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Larynx
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2. Technique of Indirect Laryngoscopy
Laryngeal examination
indirect laryngoscopy
Technique of Indirect Laryngoscopy
Warm the mirror to the body temperature to avoid
fogging of the mirror by the respiratory water vapour
- Hold the tongue by a piece of gauze by your left hand
Hold the mirror by your right hand and place against
the base of the uvula
- Ask the patient to say eeee to assess adduction
- Ask the patient to take deep inspiration to assess
abduction
Laryngeal
Mirror

3. During quiet inspiration
Base of the tongue
Epiglootis
Epiglootis
Vocal folds
Ary-epiglottic fold
Arytenoid
Pyriform fossa
During phonation
During quiet inspiration

4. Laryngeal examination Flexible fiberoptic nasolaryngoscopy
Flexible endoscopic
Examination of
Nasal cavity
Hypopharynx
Larynx

5. Rigid endoscopic examination of the larynx and hypopharynx

6. Direct Laryngoscope Indications Contraindications Diagnostic
To examine the Larynx
To take biopsy
Therapeutic
Excision of benign lesions
Excision of small malignant tumors
Teflon injection
Arytenoidectomy
Removal of FB
Severe Kyphosis

7. Micro-laryngeal surgery
The use of the operating Microscope in direct
Laryngoscopy is called MICRO-LARYNGOSCOPY
Advantage:
Provides Magnification
Provides good illumination

8. Micro-laryngeal surgery employing laser
Microscope
Laryngoscope

9. Abduction: The vocal cords are apart for breathing in.
The rings of the trachea can be seen ( yellow arrow).

10. During Phonation the vocal cords are adducted .

11. Laryngeal Web Whitish band in the anterior part of the glottis
Congenital laryngeal Web
Presentation
- Newly born with hoarse weak cry

12. laryngomalacia
The supraglottis is collapsing inwards during inspiration
Presentation:
Inspiratory stridors
Starts soon after birth
Improves in prone position
Normal cry

13. Subglottic Hemangioma
May be accompanied with hemangiomas in other sites

14. Posterior laryngeal cleft

15. Intubation granuloma
Causes
Prolonged intubation
Blind intubation

16. Reinke’s edema
Voice abuse

17. Vocal nodules

18. Vocal polyp

19. Multiple Papillomatosis

20. Epiglottitis

21. Croup

22. Laryngoscleroma (subglottic web)
Vocal
cord
Vocal
cord
Greenish
crusts
Rhinoscleroma
Subglottic stenosis
Laryngoscleroma (subglottic web)

23. a T1 squamous cell carcinoma of the vocal cord
The right picture shows the immediate post-operative appearance of the vocal cords after surgical biopsy.  This patient will be treated with full course radiation therapy and should have greater than a 90% chance of cure.    

24. Laryngeal Carcinoma

25. The picture on the left is a cancer of the epiglottis or top of the voice box.  The middle picture is a cancer of the true vocal cords and the picture on the far right is a cancer of the sub-glottis or below the vocal cords.