Gross anatomy

This is an illustrated manual of gross anatomy. It was designed as a supplement to lectures

Development of congenital laryngeal atresias and clefts.

Congenital supraglottic laryngeal obstruction still is being described as subglottic stenosis. There are three clearly defined types of congenital laryngeal atresia, which result from arrest at consecutive developmental stages. Type 1 consists of a supraglottic obstruction, absent vestibule, and stenotic infraglottis, and type 2 is a supraglottic obstruction that separates a shallow primitive vestibule above from a nonstenotic infraglottis. These two types usually are accompanied by other defects, many of them severe. In type 3, a perforated membrane partly obstructs the glottis. Arrest of the dorsal advance of the chondrifying cricoid before the ends meet to form the dorsal lamina results in a complete laryngeal cleft, and incomplete fusion of the ends may leave a notch and/or foramen within the lamina. Failure of the interarytenoid tissue to develop will produce a local cleft, and maldevelopment of the cricoid cartilage or infraglottic submucosa can result in true subglottic stenosis without supraglottic obstruction.

Reexamination of the origin and early development of the human larynx.

The respiratory primordium buds off the primitive foregut and grows caudally, on a lengthening stalk; the cephalic end of the stalk develops into the glottis and infraglottis, and the rest becomes the trachea. Compression by pharyngeal mesoderm cephalic to the respiratory diverticulum obliterates the foregut lumen ventrodorsally as far cranially as the 4th pharyngeal pouches, forming an epithelial lamina with a narrow pharyngoglottic duct along its dorsal border. The mesoderm also raises an epiglottic and two arytenoid swellings in the pharyngeal floor at the level of the 4th pouches; the triangular 'cecum', bounded by these swellings, grows caudally along the ventral border of the epithelial lamina to just above the glottis. Beginning at stage 21, the epithelial lamina separates cephalocaudally, bringing the cecal lumen into continuity with the pharyngoglottic duct to form the laryngeal vestibule; when the separation is complete, the vestibule is continuous with the infraglottic cavity. Meanwhile, bilateral pouches arising from the caudal end of the cecum form the ventricles, the lower lips of which become the vocal folds, and the pharyngeal mesoderm surrounding the laryngeal cavity gives rise to the laryngeal cartilages and intrinsic musculature. The cricoid chondrifies bilaterally from a single center in the ventral arch of a precartilaginous template that encircles the infraglottic cavity, and on meeting forms the dorsal lamina. Each arytenoid chondrifies from a single center, and each half of the thyroid cartilage chondrifies from two. Anlagen for the intrinsic muscles appear during stage 17, sites of individual muscles are recognizable by stage 23, and myofibrils are present by the 12th week.

The tracheo-esophageal septum--fact or fantasy? Origin and development of the respiratory primordium and esophagus.

The so-called tracheo-esophageal septum is in fact the curved primitive floor that results from the ventrocaudal out-growth of the respiratory primordium from the caudal end of the laryngeal sulcus of the foregut. This floor, which separates the openings of the respiratory diverticulum and esophagus, is apparent in transverse sections as a bridge of tissue separating the lumina. The respiratory and hepatic primordia are contiguous initially, but they are separated very early by the rapid growth of the heart and liver, and the resultant stretching of the slower-growing foregut. The portion of foregut between the primordia is drawn out into a narrowing tube that develops into the esophagus and stomach. The respiratory primordium is drawn cranialward; it proliferates, dilates, bifurcates, and grows caudally, dragging out a stalk from the ventral aspect of the foregut. Most of the stalk above the bifurcation will develop into the trachea.