THE LARYNX, BRONCHI AND OESOPHAGUS
Tarch, (2>) a double aortic arch, (c) a vascular constricting ring formed by
a patent ductus arteriosus or a ligamentum arteriosum and the pulmonary
artery or aortic arch, (d) an abnormal right subclavian artery, and (e) an
abnormal innominate artery. Diagnosis is made by a lipiodol swallow (Fig.
103) or by arteriography. At bronchoscopy a pulsatile swelling may be seen
on the right anterolateral tracheal wall some 2 cm above the carina, and is
best seen if the head of the baby is not overextended. If this swelling is
occluded by the tip of the bronchoscope: (1) the right radial and right
temporal pulses will stop if there is an abnormal innominate artery, (2) the
right radial pulse stops but the right temporal pulse is unaffected if there is an
abnormal subclavian artery, and (3) neither pulse is obliterated if there is a
double aortic arch. The treatment is carried out by a thoracic surgeon.
Laryngismus stridulus is a very uncommon condition causing stridor in
undernourished children about the age of 2 years, and it is frequently
associated with rickets and coeliac disease. The cause is thought to be a
hyperventilation causing an alkalosis, a fall in serum calcium and an increased
excitability of muscle tissue. It is treated by calcium gluconate.
Laryngeal spasm may be due to tetany, large tonsils causing dysphagia and
to various anaesthetic agents.
Stridor is the noise produced by an obstruction to the passage of air in and out
of the lower respiratory tract. It may be inspiratory, expiratory and mixed
inspiratory and expiratory. Laryngeal stridor is usually inspiratory, bronchial
stridor is usually expiratory and the rare inspiratory and expiratory variety
must bring to mind the possibility of an abnormal vessel arising from the
The following account will deal almost exclusively with the common
laryngeal inspiratory stridor. Allergic or infective bronchospasm is the
commonest cause of expiratory stridor but the otolaryngologist should always
bear in mind the possibility of an inhaled foreign body, like a peanut or a
bead, in these cases.
Web Subglottic stenosis Cyst Laryngomalacia Vocal cord paralysis Vascular anomaly Lymphangioma Haemangioma Mkrognathia Cleft larynx
APYREXIAL Foreign body Injury Scald Papillomata Laryngismus stridulus
Acute epiglottitis Acute laryngitis Acute laryngotracheo-bronchitis Diphtheria