Clinical evaluation

Vocal cord polyps and tumours may cause hoarseness. Large laryngeal tumours and infraglottic tumours cause airway obstruction. Hypopharyngeal tumours frequently cause dysphagia or pain on swallowing. Following examination of the neck and oral cavity, the larynx and upper portion of the hypopharynx is best examined by mirror examination (indirect laryngoscopy) and direct laryngoscopy by flexible fibreoptic nasopharyngolaryngoscopy which is done as an outpatient procedure. For more complete examination of the hypopharynx, direct laryngoscopy with rigid laryngoscope under general anaesthesia is required.

Parapharyngeal space Pharyngobasilar fascia

Retropharyngeal space Prevertebral fascia Carotid space

Medial pterygoid Lateral pterygoid Masseter

Tensor veli palatini Levator veli palatini Lingual (branch of V3) Internal carotid artery Styloid process Parotid gland Jugular vein Prevertebral muscles

Sympathetic plexus IX-XII Figure 20.17. Parapharyngeal space at the level of the nasopharynx.
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