Diseases of Diseases of Pharynx and Pharynx and

LarynxLarynx

Anatomy of PharynxAnatomy of Pharynx

Fibromuscular TubeFibromuscular Tube Base of Skull to C6 (12cm)Base of Skull to C6 (12cm) Divided into three partsDivided into three parts

NasopharynxNasopharynx OropharynxOropharynx LaryngopharynxLaryngopharynx

4 Layers4 Layers Mucosal, submucosal (Fibrous), Mucosal, submucosal (Fibrous),

Muscular, Fascial layer (buccal Muscular, Fascial layer (buccal pharyngeal)pharyngeal)

NasopharynxNasopharynx

Base of skull to the Base of skull to the soft palatesoft palate

Key componentsKey components Pharyngeal Tonsil Pharyngeal Tonsil

(Adenoids)(Adenoids) Pharyngeal Recess Pharyngeal Recess

(ICA)(ICA) Opening of Auditory Opening of Auditory

tubetube

OropharynxOropharynx Soft Palate to the Soft Palate to the

epiglottisepiglottis Key ComponentsKey Components

Palatopharyngeal Palatopharyngeal and Palatoglossal and Palatoglossal archesarches

Palantine Tonsil – Palantine Tonsil – project from project from tonsillar fossatonsillar fossa

Lingual TonsilLingual Tonsil Valleculae – lie Valleculae – lie

between epiglottis between epiglottis and posterior border and posterior border of the tongueof the tongue

LaryngopharynxLaryngopharynx

Epiglottis to the Epiglottis to the level of cricoid level of cricoid cartilagecartilage

Key featuresKey features Opening to the Opening to the

larynxlarynx Piriform recess Piriform recess

(endoscope)(endoscope)

Anatomy of PharynxAnatomy of Pharynx

Blood supplyBlood supply Branches of many arteries (ascending Branches of many arteries (ascending

pharyngeal, greater palantine, lingual, pharyngeal, greater palantine, lingual, tonsilar)tonsilar)

Nerve SupplyNerve Supply Afferent; maxillary nerve, Afferent; maxillary nerve,

glossopharyngeal, internal and recurrent glossopharyngeal, internal and recurrent laryngeal nerveslaryngeal nerves

Motor; Pharyngeal Plexus (Vagus, Motor; Pharyngeal Plexus (Vagus, glossopharyngeal, Cervical Sympathetic)glossopharyngeal, Cervical Sympathetic)

LarynxLarynx

Respiratory OrganRespiratory Organ Lying between pharynx and tracheaLying between pharynx and trachea Becomes continuous with the trachea at Becomes continuous with the trachea at

the level of the cricoid cartilage (C6)the level of the cricoid cartilage (C6) FunctionFunction

Primary – protective sphincter at the Primary – protective sphincter at the inlet of the air passagesinlet of the air passages

PhonationPhonation

LarynxLarynx ComponentsComponents

Cartilages Cartilages Singular; thyroid, cricoid, epigolitticSingular; thyroid, cricoid, epigolittic Paired; Arytenoid, corniculate, cuneiformPaired; Arytenoid, corniculate, cuneiform

Joints Joints Cricothyroid, cricoarytenoidCricothyroid, cricoarytenoid

Ligaments and MembranesLigaments and Membranes Intrinsic; Quandrangular membrane, Intrinsic; Quandrangular membrane,

Cricothyroid ligament (Vocal folds)Cricothyroid ligament (Vocal folds) Extrinsic; Thyrohyoid membrane, Extrinsic; Thyrohyoid membrane,

cricotracheal, hypoepiglottic, thyroepiglottic cricotracheal, hypoepiglottic, thyroepiglottic ligaments, cricothyroidligaments, cricothyroid

CavitiesCavities

Inlet + Inlet + Vestibule Vestibule

Rima of Rima of glottisglottis

Subglottic Subglottic spacespace

Layrnx - Intrinsic Layrnx - Intrinsic MembranesMembranes

Quadrangular membraneQuadrangular membrane Arytenoid Cartilage and epiglottisArytenoid Cartilage and epiglottis Lower border; vestibular folds (false cord)Lower border; vestibular folds (false cord) Upper border; aryepiglottic foldsUpper border; aryepiglottic folds

Cricovocal MembraneCricovocal Membrane Formed from lateral part of cricothyroid Formed from lateral part of cricothyroid

ligamentligament Upper thickened border forms cricovocal Upper thickened border forms cricovocal

ligaementligaement Vocal folds which bounds the glottis Vocal folds which bounds the glottis

anteriorlyanteriorly

Laryngeal Muscles - Laryngeal Muscles - IntrinsicIntrinsic

1. Those that alter size and shape of 1. Those that alter size and shape of the inletthe inlet Aryepiglottic MusclesAryepiglottic Muscles Oblique arytenoidsOblique arytenoids Thyroepiglottic musclesThyroepiglottic muscles

Act as Sphincter for the inlet Act as Sphincter for the inlet Provide valvular protection from Provide valvular protection from

aboveabove

Laryngeal Muscles - Laryngeal Muscles - IntrinsicIntrinsic

2. Responsible for Phonation by 2. Responsible for Phonation by moving vocal foldsmoving vocal folds Abduction; Posterior CricoarytenoidsAbduction; Posterior Cricoarytenoids Adduction; Lateral cricoarytenoid and Adduction; Lateral cricoarytenoid and

transverse arytenoidtransverse arytenoid Lengthen; CricothryroidLengthen; Cricothryroid Shorten; Thyroarytenoid, vocalisShorten; Thyroarytenoid, vocalis

PhonationPhonation

Pitch; Vibration of the folds through Pitch; Vibration of the folds through shortening and lengthing of the shortening and lengthing of the voldsvolds

Intensity; Pressure through the Intensity; Pressure through the glottisglottis

Quality; Resonating chambers above Quality; Resonating chambers above the glottisthe glottis

Articulation; tongue, teeth and lipsArticulation; tongue, teeth and lips

LarynxLarynx

Blood supplyBlood supply Superior and Inferior Laryngeal Branches Superior and Inferior Laryngeal Branches

from Superior and Inferior Thyroid Arteryfrom Superior and Inferior Thyroid Artery Nerve SupplyNerve Supply

Recurrent Laryngeal NerveRecurrent Laryngeal Nerve All intrinsic Muscles except cricothyroidAll intrinsic Muscles except cricothyroid Mucous Membranes below the foldsMucous Membranes below the folds

External Layngeal NerveExternal Layngeal Nerve Cricothyroid muscleCricothyroid muscle

Internal Laryngeal NerveInternal Laryngeal Nerve Mucous Membranes below the foldsMucous Membranes below the folds

Nerve PalsiesNerve Palsies Recurrent Laryngeal NerveRecurrent Laryngeal Nerve

Number of causesNumber of causes Left;Left;

Carcinoma of bronchus, oesophagus, Aortic anuersym, Carcinoma of bronchus, oesophagus, Aortic anuersym, cardiac surgcardiac surg

Left or Right;Left or Right; Iatrogenic, Trauma, Thyroid diseaseIatrogenic, Trauma, Thyroid disease

Complete (Cadaveric Position)Complete (Cadaveric Position) Half abducted position with arytenoid cartilage slightly in Half abducted position with arytenoid cartilage slightly in

frontfront Hoarse VoiceHoarse Voice Bovine coughBovine cough

IncompleteIncomplete Adducted position as posterior cricoarytenoid more Adducted position as posterior cricoarytenoid more

susceptiblesusceptible External Laryngeal NerveExternal Laryngeal Nerve

Hoarse voice that recoversHoarse voice that recovers Inability to hit high frequenciesInability to hit high frequencies

Extrinsic MusclesExtrinsic Muscles

ElevatorsElevators Indirectly; Indirectly;

Mylohyoid, digastric, stylohyoid, geniohyoidMylohyoid, digastric, stylohyoid, geniohyoid Directly;Directly;

Stlyopharyngeus, salingopharyngeus, Stlyopharyngeus, salingopharyngeus, palatopharyngeus palatopharyngeus

DepressorsDepressors Sternohyoid, omohyoid stenothyroidSternohyoid, omohyoid stenothyroid

4 year old boy4 year old boy Pain in right ear and feversPain in right ear and fevers Recurrent ear infectionsRecurrent ear infections Noisy breather Noisy breather OverweightOverweight Examination – Sore right ear, Examination – Sore right ear,

hyperaemic tympanic membrane, hyperaemic tympanic membrane, breathing with mouth openbreathing with mouth open

Adenoid HypertrophyAdenoid Hypertrophy Occupies large area of nasopharynx age <6Occupies large area of nasopharynx age <6 Atrophies and by age 15 little remainsAtrophies and by age 15 little remains Recurrent URTI or allergies can lead to Recurrent URTI or allergies can lead to

hypertrophyhypertrophy ClinicalClinical

Nasal Obstruction; Mouth breathing / Adenoid Nasal Obstruction; Mouth breathing / Adenoid Facies, chest infections, pharyngeal infections, Facies, chest infections, pharyngeal infections, sinusitis, snoringsinusitis, snoring

Eustachian Tube; Recurrent Otitis Media, Eustachian Tube; Recurrent Otitis Media, CSOMCSOM

Choanal Obstruction; OSA, chronic sinusitisChoanal Obstruction; OSA, chronic sinusitis

IxIx Nasopharyngeal ExamNasopharyngeal Exam Nasopharyngoscopic Nasopharyngoscopic

ExamExam Lateral XrayLateral Xray

TxTx SupportiveSupportive AdenoidectomyAdenoidectomy

AdenoidectomyAdenoidectomy Criteria for surgeryCriteria for surgery

Chronic upper airway obstruction with OSA Chronic upper airway obstruction with OSA +/- cor pulmonale+/- cor pulmonale

Chronic serous/suppurative otitis media Chronic serous/suppurative otitis media Recurrent acute otitis mediaRecurrent acute otitis media Suspicion of nasopharyngeal malignancySuspicion of nasopharyngeal malignancy Chronic sinusitisChronic sinusitis

ComplicationsComplications Early HaemorrhageEarly Haemorrhage Otitis mediaOtitis media Regrowth of residual adenoid tissueRegrowth of residual adenoid tissue

TonsillitisTonsillitis

Commonest area of infection of head and neckCommonest area of infection of head and neck Clinical; Sore throat and Odynophagia, Clinical; Sore throat and Odynophagia,

Otalgia, headache, malaise, Fever, Otalgia, headache, malaise, Fever, hyperaemic tonsils, cervical lymphadenopathyhyperaemic tonsils, cervical lymphadenopathyDDx;DDx; ViralViral Group A Streptococcus (20-30%)Group A Streptococcus (20-30%) EBV; Palatal petechiaEBV; Palatal petechia Diptheria; Unimmunised, grey membraneDiptheria; Unimmunised, grey membrane

Tx; Rest, paracetamol +/- ABxTx; Rest, paracetamol +/- ABx

TonsillitisTonsillitis

Complications;Complications; Acute Otitis Media (most common)Acute Otitis Media (most common) Peritonsillar abscess (Quinsy)Peritonsillar abscess (Quinsy) GASGAS

Post Strep GNPost Strep GN Rhuematic FeverRhuematic Fever Scarlet Fever; Strawberry tongue and Scarlet Fever; Strawberry tongue and

scarlitiform rashscarlitiform rash Recurrent TonsillitisRecurrent Tonsillitis Tonsillar HypertrophyTonsillar Hypertrophy

TonsillectomyTonsillectomy Indications for surgeryIndications for surgery

AbsoluteAbsolute Airway obstructionAirway obstruction Suspicion of malignancySuspicion of malignancy

RelativeRelative Sleep apnoea, mouth breathing, difficulty swallowingSleep apnoea, mouth breathing, difficulty swallowing Recurrent tonsillitis >5 episodesRecurrent tonsillitis >5 episodes Any complicationsAny complications

ComplicationsComplications Reactionary haemorrhageReactionary haemorrhage Secondary haemorrhageSecondary haemorrhage

5-10 days post op5-10 days post op Due to fibrinolysis aggravated by infectionDue to fibrinolysis aggravated by infection

PharyngitisPharyngitis

AcuteAcute >70% Viral Cause, GAS>70% Viral Cause, GAS Supportive TreatmentSupportive Treatment

Chronic Chronic Persistent mild soreness and drynessPersistent mild soreness and dryness Predisoposing factors include; smoking, Predisoposing factors include; smoking,

ETOH, mouth breathing, chronic ETOH, mouth breathing, chronic sinusitis, Industrial fumes, antiseptic sinusitis, Industrial fumes, antiseptic throat lozengersthroat lozengers

Enlarged lymphoid tissue can be removedEnlarged lymphoid tissue can be removed

64 Male recently Immigrated from 64 Male recently Immigrated from Hong KongHong Kong

Lump in right side of neckLump in right side of neck Progressive enlarged, non-painfulProgressive enlarged, non-painful Exam; firm, fixed, solid mass lateral Exam; firm, fixed, solid mass lateral

to midline in posterior triangleto midline in posterior triangle

Nasopharyngeal Nasopharyngeal CarcinomaCarcinoma

Rare in Europe Rare in Europe Common in Asian countriesCommon in Asian countries

20% of all malignancies in Hong Kong20% of all malignancies in Hong Kong PathologyPathology

Squamous cell/undifferentiatedSquamous cell/undifferentiated AietologyAietology

Unknown, however EBV plays a roleUnknown, however EBV plays a role Others; ingestion of preserved foods Others; ingestion of preserved foods

Nasopharyngeal Nasopharyngeal CarcinomaCarcinoma

Clinical;Clinical; Most commonly as lump in the neckMost commonly as lump in the neck Local; Nasal obstruction, blood stained Local; Nasal obstruction, blood stained

dischargedischarge Neurological; Invasion of skull base Neurological; Invasion of skull base

causing cranial nerve palsies (V, VI, IX, causing cranial nerve palsies (V, VI, IX, X, XII)X, XII)

Otological; Serous otitis mediaOtological; Serous otitis media Metastasis to bone, lung, liverMetastasis to bone, lung, liver

Nasopharyngeal Nasopharyngeal CarcinomaCarcinoma

Ix;Ix; Tissue sampling, CT/MRI, StagingTissue sampling, CT/MRI, Staging

ManagementManagement Radiotherapy with concominant Radiotherapy with concominant

chemotherapychemotherapy Poorly amendable to surgery due to Poorly amendable to surgery due to

anatomical locationanatomical location DDxDDx

Lymphoma, cystic adenocarcinoma, Lymphoma, cystic adenocarcinoma, InfectionInfection

Pathology of the LarynxPathology of the Larynx

InfectiousInfectious InflammatoryInflammatory CongenitalCongenital MucosalMucosal MalignancyMalignancy

5 Year old boy5 Year old boy Hx ofHx of 3/7 Low grade fever and URTI Sx3/7 Low grade fever and URTI Sx 1/7 history Biphasic Stridor, barking 1/7 history Biphasic Stridor, barking

coughcough No obvious respiratory distressNo obvious respiratory distress

Laryngotracheitis Laryngotracheitis (Croup)(Croup)

Inflammation of tissues of subglottic Inflammation of tissues of subglottic space +/- tracheobronchial treespace +/- tracheobronchial tree

Mucopurulent exudate -> airway Mucopurulent exudate -> airway obstructionobstruction

Aetiology; Parainfluenza I (most Aetiology; Parainfluenza I (most common), II,III, influenza A,B, RSVcommon), II,III, influenza A,B, RSV

Presentation; night, inspiratory/biphasic Presentation; night, inspiratory/biphasic stridor, barking coughstridor, barking cough

Beware loss of stridor, Decr SaO2Beware loss of stridor, Decr SaO2 DDx; FB, subglottic stenosis, EpiglottitisDDx; FB, subglottic stenosis, Epiglottitis

Laryngotracheitis + Laryngotracheitis + EpiglottitisEpiglottitis

FeatureFeature LaryngotracheitisLaryngotracheitis EpiglottitisEpiglottitis

Inflammation Subglottic space Supraglottic spaceInflammation Subglottic space Supraglottic space

Age Age 4month-5 years4month-5 years 1-4 years1-4 years

OnsetOnset Gradual (days)Gradual (days) Acute (hours)Acute (hours)

Fever Low grade/afebrile High feversFever Low grade/afebrile High fevers

Stridor Biphasic/inspiratory InspiratoryStridor Biphasic/inspiratory Inspiratory

CoughCough BarkyBarky NormalNormal

PosturePosture SupineSupine SittingSitting

DroolingDrooling NoNo YesYes

RadiographRadiograph Steeple sign Steeple sign Thumb sign, enlarged Thumb sign, enlarged epiglottisepiglottis

Appearance Non-toxic Toxic/cyanoticAppearance Non-toxic Toxic/cyanotic

Cause Cause ViralViral BacterialBacterial

TreatmentTreatment Supportive Supportive Keep child Keep child calmcalm

O2, Adrenalin nebsO2, Adrenalin nebs Airway management -Airway management -ETT ETT

Steroids ABx, IV hydration, Steroids ABx, IV hydration, Moist airMoist air

18 month girl18 month girl ““Asthma Attack”Asthma Attack” WheezyWheezy ?trigger?trigger Family Hx of Asthma, EczemaFamily Hx of Asthma, Eczema No stridor, but tachypnea, No stridor, but tachypnea,

intercostal recessionintercostal recession Unilateral wheeze on Right with Unilateral wheeze on Right with

Decreased air entry in lower zonesDecreased air entry in lower zones

Foreign BodyForeign Body Usually stuck at right main bronchusUsually stuck at right main bronchus Anything that’s small enoughAnything that’s small enough Presentation;Presentation;

Stridor if at level of tracheaStridor if at level of trachea ““Unilateral asthma” if bronchialUnilateral asthma” if bronchial

ComplicationsComplications Atelectasis, lobar pneumonia, pneumothorax, Atelectasis, lobar pneumonia, pneumothorax,

mediastinal shiftmediastinal shift Dx;Dx;

Inspiratory/Expiratory X-raysInspiratory/Expiratory X-rays BronchoscopyBronchoscopy

Signs of Airway Signs of Airway ObstructionObstruction

Stretor; obstruction in the throat, low Stretor; obstruction in the throat, low pitched choking noisespitched choking noises

Stridor; High pitched, inspiratory, biphasic Stridor; High pitched, inspiratory, biphasic or expiratory depending on locationor expiratory depending on location

Accessory Muscle useAccessory Muscle use Pallor, diaphoresis, restlessnessPallor, diaphoresis, restlessness TachycardiaTachycardia Cyanosis and altered concious stateCyanosis and altered concious state Intercostal recessionIntercostal recession Nasal FlaringNasal Flaring Exhaustion Exhaustion Bradycardia – most dangerous signBradycardia – most dangerous sign

Upper Airway Obstruction - Upper Airway Obstruction - NeonatesNeonates

Subglottic StenosisSubglottic Stenosis Congenital or Acquired (trauma, intubation)Congenital or Acquired (trauma, intubation) Biphasic stridor, resp distress, recurrent croup Biphasic stridor, resp distress, recurrent croup Diagnosis; CT, laryngoscopyDiagnosis; CT, laryngoscopy Tx; Soft tissue – laser and steroidsTx; Soft tissue – laser and steroids

Cartilage – Laryngotracheoplasty or Cartilage – Laryngotracheoplasty or tracheostomy (intubation)tracheostomy (intubation)

LaryngomalaciaLaryngomalacia Soft immature cartilage Children or older Soft immature cartilage Children or older

patients with NM disorderspatients with NM disorders Inspiratory stridor at 1-2 weeks, worse supine Inspiratory stridor at 1-2 weeks, worse supine

+ feeding difficulties+ feeding difficulties Dx; BronchoscopyDx; Bronchoscopy Tx; Usually self resolves after 18-24monthsTx; Usually self resolves after 18-24months

44 Female44 Female 6 week history of hoarse voice6 week history of hoarse voice Irritation and dryness in throatIrritation and dryness in throat History of heartburnHistory of heartburn SmokerSmoker No history of weight loss, fatigueNo history of weight loss, fatigue Examination; UnremarkableExamination; Unremarkable

Chronic LaryngitisChronic Laryngitis Most common cause is GORDMost common cause is GORD

Recurrent Acute laryngitisRecurrent Acute laryngitis Heavy smokingHeavy smoking Chronic infection of nasal sinusesChronic infection of nasal sinuses Mouth breathing from nasal obstructionMouth breathing from nasal obstruction

ClinicallyClinically Hoarseness or loss of voiceHoarseness or loss of voice Spasmodic coughSpasmodic cough DDx; Malignancy, inhaled corticosteroids, DDx; Malignancy, inhaled corticosteroids,

laryngeal paralysis, TBlaryngeal paralysis, TB General; Voice resting, avoid smokingGeneral; Voice resting, avoid smoking Specific; eg. Lifestyle modifications, Specific; eg. Lifestyle modifications,

MedicationsMedications

35 year old35 year old Blunt trauma to neck 5 hours agoBlunt trauma to neck 5 hours ago Difficulty swallowing + Voice changesDifficulty swallowing + Voice changes No history of LOC, resp distress, No history of LOC, resp distress,

confusionconfusion Examination showed midline Examination showed midline

tenderness of neck, subcutaneous tenderness of neck, subcutaneous emphysemaemphysema

Laryngeal TraumaLaryngeal Trauma RareRare CausesCauses

PenetratingPenetrating Blunt trauma; majority are MVA’s, clothesline Blunt trauma; majority are MVA’s, clothesline

injuries, sporting injuries injuries, sporting injuries Manual strangulationManual strangulation Inhaled flamesInhaled flames Swallowed poisons, foreign bodySwallowed poisons, foreign body ETTETT

Injuries;Injuries; Cricotracheal separation -> AsphyxiaCricotracheal separation -> Asphyxia Fractures of larynx, hyoid bone, joint disruptionFractures of larynx, hyoid bone, joint disruption Open woundsOpen wounds Mucosal TearsMucosal Tears

Laryngeal InjuriesLaryngeal Injuries PresentationPresentation

Significant cervical traumaSignificant cervical trauma Hoarse voice, neck pain, dyspnea, hypoxia, Hoarse voice, neck pain, dyspnea, hypoxia,

aphonia dysphasiaaphonia dysphasia Goals of treatmentGoals of treatment

Protect the airway; Intubation, Protect the airway; Intubation, tracheostomytracheostomy

Restoration of function; Surgical repairRestoration of function; Surgical repair ComplicationsComplications

Laryngeal stenosis; permanent Laryngeal stenosis; permanent tracheostomytracheostomy

33 year old male singing teacher33 year old male singing teacher Progressively hoarse voiceProgressively hoarse voice Normal CoughNormal Cough Non-smoker Non-smoker No weight loss/fatigueNo weight loss/fatigue

Benign Vocal Fold Benign Vocal Fold LesionsLesions

Reactive nodules (singers nodules)Reactive nodules (singers nodules) Bilateral Bilateral Smooth, rounded/pedunculatedSmooth, rounded/pedunculated Small Small Located on true vocal foldsLocated on true vocal folds Treatment;Treatment;

Voice training, re-educationVoice training, re-education Rarely surgical if fibrosed, chronicRarely surgical if fibrosed, chronic

Virtually never give rise to malignancyVirtually never give rise to malignancy

LaryngoceleLaryngocele Abnormal dilatation of the laryngeal ventricleAbnormal dilatation of the laryngeal ventricle Contains airContains air Men>WomenMen>Women Bilateral 25%Bilateral 25% Aeitology;Aeitology;

Acquired; Incr. Intraluminal pressure (musicians)Acquired; Incr. Intraluminal pressure (musicians) CongenitalCongenital SCC <15%SCC <15%

Hoarse voice, pain, dysphagia, lateral neck Hoarse voice, pain, dysphagia, lateral neck massmass

Squamous PapillomaSquamous Papilloma

Most common benign neoplasm of larynx (84%)Most common benign neoplasm of larynx (84%) Found on true vocal cordsFound on true vocal cords Caused by HPV 6 and 11Caused by HPV 6 and 11 Soft Raspberry like appearanceSoft Raspberry like appearance May ulcerate resulting in haemoptysisMay ulcerate resulting in haemoptysis Usually Single in AdultsUsually Single in Adults Multiple in Children (Laryngeal Papillomatosis) Multiple in Children (Laryngeal Papillomatosis)

with extended growth and recurrencewith extended growth and recurrence Malignant transformation extremely rareMalignant transformation extremely rare

Investigation and Investigation and TreatmentTreatment

Ix;Ix; LaryngoscopyLaryngoscopy

Tx;Tx; CO2 LaserCO2 Laser Surgical removalSurgical removal ?Antivirals?Antivirals

55 year old male55 year old male History of GORD, cardiac diseaseHistory of GORD, cardiac disease Recurrent hoarse voiceRecurrent hoarse voice Right otalgiaRight otalgia Smoker + ETOH abuseSmoker + ETOH abuse

Squamous Cell Squamous Cell CarcinomaCarcinoma

Most common malignancy of larynxMost common malignancy of larynx Male>Female 6;1xMale>Female 6;1x 2.5% all cancers in men2.5% all cancers in men AeitologyAeitology

Tobacco: Tobacco: Alcohol: Alcohol: (x 2.2) (x 2.2) Radiation, asbestosRadiation, asbestos GORDGORD HPVHPV

Squamous Cell Squamous Cell CarcinomaCarcinoma

Glottic SCC most common (60%) > Glottic SCC most common (60%) > supraglottic SCC (30%) > subglottic supraglottic SCC (30%) > subglottic SCC (<10%).SCC (<10%).

Sx: hoarseness, throat pain, cough, Sx: hoarseness, throat pain, cough, hemoptysis, referred otalgia, hemoptysis, referred otalgia, dysphagiadysphagia

Diagnosis;Diagnosis; Laryngoscopy with FNALaryngoscopy with FNA CT/MRICT/MRI

Squamous Cell Squamous Cell CarcinomaCarcinoma

ManagementManagement Eradication of diseaseEradication of disease Restoration of function; swallowing and Restoration of function; swallowing and

speechspeech Radiation treatmentRadiation treatment

Especially early stage diseaseEspecially early stage disease Cure rates equivalent to surgeryCure rates equivalent to surgery

Surgical ManagementSurgical Management Emphasis on organ preservationEmphasis on organ preservation Partial LarygectomyPartial Larygectomy

www.surgical-www.surgical-tutortutor..orgorg.uk .uk Learning RadiologyLearning Radiology Clinical Cases and Osces in Surgery. Clinical Cases and Osces in Surgery.

Ramachandran, PooleRamachandran, Poole Apleys OrthopaedicsApleys Orthopaedics