Laryngology



FIGURE 7.1 Three-Dimensional Effects of Posterior Cricoarytenoid Muscle Contraction.

(A) Sagittal view. (B) Posterior view. (From Flint PW, Haughey BH, Lund VJ, et al. Cummings Otolaryngology—Head and Neck Surgery. 6th ed. Philadelphia, PA: Saunders; 2015, fig. 54-3.)



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FIGURE 7.2 Movements of different portions of vocal folds during one cycle of vibration shown schematically in the coronal plane (left) and from above (right). Mucosal upheaval begins caudally (1) and then moves rostrally. The lower portion is closing as the upper margin is opening (5). (From Hirano M. Clinical Examination of Voice. New York, NY: Springer-Verlag; 1981; and Flint PW, Haughey BH, Lund VJ, et al. Cummings Otolaryngology—Head and Neck Surgery. 6th ed. Philadelphia, PA: Saunders; 2015, fig. 54-11.)


Thyroarytenoid muscle


Perichondrium and thyroid cartilage provides the lateral boundary of the vocal fold (Fig. 7.3)



Visualization of the Larynx


Indirect Methods of Visualize the Larynx



1. Mirror laryngoscopy


2. Rigid indirect laryngoscopy


3. Flexible indirect laryngoscopy

Benefits of Rigid Indirect Laryngoscopy



1. Higher resolution


2. Brighter, clearer picture

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FIGURE 7.3 Cross Section of the Vocal Fold.

 (From Flint PW, Haughey BH, Lund VJ, et al. Cummings Otolaryngology—Head and Neck Surgery. 6th ed. Philadelphia, PA: Saunders; 2015, fig. 61-1.)


3. Image is more accurately magnified


4. Generally does not require topical anesthesia

Drawbacks of Rigid Indirect Laryngoscopy



1. Cannot visualize the larynx while patient performs complex speaking tasks


2. May be difficult to visualize arytenoid abduction/adduction in certain patients

Benefits of Flexible Indirect Laryngoscopy



1. Can visualize the larynx during speaking/singing tasks


2. The larynx is in a more natural configuration for neurological evaluation

Drawbacks of Flexible Indirect Laryngoscopy



1. Generally requires topical anesthesia


2. Distortion at the periphery of the image


3. Inferior light transport/magnification versus rigid

Key Structures and Finding to Be Evaluated with Laryngopharyngeal Endoscopy



1. Overall structure of vocal folds



Bowed (atrophy)


Scar/sulcus deformity


2. Masses or lesions


3. Abduction and adduction of true vocal folds



Vocal fold paresis/paralysis


Cricoarytenoid joint fixation


Posterior glottic stenosis


4. Supraglottic configuration



Relaxed: can see the whole vocal fold


Asymmetric: may imply paresis or be seen with paralysis


Symmetric: may be a normal variant or muscle tension dysphonia (MTD)


5. Pooling of secretions



Vallecula: consider tongue-base weakness


Piriform sinuses/postcricoid region



• Pharyngeal weakness


• Lack of sensation/neurologic deficit


• Esophageal obstruction: see the dysphagia/esophageal section



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FIGURE 7.4 Glottal Closure and Gap Patterns.

(A) Complete closure. (B) Posterior glottal gap. (C) Anterior glottal gap. (D) Spindle-shaped gap. (E) Hourglass-shaped gap. (From Flint PW, Haughey BH, Lund VJ, et al. Cummings Otolaryngology—Head and Neck Surgery. 6th ed. Philadelphia, PA: Saunders; 2015, fig. 55-3.)

Videostroboscopy Basics


Feb 18, 2017 | Posted by in OTOLARYNGOLOGY | Comments Off on Laryngology

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