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.