الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Summary
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The human larynx is a marvelously dynamic structure
serving as a protective gate to the lower respiratory
tract. It has been adapted to produce speech in
man which has contributed greatly to man’s ascendancy
and to his commanding position in the animal kingdom.
On the other hand laryngeal dysf’unction can lead to
the isolation of”the individual and to a sense of’loneliness
because of the inability to communicate normally
and he is generally drown into seclusion because of his
handicap.
Hence, it is imperative to make a review on the
studies, researches and achievements dealing with the
laryngeal neuromuscular dysfunction.
This eSSay is divided into five chapters.
(1) AnatoillY01’ the larynx.:
A briel’ review of the anatomy of the laryn.<:
will help in understanding the physiologic mechanf.
sms and. appearance oi: the laryILc in health and
in disease. The laryILc consists of cartilagenous
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skeleton, the cartilages are held together
by fibroelastic ligaments and membranes, moved
by muscles and lined by mucosa. The larynx is
supplied by the paired superior and recurrent
laryngeal nerves derived on each side trom the
vagus nerves.
It is necessary to make a review on the
physiologic functions of’the laryru, since the
impairment of the physiologic fmlctions is the
basis of the clinical aspect.
It deals with the two most important functions
Which are protection of the lower respiratory
tract and-phonation. It covers both the
neuromuscular and .erodynamic theories of the
origin of the vibrations of the vocal cord.
Circulatory function and its function as a
receptive field for cough reflex are »errt i oneo
briefly. Chapter tw.o alse presents the resptrF.ltory
function with acid-base regulation •
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(3) ~~~~!~5l_~f_~~~_~~~~~~£~!~_~l~f~£~!~~:
~euromuscular dysfunction of the larynx has
a myraid of causes located from the brain to the
aortic arch level. Chapter three is divided
into four diagnostic categories. 1) Neuralogical
category which is subgrouped as peripheral and
central neural disorders. 2) Myoneural junction
category,due to rapid splitting of the acetyl
choline as in myasthenia gravis or due to diminished
reali~ing 01 the acetyl choline as in the
lli,yasthenialike syndrome. 3) Myogenic category,
includes illyotonia,myopathies, and dermatomyositis
and polym,yositis. 4) Psychogenic group, conversion
01” the psychic conf’lict into spastic dysphonia,
ventricular dysphonia, hysterical aphonia, and
others are presented.
In chapter four the diagnostic evaluation
protocol is presented. It begins with the history
and physical examination to include the laboratory
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and radiologic studies. The diagnostic protocol
includes also the panendoscopy and special tests.
History wid physical examination are the
mainstay in the diagnosis and if they do not clarify
the etiology,laooratory and radiologic studies are
necessary. Direct laryngoscopy is mandatory to
determine the passive mobility of the arytenoid.
The value of the special tests as a f’actor in
achieving correct diagnosis are emphasized. The
special tests which have been reviewed include
electromyography. cornputarized a.c iaI tomographic
scanning, voice tape recording, cinephotography,
stroposcopy, andr)ulmOnary flow loop.
(5) M.anagement;
Chapter 5 covers the different procedures
for the treatment of laryngeal dysfunctions.
The treatment of the etiologic process is
usually unrelated to the physiologic dysfunction.
Before furgical interference other than
tracheotomy, 6-12 mouths should be elapsed to
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allow l’or spontaneous recovery or maximum compensation,
i~ recovery has not occured one or other of several
procedures, which have been presented,have been restored
to restore the physiologic function.
Bilateral abductor paralysis is much more important
as the patients are at risk of total respiratory obstruction.
Among the several procedures presented, nervemuscle
pedicle reinnervation has special attention.
Ji.veryPossible lines of treatmen.t 01’ unilateral
abductor and adductor paralysis, bilateral adductor
paralysis, and abductor and adductor types of Spastic
dysphonia have also been presented.