CONGENITAL LARYNGEAL DISORDERS

DR PRASHANTH

CLASSIFICATION

1. SUPRAGLOTTIS LARYNGOMALACIA LARYNGEAL CYST CONGENITAL LARYNGOCELE 2. GLOTTIS LARYNGEAL WEB CRI-DU CHAT SYNDROME VOCAL CORD PARALYSIS

CLASSSIFICATION CONTD….

3. SUBGLOTTIS: SUBGLOTTIC STENOSIS SUBGLOTTIC HEMANGIOMA LARYNGOTRACHEAL CLEFT

LARYNGOMALACIA

MALACIA= SOFTENING (GREEK) JACKSON IN 1942 MOST COMMON CAUSE OF

CONGENITAL STRIDOR. FEATURES: 1. SOFT FLABBY LARYNGEAL TISSUES 2. THIN LARYNGEAL CARTILAGES 3. LOOSE, REDUNDANT MUCOSA OF LARYNX

C/F: M:F= 1:1, CRY IS NORMAL

INSPIRATORY STRIDOR: HIGH PITCH, “FLUTTERING” , WITHIN FEW DAYS OF BIRTH , OR URTI INCREASES TILL FIRST YEAR STARTS RESOLVING.

SUPINE POSITION, SUCKLING, CRYING WORSENS STRIDOR

IMPROVES IN PRONE POSITION

DIAGNOSIS: HISTORY VIDEOLARYNGOSCOPY/FLEXIBLE NASO LARYNGOSCOPY: 1. OMEGA SHAPED EPIGLOTTIS 2. SHORT AE FOLD, PROLAPSES INWARDS 3. PROMINENT ARYTENOIDS, LOOSE MUCOSA, MOVE INWARDS 4. DIFFICULT TO SEE VOCAL CORDS

TREATMENT: 1. 90% CASES RESOLVE BY 2 YEARS 2. TREAT URTI EFFECTIVELY

SEVERE RESPIRATORY DISTRESS, FEEDING DIFFICULTY( HIGH INTRA THORACIC NEGATIVE PRESSURE GERD ) WITH FAILURE TO THRIVE ACTIVE INTERVENTION

EMERGENCY MANAGEMENT:

1. ENDOTRACHEAL INTUBATION 2. TEMPORARY TRACHEOSTOMY

CONSERVATIVE MANAGEMENT

ENDOSCOPIC ARY- EPIGLOTTOPLASTY ( SUPRAGLOTTOPLASTY)

CO2 / COLD KNIFE AE FOLD RELEASED FROM EPIGLOTTIS & REDUNDANT MUCOSA OF ARYTENOID EXCISED IF NEEDED ALONG

WITH CUNEIFORM CARTILAGES

LARYNGOCELE

AIR-FILLED DILATATION OF SACCULUS

ETIOLOGY: 1. CONGENITALLY LARGE SACCULE 2. INCREASED INTRA LARYNGEAL PRESSURE GAS BLOWERS, SAXOPHONE PLAYERS, COUGHING etc

VENTRICLE

TYPES:

INTERNAL- WITHIN THE LARYNX EXTERNAL- PROJECTS THROUGH THE

THYRO-HYOID MEMBRANE AND PRESENTS AS SWELLING IN THE LATERAL NECK

COMBINED

INTERNAL LARYNGOCELE

CLINICAL FEATURES

ASYMPTOMATIC HOARSENESS RESPIRATORY DISTRESS INCREASES ON

CRYING OR STRAINING NECK: CYSTIC, PAINLESS SWELLING,

REDUCIBLE, INCREASES ON VALSALVA ILS: SMOOTH BULGE ON THE

VENTRICULAR BAND, MAY OBSCURE THE VOCAL CORDS

BRYCE’S SIGN: GIRGLING & HISSING SOUND IN THROAT WHEN EXTERNAL MASS IS COMPRESSED

IF SAC OPENING IS OBSTRUCTED MUCOCELE ( SACCULAR CYST )

MANAGEMENT

SOFT TISSUE XRAY NECK/ CT SCAN DURING VALSALVA

DIRECT LARYNGOSCOPY TO RULE OUT UNDERLYING MALIGNANCY

TREATMENT:1. MLS & MARSUPIALIZATION OF SAC

(VENTRICULAR BAND & LARYNGOCELE IS CUT & MARGINS EVERTED)

2. EXTERNAL (TRANSCERVICAL) EXCISION (EITHER CUT THE NECK OF SAC & SUTURE OR LARYNGOFISSURE & SAC EXCISION)

LARYNGEAL WEB

FAILURE OF COMPLETE CANALIZATION OF LARYNX DURING 5TH WEEK OF IU LIFE

MOST COMMON IS GLOTTIC WEB(75%), LESS COMMON ARE SUPRA & SUB GLOTTIC

MOSTLY ANTERIOR GLOTTIC WEBS POSTERIOR INTERARYTENOID WEBS MAY

BE ASSOCIATED WITH CRICOARYTENOID JOINT FIXATION

C/F: WEAK CRY AT BIRTH RECURRENT CROUP INSPIRATORY OR BIPHASIC STRIDOR

DIAGNOSIS: VIDEODIRECT ENDOSCOPY/ FLEXIBLE NASOLARYNGOSCOPY

ANTERIOR GLOTTIC WEB

Rx: ASYMPTOMATIC REASSURANCE

SYMPTOMATIC WEBS

THIN WEBS THICK WEBS

EXCISION WITH COLD KNIFE OR

CO2 LASER

EXCISION & INSERTION OF SILASTIC KEEL

INNER FLANGE GOES IN

BETWEEN THE VOCAL CORDS

OUTER FLANGES SUTURED TO THE THYROID

CARTILAGE

SILASTIC KEEL

PREFERABLY KEEL INSERTED AT AGE OF 3 YRS & ABOVE

TEMPORARY TRACHEOSTOMY WHEN KEEL IN-SITU ( 2- 5 WEEKS)

INSERTED ENDOSCOPICALLY WITH COMBINED LARYNGOFISSURE APPROACH

VERY SEVERE WEB INVOLVING SUBGLOTTIS EMERGENCY TRACHEOSTOMY AT 2 yrs LTR ( Laryngo tracheal reconstruction)

WITH ANTERIOR CARTILAGE GRAFTING

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