The structure of the human nasopharynx, oropharynx and larynx with photographs

To the reference book Palpation of the larynx and neck is one of the diagnostic methods that are used in otolaryngology in the treatment of diseases of the ENT organs.

Author:

• Oganesyan Tigran Sergeevich

  ENT pathology expert

3.75 (Votes: 4)

Palpation of the larynx and neck is a visual diagnosis of diseases of the pharynx and larynx, which allows you to assess the condition of the skin, the severity of the local vascular network, the shape and position of the organ.

Much becomes clear already during a conversation with the patient, for example, by the sound of his voice (the presence of nasality, rattling, shortness of breath and other characteristic symptoms), the complaints presented (their dynamics, concomitant diseases in the anamnesis). After examining and questioning the patient, the doctor proceeds to palpation of the larynx and neck. Depending on the indications, it can be superficial or deep.

Where does red throat come from?

A red throat is hyperemia of the pharyngeal mucosa - a symptom that accompanies various diseases of the pharynx in adults and children. Hyperemia can only be in the area of ​​the arches, tonsils or posterior wall of the pharynx; all areas can also be involved at once, including the soft palate. The process can also be one-sided or two-sided.

But it is worth noting that the assessment of this symptom is sometimes not objective, since it is influenced by the color perception of both the patient and the doctor, and external lighting. Therefore, the patient should consult a doctor in order to carefully collect the entire history of the disease and identify the cause of the red throat.

Deep palpation

The doctor examines in detail the area of ​​the hyoid bone and palpates the angles of the lower jaw. The movements of the doctor's fingers are directed from top to bottom, going down along the edges of the sternocleidomastoid muscle. After palpation of the supraclavicular fossa, it moves directly to the larynx itself. The otolaryngologist touches all its elements with the fingers of both hands, excluding/establishing pain, determines the shape and consistency of the structures.

Moving the larynx from side to side helps assess the degree of its mobility. In case of injuries, for example, in the case of a cartilage fracture, when the organ is displaced to the right or left, a crunching sound becomes audible.

By palpating the larynx, you can also identify the isthmus of the thyroid gland, which is located close to the cricoid cartilage. Feeling this area, the doctor asks the patient to swallow saliva. If during such actions a kind of push is felt, this may indicate the presence of an ectopic area in the tissues of the thyroid gland.

To make an appointment with an otolaryngologist, call one of the numbers listed or leave an online request on the website. All specialists are accepted by appointment. In emergencies and emergency conditions, you can use the service of calling a doctor at home.

Anatomy of the pharynx

The pharynx is located behind the nasal and oral cavities; begins at the base of the skull and reaches the lower edge of the 6th cervical vertebra, where it narrows in a funnel-shaped manner and passes into the esophagus.

There are three sections of the pharynx:

• upper – nasopharynx
• middle – oropharynx
• lower – laryngopharynx

Nasopharynx

In the nasopharynx there is an accumulation of lymphoid tissue, which forms the pharyngeal tonsil - adenoids. Also in the nasopharynx are the tubal tonsils, which are located around the pharyngeal openings of the auditory tube.

This part of the pharynx is visualized only with the help of instruments or video endoscopic examination.

Oropharynx

The oropharynx is precisely that part of the pharynx that attracts attention when examined by an otolaryngologist and is accessible for examination by the patient himself.
It is located behind the oral cavity and is delimited by the pharynx. The pharynx is an opening formed above by the soft palate and uvula, on the sides by the anterior and posterior arches, and below by the root of the tongue. Between the anterior and posterior palatine arches there are another lymphoid accumulations - the palatine tonsils.

The palatine tonsils, arches, and uvula are subject to friction at the time of swallowing, due to which their mucous membrane may appear redder (hyperemic), in contrast to the entire oral cavity, gums, etc. But this is just a physiological factor.

The mucous membrane of the posterior pharyngeal wall contains elements of lymphoid tissue that visually resemble granules. The mucous membrane of the oropharynx has a dense network of vascular and lymphatic capillaries with rich sensory innervation, and therefore pathological processes are accompanied by symptoms - pain and discomfort in the throat, sensations of dryness, etc.1

hypopharynx

The laryngopharynx begins at the level of the upper edge of the epiglottis and passes into the initial part of the esophagus.
This part is also visualized only using instrumental and video endoscopic methods. This area is visually inaccessible to the patient.

Diseases of the oral mucosa are accompanied by various pathomorphological changes. Inflammation is one of the most common pathological processes of the mucous membrane of the mouth and pharynx and is a manifestation of the body’s protective reaction to the influence of a pathogenic factor. The course and outcome of the inflammatory process depends on the reactivity of the body, localization, activity and duration of action of the pathogenic factor.2

Features of the structure of smooth muscles

The muscles of this group are found in almost all important internal organs, such as the intestines, stomach, uterus, and they are also present in the walls of blood vessels, skin and eyes. Smooth muscles perform involuntary movements, obeying only automatic signals from the nervous system.

Muscle cells have a spindle-shaped shape; they shorten due to the sliding of their filaments. The speed of this process is much slower than that of skeletal muscles, due to which they are able to remain in a tense state for a long time without expending a lot of energy.

An important feature of smooth muscles is their ability to maintain their shape, changed by stretching or deformation, as well as high plasticity, which is important for the functioning of internal organs. The muscles of this group are characterized by the slowest contraction and relaxation, which can last up to several tens of seconds. They can also remain in a state of tone for a long time, practically without getting tired. The main functions of smooth muscles: •

• maintaining pressure in hollow internal organs (ureter, intestines, uterus);
• contracting, they ensure natural peristalsis of organs and their emptying;
• regulate pressure in blood vessels;
• in the organs of vision they provide dilation and constriction of the pupil;
• located on the skin, they promote the secretion of subcutaneous fat.

Prolonged stretching of smooth muscles leads to their tension, which, in turn, plays an important role in promoting the contents of the gastrointestinal tract and ureters. The smooth muscles of the walls of blood vessels, contracting, affect the body's blood supply and blood pressure.

Causes of a red throat

In 70% of cases, inflammation of the pharyngeal mucosa is caused by ARVI viruses (rhinoviruses, adenoviruses, coronaviruses, influenza and parainfluenza viruses), as well as other viruses (enterovirus, herpes virus, Epstein-Barr virus for infectious mononucleosis, and others).

The cause of inflammation can be bacteria:

• group A beta-hemolytic streptococcus (GABHS)
• Staphylococcus aureus
• Streptococcus pneumoniae
• Haemophilus influenza

It should be remembered that a red throat can be a manifestation of infectious diseases such as measles, scarlet fever, and rubella. In some cases, differential diagnosis with other infectious diseases is required.

Why surgery is needed

Benign formations of the laryngopharynx do not manifest themselves in any way at the initial stage and are more often discovered when the patient seeks treatment for other diseases of the ENT organs. However, as they grow, various discomforts arise in the throat, nasal sound, changes in voice timbre and even complete aphonia appear. Volumetric tumors provoke breathing difficulties and sometimes cause asphyxia.

Despite their benign nature, certain types of formations, for example, chondromas and extramedullary plasmacytomas, can transform into a malignant process. The treatment of such pathologies is surgical. The method of surgical intervention is selected depending on the clinical characteristics.

Diagnosis of red throat

To identify the cause of a red throat, the patient must consult an otorhinolaryngologist (ENT) or therapist.

If a child has a red throat, a pediatrician’s consultation is necessary.

To identify lesions of the oropharynx, certain rules must be followed. First of all, the inspection requires sufficient lighting (fluorescent lamp, frontal reflector, etc.). The doctor carefully collects anamnesis to make the correct diagnosis.

An otorhinolaryngologist may prescribe a consultation with other specialists: a gastroenterologist, a dentist, and others.

Various laboratory tests are performed: bacteriological examination (culture from the back of the throat and tonsils and PCR), blood tests (complete blood count, ESR, C-reactive protein).

Cost of removal of benign tumors of the pharynx and larynx

The prices indicated in the price list may differ from the actual prices. Please check the current cost by calling +7 495 104 8605 (24 hours a day) or at the GMS Hospital clinic at the address: Moscow, st. Kalanchevskaya, 45.

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Make an appointment We will be happy to answer any questions Coordinator Oksana

How is the operation performed?

All interventions are carried out via intrapharyngeal access using endoscopic equipment. Local anesthesia is predominantly used. The otolaryngologist carefully inserts an endoscope into the laryngopharynx and carefully examines all parts, assessing the size and location of the tumor. Then, the doctor identifies the tumor and removes it using micro-instruments, while coagulating the vessels.

• cysts, fibromas, neurogenic formations are removed by peeling them together with the capsule;
• for teratomas, the doctor first ligates the base of the tumor, stopping its blood supply, and then excises it, cauterizing the bed;
• local hemangioma, expanding into the lumen of the organ, is excised, followed by diathermocoagulation, laser or cryotherapy. For large hemangiomas growing deep into the tissue, sclerosis or occlusion of the vessels feeding it is used.

Simultaneously with the removal of altered tissues, coagulation of blood vessels is performed to prevent bleeding. Modern endoscopic stands used at the GMS Hospital surgery center allow us to examine in detail the relief of the laryngopharynx mucosa and perform targeted removal of the tumor along with the growth zone. The removed tissues are sent for histological analysis.

You have questions? We will be happy to answer any questions Coordinator Tatyana

Indications for surgery

A direct indication for surgical intervention is the presence of a benign formation in the pharynx or larynx. You definitely need to consult an otolaryngologist if the following symptoms occur:

• sensation of a foreign body in the throat;
• change in voice timbre (hoarseness, nasality, hoarseness);
• swallowing disorder;
• systematic sore throat;
• coughing not associated with inflammation of the ENT organs;
• admixtures of blood in saliva and sputum (with hemangiomas).

The decision on the operation and surgical technique is made by the otolaryngologist based on the examination and the results of a comprehensive examination.