagnosis rate of CPSF after dilution of barium sulfate with esophagus.Using Mimics 17.0 software to process CT data,the obtained 3D images can be more intuitive to determine the fistula and its surrounding structures(mainly include thyroid cartilage,cricoid cartilage,thyroid)space three-dimensional relationship,and this can provide guidance for the operation.The second part Clinical anatomy related to CPSF Objective:According to the spatial relationship between the piriform fistula and the surrounding tissues in the first part of the study,we complete the general anatomy and the microscopic anatomy of the throat specimens of adult cadavers.The surrounding structures associated with piriform fistula,especially the intralaryngeal nerves,muscles,and joints,were observed,to provide anatomical guidance and avoid the occurrence for the CPSF associated with intralaryngeal surgery.Methods:20 sides of the general anatomy of the throat specimens of adult cadavers were completed by us to record the composition of the structure around the pyriform sinus and where the recurrent laryngeal nerve and the superior laryngeal nerve into the throat.Under the microscope,the specimens were dissected and the structures seen during the operation were observed.We focused on the intralaryngeal anatomy of the recurrent laryngeal nerve,to observe its distribution in the throat.Results:In the general anatomy of the specimen,the pyriform sinus is located on both sides of the throat,and the thyroid cartilage forms the anterior and lateral wall.The intralaryngeal muscle is the medial wall and the hypopharynge is the posterior wall.Under the microscope,anatomical observation of the superior laryngeal nerve through the thyroid periosteum into the throat,into the pyriform sinus laryngeal nerve folds,the branches distributed in the vocal cords and laryngeal mucosa and laryngeal mucosa.Recurrent laryngeal nerve in the lower edge of the lower part of the pharyngeal muscle,the ring after the articulation of the laryngeal nerve into the throat,the branches distributed in most of the laryngeal muscle,vocal cord laryngeal mucosa,laryngeal mucosa,and branch and throat nerve Internal match.The distance from the cutting edge of pyriform sinus to the muscular process of arytenoid cartilage is(0.9±0.2)cm,to the lateral cricoarytenoid branch of recurrent laryngeal nerve is(1.7±0.4)cm,to the cricothyroid joint is(2.8±0.3)cm.Conclusion:The anatomical relationship around the piriform sinus is closely related to the gap next to the glimpse,the superior laryngeal nerve,the recurrent laryngeal nerve and the intralaryngeal muscle.In clinical,CPSF associated with intralaryngeal surgery fistula closed from intralaryngeal path,the probe can not be inserted too deep,within 1.7cm for a safe distance,up to no more than 2.0cm,so as not to damage the recurrent laryngeal nerve.the probe should toward the front lateral direction(thyroid cartilage plate).The scope of operating should be limited to the shallow fissure around the fistula,and pay attention to the depth of burning and shorten the operation time,reduce muscle damage and bleeding,avoid nerve thermal damage.