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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
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).
• During Phonation the vocal cords are adducted .
Laryngeal Web
• Whitish band in the anterior part of the glottis
• Congenital laryngeal Web
Presentation- Newly born with
hoarse weak cry
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
Intubation granuloma
CausesProlonged intubation
Blind intubation
Vocal nodules
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.