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 !!!