X-ray of the larynx and pharynx
Last reviewed: 19.11.2021
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The larynx is a hollow organ, therefore, in radiologic examination of the larynx, there is no need to use contrasting radiology, but in some cases this method can serve as a method of choice. With a survey and tomographic examination of the larynx, a straight and lateral projection is used. Since with a direct projection, the imposition of the spine on the larynx cartilage almost completely obscures them, with this projection using X-ray tomography, which takes the shadow of the spine behind the image plane, keeping only the radiopaque elements of the larynx in focus.
With a lateral projection against the background of airy cavities of the larynx, its cartilaginous skeleton and soft tissues are well seen.
Thus, with a lateral projection, the epiglottis, thyroid and cricoid cartilage are clearly visible, but the region of the arytenoid cartilages is worse visualized. To improve the visibility of the larynx and the posterior wall of her from the cervical vertebrae to the examinee at the time of exposure, suggest closing your nose and blowing heavily into it (like Valsalva's test). Inflammation of the epiglottial space and the laryngopharynx leads to a more distinct manifestation of the margins of the epiglottis, the areas of the arytenoid cartilages and the ventricles of the larynx.
When analyzing the results of radiographic examination of the larynx, the age of the patient and the degree of calcification of the larynx cartilage, whose islets appear, according to I. Pane, from the age of 18-20, should be taken into account. The thyroid cartilage is the most susceptible to this process.
Calcification of the cricoid cartilage begins at the upper edge of the plate. The centers of calcification with age increase in different directions, acquiring unpredictable individual forms. Earlier and more intensive calcification of the cartilage of the larynx occurs in men.
In some cases, resort to X-ray laryngoscopy with contrasting method of aerosol spraying of contrast agent.
Pharyngoscopy and laryngoscopy provide the study 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 surrounding tissue and cartilage of the larynx, allows obtaining a computed tomography.
With injuries on computer tomograms, fractures of cartilage, edema and hematoma in the zone of vocal cords, anterior commissure of the larynx, hemorrhage in the surrounding space and the displacement of the skeleton of the larynx are seen. With stenoses of the larynx caused by tuberculosis or scleroma, it is possible to establish the level and degree of narrowing, the prevalence of infiltration and granulation proliferation. In cancer of the larynx, CT can solve the main problem - to establish the spread of the tumor in the surrounding space, pear-shaped sinuses, tissues in front of the epiglottis. In addition, computer tomograms facilitate the detection of metastases in the lymph nodes of the neck. The lymph node that is affected by the tumor emerges as a rounded formation larger than 2 cm with a reduced density in the center. After radiation treatment, CT is used to assess the severity of the laryngeal edema, and then - to determine the degree of post-radiation fibrosis.
Computer tomography virtually replaced radiographic tomography and techniques with artificial contrasting of the pharynx and larynx. However, in institutions that are not yet available for CT, they are limited to performing X-rays of the pharynx and larynx (mainly in the lateral projection) and conventional tomograms (mainly in a direct projection). On the lateral shots and direct tomograms, the basic anatomical elements of the organ clearly appear: the epiglottis, the epiglottis fossa (valleculae), the pre-glandular space, the pear-shaped sinuses, the ventricular and true ligaments, the laryngeal (blink) ventricles, the scaly patches, the thyroid cartilage. Beginning with the age of 15-18 years, lime deposits appear in the cartilages of the larynx; they are also clearly visible on the radiographs and tomograms.
The development of a laryngeal tumor leads to an increase in its affected element in pictures and tomograms; accordingly adjacent air-bearing cavities are deformed - guttural ventricles, pear-shaped sinuses, etc. Approximately the same symptoms are characteristic of tumors of the pharynx: the shadow of the tumor itself, often with a tuberous surface, and deformation of the lumen of the organ. In children, survey images and tomograms allow you to clearly detect adenoid growths that go into the nasopharynx from the arch and posterior pharyngeal wall. Arched contours of large adenoids are clearly visible, as well as a small unevenness in the outline of the posterior nasopharynx wall, caused by small growths.