For any suggestions please call 0122358933. Laryngeal examination indirect laryngoscopy Laryngeal...

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Laryngeal examination

indirect laryngoscopy

LaryngealMirror

Technique of Indirect Laryngoscopy-Warm the mirror to the body temperature to avoid fogging of the mirror by the respiratory water vapour- Hold the tongue by a piece of gauze by your left hand-Hold the mirror by your right hand and place against the base of the uvula- Ask the patient to say eeee to assess adduction- Ask the patient to take deep inspiration to assess abduction

During phonation During quiet inspiration

Base of the tongue

Epiglootis Epiglootis

Pyriform fossa

Vocal folds Ary-epiglottic fold

Arytenoid

Laryngeal examination

Flexible fiberoptic nasolaryngoscopy

Flexible endoscopic Examination of-Nasal cavity-Nasal cavity-Hypopharynx-Larynx

Rigid endoscopic examination of the larynx and hypopharynx

Direct Laryngoscope• Indications• Contraindications

Diagnostic-To examine the Larynx-To take biopsyTherapeutic-Excision of benign lesions-Excision of small malignant tumors-Teflon injection-Arytenoidectomy-Removal of FB

Severe Kyphosis

http://rds.yahoo.com/_ylt=A9gnMiO020hF5FkB33WJzbkF;_ylu=X3oDMTBjYzZubXM2BHBvcwM4BHNlYwNzcg--/SIG=1ld85v4a9/EXP=1162489140/**http%3A//images.search.yahoo.com/search/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253F_adv_prop%253Dimages%2526imgsz%253Dall%2526imgc%253D%2526vf%253Dall%2526va%253Dkyphosis%2526fr%253Dyfp-t-501%2526ei%253DUTF-8%26w=233%26h=305%26imgurl=www.mercksource.com%252Fppdocs%252Fus%252Fcommon%252Fdorlands%252Fdorland%252Fchapters%252Fimages%252Fw0146_k_12.jpg%26rurl=http%253A%252F%252Fwww.mercksource.com%252Fpp%252Fus%252Fcns%252Fcns_hl_dorlands.jspzQzpgzEzzSzppdocszSzuszSzcommonzSzdorlandszSzdorlandzSzdmd_k_04zPzhtm%26size=14.6kB%26name=w0146_k_12.jpg%26p=kyphosis%26type=jpeg%26no=8%26tt=919%26oid=5d594f8010031a3c%26ei=UTF-8

Micro-laryngeal surgery

The use of the operating Microscope in direct Laryngoscopy is called MICRO-LARYNGOSCOPY

Advantage:Provides MagnificationProvides good illumination

Micro-laryngeal surgery employing laser

Microscope

Laryngoscope

• Abduction: The vocal cords are apart for breathing in.

• The rings of the trachea can be seen ( yellow arrow).

http://www.voicedoctor.net/media/photo/normal/52117/5211803rab.jpg

• During Phonation the vocal cords are adducted .

http://www.voicedoctor.net/media/photo/normal/52117/5211815rsthigh.jpg

Laryngeal Web

• Whitish band in the anterior part of the glottis

• Congenital laryngeal Web

Presentation- Newly born with

hoarse weak cry

http://rds.yahoo.com/_ylt=A9gnMiDOWjFFAbEAf.6JzbkF;_ylu=X3oDMTBkbzMyZHR2BHBvcwMzOQRzZWMDc3I-/SIG=1kl647c54/EXP=1160948814/**http%3A//images.search.yahoo.com/search/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dvocal%252Bpolyp%252Bimage%2526ei%253DUTF-8%2526qp_p%253Dvocal%252Bpolyp%2526imgsz%253Dall%2526fr%253Dyfp-t-500%2526b%253D21%26w=240%26h=166%26imgurl=www.cardioanaesthesie.de%252FAusbildung%252520und%252520Training%252Flarynxbilder%252Fvocal_cord_web.jpg%26rurl=http%253A%252F%252Fwww.cardioanaesthesie.de%252FAusbildung%252520und%252520Training%252Flarynxbilder%252Flaryngstart.htm%26size=13.2kB%26name=vocal_cord_web.jpg%26p=vocal%2Bpolyp%2Bimage%26type=jpeg%26no=39%26tt=98%26oid=e033299673565eaa%26ei=UTF-8

laryngomalacia

• The supraglottis is collapsing inwards during inspiration

Presentation:- Inspiratory stridors- Starts soon after

birth- Improves in prone

position- Normal cry

Subglottic Hemangiom

aMay be accompanied with

hemangiomas in other sites

http://rds.yahoo.com/_ylt=A9gnMiLgSjFFkqcAgAWJzbkF;_ylu=X3oDMTBkN2lwNjljBHBvcwMxOARzZWMDc3I-/SIG=1j7k4lmpg/EXP=1160944736/**http%3A//images.search.yahoo.com/search/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dhemangioma%252Bimage%2526ei%253DUTF-8%2526fr%253Dyfp-t-500%2526x%253Dwrt%26w=600%26h=480%26imgurl=www.library.vcu.edu%252Fpdfgif%252Ftml%252Foralpathology%252F7-hemangioma.jpg%26rurl=http%253A%252F%252Fwww.library.vcu.edu%252Fcfapps%252Ftml%252Foralpathology%252Fbrowse_oral.cfm%253Ftype%253Dall%2526display%253Dlong%2526startrow%253D22%26size=112.1kB%26name=7-hemangioma.jpg%26p=hemangioma%2Bimage%26type=jpeg%26no=18%26tt=7,432%26oid=4efaf71c81a94136%26ei=UTF-8

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http://rds.yahoo.com/_ylt=A9gnMiCxSzFFAakA2e2JzbkF;_ylu=X3oDMTBlbWJhbmZwBHBvcwMxNjIEc2VjA3Ny/SIG=1hjond5c7/EXP=1160944945/**http%3A//images.search.yahoo.com/search/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dhemangioma%252Bimage%2526ei%253DUTF-8%2526qp_p%253Dhemangioma%2526imgsz%253Dall%2526fr%253Dyfp-t-500%2526b%253D161%26w=490%26h=305%26imgurl=matrix.ucdavis.edu%252Ftumors%252Fbenign%252Fhemangioma2.jpeg%26rurl=http%253A%252F%252Fmatrix.ucdavis.edu%252Ftumors%252Fbenign%252Fbenign.html%26size=17.4kB%26name=hemangioma2.jpeg%26p=hemangioma%2Bimage%26type=jpeg%26no=162%26tt=7,432%26oid=05baae11881ffe3e%26ei=UTF-8

http://rds.yahoo.com/_ylt=A9gnMiHXSzFF6S8A1LKJzbkF;_ylu=X3oDMTBlYmtlanYyBHBvcwMxOTIEc2VjA3Ny/SIG=1ggffsdh6/EXP=1160944983/**http%3A//images.search.yahoo.com/search/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dhemangioma%252Bimage%2526ei%253DUTF-8%2526qp_p%253Dhemangioma%2526imgsz%253Dall%2526fr%253Dyfp-t-500%2526b%253D181%26w=240%26h=236%26imgurl=www.birthmarks.us%252Fhemangioma_lip_2.JPG%26rurl=http%253A%252F%252Fwww.birthmarks.us%252Fhemangioma.htm%26size=11.1kB%26name=hemangioma_lip_2.JPG%26p=hemangioma%2Bimage%26type=jpeg%26no=192%26tt=7,432%26oid=83541ecce8def75a%26ei=UTF-8

Posterior laryngeal cleft

http://rds.yahoo.com/_ylt=A9gnMilZUDFFiugANnWJzbkF;_ylu=X3oDMTBjcDR2NTN2BHBvcwM2BHNlYwNzcg--/SIG=1hoj6qhot/EXP=1160946137/**http%3A//images.search.yahoo.com/search/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dlaryngeal%252Bcleft%2526ei%253DUTF-8%2526fr%253Dyfp-t-500%2526x%253Dwrt%26w=259%26h=250%26imgurl=www.sickkids.on.ca%252Fotolaryngology%252FEducationalMaterial%252Fairway%252Fimages%252FLcleft.gif%26rurl=http%253A%252F%252Fwww.gfmer.ch%252Fgenetic_diseases_v2%252Fgendis_detail_list.php%253Fcat3%253D579%26size=27.7kB%26name=Lcleft.gif%26p=laryngeal%2Bcleft%26type=gif%26no=6%26tt=14%26oid=08d97c9caf195ee0%26ei=UTF-8

Intubation granuloma

CausesProlonged intubation

Blind intubation

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http://rds.yahoo.com/_ylt=A9gnMijvVzFFwxEAuYuJzbkF;_ylu=X3oDMTBjdmNoOTVjBHBvcwMyBHNlYwNzcg--/SIG=1h08cmuip/EXP=1160948079/**http%3A//images.search.yahoo.com/search/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dintubation%252Bgranuloma%252Bimage%2526ei%253DUTF-8%2526fr%253Dyfp-t-500%2526x%253Dwrt%26w=505%26h=520%26imgurl=www.ghorayeb.com%252Ffiles%252FIntubationGranulomaGG1.jpg%26rurl=http%253A%252F%252Fwww.ghorayeb.com%252FLarynxIntubationGranuloma.html%26size=185.3kB%26name=IntubationGranulomaGG1.jpg%26p=intubation%2Bgranuloma%2Bimage%26type=jpeg%26no=2%26tt=11%26oid=b20cd5573ab1c53a%26ei=UTF-8

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Reinke’s edema

Voice abuse

http://rds.yahoo.com/_ylt=A9gnMinBWDFFeO0A9qWJzbkF;_ylu=X3oDMTBkYTNuNGk0BHBvcwMxMARzZWMDc3I-/SIG=1grrc4d01/EXP=1160948289/**http%3A//images.search.yahoo.com/search/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DReinke%252527s%252Bedema%252Bimage%2526ei%253DUTF-8%2526fr%253Dyfp-t-500%2526x%253Dwrt%26w=115%26h=150%26imgurl=www.yorku.ca%252Fearmstro%252Fjourney%252Fimages%252Freinkes1.jpg%26rurl=http%253A%252F%252Fwww.yorku.ca%252Fearmstro%252Fjourney%252Finjuries.html%26size=3.9kB%26name=reinkes1.jpg%26p=Reinke%2527s%2Bedema%2Bimage%26type=jpeg%26no=10%26tt=48%26oid=80f221eac631c2fc%26ei=UTF-8

Vocal nodules

• Vocal polyp

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Multiple Papillomatosis

EpiglottitisEpiglottitis

CrouCroupp

Laryngoscleroma (subglottic web)

Vocal cord

Greenishcrusts

Vocal cord

Rhinoscleroma

Subglottic stenosis

• a T1 squamous cell carcinoma of the vocal cord • The right picture shows the immediate post-

operative appearance of the vocal cords after surgical biopsy. This patient will be treated with full course radiation therapy and should have greater than a 90% chance of cure.

Laryngeal Carcinoma

• The picture on the left is a cancer of the epiglottis or top of the voice box. The middle picture is a cancer of the true vocal cords and the picture on the far right is a cancer of the sub-glottis or below the vocal cords.

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