Examination of the Pharynx and Larynx

SFig. 1.59 Examination of the pharynx. A tongue ^h depressor is necessary to

I obtain a clear view of the tonsil region in most cases.

I Patients vary however in how easily the fauces and posterior aspects of the tongue can be seen. On occasion a very clear view is obtained (Fig.

Papillae Circumvallatae

Fig. 1.60 Circumvallate papillae. These are often prominent on the base of the tongue. A patient may be alarmed when looking at the tongue to notice these normal structures and mistake them for a serious disease. The foliate linguae on the margin of the tongue near the anterior pillar of the fauces may cause similar concern. The top arrow indicates the circumvallate papillae. The bottom arrow points to the foliate linguae.

Fig. 1.60 Circumvallate papillae. These are often prominent on the base of the tongue. A patient may be alarmed when looking at the tongue to notice these normal structures and mistake them for a serious disease. The foliate linguae on the margin of the tongue near the anterior pillar of the fauces may cause similar concern. The top arrow indicates the circumvallate papillae. The bottom arrow points to the foliate linguae.

Prominent Foliate PapillaePharynx Examination

Fig. 1.61 Examination of the larynx using the laryngeal mirror (indirect laryngoscopy). A good view of the larynx is obtained with most patients. The valleculae, pyriform fossae, arytenoids, ventricular bands, and cords should all be clearly seen. It requires some inhibition of the gag reflex by the patient, and a local anesthetic lozenge or spray may be necessary. The tongue is held between the thumb and middle finger, and the upper lip retracted with the index finger. This examination is difficult in children, not only because they may be uncooperative, but because the infantile epiglottis is curved, unlike the "flat" adult epiglottis, and occludes a clear view of the larynx. Therefore, direct laryngoscopy under anesthetic may be necessary to diagnose the cause of hoarseness in a child. Fiberoptic laryngoscopy is necessary for seeing the larynx, which cannot be clearly seen on indirect laryngoscopy.

Fig. 1.61 Examination of the larynx using the laryngeal mirror (indirect laryngoscopy). A good view of the larynx is obtained with most patients. The valleculae, pyriform fossae, arytenoids, ventricular bands, and cords should all be clearly seen. It requires some inhibition of the gag reflex by the patient, and a local anesthetic lozenge or spray may be necessary. The tongue is held between the thumb and middle finger, and the upper lip retracted with the index finger. This examination is difficult in children, not only because they may be uncooperative, but because the infantile epiglottis is curved, unlike the "flat" adult epiglottis, and occludes a clear view of the larynx. Therefore, direct laryngoscopy under anesthetic may be necessary to diagnose the cause of hoarseness in a child. Fiberoptic laryngoscopy is necessary for seeing the larynx, which cannot be clearly seen on indirect laryngoscopy.

Pic Indirect Laryngoscopy
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