Larynx Imaging 4th part virtual laryngoscopy vocal cord paralysis CT MRI Dr Ahmed Esawy Laryngomalacia Ductal retention cyst Cystic hygroma Bifid epiglottis Vocal cord paralysis Web and atresia Interarytenoid web Posterior laryngeal cleft Cri-du-chat syndrome Cong. Subglottic stenosis Subglottic hemangioma Web & atresia Cysts Croup Epiglottic Enlargement Epiglottitis Squamous cell carcinoma is mucosal disease Glottic carcinoma subglottic carcinoma supraglottic carcinoma virtual laryngoscopy vocal cord paralysis Hyiod bone Laryngeal skeleton the paired 1- arytenoid, 2- corniculate 3- cuneiform cartilage the unpaired 4- thyroid 5- cricoid 6- epiglottic cartilages supraglottic 7- Valleculae 8- Aryepiglottic fold 9- Glossoepiglottic fold 10- Laryngeal vestibule 11- False cord 12- Ventricle 13- Preepiglottic space

1. CTVL (CT virtual laryngoscopy)
is a new method for
demonstrating the endoluminal
structures of the laryngeal and
hypopharyngeal region
simulating actual laryngoscopy.

2. SUPRAGLOTTIC LEVEL

3. SUPRAGLOTTIC LEVEL

4. GLOTTIC LEVEL

5. SUBGLOTTIC LEVEL

8. • CT in Carcinoma of the
Larynx and Pyriform
Sinus:Value of Phonation
Scans

9. • A, CT scan in normal subject during quiet breathing at level of true vocal
cords. Arytenoid cartilages (arrows) cleanly visible in close proximity to inner
margin of thyroid cartilage. Right anytenoid slightly larger than left.
• B, During phonation of letter E, arytenoid cartilages adduct and
rotateinwards. Distended pyniform sinuses (P) are seen lateral to arytenoid
cartilages.

10. • A, Scan during quiet breathing at level of true vocal
cords in patient with clinical fixation of right true cord.
Cordal mass (arrows) displaces vocal process of right
arytenoid cartilage medially.
• B, During phonation. Left anytenoid moves normally.
Right arytenoid remains fixed in abducted position.

11. •RULE OF CT in the
Diagnosis of Vocal
Cord Paralysis

12. VOCAL CORD PARALYSIS
• Etiology:
• Causes of vocal cord paralysis may be divided as:
• A) Congenital:
• For example; nuclear aplasia, cerebral agenesis, birth trauma, stretch at the
skull base in meningioceles and hydrocephalus (Arnold-Chiari malformation).
• B) Acquired: These include:
• 1. Trauma:
• Surgical trauma: is the most common cause of vocal cord paralysis (25%). The
most common surgery is thyroid surgery. Other operations include; radical neck
dissection, carotid artery surgery, oesophageal surgery, cardiac surgery and
mediastinal surgery.
• Accidental trauma: as gunshots and stab wounds to the neck or chest.
• 2. Neoplasms:
• As bronchogenic carcinoma (most common). esophageal and postcricoid
carcinoma and thyroid tumors.
• 3. Systemic disorders:
• Infections: Viral (as influenza), or bacterial (TB, or syphilis)
• Toxic neuritis: Diabetes, lead and alcohol poisoning.
• Cardiovascular: Cardiomegally e.g. in mitral stenosis, and aortic aneurysm.
• 4. Idiopathic

13. CT signs of cord paralysis
• paramedian position of the cords,
• displaced arytenoid cartilage,
• ipsilateral dilatation of the pyriform sinus,
• tilting of the thyroid cartilage,
• medial positioning and thickening of the ipsilateral
aryepiglottic fold,
• ipsilateral laryngeal ventricle dilatation
• Ipsilateral pharyngeal constrictor muscle atrophy
• peripheral and central vagal neuropathy

14. • Usefulness of Laryngeal
Phonation CT in the Diagnosis of
Vocal Cord Paralysis

15. • DURING PHONATION ARYTENIOD
ADDUCT
• ARY ABDUCT AT QUIET

16. -distance between cord tip
and
midline of laryngeal
airway
during phonation.
-Black arrows indicate
stretched
vocal cord during
phonation.
-Angle between long axis
of the vocal cord and
midlline Dr Ahmed Esawy

17. A —29-year-old
woman in good health.
Coronal reconstructed
• CT image of larynx during
normal breathing shows larynx at
level of vocal cords appears to
be flat, without vocal cord
protrusion.
B- during phonation
protrude,symmetrical
Dr Ahmed Esawy

18. • Fig. A —65-year-old woman with left vocal
cord paralysis for 2 years. Coronal
reconstructed CT image of larynx during
normal breathing shows relaxed
appearance of both vocal cords without
protrusion (arrows).
Dr Ahmed Esawy

19. • Using CT to Localize Side and
Level of Vocal Cord Paralysis

20. dilatation of right vallecula (arrow, A) and
dilatation of right pyriform sinus (A),
dilatation of right pyriform sinus and
thickening and medial positioning of right
aryepiglottic fold
and dilatation of right
laryngeal ventricle (white
arrow
and anterior positioning of right
arytenoid cartilage (black arrow, C).
Dr Ahmed Esawy

21. dilatation of right vallecula
dilatation of right pyriform sinus and
thickening and medial positioning of right
aryepiglottic fold
fullness of right true vocal cord and slight
anterior positioning of right arytenoid
cartilag
right subglottic fullness
Dr Ahmed Esawy

22. dilatation of right pyriform sinus (large
arrow, A), thickening and medial
positioning of left aryepiglottic fold (small
arrow, A
dilatation of left laryngeal ventricle
(arrow)
ullness of right true vocal cord Dr Ahmed Esawy

23. dilated left oropharynx with thinning and
atrophy of pharyngeal wall (arrow)
dilatation of left pyriform sinus and
thickening and medial positioning of left
aryepiglottic fold
64-year-old man with hoarseness, left
vocal cord paralysis, and left-sided palatal
weakness CT+C

24. Left VF Palsy- Aortic
aneurism.

25. 1-STRIDOR
• Definition: Difficult noisy breathing
due to partial laryngeal obstruction.
Early it is inspiratory, later it
becomes both inspiratory and
expiratory when obstruction
increases.

26. Causes of stridor ( laryngeal
obstruction ):
• Congential :
• Congenital web .
• Congenital laryngeal stridor :
• Infantile larynx.
• Congenital laryngomalacia.
• Traumatic :
• Foreign body .
• Accidental trauma:
• External Trauma e.g cut throat or strangulation
• Internal trauma:
• Chemical e.g corrosives.
• Physical e.g hot water or burns.
• surgical trauma ( Iatrogenic ):
• I – Immediate: e.g oedema following endoscopy or difficult endotracheal intubation.
• II – Late: e.g stenosis following high tracheostony or prolonged endotracheal intubation.
• Inflammatory :
• Acute:
• Non specific : in children .
• Specific : diphtheria .
• Chronic:
• I- Non specific : only with acute exacerbation
• II- Specific : Scleroma , syphilis , T.B .
• Allergic oedema :
• e.g angioneurotic oedema or durg sensitivity e.g. to penicillin
• Neoplastic :
• Benign: multiple popillomatata in childern.
• Malignant: carcinoma.
• Neurogenic :
• Bilateral abductor paralysis : most commonly after thyroidectomy.
• Functional
• Laryngismus stridulus

27. 2-HOARSENESS OF VOICE:
• Definition: Rough, harsh quality to
voice or cry.
• Causes: Lesions in the true vocal
cords.