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Transcript of Diseases of Pharynx and Larynx. Anatomy of Pharynx Fibromuscular Tube Fibromuscular Tube Base of...
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