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Hypopharynx, Larynx, and Trachea Overview
Summary Thoughts: Hypopharynx & Larynx
The hypopharynx and larynx both begin at the lower margin of the oropharynx and end at the lower margin of the cricoid cartilage. The hypopharynx is part of the digestive tract, carrying food and liquids to the esophagus. The larynx is part of the respiratory tract, connecting to the trachea, creating speech, and preventing aspiration.
Imaging of the hypopharynx and larynx is commonly performed for evaluation and staging of squamous cell carcinoma (SCCa) . Other common pathologies include laryngocele, thyroglossal duct cyst, and trauma. Important tracheal lesions include stenosis from intubation or tracheostomy, extrinsic compression or invasion by mass, and, less commonly, tracheal inflammatory diseases.
The larynx and hypopharynx are intimately related anatomically, sharing 2 common walls. This means that pathology in 1 location readily involves the other. One should be able to distinguish the 2 sites and define their anatomical subsites, particularly when staging SCCa .
Imaging Techniques & Indications
CECT with sagittal and coronal reformations is the study of choice for the hypopharynx, larynx, and trachea. A standard protocol covers from the alveolar mandible to the clavicles at 2.5- to 3.0-mm intervals during quiet respiration, 90 seconds after contrast bolus. For hypopharyngeal or laryngeal SCCa, a 2nd pass may help assess vocal cord motion. This is performed from the hyoid to cricoid during a breath hold, which opens the pyriform sinuses while the cords adduct.
MR is less commonly used because of breathing artifacts, but it is a useful adjunctive modality for staging of SCCa because of better detection of laryngeal cartilage invasion .
FDG-PET/CT can help identify 2nd primary malignancies of the lung and upper aerodigestive tract in SCCa patients. It is useful for evaluation of recurrent or residual SCCa but is subject to false-positive results in the 2-3 months after radiation therapy. It increases nodal detection in advanced T tumors but does not consistently identify subcentimeter nodes due to camera resolution limitations.
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