X-rays of the larynx and pharynx

The larynx is a hollow organ, so there is no need to use contrast in the X-ray image during X-ray examination of the larynx, but in some cases this method may be the method of choice. Direct and lateral projections are used during survey and tomographic examination of the larynx. Since the superposition of the spine on the laryngeal cartilages during direct projection almost completely obscures them, X-ray tomography is used during this projection, which removes the shadow of the spine beyond the plane of the image, keeping only the radiopaque elements of the larynx in focus.

In the lateral projection, against the background of the air cavities of the larynx, its cartilaginous skeleton and soft tissues are clearly visible.

Thus, in the lateral projection, the epiglottis, thyroid and cricoid cartilages are clearly visible, but the area of the arytenoid cartilages is less well visualized. To improve visibility of the larynx and to distance its posterior wall from the bodies of the cervical vertebrae, the subject is asked to close his nose and blow strongly into it (similar to the Valsalva maneuver) at the time of exposure. Inflation of the epiglottis and laryngopharynx leads to a more distinct manifestation of the edges of the epiglottis, the area of the arytenoid cartilages and the ventricles of the larynx.

When analyzing the results of an X-ray examination of the larynx, one should take into account the patient's age and the degree of calcification of the laryngeal cartilages, the islets of which appear, according to I. Pane, starting from the age of 18-20. The thyroid cartilage is most susceptible to this process.

Calcification of the cricoid cartilage begins from the upper edge of the plate. The calcification foci increase in different directions with age, acquiring unpredictable individual forms. Calcification of the laryngeal cartilage occurs earlier and more intensely in men.

In some cases, they resort to X-ray laryngoscopy with contrast using aerosol spraying of a contrast agent.

Pharyngoscopy and laryngoscopy provide an examination of the mucous membrane of the pharynx and larynx and the function of the vocal cords. Important additional data on the condition of the walls of these organs, in particular on the perilaryngeal tissues and cartilages of the larynx, can be obtained by computed tomography.

In trauma, computed tomography scans show cartilage fractures, edema and hematoma in the vocal cord area, anterior commissure of the larynx, hemorrhages in the perilaryngeal spaces and displacement of the laryngeal skeleton. In laryngeal stenosis caused by tuberculosis or scleroma, it is possible to establish the level and degree of narrowing, the prevalence of infiltration and granulation growths. In laryngeal cancer, CT allows solving the main problem - to establish the spread of the tumor to the perilaryngeal spaces, pyriform sinuses, tissues located in front of the epiglottis. In addition, CT scans facilitate the detection of metastases in the lymph nodes of the neck. A lymph node affected by a tumor appears as a rounded formation more than 2 cm in size with reduced density in the center. After radiation therapy, CT is used to assess the severity of laryngeal tissue edema, and then to determine the degree of post-radiation fibrosis.

Computer tomography has practically replaced X-ray tomography and methods with artificial contrast of the pharynx and larynx. However, in institutions where CT is not yet available, they limit themselves to performing X-rays of the pharynx and larynx (mainly in the lateral projection) and conventional tomograms (mainly in the direct projection). On lateral images and direct tomograms, the main anatomical elements of the organ are quite clearly outlined: the epiglottis, the supraglottic-lingual fossae (valleculae), the preepiglottic space, the pyriform sinuses, the ventricular and true ligaments, the laryngeal (Morgagni) ventricles, the aryepiglottic ligaments, and the thyroid cartilage. Beginning at the age of 15-18, lime deposits appear in the cartilages of the larynx; they are also clearly visible on X-rays and tomograms.

The development of a laryngeal tumor leads to an increase in the size of the affected element on images and tomograms; accordingly, the adjacent air-containing cavities are deformed - the laryngeal ventricles, pyriform sinuses, etc. Approximately the same symptoms are characteristic of pharyngeal tumors: a shadow of the tumor itself, often with a bumpy surface, and deformation of the lumen of the organ. In children, survey images and tomograms allow one to clearly detect adenoid growths protruding into the nasopharynx from the side of the vault and the back wall of the pharynx. The arched contours of large adenoids are clearly visible, as well as the small unevenness of the outlines of the back wall of the nasopharynx, caused by small growths.