2. Anatomy of PharynxAnatomy of Pharynx
Fibromuscular TubeFibromuscular Tube
Base of Skull to C6 (12cm)Base of Skull to C6 (12cm)
Divided into three partsDivided into three parts
NasopharynxNasopharynx
OropharynxOropharynx
LaryngopharynxLaryngopharynx
4 Layers4 Layers
Mucosal, submucosal (Fibrous), Muscular, FascialMucosal, submucosal (Fibrous), Muscular, Fascial
layer (buccal pharyngeal)layer (buccal pharyngeal)
3. NasopharynxNasopharynx
Base of skull to the softBase of skull to the soft
palatepalate
Key componentsKey components
Pharyngeal TonsilPharyngeal Tonsil
(Adenoids)(Adenoids)
Pharyngeal Recess (ICA)Pharyngeal Recess (ICA)
Opening of Auditory tubeOpening of Auditory tube
4. OropharynxOropharynx
Soft Palate to theSoft Palate to the
epiglottisepiglottis
Key ComponentsKey Components
Palatopharyngeal andPalatopharyngeal and
Palatoglossal archesPalatoglossal arches
Palantine Tonsil – projectPalantine Tonsil – project
from tonsillar fossafrom tonsillar fossa
Lingual TonsilLingual Tonsil
Valleculae – lie betweenValleculae – lie between
epiglottis and posteriorepiglottis and posterior
border of the tongueborder of the tongue
5. LaryngopharynxLaryngopharynx
Epiglottis to the levelEpiglottis to the level
of cricoid cartilageof cricoid cartilage
Key featuresKey features
Opening to theOpening to the
larynxlarynx
Piriform recessPiriform recess
(endoscope)(endoscope)
6. Anatomy of PharynxAnatomy of Pharynx
Blood supplyBlood supply
Branches of many arteries (ascending pharyngeal,Branches of many arteries (ascending pharyngeal,
greater palantine, lingual, tonsilar)greater palantine, lingual, tonsilar)
Nerve SupplyNerve Supply
Afferent; maxillary nerve, glossopharyngeal, internalAfferent; maxillary nerve, glossopharyngeal, internal
and recurrent laryngeal nervesand recurrent laryngeal nerves
Motor; Pharyngeal Plexus (Vagus, glossopharyngeal,Motor; Pharyngeal Plexus (Vagus, glossopharyngeal,
Cervical Sympathetic)Cervical Sympathetic)
7. LarynxLarynx
Respiratory OrganRespiratory Organ
Lying between pharynx and tracheaLying between pharynx and trachea
Becomes continuous with the trachea at the level ofBecomes continuous with the trachea at the level of
the cricoid cartilage (C6)the cricoid cartilage (C6)
FunctionFunction
Primary – protective sphincter at the inlet of the airPrimary – protective sphincter at the inlet of the air
passagespassages
PhonationPhonation
10. Layrnx - Intrinsic MembranesLayrnx - Intrinsic Membranes
Quadrangular membraneQuadrangular membrane
Arytenoid Cartilage and epiglottisArytenoid Cartilage and epiglottis
Lower border; vestibular folds (false cord)Lower border; vestibular folds (false cord)
Upper border; aryepiglottic foldsUpper border; aryepiglottic folds
Cricovocal MembraneCricovocal Membrane
Formed from lateral part of cricothyroid ligamentFormed from lateral part of cricothyroid ligament
Upper thickened border forms cricovocal ligaementUpper thickened border forms cricovocal ligaement
Vocal folds which bounds the glottis anteriorlyVocal folds which bounds the glottis anteriorly
11.
12. Laryngeal Muscles - IntrinsicLaryngeal Muscles - Intrinsic
1. Those that alter size and shape of the inlet1. Those that alter size and shape of the inlet
Aryepiglottic MusclesAryepiglottic Muscles
Oblique arytenoidsOblique arytenoids
Thyroepiglottic musclesThyroepiglottic muscles
Act as Sphincter for the inletAct as Sphincter for the inlet
Provide valvular protection from aboveProvide valvular protection from above
13. Laryngeal Muscles - IntrinsicLaryngeal Muscles - Intrinsic
2. Responsible for Phonation by moving vocal2. Responsible for Phonation by moving vocal
foldsfolds
Abduction; Posterior CricoarytenoidsAbduction; Posterior Cricoarytenoids
Adduction; Lateral cricoarytenoid and transverseAdduction; Lateral cricoarytenoid and transverse
arytenoidarytenoid
Lengthen; CricothryroidLengthen; Cricothryroid
Shorten; Thyroarytenoid, vocalisShorten; Thyroarytenoid, vocalis
14. PhonationPhonation
Pitch; Vibration of the folds through shorteningPitch; Vibration of the folds through shortening
and lengthing of the voldsand lengthing of the volds
Intensity; Pressure through the glottisIntensity; Pressure through the glottis
Quality; Resonating chambers above the glottisQuality; Resonating chambers above the glottis
Articulation; tongue, teeth and lipsArticulation; tongue, teeth and lips
15. LarynxLarynx
Blood supplyBlood supply
Superior and Inferior Laryngeal Branches from Superior andSuperior and Inferior Laryngeal Branches from Superior and
Inferior Thyroid ArteryInferior Thyroid Artery
Nerve SupplyNerve Supply
Recurrent Laryngeal NerveRecurrent Laryngeal Nerve
All intrinsic Muscles except cricothyroidAll intrinsic Muscles except cricothyroid
Mucous Membranes below the foldsMucous Membranes below the folds
External Layngeal NerveExternal Layngeal Nerve
Cricothyroid muscleCricothyroid muscle
Internal Laryngeal NerveInternal Laryngeal Nerve
Mucous Membranes below the foldsMucous Membranes below the folds
16. Nerve PalsiesNerve Palsies
Recurrent Laryngeal NerveRecurrent Laryngeal Nerve
Number of causesNumber of causes
Left;Left;
Carcinoma of bronchus, oesophagus, Aortic anuersym, cardiac surgCarcinoma of bronchus, oesophagus, Aortic anuersym, cardiac surg
Left or Right;Left or Right;
Iatrogenic, Trauma, Thyroid diseaseIatrogenic, Trauma, Thyroid disease
Complete (Cadaveric Position)Complete (Cadaveric Position)
Half abducted position with arytenoid cartilage slightly in frontHalf abducted position with arytenoid cartilage slightly in front
Hoarse VoiceHoarse Voice
Bovine coughBovine cough
IncompleteIncomplete
Adducted position as posterior cricoarytenoid more susceptibleAdducted position as posterior cricoarytenoid more susceptible
External Laryngeal NerveExternal Laryngeal Nerve
Hoarse voice that recoversHoarse voice that recovers
Inability to hit high frequenciesInability to hit high frequencies
20. 4 year old boy4 year old boy
Pain in right ear and feversPain in right ear and fevers
Recurrent ear infectionsRecurrent ear infections
Noisy breatherNoisy breather
OverweightOverweight
Examination – Sore right ear, hyperaemicExamination – Sore right ear, hyperaemic
tympanic membrane, breathing with mouthtympanic membrane, breathing with mouth
openopen
21. Adenoid HypertrophyAdenoid Hypertrophy
Occupies large area of nasopharynx age <6Occupies large area of nasopharynx age <6
Atrophies and by age 15 little remainsAtrophies and by age 15 little remains
Recurrent URTI or allergies can lead toRecurrent URTI or allergies can lead to
hypertrophyhypertrophy
ClinicalClinical
Nasal Obstruction; Mouth breathing / AdenoidNasal Obstruction; Mouth breathing / Adenoid
Facies, chest infections, pharyngeal infections,Facies, chest infections, pharyngeal infections,
sinusitis, snoringsinusitis, snoring
Eustachian Tube; Recurrent Otitis Media, CSOMEustachian Tube; Recurrent Otitis Media, CSOM
Choanal Obstruction; OSA, chronic sinusitisChoanal Obstruction; OSA, chronic sinusitis
23. AdenoidectomyAdenoidectomy
Criteria for surgeryCriteria for surgery
Chronic upper airway obstruction with OSA +/- corChronic upper airway obstruction with OSA +/- cor
pulmonalepulmonale
Chronic serous/suppurative otitis mediaChronic serous/suppurative otitis media
Recurrent acute otitis mediaRecurrent acute otitis media
Suspicion of nasopharyngeal malignancySuspicion of nasopharyngeal malignancy
Chronic sinusitisChronic sinusitis
ComplicationsComplications
Early HaemorrhageEarly Haemorrhage
Otitis mediaOtitis media
Regrowth of residual adenoid tissueRegrowth of residual adenoid tissue
24.
25. TonsillitisTonsillitis
Commonest area of infection of head and neckCommonest area of infection of head and neck
Clinical; Sore throat and Odynophagia, Otalgia,Clinical; Sore throat and Odynophagia, Otalgia,
headache, malaise, Fever, hyperaemic tonsils, cervicalheadache, malaise, Fever, hyperaemic tonsils, cervical
lymphadenopathylymphadenopathy
DDx;DDx;
ViralViral
Group A Streptococcus (20-30%)Group A Streptococcus (20-30%)
EBV; Palatal petechiaEBV; Palatal petechia
Diptheria; Unimmunised, grey membraneDiptheria; Unimmunised, grey membrane
Tx; Rest, paracetamol +/- ABxTx; Rest, paracetamol +/- ABx
26. TonsillitisTonsillitis
Complications;Complications;
Acute Otitis Media (most common)Acute Otitis Media (most common)
Peritonsillar abscess (Quinsy)Peritonsillar abscess (Quinsy)
GASGAS
Post Strep GNPost Strep GN
Rhuematic FeverRhuematic Fever
Scarlet Fever; Strawberry tongue and scarlitiform rashScarlet Fever; Strawberry tongue and scarlitiform rash
Recurrent TonsillitisRecurrent Tonsillitis
Tonsillar HypertrophyTonsillar Hypertrophy
27.
28. TonsillectomyTonsillectomy
Indications for surgeryIndications for surgery
AbsoluteAbsolute
Airway obstructionAirway obstruction
Suspicion of malignancySuspicion of malignancy
RelativeRelative
Sleep apnoea, mouth breathing, difficulty swallowingSleep apnoea, mouth breathing, difficulty swallowing
Recurrent tonsillitis >5 episodesRecurrent tonsillitis >5 episodes
Any complicationsAny complications
ComplicationsComplications
Reactionary haemorrhageReactionary haemorrhage
Secondary haemorrhageSecondary haemorrhage
5-10 days post op5-10 days post op
Due to fibrinolysis aggravated by infectionDue to fibrinolysis aggravated by infection
29.
30. PharyngitisPharyngitis
AcuteAcute
>70% Viral Cause, GAS>70% Viral Cause, GAS
Supportive TreatmentSupportive Treatment
ChronicChronic
Persistent mild soreness and drynessPersistent mild soreness and dryness
Predisoposing factors include; smoking, ETOH,Predisoposing factors include; smoking, ETOH,
mouth breathing, chronic sinusitis, Industrial fumes,mouth breathing, chronic sinusitis, Industrial fumes,
antiseptic throat lozengersantiseptic throat lozengers
Enlarged lymphoid tissue can be removedEnlarged lymphoid tissue can be removed
31. 64 Male recently Immigrated from Hong Kong64 Male recently Immigrated from Hong Kong
Lump in right side of neckLump in right side of neck
Progressive enlarged, non-painfulProgressive enlarged, non-painful
Exam; firm, fixed, solid mass lateral to midlineExam; firm, fixed, solid mass lateral to midline
in posterior trianglein posterior triangle
32. Nasopharyngeal CarcinomaNasopharyngeal Carcinoma
Rare in EuropeRare in Europe
Common in Asian countriesCommon in Asian countries
20% of all malignancies in Hong Kong20% of all malignancies in Hong Kong
PathologyPathology
Squamous cell/undifferentiatedSquamous cell/undifferentiated
AietologyAietology
Unknown, however EBV plays a roleUnknown, however EBV plays a role
Others; ingestion of preserved foodsOthers; ingestion of preserved foods
33. Nasopharyngeal CarcinomaNasopharyngeal Carcinoma
Clinical;Clinical;
Most commonly as lump in the neckMost commonly as lump in the neck
Local; Nasal obstruction, blood stained dischargeLocal; Nasal obstruction, blood stained discharge
Neurological; Invasion of skull base causing cranialNeurological; Invasion of skull base causing cranial
nerve palsies (V, VI, IX, X, XII)nerve palsies (V, VI, IX, X, XII)
Otological; Serous otitis mediaOtological; Serous otitis media
Metastasis to bone, lung, liverMetastasis to bone, lung, liver
34. Nasopharyngeal CarcinomaNasopharyngeal Carcinoma
Ix;Ix;
Tissue sampling, CT/MRI, StagingTissue sampling, CT/MRI, Staging
ManagementManagement
Radiotherapy with concominant chemotherapyRadiotherapy with concominant chemotherapy
Poorly amendable to surgery due to anatomicalPoorly amendable to surgery due to anatomical
locationlocation
DDxDDx
Lymphoma, cystic adenocarcinoma, InfectionLymphoma, cystic adenocarcinoma, Infection
35. Pathology of the LarynxPathology of the Larynx
InfectiousInfectious
InflammatoryInflammatory
CongenitalCongenital
MucosalMucosal
MalignancyMalignancy
36. 5 Year old boy5 Year old boy
Hx ofHx of
3/7 Low grade fever and URTI Sx3/7 Low grade fever and URTI Sx
1/7 history Biphasic Stridor, barking cough1/7 history Biphasic Stridor, barking cough
No obvious respiratory distressNo obvious respiratory distress
37. Laryngotracheitis (Croup)Laryngotracheitis (Croup)
Inflammation of tissues of subglottic space +/-Inflammation of tissues of subglottic space +/-
tracheobronchial treetracheobronchial tree
Mucopurulent exudate -> airway obstructionMucopurulent exudate -> airway obstruction
Aetiology; Parainfluenza I (most common),Aetiology; Parainfluenza I (most common),
II,III, influenza A,B, RSVII,III, influenza A,B, RSV
Presentation; night, inspiratory/biphasic stridor,Presentation; night, inspiratory/biphasic stridor,
barking coughbarking cough
Beware loss of stridor, Decr SaO2Beware loss of stridor, Decr SaO2
DDx; FB, subglottic stenosis, EpiglottitisDDx; FB, subglottic stenosis, Epiglottitis
38. Laryngotracheitis + EpiglottitisLaryngotracheitis + Epiglottitis
FeatureFeature LaryngotracheitisLaryngotracheitis EpiglottitisEpiglottitis
Inflammation Subglottic space Supraglottic spaceInflammation Subglottic space Supraglottic space
AgeAge 4month-5 years4month-5 years 1-4 years1-4 years
OnsetOnset Gradual (days)Gradual (days) Acute (hours)Acute (hours)
Fever Low grade/afebrile High feversFever Low grade/afebrile High fevers
Stridor Biphasic/inspiratory InspiratoryStridor Biphasic/inspiratory Inspiratory
CoughCough BarkyBarky NormalNormal
PosturePosture SupineSupine SittingSitting
DroolingDrooling NoNo YesYes
RadiographRadiograph Steeple signSteeple sign Thumb sign, enlarged epiglottisThumb sign, enlarged epiglottis
Appearance Non-toxic Toxic/cyanoticAppearance Non-toxic Toxic/cyanotic
CauseCause ViralViral BacterialBacterial
TreatmentTreatment SupportiveSupportive Keep child calmKeep child calm
O2, Adrenalin nebsO2, Adrenalin nebs Airway management -ETTAirway management -ETT
Steroids ABx, IV hydration, Moist airSteroids ABx, IV hydration, Moist air
39.
40. 18 month girl18 month girl
““Asthma Attack”Asthma Attack”
WheezyWheezy
?trigger?trigger
Family Hx of Asthma, EczemaFamily Hx of Asthma, Eczema
No stridor, but tachypnea, intercostal recessionNo stridor, but tachypnea, intercostal recession
Unilateral wheeze on Right with Decreased airUnilateral wheeze on Right with Decreased air
entry in lower zonesentry in lower zones
41.
42. Foreign BodyForeign Body
Usually stuck at right main bronchusUsually stuck at right main bronchus
Anything that’s small enoughAnything that’s small enough
Presentation;Presentation;
Stridor if at level of tracheaStridor if at level of trachea
““Unilateral asthma” if bronchialUnilateral asthma” if bronchial
ComplicationsComplications
Atelectasis, lobar pneumonia, pneumothorax, mediastinalAtelectasis, lobar pneumonia, pneumothorax, mediastinal
shiftshift
Dx;Dx;
Inspiratory/Expiratory X-raysInspiratory/Expiratory X-rays
BronchoscopyBronchoscopy
43.
44. Signs of Airway ObstructionSigns of Airway Obstruction
Stretor; obstruction in the throat, low pitched chokingStretor; obstruction in the throat, low pitched choking
noisesnoises
Stridor; High pitched, inspiratory, biphasic orStridor; High pitched, inspiratory, biphasic or
expiratory depending on locationexpiratory depending on location
Accessory Muscle useAccessory Muscle use
Pallor, diaphoresis, restlessnessPallor, diaphoresis, restlessness
TachycardiaTachycardia
Cyanosis and altered concious stateCyanosis and altered concious state
Intercostal recessionIntercostal recession
Nasal FlaringNasal Flaring
ExhaustionExhaustion
Bradycardia – most dangerous signBradycardia – most dangerous sign
45. Upper Airway Obstruction -Upper Airway Obstruction -
NeonatesNeonates
Subglottic StenosisSubglottic Stenosis
Congenital or Acquired (trauma, intubation)Congenital or Acquired (trauma, intubation)
Biphasic stridor, resp distress, recurrent croupBiphasic stridor, resp distress, recurrent croup
Diagnosis; CT, laryngoscopyDiagnosis; CT, laryngoscopy
Tx; Soft tissue – laser and steroidsTx; Soft tissue – laser and steroids
Cartilage – Laryngotracheoplasty or tracheostomyCartilage – Laryngotracheoplasty or tracheostomy
(intubation)(intubation)
LaryngomalaciaLaryngomalacia
Soft immature cartilage Children or older patients with NMSoft immature cartilage Children or older patients with NM
disordersdisorders
Inspiratory stridor at 1-2 weeks, worse supine + feedingInspiratory stridor at 1-2 weeks, worse supine + feeding
difficultiesdifficulties
Dx; BronchoscopyDx; Bronchoscopy
Tx; Usually self resolves after 18-24monthsTx; Usually self resolves after 18-24months
46. 44 Female44 Female
6 week history of hoarse voice6 week history of hoarse voice
Irritation and dryness in throatIrritation and dryness in throat
History of heartburnHistory of heartburn
SmokerSmoker
No history of weight loss, fatigueNo history of weight loss, fatigue
Examination; UnremarkableExamination; Unremarkable
47.
48. Chronic LaryngitisChronic Laryngitis
Most common cause is GORDMost common cause is GORD
Recurrent Acute laryngitisRecurrent Acute laryngitis
Heavy smokingHeavy smoking
Chronic infection of nasal sinusesChronic infection of nasal sinuses
Mouth breathing from nasal obstructionMouth breathing from nasal obstruction
ClinicallyClinically
Hoarseness or loss of voiceHoarseness or loss of voice
Spasmodic coughSpasmodic cough
DDx; Malignancy, inhaled corticosteroids, laryngeal paralysis,DDx; Malignancy, inhaled corticosteroids, laryngeal paralysis,
TBTB
General; Voice resting, avoid smokingGeneral; Voice resting, avoid smoking
Specific; eg. Lifestyle modifications, MedicationsSpecific; eg. Lifestyle modifications, Medications
49. 35 year old35 year old
Blunt trauma to neck 5 hours agoBlunt trauma to neck 5 hours ago
Difficulty swallowing + Voice changesDifficulty swallowing + Voice changes
No history of LOC, resp distress, confusionNo history of LOC, resp distress, confusion
Examination showed midline tenderness ofExamination showed midline tenderness of
neck, subcutaneous emphysemaneck, subcutaneous emphysema
57. 33 year old male singing teacher33 year old male singing teacher
Progressively hoarse voiceProgressively hoarse voice
Normal CoughNormal Cough
Non-smokerNon-smoker
No weight loss/fatigueNo weight loss/fatigue
58. Benign Vocal Fold LesionsBenign Vocal Fold Lesions
Reactive nodules (singers nodules)Reactive nodules (singers nodules)
BilateralBilateral
Smooth, rounded/pedunculatedSmooth, rounded/pedunculated
SmallSmall
Located on true vocal foldsLocated on true vocal folds
Treatment;Treatment;
Voice training, re-educationVoice training, re-education
Rarely surgical if fibrosed, chronicRarely surgical if fibrosed, chronic
Virtually never give rise to malignancyVirtually never give rise to malignancy
59.
60. LaryngoceleLaryngocele
Abnormal dilatation of the laryngeal ventricleAbnormal dilatation of the laryngeal ventricle
Contains airContains air
Men>WomenMen>Women
Bilateral 25%Bilateral 25%
Aeitology;Aeitology;
Acquired; Incr. Intraluminal pressure (musicians)Acquired; Incr. Intraluminal pressure (musicians)
CongenitalCongenital
SCC <15%SCC <15%
Hoarse voice, pain, dysphagia, lateral neck massHoarse voice, pain, dysphagia, lateral neck mass
61. Squamous PapillomaSquamous Papilloma
Most common benign neoplasm of larynx (84%)Most common benign neoplasm of larynx (84%)
Found on true vocal cordsFound on true vocal cords
Caused by HPV 6 and 11Caused by HPV 6 and 11
Soft Raspberry like appearanceSoft Raspberry like appearance
May ulcerate resulting in haemoptysisMay ulcerate resulting in haemoptysis
Usually Single in AdultsUsually Single in Adults
Multiple in Children (Laryngeal Papillomatosis) withMultiple in Children (Laryngeal Papillomatosis) with
extended growth and recurrenceextended growth and recurrence
Malignant transformation extremely rareMalignant transformation extremely rare
62. Investigation and TreatmentInvestigation and Treatment
Ix;Ix;
LaryngoscopyLaryngoscopy
Tx;Tx;
CO2 LaserCO2 Laser
Surgical removalSurgical removal
?Antivirals?Antivirals
63. 55 year old male55 year old male
History of GORD, cardiac diseaseHistory of GORD, cardiac disease
Recurrent hoarse voiceRecurrent hoarse voice
Right otalgiaRight otalgia
Smoker + ETOH abuseSmoker + ETOH abuse
64. Squamous Cell CarcinomaSquamous Cell Carcinoma
Most common malignancy of larynxMost common malignancy of larynx
Male>Female 6;1xMale>Female 6;1x
2.5% all cancers in men2.5% all cancers in men
AeitologyAeitology
Tobacco:Tobacco: ↑↑↑↑
Alcohol:Alcohol: ↑↑ (x 2.2)(x 2.2)
Radiation, asbestosRadiation, asbestos
GORDGORD
HPVHPV
65. Squamous Cell CarcinomaSquamous Cell Carcinoma
Glottic SCC most common (60%) >Glottic SCC most common (60%) >
supraglottic SCC (30%) > subglottic SCCsupraglottic SCC (30%) > subglottic SCC
(<10%).(<10%).
Sx: hoarseness, throat pain, cough, hemoptysis,Sx: hoarseness, throat pain, cough, hemoptysis,
referred otalgia, dysphagiareferred otalgia, dysphagia
Diagnosis;Diagnosis;
Laryngoscopy with FNALaryngoscopy with FNA
CT/MRICT/MRI
66.
67. Squamous Cell CarcinomaSquamous Cell Carcinoma
ManagementManagement
Eradication of diseaseEradication of disease
Restoration of function; swallowing and speechRestoration of function; swallowing and speech
Radiation treatmentRadiation treatment
Especially early stage diseaseEspecially early stage disease
Cure rates equivalent to surgeryCure rates equivalent to surgery
Surgical ManagementSurgical Management
Emphasis on organ preservationEmphasis on organ preservation
Partial LarygectomyPartial Larygectomy
Floor of the tonsillar fossa is known as the bed and the glossopharyngeal nerve (CNIX) runs across this bed as well as tonsillar and ascending palantine arteries
Waldeyers ring; Palatine, lingual, pharyngeal and tubal tonsils
Valleculae; shallow pits. If crumb gets caught down wrong way will get lodged in and set about the coughing reflex
Animals such as fish have a larynx.
Corniculate cartilage is the apex of the arytenoid cartilages
Apex of the arytenoid catilage is corniculate cartilage
Cuneiform cartilage – elongated cartilage placed on each side of aryepiglottic folds in front of arytenoid cartilages
Phonation only possible when vocal cords are in contact with each other thus when they are adducted. Lengthening and shortening of the cords has no impact when the cords are open however when they are closed control the pitch of the voice. At rest the vocal cords are seprated as to allow for quite respiration. However during speech the cords are held together and air pressure causes vibrations of the folds giving rise to sound waves with a certain pitch. Intensity of the sound will vary with pressure through the glottis. Quality is dependent on the resonating chambers above the glottis such as vestibule of the larynx, pharynx, paranasal sinuses mouth and nose. Artibulation is dependent of breaking up the sound by use of tongue, teeth and lips.
Cadaveric position (2-3mm lateral to the laryngeal midline)
Open mouth/mouth breathing, Long elongated face, prominent incisors, Hypoplastic maxilla Short upper lip, Elevated nostrils, High arched palate,
Diagnosis by enlarged adenoids on mirror nasopharyngeal exam or nasopharyngoscopic exam, enlarged adenoid shadow on X-ray
Penicillin + EBV Rash maculopapular rash on trunk
DDx; Malignancy, Reactive lymphadenopathy, including TB, Branchial Cysts,
80% of lateral neck lumps are malignant
Axial (cross sectional), contrast enhanced, T1 weighted MRI through the nasopharynx and skull base. This scan demonstrates a right sided (on your left) nasopharyngeal squamous cell carcinoma with deep invasion
Soft immature cartilage that collapses during inspiration
Laryngeal Webs
Laryngeal Cysts
Vascular ring
Strangulation – mucosal tears, haematoma, multiple fractures and cartilaginous displacement.
Access to the laryngeal cartilage. Transvere incision in the neck. (strap muscles, sternohyoid, thyrohyoid, sternothyroid) dissected
Suspect upper-airway injury in any patient who has signs of cervical trauma. Common presenting symptoms in patients with laryngeal trauma include hoarseness, neck pain, dyspnea, dysphonia, aphonia, dysphasia, odynophonia, and odynophagia. Often not direct injury which can be lethal but the delayed oedema, haematoma can lead to airway obstruction. Many of those with laryngeal trauma have significant injuries elsewhere and are already intubated.