Chapter 15 Soft Tissue Neck: Pharynx, Larynx, Thyroid Gland 2/ 24/ 2011

Anatomy: Neck Region between skull and thorax Radiographically divided into: Anterior - soft tissues Posterior - bony tissues

Anterior Part of Neck Principal structures: Upper respiratory parts (trachea) Upper digestive parts (esophagus) Thyroid gland Parathyroid gland Larger part of submandibular salivary gland

Thyroid Gland 2 lateral lobes Connected by narrow median portion- Connected by narrow median portion- isthmus Lobes located on sides of trachea from lower 3rd of thyroid cartilage to T1 Controls: how quickly body burns energy & makes proteins how quickly body burns energy & makes proteins how sensitive body should be to other hormones) how sensitive body should be to other hormones) Left Lateral Projection

Parathyroid Glands beside; near; alongside) (Para: beside; near; alongside) Small, ovoid structures on posterior aspect of thyroid gland lobes 2 on each side Superior Inferior Only function: maintain body’s calcium level within very narrow range, so nervous system and muscular systems function properly Left Lateral (Adams Apple)

Slide 6 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Adam’s Apple Also known as Also known as laryngeal prominence

Women have Adam’s Apples  Not as pronounced as men  Cosmetic surgery to reduce size of a laryngeal prominence -chondrolaryngoplasty  Surgery may change pt's voice and cause permanent damage & leave a visible scar  performed in many types of gender reassignment surgery

Musculomembranous, tubular structure in front of vertebrae, behind nose, mouth, & larynx Serves as a passage for both food and air   Subdivided into 3 parts:   Nasopharynx   Oropharynx   Laryngeal Pharynx Pharynx

Larynx Organ of voice Part of respiratory system Air passageway between pharynx and trachea

Vocal Cords

Epiglottis Situated above larynx Said to prevent food from passing into during swallowing Said to prevent food from passing into larynx during swallowing

4 types of Radiographic Exams for Soft Palate, Pharynx, and Larynx CT and MRI This exams are largely obsolete, replaced by CT and MRI Palatography- investigate tumors of soft palate and cleft palate Nasopharyngography- demonstrates hypertrophy of pharyngeal tonsils and adenoids Pharyngography- performed to study the act of deglutition or? Swallowing Laryngopharyngography- determine exact site, size and extent of tumor masses

Example of soft tissue study- (Pharyngography) Thick, creamy barium sulfate suspension Take AP and lateral images during swallowing Fluoroscopy often used due to rapid motion of swallowing AP Pharynx Lateral Pharynx

Contrasts Negative - Air Positive- Barium or or iodinated Oil

Respiratory and Stress Maneuvers Quiet inspiration- simply breathe in -tests abduction of vocal cords Normal (expiratory) phonation- deep breath in, exhale making high pitched e-e-e or low pitched a-a-h -tests adduction of vocal cords Inspiratory phonation- AKA- aspirant manuever- exhale then breath in making e-e-e- sound -demonstrates laryngeal ventricle

Respiratory and Stress Maneuvers cont’d Valsalva’s maneuver- forced expiration against closed glottis -tests elasticity and functional integrity of glottis Modified Valsalva’s maneuver- pinched nose, blow out and inflate cheeks -tests elasticity of laryngeal pharynx and piriform recesses