Anatomy of the Head & Neck

Paired organs include the tonsils, parotid glands, other major salivary glands, maxillary and frontal sinuses, and the nasal cavities. Specific sub sites of these organs, which are considered lateral sites, are indicated with an asterisk (*) in the code table above. All other sites are considered single or non-paired organs.

The anatomy of the head and neck is complex because so many different functional structures are located close to each other. Elements of the digestive, respiratory, nervous, and endocrine systems are located sometimes within millimeters of each other. Many structures have a number of names as well. Please review the anatomic diagrams on the following pages for details on organ structures and synonyms for organ names.

The oral cavity extends from the vermilion (red) border of the lips to the junction of the hard and soft palates in the roof of the mouth, and to the circumvallate papillae on the tongue. The oral cavity consists of the lips, commissures, all surfaces (anterior 2/3 or oral, dorsal, ventral, border) of the tongue except the base of tongue, lingual tonsil, gums (alveolar ridge), floor of mouth, hard palate, buccal mucosa, and retromolar trigone.

For purposes of TNM staging, the pharynx includes the following:

Oropharynx

Tonsillar fossae, tonsillar pillars (faucial arch), vallecula, lateral and posterior walls of oropharynx, the base of tongue, soft palate, uvula, and branchial cleft as a site of neoplasm.

Nasopharynx

Anterior, superior, posterior, and lateral walls of nasopharynx.

Hypopharynx

Pyriform sinus (70% of all hypopharyngeal malignancies), postcricoid region (15%), hypopharyngeal aspect of aryepiglottic fold, posterior wall (15%), and laryngopharynx.

The larynx is comprised of three sub sites or regions. The supraglottis (35% of all laryngeal cancers) consists of the ventricular bands (false cords), arytenoids, ventricles, suprahyoid epiglottis, infrahyoid epiglottis, and laryngeal aspect of the arytenoepiglottic folds. The glottis (65%) consists of the true vocal cords and their anterior and posterior commissures. The subglottis (1%) consists of the subglottic space extending to the first tracheal ring.

The paranasal (or accessory) sinuses include (in order of frequency) the maxillary, ethmoid, sphenoid, and frontal sinuses. The maxillary sinus (antrum of Highmore) is divided into the infrastructure (anterior and inferior portion) and the suprastructure (superior and posterior). The nasal cavity is divided into two chambers by the nasal septum. The nostrils are the external opening, and the choana is the opening into the nasopharynx. All sinuses and the nasal cavity are paired sites.

The major salivary glands are the parotid (accounting for 90% of all salivary gland tumors), submandibular or submaxillary (about 10%), and sublingual glands (1%). Minor salivary glands are located in many oral cavity structures, including the oral mucosa, palate, uvula, posterior tongue, retromolar trigone, paranasal sinuses, pharynx, larynx, peritonsillar area, and floor of mouth.

The thyroid gland consists of two lateral lobes joined by an isthmus. Sometimes a pyramidal lobe is also present, extending upward anterior to the thyroid cartilage.

Waldeyer’s ring: the lymphoid tissues that form a ring around the opening of the throat: tonsils laterally, adenoids superiorly, and lingual tonsil at the base. Waldeyer’s ring is considered part of the pharynx.

Ohngren’s line: imaginary line or plane dividing the upper and lower portions of the maxillary sinus.

Field defect: pre-disposition of mucosa to develop more than one primary tumor; also called regional diathesis.

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Laryngitis Information | Mount Sinai

Hoarseness – laryngitis

Laryngitis is swelling and irritation (inflammation) of the voice box (larynx). The problem is most often associated with hoarseness or loss of voice.

Structures of the throat include the esophagus, trachea, epiglottis and tonsils.

Causes

The voice box (larynx) is located at the top of the airway to the lungs (trachea). The larynx contains the vocal cords. When the vocal cords become inflamed or infected, they swell. This can cause hoarseness. Sometimes, the airway can get blocked.

The most common form of laryngitis is an infection caused by a virus. It may also be caused by:

• Allergies
• Bacterial infection
• Bronchitis
• Gastroesophageal reflux disease (GERD)
• Injury
• Irritants and chemicals

Laryngitis often occurs with an upper respiratory infection, which is typically caused by a virus.

Several forms of laryngitis occur in children that can lead to a dangerous or fatal respiratory blockage. These forms include:

• Croup
• Epiglottitis

Symptoms

Symptoms may include:

• Fever
• Hoarseness
• Swollen lymph nodes or glands in the neck

Exams and Tests

A physical exam can find whether hoarseness is caused by a respiratory tract infection.

People with hoarseness that lasts more than a month (especially smokers) should see an ear, nose, and throat doctor (otolaryngologist). An exam of the throat and upper airway will be done.

Treatment

Laryngitis is often caused by a virus, so antibiotics likely will not help. Your health care provider will make this decision.

Resting your voice helps to reduce inflammation of the vocal cords. A humidifier may soothe the scratchy feeling that comes with laryngitis. Decongestants and pain medicines may relieve the symptoms of an upper respiratory infection.

Outlook (Prognosis)

Laryngitis that is not caused by a serious condition often gets better on its own.

Possible Complications

In rare cases, severe respiratory distress develops. This requires immediate medical attention.

When to Contact a Medical Professional

Contact your provider if:

• A small child who is not teething has difficulty breathing, swallowing, or is drooling
• A child less than 3 months old has hoarseness
• Hoarseness has lasted for more than 1 week in a child, or 2 weeks in an adult

Prevention

To prevent getting laryngitis:

• Try to avoid people who have upper respiratory infections during cold and flu season.
• Wash your hands often.
• Do not strain your voice.
• Stop smoking. This can help prevent tumors of the head and neck or lungs, which can lead to hoarseness.

Allen CT, Nussenbaum B, Merati AL. Acute and chronic laryngopharyngitis. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 61.

Flint PW. Throat disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 401.

Rodrigues KK, Roosevelt GE. Acute inflammatory upper airway obstruction (croup, epiglottitis, laryngitis, and bacterial tracheitis). In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 412.

Last reviewed on: 10/20/2022

Reviewed by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Squamous cell carcinoma of the larynx – symptoms, treatment methods, prevention and diagnosis

Among the cancers that affect the upper respiratory tract, laryngeal cancer ranks first. At the same time, malignant tumors are heterogeneous, and most often, in about 95% of cases, squamous cell carcinoma of the larynx is diagnosed. It starts from squamous epithelium and spreads to other tissues. For a long time, the risk group was, first of all, men over the age of 50, who smoked a lot and worked in hazardous industries. But the deterioration of the environment and the spread of smoking among women led to a change in the situation.

Treatment of throat cancer is one of the activities of the oncological center “Sofia”. Experienced specialists, who have modern equipment at their disposal, are ready to provide the necessary medical care.

Symptoms of cancer of the larynx

The main symptoms of laryngeal cancer are:

• feeling of constant coma in the throat, discomfort when swallowing;

• the appearance of hoarseness and hoarseness, a change in the usual timbre of the voice;

• bouts of dry cough that does not go away for a long time;

• swelling, local inflammation of the lymph nodes in the neck;

• sore throat, which gradually increases and may radiate to the parotid region;

• loss of strength, feeling of weakness, a slight increase in temperature;

• weight loss;

• the appearance of blood clots in the sputum when coughing;

• persistent putrid odor from the mouth.

If you experience any of these symptoms, be sure to see your doctor for diagnosis and treatment of squamous cell carcinoma. The sooner the diagnosis is made, the higher the likelihood that doctors will develop an effective treatment strategy and the cancer will be defeated.

Stages of laryngeal cancer

Squamous cell carcinoma of the larynx goes through several stages in its development. The international TNM classification system is used:

• T is a characteristic of the size and boundaries of tumor germination;

• N – shows the spread of metastases to regional lymph nodes;

• M is a parameter describing the involvement of the whole organism in the process and the presence of metastases in distant organs.

The first stage of laryngeal cancer according to this classification is described as T1N0M0. There is a small area of ​​the lesion, which is localized in a strictly defined place, while the surrounding tissues are not changed. If treatment begins at this stage, then its prognosis will be favorable.

The second stage of throat cancer involves further growth of the tumor, which spreads to adjacent tumors. Pain may occur, the timbre of the voice may change. In some cases, the lymph nodes are enlarged. For 80% of people, timely initiation of treatment at this stage means life extension for up to 5 years.

The third stage of laryngeal cancer is characterized by aggravation of symptoms. Often observed:

• weight loss;

• general weakness;

• sensation of a foreign body in the throat;

• difficulty breathing;

• voice change up to its complete loss.

Lymph nodes increase, become dense. Treatment at this stage is complex, which allows 50% of patients to prolong life by 5 years.

The fourth stage of laryngeal cancer involves the further development and spread of the tumor process. The disease affects the entire body, and the consequences of this are:

• malaise, severe weakness;

• emaciation;

• temperature increase;

• pain when trying to pronounce sounds;

• dry cough;

• asthma attacks;

• hemoptysis.

The peculiarity of treatment at this stage is that it is aimed only at prolonging the life of the patient. The long-term prognosis is unfavorable.

Cancer diagnostics

There are several diagnostic methods to determine the cancer, its type and stage. Early diagnostic methods are:

• smear and biopsy: allow you to determine the nature of the tumor – benign or malignant;

• laryngoscopy examination;

• test for tumor markers.

Clarifying methods are ultrasound, computed tomography and radiographic examination. With their help, doctors study the condition of the patient’s larynx, identify pathological changes, determine the condition of the lymph nodes and localize the tumor.

Methods of treatment for cancer of the larynx

There are three main methods – radiation therapy, chemotherapy and surgery.

In stages I-II of laryngeal cancer, radiation therapy is considered more effective, and in stages III-IV – chemotherapy. However, the best result can be achieved with the help of surgery.

There are several types of surgery:

• resection – partial removal of the larynx in the early stages of squamous cell carcinoma;

• hemilaryngectomy – if the tumor has affected only one side of the larynx, it is excised, while maintaining speech function;

• chordectomy – performed when the tumor is located in the middle section and involves partial or complete removal of the vocal fold;

• upper laryngeal laryngectomy – is used when the tumor is located in the upper section and involves the complete removal of the larynx;

• total laryngectomy – complete removal of the larynx along with the vocal cords.

Benefits of the clinic

Oncological center “Sofia” works at JSC “Medicine” (clinic of Academician Roitberg). Our advantages are:

• great experience and high qualification of doctors;

• availability of modern equipment and the use of advanced medical technologies;

• high quality and safety of medical services, which is confirmed by numerous awards, prizes, certificates, as well as successful certification in accordance with the requirements of the international JCI system;

• convenient location in the center of Moscow – we are easily accessible by personal and public transport.

Call +7 (495) 121-36-07 to make an appointment, or leave your contact details on the website, and the manager of the Sofia Cancer Center will contact you.

Pharyngitis: signs, symptoms, treatment – MedCom

Causes of the disease

A natural process for a person is nasal breathing. The nasal passages are designed so that the inhaled air comes with a slight delay. During these pauses, it warms up, is filtered and in this form is fed into the body. When the nose is stuffed up and breathing occurs through the mouth, the risk of pharyngitis increases – after all, the air does not pass through the “filters” and enters through the mouth with bacteria, viruses, dust, etc. The unnatural process causes the throat to dry out, it becomes a favorable environment for the development of pathogenic flora .

The second common cause of pharyngitis is a runny nose against the background of SARS. In this case, the focus of inflammation is in the throat, developing gradually. Frequent treatment of the nasal passages with vasoconstrictor drops negatively affects the condition of the pharynx, which also causes the development of the disease.

Other causes include:

• beriberi and malnutrition;
• bad habits;
• injuries;
• individual features in the structure of the nasopharynx;
• long-term antibiotic treatment;
• chemical fumes;
• exposure to allergens.

Often pharyngitis is promoted by past diseases, for example, diabetes mellitus, dental caries, heart, kidney failure, sinusitis, sinusitis and others.

Stages and symptoms of the disease

Symptoms of pharyngitis are often confused with the usual manifestations of SARS and tonsillitis. The patient begins self-treatment, which is ineffective and leads to complications.

Experts distinguish four stages of the disease, each of which has its own visible signs and symptoms:

1. Catarrhal – accompanied by coughing and sore throat.
2. Granular – there is a feeling of “tickling” in the throat. Small tubercles on the mucous membrane of the throat increase in size.
3. Purulent – the tubercles are inflamed, swelling, purulent plaque and ulcers are observed.
4. Atrophic – leads to atrophy of the tissues of the throat, swallowing functions are almost impossible.

At the first sign of illness, you should not hesitate. Contact your doctor for help as soon as possible. Pharyngitis can be acute and chronic. The first type is characterized by the following symptoms:

• sore and dry throat;
• dead voice;
• fever;
• swollen lymph nodes.

There is a sensation of a foreign object in the throat, problems with swallowing, general ailments, as in viral diseases (headache, aches, fever). Another sign is that mucous accumulations are felt in the throat, which cannot be got rid of.

In chronic pharyngitis, patients complain of dryness and sore throat, often there is a dry cough, strong purulent discharge, a constant desire to swallow a lump, cough up. Often such urges are accompanied by vomiting. The cough is worse in the morning and is accompanied by nausea. Another symptom is swelling and sore throat, aggravated by swallowing.

Diagnosis and treatment

Diagnosis and treatment of pharyngitis is carried out by a specialist otolaryngologist (ENT). To make a diagnosis, a number of laboratory tests are used (blood tests, throat swabs, and others). Based on the results of the tests and examination of the patient, a treatment regimen for pharyngitis is selected.

The choice of therapy also depends on the age of the patient. When treating children, the methods differ significantly. Mandatory recommendations include plenty of warm drinking, ventilation and wet cleaning in the room. Inhalations and sprays – only with the permission of a doctor and under the supervision of adults. The same careful approach to procedures is required for pregnant women. Taking medication can be dangerous for a child, so a gentle scheme is drawn up by a specialized specialist.

The choice of course depends on the causes and pathogens of the disease. Among the effective methods of treating pharyngitis are:

1. Drug treatment – antibiotics, antivirals, anti-inflammatory drugs.
2. Complexes of vitamins and minerals.
3. Physiotherapy (electrophoresis, UHF, inhalations).

In some cases, acute pharyngitis requires instrumental intervention.

General recommendations for the treatment of pharyngitis of various origins include: plentiful warm drink, diet, rejection of bad habits. Treatment may include lozenges, lozenges, aerosols, and oils.

Folk remedies have proven themselves well in the treatment of pharyngitis. These can be herbal rinses, foot baths, soda inhalations. So that treatment with folk methods does not cause complications, remember: a doctor should give appointments.

Complications of the disease

It is necessary to treat pharyngitis in a timely manner and in compliance with all prescriptions.