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Anatomy and Physiology of the Larynx
Anatomy of the larynx <ul><li>Larynx is situated in the midline of the neck. </li></ul><ul><li>From 3 rd  to 6 th  cervica...
Laryngeal cartilages <ul><li>Unpaired </li></ul><ul><li>Thyroid  </li></ul><ul><li>Cricoid </li></ul><ul><li>epiglottis </...
Thyroid cartilage <ul><li>The largest, each </li></ul><ul><li>half consists of  </li></ul><ul><li>Ala (lamina) </li></ul><...
Thyroid cartilage <ul><li>The 2 ala meet in the midline; </li></ul><ul><li>Forming an angle of </li></ul><ul><li>- 90 in m...
Thyroid cartilage <ul><li>An  oblique line  is running downward and foreward on the surface of each lamina, </li></ul><ul>...
Cricoid cartilage <ul><li>Resembles a signet ring, narrow in front and broad behind. </li></ul><ul><li>Ossification begins...
Cartilage of epiglottis <ul><li>Rises up behind the tongue. </li></ul><ul><li>It is a thin leaf-like sheet of elastic fibr...
Cartilage of epiglottis <ul><li>Anterior surface : </li></ul><ul><li>Free in upper part. </li></ul><ul><li>In its lower pa...
Cartilage of epiglottis <ul><li>Posterior surface : </li></ul><ul><li>Is indented by several small pits, in which mucous g...
Arytenoid cartilages <ul><li>Pyramidal in shape; </li></ul><ul><li>Posterior surface is triangular and concave, it extend ...
Arytenoid cartilages <ul><li>Anterolateral surf. is convex, it extends foreward into a vocal process. </li></ul>
Corniculate cartilages (The cartilages of Santorini) <ul><li>They articulate with the apices of the arytenoid cartilages a...
 
Cuneiform cartilages (The cartilages of Wrisberg) <ul><li>Are small bars of yellow elastic cartilage. </li></ul><ul><li>Th...
 
Laryngeal joints <ul><li>Crico-thyroid joint. </li></ul><ul><li>Crico-arytenoid joint . </li></ul>
Laryngeal ligaments and membranes <ul><li>Intrinsic  : </li></ul><ul><li>Uniting the cartilages of the larynx to one anoth...
Intrinsic laryngeal ligaments and membranes <ul><li>The elastic membrane of the larynx. </li></ul><ul><li>Thyroepiglottic ...
The elastic membrane of the larynx. <ul><li>It is the fibrous framework of the larynx. </li></ul><ul><li>It lies beneath t...
The elastic membrane of the larynx. <ul><li>- Contribute to the support of the aryepiglottic and ventricular folds. </li><...
The elastic membrane of the larynx. <ul><li>The lower part (conus elasticus or cricovocal mem.)  </li></ul><ul><li>Inferio...
Conus elasticus <ul><li>Superiorly it is attached: </li></ul><ul><li>Infront to the deep surface of the angle of the thyro...
Conus elasticus <ul><li>Behind attached to the vocal process of the arytenoid cartilage.  </li></ul>
Conus elasticus <ul><li>The vocal ligament is the free upper edge of the conus between these points of attachments. </li><...
Intrinsic laryngeal ligaments and membranes <ul><li>2. Thyroepiglottic lig . </li></ul><ul><li>. </li></ul>Attaches the ep...
Extrinsic laryngeal ligaments and membranes <ul><li>Thyrohoid membrane </li></ul><ul><li>It is a broad sheet of fibro-elas...
Thyrohoid membrane <ul><li>The subhyoid bursa separates the membrane from the posterior surface of the body of hyoid bone....
Extrinsic laryngeal ligaments and membranes <ul><li>Median thyrohyoid ligament.  </li></ul><ul><li>Lateral thyrohyoid liga...
Intrinsic laryngeal muscles <ul><li>Abductors of the vocal cords. </li></ul><ul><li>Adductors of the vocal cords. </li></u...
Abductors of the vocal cords Posterior crico-arytenoid muscle
 
Posterior crico-arytenoid muscle
Adductors of the vocal cords <ul><li>Are 3 on each side: </li></ul><ul><li>Lateral crico-arytenoid muscle. </li></ul><ul><...
Lateral crico-arytenoid muscle
 
Lateral crico-arytenoid muscle
Transverse portion of interarytenoid muscle
 
Action of transverse portion of interarytenoid muscle
External portion of thyro-arytenoid muscle
 
Thyro-arytenoid muscle
Tensors of the vocal cords <ul><li>Cricothyroid muscle ( external tensor). </li></ul><ul><li>Internal portion of thyro-ary...
Cricothyroid muscle  (external tensor)
Action of cricothyroid muscle
Internal portion of thyro-arytenoid (vocalis muscle)
 
Openers of the laryngeal inlet <ul><li>Thyro-epiglottic muscle </li></ul>
Closers of the laryngeal inlet <ul><li>Oblique portion of interarytenoid muscle. </li></ul>
 
Closers of the laryngeal inlet <ul><li>Aryepiglottic muscle   </li></ul>
Extrinsic muscles of the larynx <ul><li>Between the larynx and neighbouring structures; are 2 main groups: </li></ul><ul><...
Strap muscles
Cavity of the larynx <ul><li>2 folds </li></ul><ul><li>False vocal cord. </li></ul><ul><li>True vocal cord. </li></ul><ul>...
Vestibule. Ventricle. Subglottic space
False vocal cord <ul><li>These are the ventricular bands which are formed by the mucous membrane covering the ventricular ...
True vocal cords  <ul><li>Project further into than the false cords, and lie at a lower level.  </li></ul><ul><li>The cove...
Vestibule  <ul><li>Bounderies: </li></ul><ul><li>Posterior surface of epiglottis in front. </li></ul><ul><li>Interval betw...
Ventricle of the larynx <ul><li>A recess between the true and false cords. </li></ul><ul><li>It is lines by mucous membran...
Saccule <ul><li>The saccule is a conical pouch which ascends from the anterior part of the ventricle </li></ul><ul><li>It ...
Vestibule. Ventricle. Subglottic space
Large laryngeal saccule
Rima glottidis <ul><li>The glottis (rima glottidis) is the interval between: </li></ul><ul><li>The true vocal cord in its ...
 
Subglottic space <ul><li>Lies between the true vocal cord and the lower border of the cricoid cartilage. </li></ul>
Blood supply of the larynx <ul><li>Laryngeal branches of the superior thyroid artery. </li></ul><ul><li>Laryngeal branches...
Blood supply of the larynx Inferior thyroid artery superior thyroid artery
Nerve supply of the larynx supplied by branches of  vagus <ul><li>Superior laryngeal nerve, has 2 branches: </li></ul><ul>...
Superior laryngeal nerve External branch <ul><li>Travel down on the inferior constrictor muscle of the pharynx. </li></ul>...
Suprior laryngeal nerve  Internal branch   <ul><li>-Entirely sensoy. </li></ul><ul><li>- Pierces the thyrohyoid membrane w...
Recurrent (Inferior) laryngeal nerve <ul><li>longer coarse on the left. </li></ul><ul><li>In the left it turns round the a...
Recurrent (Inferior) laryngeal nerve <ul><li>Its terminal part passes upward, under cover of the ala of the thyroid cartil...
Lymphatic drainage of the larynx <ul><li>Vocal cord has no lymphatic vessels. </li></ul><ul><li>The edges of the vocal cor...
Lymphatic drainage of the larynx
Physiology of the larynx
<ul><ul><ul><ul><li>1. Protection of the lower air passages: This is the most important function of the larynx and the ear...
<ul><ul><ul><ul><li>2. Respiration: Larynx is part of the upper airway passages where it plays a role in adjustment of glo...
<ul><ul><ul><ul><li>3. Phonation: This is the last to develop phylogenetically, voice produced by the vibration of the voc...
<ul><ul><ul><ul><li>4. Fixation of the chest: When the larynx is closed voluntarily the thoracic cage becomes fixed permit...
<ul><ul><ul><ul><li>5. Sphencteric action: Occurs at three levels, aryepiglottic, false vocal cord, true vocal cord, in a ...
Symptoms of laryngeal disease <ul><li>Generally the laryngeal diseases are characterized by: </li></ul><ul><li>Hoarseness ...
Signs of laryngeal disease <ul><li>Voice abnormality (dysphonia): abnormal voice ranging from aphonia to hoarseness of voi...
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E.N.T.Anatomy and physiology of larynx.(dr.usif chalabe)

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E.N.T.Anatomy and physiology of larynx.(dr.usif chalabe)

  1. 1. Anatomy and Physiology of the Larynx
  2. 2. Anatomy of the larynx <ul><li>Larynx is situated in the midline of the neck. </li></ul><ul><li>From 3 rd to 6 th cervical vertebrae. </li></ul><ul><li>Consists of a framework of cartilages, connected by ligaments and membranes,lined by a mucous membrane and moved by muscles. </li></ul>
  3. 3. Laryngeal cartilages <ul><li>Unpaired </li></ul><ul><li>Thyroid </li></ul><ul><li>Cricoid </li></ul><ul><li>epiglottis </li></ul><ul><li>Paired </li></ul><ul><li>Arytenoid </li></ul><ul><li>Corniculate </li></ul><ul><li>Cuneiform </li></ul>
  4. 4. Thyroid cartilage <ul><li>The largest, each </li></ul><ul><li>half consists of </li></ul><ul><li>Ala (lamina) </li></ul><ul><li>A square plate; </li></ul><ul><li>Begin to ossify at 25; </li></ul><ul><li>May be completely converted to bone at 65. </li></ul>
  5. 5. Thyroid cartilage <ul><li>The 2 ala meet in the midline; </li></ul><ul><li>Forming an angle of </li></ul><ul><li>- 90 in men; </li></ul><ul><li>-120 in women. </li></ul><ul><li>Forming V shape notch called a thyroid notch or Adam ’ s apple. </li></ul>
  6. 6. Thyroid cartilage <ul><li>An oblique line is running downward and foreward on the surface of each lamina, </li></ul><ul><li>It is the site of muscular attachment. </li></ul>
  7. 7. Cricoid cartilage <ul><li>Resembles a signet ring, narrow in front and broad behind. </li></ul><ul><li>Ossification begins at 30 and may be complete by 65. </li></ul><ul><li>Consists of lamina and arch. </li></ul>
  8. 8. Cartilage of epiglottis <ul><li>Rises up behind the tongue. </li></ul><ul><li>It is a thin leaf-like sheet of elastic fibrocartilage. </li></ul><ul><li>The stem is long and thin and attached to the posterior surface of thyroid alae at their junction. </li></ul><ul><li>The free upper border is broad and rounded. </li></ul>
  9. 9. Cartilage of epiglottis <ul><li>Anterior surface : </li></ul><ul><li>Free in upper part. </li></ul><ul><li>In its lower part is separated from hyoid bone and thyrohyoid membrane by fatty tissue </li></ul><ul><li>(pre-epiglottic space) </li></ul>
  10. 10. Cartilage of epiglottis <ul><li>Posterior surface : </li></ul><ul><li>Is indented by several small pits, in which mucous glands are embeded. </li></ul>The tubercle of epiglottis projects backwards in its lower part.
  11. 11. Arytenoid cartilages <ul><li>Pyramidal in shape; </li></ul><ul><li>Posterior surface is triangular and concave, it extend laterally into a muscular process. </li></ul>
  12. 12. Arytenoid cartilages <ul><li>Anterolateral surf. is convex, it extends foreward into a vocal process. </li></ul>
  13. 13. Corniculate cartilages (The cartilages of Santorini) <ul><li>They articulate with the apices of the arytenoid cartilages and prolong them backwards and medially. </li></ul><ul><li>They give attachments to the upper fibers of the oesophagus. </li></ul>
  14. 15. Cuneiform cartilages (The cartilages of Wrisberg) <ul><li>Are small bars of yellow elastic cartilage. </li></ul><ul><li>There is one in each ary-epiglottic fold, where it acts as a passive prop. </li></ul><ul><li>They do not articulate with any other cartilage. </li></ul>
  15. 17. Laryngeal joints <ul><li>Crico-thyroid joint. </li></ul><ul><li>Crico-arytenoid joint . </li></ul>
  16. 18. Laryngeal ligaments and membranes <ul><li>Intrinsic : </li></ul><ul><li>Uniting the cartilages of the larynx to one another. </li></ul><ul><li>Extrinsic : </li></ul><ul><li>Uniting the cartilages of the larynx to the skeletal structures outside the larynx. </li></ul>
  17. 19. Intrinsic laryngeal ligaments and membranes <ul><li>The elastic membrane of the larynx. </li></ul><ul><li>Thyroepiglottic ligament. </li></ul>
  18. 20. The elastic membrane of the larynx. <ul><li>It is the fibrous framework of the larynx. </li></ul><ul><li>It lies beneath the laryngeal mucosa. </li></ul><ul><li>It is divided into upper & lower part by the ventricle of the larynx </li></ul>
  19. 21. The elastic membrane of the larynx. <ul><li>- Contribute to the support of the aryepiglottic and ventricular folds. </li></ul><ul><li>-The ventricular ligament is a thickening of the free border. </li></ul>The upper part(Quadrangular mem.)
  20. 22. The elastic membrane of the larynx. <ul><li>The lower part (conus elasticus or cricovocal mem.) </li></ul><ul><li>Inferiorly </li></ul><ul><li>it is attached to the superior border of the cricoid cartilage. </li></ul>
  21. 23. Conus elasticus <ul><li>Superiorly it is attached: </li></ul><ul><li>Infront to the deep surface of the angle of the thyroid cartilage. The median cricothyroid ligament is formed by the thickened anterior part of the conus. </li></ul>
  22. 24. Conus elasticus <ul><li>Behind attached to the vocal process of the arytenoid cartilage. </li></ul>
  23. 25. Conus elasticus <ul><li>The vocal ligament is the free upper edge of the conus between these points of attachments. </li></ul>
  24. 26. Intrinsic laryngeal ligaments and membranes <ul><li>2. Thyroepiglottic lig . </li></ul><ul><li>. </li></ul>Attaches the epiglottis to the thyroid cartilage
  25. 27. Extrinsic laryngeal ligaments and membranes <ul><li>Thyrohoid membrane </li></ul><ul><li>It is a broad sheet of fibro-elastic tissue attaches the upper border of thyroid cartilage and hyoid bone. </li></ul>
  26. 28. Thyrohoid membrane <ul><li>The subhyoid bursa separates the membrane from the posterior surface of the body of hyoid bone. </li></ul><ul><li>Upward movement of the larynx during deglutition is facilitated by the bursa. </li></ul><ul><li>The membrane is pierced on each side by: </li></ul><ul><li>- superior laryngeal vessels. </li></ul><ul><li>- internal branch of superior laryngeal nerve. </li></ul>
  27. 29. Extrinsic laryngeal ligaments and membranes <ul><li>Median thyrohyoid ligament. </li></ul><ul><li>Lateral thyrohyoid ligament. </li></ul><ul><li>Cricotracheal membrane. </li></ul><ul><li>Hyo-epiglottic ligament. </li></ul>
  28. 30. Intrinsic laryngeal muscles <ul><li>Abductors of the vocal cords. </li></ul><ul><li>Adductors of the vocal cords. </li></ul><ul><li>Tensors of the vocal cords. </li></ul><ul><li>Openers of laryngeal inlets. </li></ul>
  29. 31. Abductors of the vocal cords Posterior crico-arytenoid muscle
  30. 33. Posterior crico-arytenoid muscle
  31. 34. Adductors of the vocal cords <ul><li>Are 3 on each side: </li></ul><ul><li>Lateral crico-arytenoid muscle. </li></ul><ul><li>Transverse portion of interarytenoid muscle. </li></ul><ul><li>External portion of thyro-arytenoid muscle. </li></ul>
  32. 35. Lateral crico-arytenoid muscle
  33. 37. Lateral crico-arytenoid muscle
  34. 38. Transverse portion of interarytenoid muscle
  35. 40. Action of transverse portion of interarytenoid muscle
  36. 41. External portion of thyro-arytenoid muscle
  37. 43. Thyro-arytenoid muscle
  38. 44. Tensors of the vocal cords <ul><li>Cricothyroid muscle ( external tensor). </li></ul><ul><li>Internal portion of thyro-arytenoid (vocalis muscle). </li></ul>
  39. 45. Cricothyroid muscle (external tensor)
  40. 46. Action of cricothyroid muscle
  41. 47. Internal portion of thyro-arytenoid (vocalis muscle)
  42. 49. Openers of the laryngeal inlet <ul><li>Thyro-epiglottic muscle </li></ul>
  43. 50. Closers of the laryngeal inlet <ul><li>Oblique portion of interarytenoid muscle. </li></ul>
  44. 52. Closers of the laryngeal inlet <ul><li>Aryepiglottic muscle </li></ul>
  45. 53. Extrinsic muscles of the larynx <ul><li>Between the larynx and neighbouring structures; are 2 main groups: </li></ul><ul><li>Strap muscles. (sternothyroid & thyrohyoid). </li></ul><ul><li>Pharyngeal muscles. </li></ul>
  46. 54. Strap muscles
  47. 55. Cavity of the larynx <ul><li>2 folds </li></ul><ul><li>False vocal cord. </li></ul><ul><li>True vocal cord. </li></ul><ul><li>3 parts </li></ul><ul><li>Vestibule. </li></ul><ul><li>Ventricle. </li></ul><ul><li>Subglottic space </li></ul><ul><li>Extends from the inlet of the larynx to the lower border of the cricoid cartilage, it is divided into 3 parts by 2 folds of mucous membrane: </li></ul>
  48. 56. Vestibule. Ventricle. Subglottic space
  49. 57. False vocal cord <ul><li>These are the ventricular bands which are formed by the mucous membrane covering the ventricular ligament and the upper part of the external portion of the thyroarytenoid muscle. </li></ul>
  50. 58. True vocal cords <ul><li>Project further into than the false cords, and lie at a lower level. </li></ul><ul><li>The covering epithelium is closely bound down to the underlying vocal ligament. </li></ul><ul><li>The blood supply is poor, hence the pearly white appearance of the vocal cords. </li></ul>
  51. 59. Vestibule <ul><li>Bounderies: </li></ul><ul><li>Posterior surface of epiglottis in front. </li></ul><ul><li>Interval between the arytenoid cartilages behind. </li></ul><ul><li>Inner surface of the aryepiglottic folds and upper surfaces of the false cords on each side. </li></ul><ul><li>Lies between the laryngeal inlet and the edges of the false cords. </li></ul>
  52. 60. Ventricle of the larynx <ul><li>A recess between the true and false cords. </li></ul><ul><li>It is lines by mucous membrane which is covered externally by the thyroarytenoid muscle. </li></ul><ul><li>Compsed of 2 parts </li></ul><ul><li>Saccule. </li></ul><ul><li>Rimaglottidis. </li></ul>
  53. 61. Saccule <ul><li>The saccule is a conical pouch which ascends from the anterior part of the ventricle </li></ul><ul><li>It lies between the inner surface of thyroid cartilage and the false cords. </li></ul><ul><li>Numerous mucous glands open onto the surface of its lining mucosa. </li></ul>
  54. 62. Vestibule. Ventricle. Subglottic space
  55. 63. Large laryngeal saccule
  56. 64. Rima glottidis <ul><li>The glottis (rima glottidis) is the interval between: </li></ul><ul><li>The true vocal cord in its anterior 3/5. </li></ul><ul><li>The vocal processes of the arytenoid cartilages in its posterior 2/5. </li></ul><ul><li>Its average length: </li></ul><ul><li>In the adult male is about 2.5 cm. </li></ul><ul><li>In the adult female is about 1.6 cm. </li></ul>
  57. 66. Subglottic space <ul><li>Lies between the true vocal cord and the lower border of the cricoid cartilage. </li></ul>
  58. 67. Blood supply of the larynx <ul><li>Laryngeal branches of the superior thyroid artery. </li></ul><ul><li>Laryngeal branches of the inferior thyroid artery. </li></ul><ul><li>Cricothryoid branches of superior thyroid artery (cross the midline at the upper part of the cricothyroid membrane). </li></ul>
  59. 68. Blood supply of the larynx Inferior thyroid artery superior thyroid artery
  60. 69. Nerve supply of the larynx supplied by branches of vagus <ul><li>Superior laryngeal nerve, has 2 branches: </li></ul><ul><li>Internal. </li></ul><ul><li>External. </li></ul><ul><li>Recurrent (Inferior) laryngeal nerve : </li></ul><ul><li>Anterolateral (motor) </li></ul><ul><li>Posteromedial(sensory) </li></ul>
  61. 70. Superior laryngeal nerve External branch <ul><li>Travel down on the inferior constrictor muscle of the pharynx. </li></ul><ul><li>Supplies the cricothyroid muscle and part of the anterior subglottis. </li></ul>
  62. 71. Suprior laryngeal nerve Internal branch <ul><li>-Entirely sensoy. </li></ul><ul><li>- Pierces the thyrohyoid membrane with the superior laryngeal artery and vein. </li></ul><ul><li>-Supplies the cavity of the larynx as far down as the level of the vocal cords. </li></ul>
  63. 72. Recurrent (Inferior) laryngeal nerve <ul><li>longer coarse on the left. </li></ul><ul><li>In the left it turns round the arch of the aorta. </li></ul><ul><li>On the right it turns round the subclavian artery. </li></ul><ul><li>In the neck it lies between the trachea and the oesophagus </li></ul>
  64. 73. Recurrent (Inferior) laryngeal nerve <ul><li>Its terminal part passes upward, under cover of the ala of the thyroid cartilage immediately behind the inferior cricothyroid joint, it then divided into: </li></ul><ul><li>Anterolateral (motor) branch which supplies all the intrisic muscles of the larynx except cricothyroid muscle. </li></ul><ul><li>Postromedial (sensory) branch which supplies the cavity of the larynx below the level of the vocal cords. </li></ul>
  65. 74. Lymphatic drainage of the larynx <ul><li>Vocal cord has no lymphatic vessels. </li></ul><ul><li>The edges of the vocal cord divide the lymphatic of the larynx into 2 parts: </li></ul><ul><li>Supraglottic drain into: </li></ul><ul><li>2. Subglottic drain into: </li></ul><ul><li>Pre-epiglottic nodes. </li></ul><ul><li>Upper deep cervical nodes. </li></ul><ul><li>Prelaryngeal and pretracheal nodes. </li></ul><ul><li>Lower deep cervical. </li></ul>
  66. 75. Lymphatic drainage of the larynx
  67. 76. Physiology of the larynx
  68. 77. <ul><ul><ul><ul><li>1. Protection of the lower air passages: This is the most important function of the larynx and the earliest one to develop phylogenetically, several mechaniusms involved including closure of the laryngeal inlets of epiglottic sphincters, aryepiglottic and glottic sphincter during the act of swallowing to protect the lower air passages and direct the food smoothly into the pyriform fossa. Automatic cessation of the respiration by the efferent pathway of the CN IX is another mechanism of protection in addition to cough reflex. This is also initiated in the trachea and bronchi. </li></ul></ul></ul></ul>
  69. 78. <ul><ul><ul><ul><li>2. Respiration: Larynx is part of the upper airway passages where it plays a role in adjustment of glottic aperture by inspiratory abduction expiratory adduction contributing to the regulation of the acid-base balance in the blood by influencing CO 2 tension. </li></ul></ul></ul></ul>
  70. 79. <ul><ul><ul><ul><li>3. Phonation: This is the last to develop phylogenetically, voice produced by the vibration of the vocal cord changed into meaningful speech and amplified selectively by resonating chamber of the mouth, pharynx, nose, and chest. The voice has the character of: </li></ul></ul></ul></ul><ul><ul><ul><ul><li>volume (intensity) which depends on the air pressure generated in the lungs by the contraction of the abdominal and thoracic muscles. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Pitch which determines the timper (quality of the voice) by cutting the air column generated in the lungs into puffs by vibration of the fully adducted vocal cords and the frequency of these puffs determines the pitch. </li></ul></ul></ul></ul>
  71. 80. <ul><ul><ul><ul><li>4. Fixation of the chest: When the larynx is closed voluntarily the thoracic cage becomes fixed permitting climbing, digging, and during the acts of defecation and parturition by pushing the diaphragm downward and increasing the intra abdominal pressure. </li></ul></ul></ul></ul>
  72. 81. <ul><ul><ul><ul><li>5. Sphencteric action: Occurs at three levels, aryepiglottic, false vocal cord, true vocal cord, in a sequence from below upward during the act of swallowing to protect the air passage. </li></ul></ul></ul></ul>
  73. 82. Symptoms of laryngeal disease <ul><li>Generally the laryngeal diseases are characterized by: </li></ul><ul><li>Hoarseness of the voice which means rough voice, maybe a manifestation of any laryngeal disease whether congenital, traumatic, inflammatory, or neoplastic, or as a systemic disease as hypothyroidism , lung cancer. </li></ul><ul><li>Stridor: this is produced by the turbulence of diminished air flow at the nearly completely or partially obstructed larynx in the form of musical sounds, it’s usually inspiratory at the supraglottic and glottic and by phasic in the subglottic down to the carrina, expiratory stridor (wheez) at the lower air passages. </li></ul><ul><li>Aspiration: inhalation of the food or saliva due to failure of the protective sphencteric function of the larynx manifested as chocking or coughing during swallowing or chest infection due to saliva soiling in the lungs. </li></ul><ul><li>Pain: it maybe felt in the larynx or referred to the ear (otalgia) through IX & X CN. </li></ul>
  74. 83. Signs of laryngeal disease <ul><li>Voice abnormality (dysphonia): abnormal voice ranging from aphonia to hoarseness of voice. </li></ul><ul><li>Stridor. </li></ul><ul><li>Mobility: laryngeal mobility due to swallowing and phonation (which is normally palpable) may be impalpable in laryngeal disease. </li></ul><ul><li>Neck lump: this is maybe due to lartngeal disease itself or metastasis to the neck lymphnodes. </li></ul>
  75. 84. Thank you

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