CLINYCAL ANATOMY AND PHYSIOLOGY OF THE LARYNX. DISEASES OF THE LARYNX. ONCOLOGYCAL DISEASES OF THE ENT ORGANS.
CLINICAL ANATOMY of the LARYNX
ADJACENT ORGANS
From above hypopharynx, hyoid bone, tongue. Below trachea, thyroid gland. Behind ce part of the gullet. Sideways neurovascular fascicles.
CARTILAGES of the LARYNX
Odd: cricoid, thyroid, epiglottic. Pair: arytenoide, corniculate, wedgeshaped
JOINTS of the LARYNX
Crico-thyroid. Crico-arytenoid.
LIGAMENTS of the LARYNX
Thyrohyoid membrane. Thyroepiglottic ligament. Cricotracheal ligament. Cricothyroid ligament.
MUSCLES of the LARYNX
EXTERNAL (lift and put down the larynx): First group (one end attached to larynx other to bones of the sceleton): - sternothyroid; - sternohyoid; - thyrohyoid.
MUSCLES of the LARYNX
EXTERNAL (lift and put down the larynx): Second group (one end attached to hyoid bone other to some other bone of sceleton): - stylohyoid; - omohyoid; - digastric.
MUSCLES of the LARYNX
INTERNAL (open and close the larynx): The basic dilator. The basic narrower. Helpers. The muscles managing the vocal cords. The muscles managing the epiglottis.
CAVITY of the LARYNX
PARTS: SUPERIOR (vestibule). MIDDLE (vocal folds). INFERIOR (infraglottic cavity).
CAVITY of the LARYNX
INNERVATION of the LARYNX
Sympathetic: sympathetic trunk. Parasympathetic: superior and inferior (reccurent) laryngeal nervs.
PHYSIOLOGY of the LARYNX
RESPIRATION
PHYSIOLOGY of the LARYNX
PHONATION
PHYSIOLOGY of the LARYNX
PHYSIOLOGY of the LARYNX
PHYSIOLOGY of the LARYNX
PHYSIOLOGY of the LARYNX
PHYSIOLOGY of the LARYNX
PROTECTION
PROTECTIVE MECHANISMS of the LARYNX
COUGH REFLEX SPASM OF THE TRUE GLOTTIS LIFTING AND DROPPING OF THE EPIGLOTTIS
LARYNX RESEARCH METHODS
INDIRECT LARYNGOSCOPY
LARYNX RESEARCH METHODS
DIRECT LARYNGOSCOPY
LARYNX RESEARCH METHODS
MICROLARYNGOSCOPY
LARYNX RESEARCH METHODS
FIBROLARYNGOSCOPY
LARYNX RESEARCH METHODS
X-RAY
ACUTE LARYNGITIS (kind)
Catarrhal Edematic Hemorragic Necrotic Phlegmonous
ACUTE CATARRHAL LARYNGITIS
QUINCKES EDEMA
LARYNX EDEMA
REASONS: - medicine - nonsteroidal AID, anesthetics, antibiotics, vaccins, serums; - occupational allergens; - dust, fungy, pollutants; - harmful gases; - household allergens; - cosmetics, household chemicals
STENOSIS of LARYNX
- narrowing of the larynx, which leads to disruption of air passing through it and the development of respiratory insufficiency
STENOSIS of LARYNX
Fulminant (some seconds, minutes) Acute (some hours, days) Subacute (some days, weeks) Chronic (some months, years)
STENOSIS of LARYNX
(STAGES)
Compensation Subcompensation Decompensation Asphyxia
ACUTE OBSRUCTIVE LARYNGOTRACHEOBRONCHITIS (IN CHILDREN ) Change of voice. Barking cough. Labored breathing.
STENOSIS of LARYNX
Stages
Symptom
General state
Skins color Retraction mascles Breathing
I
N or middle difficalty
Light local cyanosis
II
Middle difficalty
III
Difficalt
IV
Very difficalt
Heavy local cyanosis
Light general cyanosis
Heavy general cyanosis
++
+++
Pulse
STENOSIS of LARYNX
(TREATMENT)
Compensation - conservative. Subcompensation - conservative. Decompensation - surgical. Asphyxia - surgical.
STENOSIS of LARYNX
(CONSERVATIVE TREATMENT)
Corticosteroids Nonallegics Spasmolytics Diuretics Counter-attracting procedures Wet oxygen inhalations
STENOSIS of LARYNX
(SURGICAL TREATMENT)
STENOSIS of LARYNX
(SURGICAL TREATMENT)
CHRONIC LARYNGITIS
Catarrhal. Hypertrophic (local, diffuse). Atrophic.
CHRONIC LARYNGITIS
Reasons: Diseases of upper part of respiratory system. Acute laryngitis. Household and occupational allergens. Smoking!!!
HYPERTROPHIC LARYNGITIS precancerous diseases
Optional precancerous. Local hypertrophy.
Screamers
nodules
HYPERTROPHIC LARYNGITIS precancerous diseases
Optional precancerous. Local hypertrophy.
Fibroma
HYPERTROPHIC LARYNGITIS precancerous diseases
Optional precancerous. Local hypertrophy.
Contact
granuloma
HYPERTROPHIC LARYNGITIS precancerous diseases
Obligate precancerous.
Diffuse hyperplastic laryngitis
HYPERTROPHIC LARYNGITIS precancerous diseases
Obligate precancerous.
Dyskeratosis of the larynx
HYPERTROPHIC LARYNGITIS precancerous diseases
Obligate precancerous. Laryngeal papilomatosis
Juvenile
Adult
TUMORS of ENT-ORGANS
Localisation Nasal cavity and PRS Pharynx All tumors Tumors of the upper respiratory tract 3-10% 10-20%
0,5-2 % 0,8-3%
Larynx
0,9-8%
65-70%
Benign tumors - 0,8 - 5% from all hospitalized morbidity.
Algorithm of the diagnostics and therapeutic process
Screening and diagnosis Treatment Rehabilitation
Stages of diagnostics
1. Screening - identify people with suspected
tumors.
2. Basic diagnostics (triad):
- skopiya; - X-ray; - biopsy. 3. Supplementary diagnostics: USD, CT, MRI, angiography, radioisotopes
CANCER of the LARYNX
Superior part 70% Middle part (in 82% - V-th stage). 25%. Inferior part 5%.
X-RAY TOMOGRAPHY of the LARYNX
CANCER of the PHARYNX
Localisation
Frequency (%)
Epipharynx
Mesopharynx Hypopharynx
53
30 17
Evidences to exclusion of the epipharynx canser
Rapid progression of the unilateral hearing loss.
Unilateral violation of tne nasal breathing. Bloody discharge from the nose. Painless increment of the upper one/third part of the back group cervical lymphoid nodes.
Violation of the vision (frequently unilateral).
JUVENILE ANGIOFIBROMA
SYMPTOMS: Susceptibility to bleeding Rapid destructive growth Germination to surrounding organs Frequent recurrence
CANCER of the PHARYNX
(TONSILLAR TUMORS)
SYMPTOMS: Rapid growth. Early metastasis. Increment of the cervical lymphoid nodes is first symptom TT in 20-25% patients. Large susceptibility to dissemination. Receptive to radiotherapy and chemotherapy.
CANCER of the EPIPHARYNX
1. Tumor of the
pharyngeal tonsil 2. Posterior wall of the pharynx. 3. Lateral pharyngeal band. 4. Eustashion tube.
1
3
CANCER of the MESOPHARYNX
1. Tumor of the
palatine tonsil. 2. Soft palate. 3. Palatine arch. 4. Root of tongue.
2 3 1
TUMORS of the NOSE and PNS
70% 60% 50% 40% 30% 20% 10% 0%
25% 10% 2% 2%
70%
Evidences to exclusion of the NC and PNS canser
Rapid progression of the unilateral violation of the nasal breathing. Constant discharge from the nose (unilateral). Violation of the sensitivity of the skin in the cheek or maxillary teeth (unilateral). Increscent movability of maxillary teeth. Violation of the vision (unilateral). Displacement of the eyeball
SYMPTOMS
From side of the nasal cavity
SYMPTOMS
From the side of the face
From the side of teeth
X-RAY of PNS
SKIN TUMORS OF THE FACE
Benign
Rynofima
SKIN TUMORS OF THE FACE
Benign
Rynofima
SKIN TUMORS OF THE FACE
Malignant
(11-13% from all malignent tumors)
Bazalioma
Squamous cell carcinoma
PIGMENTARY SKIN TUMORS
OF THE FACE Benign
Naevus
SKIN TUMORS OF THE FACE
Malignant
(3-5% from all tumors of the skin)
Melanoma (melanin in urine)
BIOPSY CONTRAINDICATION ! ! !
RADIOTHERAPY
SURGICAL TREATMENT
1. Resection of the organ.
2. Removal of the organ.
I WISH YOU TO BE HEALTHY !!!
