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• Axial CT scan of the neck showing the epiglottic
cyst in the pictures above.
INJURIES OF THE LARYNX
• Results:
• Trauma may result in:
• Cartilage fracture.
• Mucosa lacerations.
• Submucosa Hge.
• Membranes rupture and surgical
emphysema
Overview
• Classification of Trauma
– Blunt
– Penetrating
– Inhalation
– Ingestion
– Iatrogenic
VERTICAL FRACTURE OF THE LARYNX
Laryngeal Fracture
• The above axial CT scan shows a fracture of the thyroid
cartilage lamina. Note the presence of an endotracheal tube
Laryngeal F.B.
Complete Obstruction: Death
Incomplete Obst.: cough, dyspnea, Aphonia
Coin In Larynx
ARYTENIOD DISLOCATION
CRICIOD ARROWHEAD
ARYTENIOD ARROW
inflammatory
Epiglottitis
• Epiglottitis is the inflammation of the
supraglottic structures
Radiographic parameters in adult
epiglottitis
• The measurement differences were significant between the groups only for the width of the epiglottis and aryepiglottic folds
•
• Width of the epiglottis greater than 8 mm and of the aryepiglottic folds greater than 7 mm seem highly suggestive of epiglottitis in the adult.
Sites of measurement of
aryepiglottic folds and epiglottis
1-width of aryepiglottic folds at
the mid piont of these folds
2- 1-width of aryepiglottic folds
behind epiglottis
3= 1-width of aryepiglottic folds
at the base of these folds
Epiglottis and
aryepiglottic
folds thickened
in epiglottitis
Classic thumprint appearance of a
swollen epiglottis is pathogonomonic
Of epiglottitis (lateral view /erect)
• CT scan in an adult with acute epiglottitis shows a column of air around the epiglottis (E). The right side is more swollen than the left, and the hypoattenuating area (A) is suggestive of fluid or an early abscess formation.
• A, Axial contrast-enhanced CT scan at the level of the hyoid bone shows marked thickening of the aryepiglottic folds (f), posterior pharyngeal wall, and platysma muscle (arrow). B, Edema is seen in the retropharyngeal space extending to the carotid arteries bilaterally (asterisks) and in the subcutaneous fat. There is obliteration of the paraglottic fat planes and thickening of the false vocal cords (V).
CROUP
• SUBGLOTTIC LARYNGITIS
Croup Vs Epiglottitis
Characteristics of Laryngotracheitis and Epiglottitis
Feature Laryngotracheitis Epiglottitis
Age <3 years >3 years
Onset Gradual (days) Acute (hours)
Cough Barky Normal
Posture Supine Sitting
Drooling No Yes
Radiograph Steeple sign, narrowed subglottis Thumb sign, enlarged
epiglottis,dilated hypopharynx
Cause Viral Bacterial
Treatment Supportive (croup tent) Airway management (intubation or
tracheotomy), antibiotics
CROUP is best appreciated on the AP view
And can be distinguished from congenital
Subglottic stenosis and post-intubation
oedema by history
The characteristic church stipple
appearances of croup results
From subglottic oedema obliterating the
normal subglottic shoulder
Of the proximal airway
CROUP is best appreciated on the AP view
And can be distinguished from congenital
Subglottic stenosis and post-intubation
oedema by history
The characteristic church stipple
appearances of croup results
From subglottic oedema obliterating the
normal subglottic shoulder
Of the proximal airway
Epiglottic Enlargement
• NORMAL VARIANT
– Prominent normal epiglottis
– Omega epiglottis
• INFLAMMATION – Acute / chronic epiglottitis
– Angioneurotic edema
– Stevens-Johnson syndrome
– Caustic ingestion
– Radiation therapy
• MASSES – Epiglottic cyst
– Aryepiglottic cyst
– Foreign body
Aryepiglottic Cyst
• Retention cyst
• Lymphangioma
• Cystic hygroma
• Thyroglossal cyst
• may be symptomatic at birth
• well-defined mass in aryepiglottic
fold
• Diphtheria.. The laryngeal cartilages are collapsed and the laryngeal airway occluded. The thyroid (arrowheads) and cricoid (arrow) cartilages are misshapened. The distance between thyroid and cricoid cartilage is diminished.