ISBN 978-9942-38-459-1

Index

Acknowledgment
Prologue
Introduction
The normal larynx
• A brief anatomical description
• Laryngeal structures through videolaryngoscopy
• Segments of the larynx
• Functions of the larynx
• Normal larynx variations through videolaryngoscopy
• Laryngeal asymmetry
• Anatomical variants
Functional pathology without structural disorder of the larynx
• Laryngeal hyperfunction
- Type I vocal hyperfunction
- Type II vocal hyperfunction
- Type III vocal hyperfunction
- Type IV vocal hyperfunction
- Advance of pharyngeal walls during phonation
- Hyperadduction or overlapping of arytenoid cartilage
• Laryngeal hypofunction
• Vocal closure
- Vocal closure defects: gaps
• Laryngeal asymmetry
- Asymmetry of arytenoid cartilages
- Rotation of the glottic axis
- Ventricular asymmetry
Functional pathology with structural disorder of the larynx
• Vocal nodules
- Incipient nodular lesions images
- Asymmetric vocal nodules
- Unilateral vocal nodules
- Vocal nodules associated with another vocal pathology
- Vocal nodules associated with minimal vascular-type structural disorders
- Infant larynx with vocal nodules
• Vocal polyps
- Vocal polyps with unusual situation

IX
 - Vocal polyps of different shapes, sizes and locations
Organic pathology without structural disorder of the larynx
• Vocal cord paralysis
- Classification
* According to the site of the injury
* According to the extent of the injury
- Associated paralysis
- Bilateral paralysis
- Unilateral paralysis
• Vocal cord paresis
Organic pathology with structural disorder of the larynx
• Laryngitis
- Acute laryngitis
- Pharyngolaryngeal reflux laryngitis
- Chronic laryngitis
• Capillary ectasia
• Vocal cords hemorrhage
• Monocorditis
• Localized edema
• Reinke's edema
• Congenital pathology of the larynx
- Laryngeal atresia
* Subglottic laryngeal web
- Vocal cord sulcus
- Vocal cord cyst
- Laryngocele
• Laryngeal granuloma
• Laryngeal papilloma
• Laryngeal leukoplakia
• Laryngeal tumors of probable malignant etiology
Other findings
• Cysts outside vocal folds
• Epiglottis hemangioma
• The Eagle syndrome
References

X
The normal larynx
 The normal larynx:
A brief anatomical description

The normal larynx

A brief anatomical description

SOFT
PALATE

PHARYNX

TONGUE

EPIGLOTTIS

ESOPHAGUS
LARYNX

TRACHEA
Source: https://arribasalud.com/faringe-y-laringe/

EPIGLOTTIS
HYOID BONE

THYROHYOID
MEMBRANE
GLOTTIS

FALSE VOCAL VENTRICLE

FOLDS
TRUE VOCAL VOCAL
FOLDS MUSCLES
THYROID
CARTILAGE

TRACHEA

Source: Drawing made by Willian Alviarez based on the authors’ criteria.

 The normal larynx:
Laryngeal structures through videolaryngoscopy

Laryngeal structures through videolaryngoscopy

Respiratory
phase

01 Epiglottis cartilage 06 Arytenoid cartilages

02 Ventricular bands 07 Interarytenoid space
03 Laryngeal ventricles 08 Piriform sinuses
04 Vocal folds 09 Subglottic space
05 Aryepiglottic folds 10 Cricoid cartilage

Phonatory
phase

01 Epiglottis cartilage 04 Aryepiglottic folds

02 Ventricular bands 05 Arytenoid cartilages
03 Vocal folds 06 Pyriform sinuses
 Functional pathology
without structural disorder of the larynx
 Functional pathology without structural disorder of the larynx:
Laryngeal hyperfunction: Type I vocal hyperfunction/Type II vocal hyperfunction

Type I vocal hyperfunction

Moderate work of ventricular bands and

longitudinal gap can be seen. In addition, a
small posterior triangular gap is observed
because the image belongs to a female
patient, which is considered physiological.

Type II vocal hyperfunction

This photo shows the advance of The advance of ventricular bands in

ventricular bands, partially covering the some cases allows the complete or
vocal cords. It corresponds to a type II partial visualization of the vocal cords.
vocal hyperfunction. There is also a Image compatible with type II vocal
posterior triangular gap. hyperfunction.

Type II vocal hyperfunction. Vascularization

and edema in the middle and posterior third
of both vocal cords. Greater middle and
posterior vocal contact during closing is
observed.
 Functional pathology without structural disorder of the larynx:
Vocal closure

Vocal closure

This unbalanced operating dynamic generates the

different types of closure:

FULL (NORMAL) BACK OPENING

PREVIOUS OPENING FRONT AND REAR OPENING IRREGULAR

OR DOUBLE GAP

FUSIFORM TRIANGULAR LONGITUDINAL

Modified from Ayarza (2012). Drawing by Willian Alviarez based on the criteria of the authors.
 Functional pathology
with structural disorder of the larynx
 Functional pathology with structural disorder of the larynx:
Vocal nodules: Incipient nodular lesions images

Incipient nodular lesions images

They are small

areas of
irregularity on
the free edge
of the vocal
fold; they can
eventually be
distorted by
edema.

The following images show edema located on the upper side of both vocal
folds associated with the right vocal nodule and left incipient nodular lesion.
 Functional pathology with structural disorder of the larynx:
Vocal polyps: Vocal polyps of different shapes, sizes, and locations

Vocal polyps of different shapes,

sizes, and locations
It is evident the great variability with which polypoid lesions are present, that
basically depend on the great extent on the force applied during phonation
and laryngeal adaptability to originate different disorders.
 Organic pathology
without structural disorder of the larynx
 Organic pathology without structural disorder of the larynx:
Vocal cord paralysis: Bilateral paralysis

Bilateral paralysis
This is a less frequent event. The bilateral paralysis can generate dyspnea.

Etiology Types Clinic

Peripherals
Paralysis in closure Dyspnea.
Post-thyroidectomy trauma.
Compressions due to neoplasm or or adduction Variable degrees
adenopathy. of stridor.

Centrals
Acute inflammatory processes
False food
of viral origin. Paralysis in opening pathways.
Anoxic lesions of vascular origin. or abduction Dysphonia.
Toxic.
Degenerative diseases.

Forms of appearance

Incomplete bilateral paralysis Complete bilateral paralysis

Posterior cricoarytenoid muscles lesion. There is paralysis of all laryngeal muscles.

Variable dyspnea. Abolition of abduction and adduction
Lack of openness. movements.
Conserved closure. Paralysis in median or paramedian position.

Bilateral paralysis of the

Bilateral paralysis in abduction position
superior laryngeal nerves
The vocal cords are in abduction position. Mixed affection: sensory and motor.
False food routes. Throat clearing.
Cough when swallowing. Paroxysmal cough.
Difficulty swallowing predominantly liquids. Moderate dysphagia.
Hoarseness with vocal fatigue. Weak voice.
Air leak when trying to speak. Difficult to emit high tones.
Affected singing voice.

Figure 4: Bilateral paralysis. Conceptual synopsis prepared by the authors based on the descriptions of laryngeal paralysis by Arias (1994).
 Organic pathology without structural disorder of the larynx:
Vocal cord paralysis: Unilateral paralysis

A bowing left vocal cord is observed, unevenness in relation to the right vocal fold,
lowered left arytenoid cartilage, compensatory work of ventricular bands and fusiform
glottal closure. These images show typical characteristics of left vocal paralysis due to
injury to the left recurrent laryngeal nerve. A right longitudinal sulcus can also be seen.

In some paralysis, swallowing failures are observed that affect the mobilization of saliva
and other secretions, forming accumulations predominantly in pyriform sinuses and
vallecula. The following images show paralysis of the left vocal fold due to injury to the
inferior laryngeal nerve.

The compensatory mechanisms in vocal fold palsies are very varied. The image shows right vocal
paralysis with marked supraglottic hyperfunction and shortening of the anteroposterior laryngeal
diameter, occluding the gap to produce a false vocal folds phonation (plicae ventricularis). There
is also rotation of the laryngeal axis and overlap of the right arytenoid cartilage on the left.
 Organic pathology
with structural disorder of the larynx
 Organic pathology with structural disorder of the larynx:
Laryngitis: Chronic laryngitis

Chronic laryngitis

The following images show long-lasting changes in the

mucous membrane, suspected of chronic inflammation.
 Organic pathology with structural disorder of the larynx:
Laryngeal papilloma

Large, sessile formations

can be found, with
subglottic origin; as seen
in these photos. These
lesions can move into
the glottis space, with
the passage of air,
during breathing. They
can be visualized in a
variety of ways during
videolaryngoscopy.

The figures reveal irregular

growth that covers both vocal
cords, causing loss of their
morphological characteristics and
reduction of the glottis space.

Lesions quite typical of

papillomatosis, translucent
and with varied deformity in
each vocal cord are seen.

Laryngeal papilloma that

occupies the entire anterior
portion up to the middle third
of both vocal cords, with a
moderate decrease in the
glottis space is observed.