الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The voice is not only the key to human communication but also serves as the primary musical instrument and voice production is a complex action that involves practically all systems of the body. In order to produce sound, adductor muscles are activated, providing resistance to exhaled air from the lungs. Air then bursts through the closed vocal folds then the pressure between the folds drops, sucking them back together; this is known as the ”Bernoulli Effect.” This vibrations are repeated hundreds or even thousands of times per second, producing what we hear as voice. Abnormal changes in the voice are called “dysphonia” they are related to disorders in the sound-producing parts (vocal folds) of the voice box (larynx). Swellings or lumps on the vocal folds hinder their vibration leading to alterion in voice quality, volume and pitch. Voice changes can caused by some dermatological diseases which affect skin and mucous membranes as the larynx is a common site to be affected in some diseases as lipoid protinosis, pemphigus vulgaris, reumatoid arthritis, TB and leprosy but it is rarely affected in lichen planus, systemic lupus erythematosus, sarcoidosis, scleroderma and syphilis.
Laryngeal mainfestation usually varies from dysphonia up to air way obstruction in severe cases. Dysphagia, dyspnea, stridor and discomfort sensation may be also present. Dysphonia is considered to be the commonest symptom and it may be the main and the first presentation as in LP. On the other hand, some laryngeal Affection may be asymptomatic or not discovered in some diseases due to lack of laryngeal examination.
In examination of larynx, supraglottic area (mainly epiglottis) is the commonest site of affection and also glottic area (mainly VFs), but subglottic area is the least common. Some diseases can show specific lesions as yellowish deposits in LP, bambo nodule in RA and ulcerative granuloma as in TB or syphilis. Other diseases can show non specific findings as oedema, hyperemia, VFs thicking or fibrosis. Fixed crico -arytenoid joint with vocal fold immobility can also occur as in RA, sarcoidosis and scleroderma.
To know the cause of laryngeal lesions, clinical examination of other manifestations with laboratory and radiological evaluation are needed. Also histopathological examination of dermal lesion or even laryngeal biopsy should be done for differational diagnosis of the cause especially if the larynx is the primary area of involvement. Treatment is usually systemic and specific. Surgical exicion using Co2 laser can be done for defined masses in larynx as yellowish deposits in LP and rheumatoid nodule in RA. Tracheostomy may be needed if there is air way obstruction. As regarding voice, it is usually improved after administration of medical treatment, rare cases that need voice therapy to improve their voice.
Finally, laryngeal examination should be done in dermatological diseases which affect skin and mucous membranes to exclude laryngeal affection and to know the incidence of laryngeal involvement in these diseases.