The fibroelastic membrane of the larynx is the continuous internal framework of the larynx, consisting of an upper quadrangular membrane (vestibular fold level) and lower conus elasticus (vocal fold level), connected by the thyroepiglottic ligament.
Provides the elastic internal skeleton of the larynx, maintains the shape of the laryngeal lumen, produces the free lower margin of the vestibular fold and upper margin of the vocal fold, and transmits vibratory forces during phonation.
The fibroelastic membrane defines the boundaries of laryngeal subsites — tumour spread through this membrane indicates advanced disease. The conus elasticus is pierced by the cricothyroid artery and is the landmark for supraglottic partial laryngectomy margins.
Laryngeal carcinoma penetrating the conus elasticus or quadrangular membrane producing transglottic spread, requiring total laryngectomy or definitive chemoradiation.
Acute epiglottitis edema distending the quadrangular membrane and vestibular fold tissue producing the classic thumbprint sign on lateral neck X-ray.
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