CTVL (CT virtual laryngoscopy)

is a new method for

demonstrating the endoluminal

structures of the laryngeal and

hypopharyngeal region

simulating actual laryngoscopy.

SUPRAGLOTTIC LEVEL

SUPRAGLOTTIC LEVEL

GLOTTIC LEVEL

SUBGLOTTIC LEVEL

• CT in Carcinoma of the

Larynx and Pyriform

Sinus:Value of Phonation

Scans

• A, CT scan in normal subject during quiet breathing at level of true vocal cords. Arytenoid cartilages (arrows) cleanly visible in close proximity to inner margin of thyroid cartilage. Right anytenoid slightly larger than left.

• B, During phonation of letter E, arytenoid cartilages adduct and rotateinwards. Distended pyniform sinuses (P) are seen lateral to arytenoid cartilages.

• A, Scan during quiet breathing at level of true vocal cords in patient with clinical fixation of right true cord. Cordal mass (arrows) displaces vocal process of right arytenoid cartilage medially.

• B, During phonation. Left anytenoid moves normally. Right arytenoid remains fixed in abducted position.

• RULE OF CT in the

Diagnosis of Vocal

Cord Paralysis

VOCAL CORD PARALYSIS

• Etiology:

• Causes of vocal cord paralysis may be divided as:

• A) Congenital:

• For example; nuclear aplasia, cerebral agenesis, birth trauma, stretch at the skull base in meningioceles and hydrocephalus (Arnold-Chiari malformation).

• B) Acquired: These include:

• 1. Trauma:

• Surgical trauma: is the most common cause of vocal cord paralysis (25%). The most common surgery is thyroid surgery. Other operations include; radical neck dissection, carotid artery surgery, oesophageal surgery, cardiac surgery and mediastinal surgery.

• Accidental trauma: as gunshots and stab wounds to the neck or chest.

• 2. Neoplasms:

• As bronchogenic carcinoma (most common). esophageal and postcricoid carcinoma and thyroid tumors.

• 3. Systemic disorders:

• Infections: Viral (as influenza), or bacterial (TB, or syphilis)

• Toxic neuritis: Diabetes, lead and alcohol poisoning.

• Cardiovascular: Cardiomegally e.g. in mitral stenosis, and aortic aneurysm.

• 4. Idiopathic

CT signs of cord paralysis

• paramedian position of the cords,

• displaced arytenoid cartilage,

• ipsilateral dilatation of the pyriform sinus,

• tilting of the thyroid cartilage,

• medial positioning and thickening of the ipsilateral

aryepiglottic fold,

• ipsilateral laryngeal ventricle dilatation

• Ipsilateral pharyngeal constrictor muscle atrophy

• peripheral and central vagal neuropathy

• Usefulness of Laryngeal

Phonation CT in the Diagnosis of

Vocal Cord Paralysis

• DURING PHONATION ARYTENIOD

ADDUCT

• ARY ABDUCT AT QUIET

-distance between cord tip

and

midline of laryngeal

airway

during phonation.

-Black arrows indicate

stretched

vocal cord during

phonation.

-Angle between long axis

of the vocal cord and

midlline Dr Ahmed Esawy

A —29-year-old

woman in good health.

Coronal reconstructed

• CT image of larynx during

normal breathing shows larynx at

level of vocal cords appears to

be flat, without vocal cord

protrusion.

B- during phonation

protrude,symmetrical

Dr Ahmed Esawy

• Fig. A —65-year-old woman with left vocal

cord paralysis for 2 years. Coronal

reconstructed CT image of larynx during

normal breathing shows relaxed

appearance of both vocal cords without

protrusion (arrows).

Dr Ahmed Esawy

• Using CT to Localize Side and

Level of Vocal Cord Paralysis

dilatation of right vallecula (arrow, A) and

dilatation of right pyriform sinus (A),

dilatation of right pyriform sinus and

thickening and medial positioning of right

aryepiglottic fold

and dilatation of right

laryngeal ventricle (white arrow

and anterior positioning of right

arytenoid cartilage (black arrow, C).

Dr Ahmed Esawy

dilatation of right vallecula dilatation of right pyriform sinus and

thickening and medial positioning of right

aryepiglottic fold

fullness of right true vocal cord and slight

anterior positioning of right arytenoid

cartilag

right subglottic fullness

Dr Ahmed Esawy

dilatation of right pyriform sinus (large arrow, A), thickening and medial

positioning of left aryepiglottic fold (small arrow, A

dilatation of left laryngeal ventricle

(arrow)

fullness of right true vocal cord Dr Ahmed Esawy

dilated left oropharynx with thinning and

atrophy of pharyngeal wall (arrow)

dilatation of left pyriform sinus and

thickening and medial positioning of left

aryepiglottic fold

64-year-old man with hoarseness, left

vocal cord paralysis, and left-sided palatal

weakness CT+C

Left VF Palsy- Aortic

aneurism.

1-STRIDOR

• Definition: Difficult noisy breathing

due to partial laryngeal obstruction.

Early it is inspiratory, later it

becomes both inspiratory and

expiratory when obstruction

increases.

Causes of stridor ( laryngeal

obstruction ):

• Congential :

• Congenital web .

• Congenital laryngeal stridor :

• Infantile larynx.

• Congenital laryngomalacia.

• Traumatic :

• Foreign body .

• Accidental trauma:

• External Trauma e.g cut throat or strangulation

• Internal trauma:

• Chemical e.g corrosives.

• Physical e.g hot water or burns.

• surgical trauma ( Iatrogenic ):

• I – Immediate: e.g oedema following endoscopy or difficult endotracheal intubation.

• II – Late: e.g stenosis following high tracheostony or prolonged endotracheal intubation.

• Inflammatory :

• Acute:

• Non specific : in children .

• Specific : diphtheria .

• Chronic:

• I- Non specific : only with acute exacerbation

• II- Specific : Scleroma , syphilis , T.B .

• Allergic oedema :

• e.g angioneurotic oedema or durg sensitivity e.g. to penicillin

• Neoplastic :

• Benign: multiple popillomatata in childern.

• Malignant: carcinoma.

• Neurogenic :

• Bilateral abductor paralysis : most commonly after thyroidectomy.

• Functional

• Laryngismus stridulus

2-HOARSENESS OF VOICE:

• Definition: Rough, harsh quality to

voice or cry.

• Causes: Lesions in the true vocal

cords.