ENT-Lec 4; Diseases of the Salivary Glands and Hypopharynx

Otolaryngology (ENT)Disorders of The Salivary Glands (Benign)Source: Boeis, L., Adams, G. and Hilger, P.(1989). Fundamentals of Otololarynglogology. Pp 282-316. Philidelphia, W.B. Saunders Company

Transcribed by: Ray Albert Cabigan

Facial nerve leaves the skull through the stylomastoid foramen. In the parotid gland, the nerve separates into the cervicofacial and termporofacial nerves.

Temporofacial nerve then separates into the temporal and zygomatic branch

Cervicofacial separates into cervical, marginal mandibular and buccal division

Passage of the facial nerve through the parotid gland divides the parotid gland into a superficial lobe and the deep lobe.Deep lobe is in close contact with CN IX, X, XI, XII and division of external carotid artery in to the superficial temporal and internal maxillary arteries

Parotid gland is the largest salivary gland. Parotid duct (Stensen’s duct) is 6cm long and arises from the anterior portion of the gland. The duct opens at the 2nd upper molar tooth

Submandibular gland lies beneath the horizontal ramus of the mandible. In digastric triangle. Wharton’s duct is 6cm long and opens lateral to the lingual frenulum

Sublingual glands lie beneath the anterior floor of the mouth.

INFLAMMATORY DISORDERSAcute ParotitisMost common is mumpsRecurrent sialdenitis occurs in children inflammation of one or both glands

Acute Suppurative Parotitis occurs in debilitated or elderly persons who may be partially dehydrated. Sudden inflammation. Usual causative agent is S. aureus. IV antibiotitcs is a must. Incision and drainage

is done as well as radiation exposure to rid of the disease.Acute Submandibular Gland SialadenitisRare in the submandibular gland.

Chronic SialdenitisLong standing, frequently recurring episodes of glandular swelling and discomfort from the major salivary glands

Chronic sialdenitis of the parotid associated with recurrent calculi, mucous plugs or strictures is known as sialodochiectasisSialectasis may involve one or more salivary glands.

Parotid gland is the most frequently involved. Where there is no observable obstruction, dilatation of the ducts are done. In cases where medical intervention does not work, parotidectomy may be done.

Salivary gland calculi (sialolithiasis) occurs more commonly in the submandibular gland. Fever occurs when infection develops. Sialdenitis of the submandibular lgand is more frequenly treated by surgery

SYSTEMIC DISEASEParotid gland is most often involved.

Sarcoidosis of the parotid (Heerfordt’s syndrome / uveoparotid fever). Diffusely swollen duct with slight tenderness. Facial nerve paralysis.

Benign lymphoepithelial disease (chronic punctuate parotitis). Mostly in women. Associated with rheumatoid disorders. Little dots. Acinar atrophy. Oral dryness

Sjogren’s syndrome, chronic parotitis plus 2-3 additonal entities (xerophthalmia or xerostomia or rheumatoid disorder). Usually involves the parotids. 44x more chance of developing lymphoma.

SIALORRHEADrooling. Cerebral palsy, demyelinating disorders, Parkinson’s.

1st Shifting Transcription by Ray Albert R. Cabigan 1

Treated surgically – rerouting; removal of the gland; tympanectomy combined with chorda tympani resection;

RADIOLOGICAL ASSESSMENT OF THE MAJOR SALIVARY GLANDSRadiosialographic ScanningDepends on increased concentration of iodine in saliva compared to plasmaParotid and sumbmandibular gland.

Normal = symmetric and smoothTumor = area of decreased uptake

SialographyInjection of water- or oil-soluble contrast material into submandibular or parotid gland. Useful in chornic disorders of the parotid gland such as recurrent sialdenitis, Sjogren’s or ductal obstruction. CI in the presence of recent, acute inflammation of the gland

Computed TomographySingle most useful radiographic diagnostic test of the salivary gland masses.

Normal parotid gland appears less dense than the surrounding structuresTumors (most common is pleomorphic adenoma) is well defined, slightly enhancing mass.

BENIGN TUMORS OF THE SALIVARY GLANDSChildrenMost common benign gland tumor of children is parotid gland hemangioma. Bluish discoloration and fluctuation in size of the mass when the child cries. Gradual inrase in size during 1st 4 – 6 mos of life.

Lymphagioma arises also in the parotid

3rd most common tumor is the pleomorphic adenoma and is the most common solid tumor found in children

Tumors in children frequently involve the parotid glands. Submandibular and minor salivary gland areas are uncommon sites.

AdultsPrimary site of origin for benign tumors is the parapharyngeal space. From salivary glands that arose from deep lobe of parotid gland and from vagus nerve or cervical sympathetic chain pushes lateral pharyngeal wall medially.

Most common tumor of the space is pleomorphic adenoma; second most common is malignant adenocystic carcinoma. The largest group of toher tumors are of neurogenic origin (schwannomas and neuromas).

Pleomorhpic adenoma (benign mixed tumor) accounts for 75% of parotid gland tumors. No pain or facial nerve weakness. Treated by complete surgical resection.

Extracapsular extension of the tumor may occur. The whole gland has to be removed to prevent recurrence.

Recurrent tumors may undergo malignant degeneration (< 6% incidence)

Pleomorphic adenoma is also the most common benign tumor of the submandibular gland as well as the minor salivary glands. Frequently on the palate near the midline at the junction of the hard and soft palates.

Papillary adenocystoma lymphomatosum (Warthin’s Tumor)Most common in 50-60 year old males. Most common tumor to occur bilaterally. Surgical resection, recurrence is unlikely

Benign Laryngeal DisordersPain from the base of the tongue, the epiglottis or the piriform sinus is referred to the ear first symptomdyspnea and stridor are usually late and serious symptoms

SPECIFIC METHODS OF DIAGNOSISIndirect (mirror) laryngoscopy or fiberoptic instrument


Direct examination through local or general anesthetic.Auscultation of the larynx differentiates laryngeal stridor from bronchial stridorPalpationCT and MRIVoice recordingsEsophagogram

CONGENITAL ANOMALIESInfants C2-C4; 7mm anteroposterior, 4mm lateralAdults C4-C6

LaryngomalaciaNo underlyikng pathologic or progressive disorder. Exaggeration of soft flabby state of the larynx. Larynx collapses on inhalation. Swallowing is unaffected. Normal cry, weight gain and development. Stridor. Chest retraction leading to pectus excavatum. Occurs 7weeks and above. Good prognosis, clears when cartilage becomes rigid by 12th – 15th month.

Congenital Subglotting StenosisSubglotting diameter < 4mm. stridor at birth. Most cases require tracheotomy. More than one congenital anomaly may exist

Webs75% glottic, 12% subglottic, 12% supraglottic. Airway and cry are affected. Begins at birth. Treated surgically, laser or dilatation

Congenital CystsAirway obstruction, failure to grow. Normal voice and swallowing. Cysts from the base of the tongue, aryepiglotting folds or false cords.

HemangiomaTumor that occurs primarily in infants under 6mos of age. . 50% have an external hemangioma. Stridor. Vascular abnormalities. May regress by 12th month. Normal voice or swalling. Smooth compressible mass on the posterior or lateral wall.

LaryngoceleResid from a small appendix or saccus of laryngeal ventricle. May be at any age. May

present as a mass in the neck on the same side to which it is grows. Stridor and airway obstruction. Diagnosed via aspiration biopsy. Dissection is a must.

Laryngotracheoesophageal cleftRare. Failure of fusion of the dorsal portions of the cricoid cartilage. Failure of the closure of the tracheoesophageal septum. Cyanosis, respiratory distress, recurrent pneumonia. Changes in cry.

Neurogenic Disorders of the NewbornVocal cord paralysis from birth canal trauma, meningocele, masses, etc. Unilateral paralysis. breathy poor cry, no respiratory distress (lateral). Stridor, DOB (median).

Bilateral paralysis. Good cry, poor respiratory exchange.Paralysis recovers in 6 – 9 mos.

LARYNGEAL TRAUMAContusions of the LarynxInternal hematoma, dislocation of arytenoids.

Laryngeal FractureHyoid fracture – no airway obstruction – separation of the greater cornu from the bodyFractures (vertical) of the thyroid cartilage are common. s/s:

1. hx of a blow to the neck2. hoarseness3. inspiratory and/or espiratory stridor4. hemoptysis5. subcutaneous emphysema

airway obstruction, facial pain. Thyroid cartilage cannot be palpated.Usually accompanies cervical spine injuries.Avulsion occurs when there is damage to the recurrent laryngeal nerves

Laryngeal and Subglottic StenosisNarrowing of airway due to scars. Heroic therapy received by some patients with endotracheal tubes causes stenosis of the airway.

Intubation Granuloma


Rare. Abration of vocal process of arytenoids leading to granuloma formation. Mild hoarseness. No airway obstruction. Often bilateral.

Allergic Diseases of the LarynxObstructive edema upon contact with allergen.

INFECTIOUS DISEASE OF THE LARYNXCroupInfection of the larynx resulting to stridor and airway obstruction. Any age. Most common in <6y.o.Two types

1. acute supraglottitis (epiglottitis) rapidly fatal; sits up with open mouth and chin forward, no hoarseness; dysphagia

2. acute sublottic laryngitis hoarse, very croupy cough, lies down

s/s: stridor, retraction and cyanosis

Rapid treatment is a must. IV insertion of fluids and inhalation of antibiotics is recommended. Steroids to reduce inflammation. Support should be provided if RR > 40 and PR > 160 with continuous restlessnessMost cases resolve in 48-72hours when treated promptly.

SupraglottisLaryngotracheobronchitis (infraglottitis)

Bacterial tracheitis

Spasmodic croup

Incidence (age in years)

3 – 6 < 3 8 – 15 1 – 5

Onset Hours Days 1-2 week period of respiratory infection with rapid deterioration

Rapid onset, usually evening

Voice Clear Hoarse Barking cough No associated infection

Dysphagia Yes None Inspiratory stridor Yes; relieved by humidity or cold

Drooling Yes No -- YesPosition of relief

Sitting up Recumbent Recumbent --

Recurrence Rare Yes Yes; intubation needed to remove secretions or pseydomembranes

--

Course Rapid Days to weeks -- --Radiograph Supraglottic

edemaNormal Irregular margins

in trachea--

Organisms H. influenzae (most common), strep, virus

Virus S. aureus most common; H. influenzae

--

Acute LaryngitisOccurs due to vocal abuse, toxic fumes, infections. Usually a paninfection. Influenxa virus, adenovirus, streep. Diphtheria if there is (-) immunization hx and there is the

presence of a membrane. Further abuse may result to hemorrhage and development of nodules


SYSTEMIC DISORDERS WITH LARYNGEAL MANIFESTATIONS

1. Rheumatoid arthritis fixed vocal cord

2. Hypothyroidism3. Infiltrative disorders supraglottic

larynx, hoarseness and dysphagia. Diffuse edema without ulceration of the supraglottic larynx. Histoplasmosis can cause

simultaneous ulceration of the larynx and oral cavity. Pepmhigus vulgaris ulcerated laryngeal surface covered with whitish membrane

4. Chronic Granulomatous Infections TB, syphilis, leprosy, candida

5. Androgen Therapy

CHRONIC NONSPECIFIC LARYNGITISConditions characterized by hoarsenss and long standing inflammatory changes due to irritation by allergens, smoke or acid reflux, in the laryngeal mucosa. Red and thickened vocal cords. Unimpaired vocal cord motility. Treated by removal of ffending cause and treating underlying disorders.

BENIGN TUMORS OF THE LARYNXVocal NodulesUnilateral as a result of improper use of vocal cords. May be soft loosely edematous tumor or firm, fibrous growth or vacular.

Diffuse Vocal Cord PolyposisPolypoid degeneration associated with prolonged coval use, smoking and persistent inflammation. Aftger surgery, smoking must be stopped otherwise recurrence is likely

Contact ulcerMore commonly in men. Granuloma formation due to forceful contacts of arytenoids cartilages. Pain and vocal change. Speech therapy aids resolution.

Juvenile PapillomaMost common tumor of the larynx in children. 18mos-7years. Involution at puberty. May recur. Hoarseness and abnormal cry. May be hormone dependent and may enlarge enough to cause airway obstruction. Treated by precise surgical

removal. Malignancy associated with smoking

Granular Cell MyoblastomaTongue and larynx. Hoarsenss. Pseudoepitheial hyperplasia.

ChondromaSlow growing tumors of hyaline cartilage arising from cricoid, thyroid, arytenoids or epiglottic cartilages

Leukoplakia or ErythroplakiaLeuko – white; erythro – red. Vocal cords are most often affected. Hoarseness. There may be hyperkeratosis (most often), carcinoma in situ or frank carcinoma. Surgical removal with cessation of smoking.

NEUROGENIC DISORDERS OF THE LARYNXVocal Cord ParalysisCaused by any lesion in the course of the recurrent laryngeal nerve. Lesions in the CNS and brain stem that affects the larynx also include other pathologies. May be through compression or through trauma. Unilateral cord paralysis may cause airway obstruction in children because of the small airway. Mobility of the paralyzed vocal cord may be regained if the recurrent laryngeal nerve is in a paramedian position such that it can grow to compensate the loss of the nerve on the other side (6-12mos)

Bilateral cord paralysis – voice is less affected though glottis is small. Dyspnea even at rest. Majority requires tracheostomy. Abducted cords are due to trauma – weak breathy voice; easy breathing. Adducted cords are due to neurologic lesions – good voice; poor airway.


Superior Laryngeal Paralysis

Unilateral Recurrent Nerve Paralysis

Bilateral Recurrent Nerve Paralysis

Complete Paralysis

Pathology Paralysis of cricothyroid muscle; sensory loss in half of larynx

Paralysis of all intrinsic muscles on one side

Paralysis of all intrinsic muscles

Vagus nerve lesion above the superior laryngeal nerve; may be unilateral or bilateral

Effect Loss of pitch; aspiration

Hoarse; good airway except in small children; breathy voice; poor cough

Good voice; poor airway especially on exertion

Similar to corresponding lesions of recurrent paralysis; more likely to aspirate

Examination

Anterior commissure looks tilted to side of lesion; areytenoid on that side tilts in

Cord in paramedian position; no lateral motion

Vocal cords do not move laterally; some patients adapt and exist with decreased exercise tolerance

Cords are immobile but in intermediate postiiokjn due to loss of adduction by cricothyroid muscle.

Idiopathic Laryngeal AspirationCompromised valve function = aspiration of food or liquidresults to coughing, choking and laryngospasms. Brain stem disorders may result to aspiration also.

Spastic dysphoniaStrained, hoarse voice often staccato-like due to hyperadduction of the true and false cords. Tension larynx. Best therapy is resectioning of he right recurrent laryngeal nerve. Unknown etiology

Myasthenia gravisAll ages. Muscle weakness with use. Involves eye or facial muscles.

Amyotrophic Lateral SclerosisPatients in 50s or 60s. swallowing and speech dysfunction. Tongue dysfunction with fasciculations are more common.

FUNCTIONAL DISORDERS OF THE LARYNXPsychogenic Aphonia

Total inability to talk. Larynx looks and moves normally. Normal cough. Hx of emotional disturbance

Dysphonia Plicae VentricularisPhonation with false cords vibrating instead of the true vocal cords husky voiceNormal larynx, false cords overhangs true cords.

Vocal WeaknessVoice lacks usual tone and vigor. Voice breaks and drops in pitch. Slightly bowed vocal cords. More prominent among the elderly.

Benign Disorders of The Salivary Glands, Nasopharynx and Hypopharynx

DISEASES OF THE NASOPHARYNXChoanal AtresiaCongenital anomalie where in during embryonic life, the nasomembrane fails to open up.May be lateral or bilateralUnilateral = persistent unilateral nasal discharge


Bilateral atresia results to no breathing among the infants.

May be membranous or bony. Requires establishment of airway.

DiagnosisSuction catheter test automatic. ChoanagramAxial CT scan – Gold Standard

To determine laterality To determine composition and

thickness of plate To determine other possible

causes of upper airway obstruction

To check for other causes of upper airway obstruction

TreatmentSurgery; if one side only, there is no need to operate immediatelyMitomycin C – anti-granulation prevents recurrence after surgery.

Hypertrophic AdenoditisIt is not normal to see children breathing through the mouth. There is hyponasality of the voice. There is prominent outer teeth and arched palate occurs. Conductive hearing loss occurs also. The most common symptom is the obstructive sleep apnea syndrome temporary cessation of respiration during sleep of more than a few minutes.

Persistent mouth breathingExcessive day time sleepinessRestless nessHigh arched palate.Pushed out upper dentition

not all obstructive sleep apnea is caused by hypertrophic adenoids. Central sleep apnea or Pickwinian syndrome

Enlarged adenoids also enlarge with tonsils.

EtiologyUncontrolled allergy; infectionExaggerated growth of the lymphoid

components of the orodigestive tract

Diagnosis

Soft tissue lateral view x-ray which includes the oropharynx and the nasopharynx.

Treatment – surgery

Juvenile Nasophagreal AngiofibromaGrows on the lateral wall near the pterygoid fossa. Patient may complain of ear problems due to obstruction of Eustachian tube

A benign lesion composed of overgrowth of blood vessels and fibrous tissue in the nasopharynx. The vascularity results predominantly profuse recurrent epistaxis, exclusive males. Age range 7 – 14y.o., average of 15-17y.o. Profuse bleeding is pales of blood.

Internal maxillary artery may be embolized to reduce the vascularity of the mass using Teflon.

The disease is histologically benign but clinically malignant since it is capable of involving the skull.

Indications for Adenoidectomy1. Obstructive sleep apnea 2. Chronic purulent nasopharyngitis3. Chronic adenoid hypertrophy 4. Acute suppurative otitis media5. Selected cases of chronic otitis media6. Biopsy purposes

BENIGN DISEASES OF THE SALIVARY GLANDSTwo broad categories of salivary glands = major and minorMajor salivary glands are located outside of the oral cavity – parotid; submandibular; sublingual. They have a duct system. Compound tubulo acinar glands

Minor salivary glands are located within the oral cavity. The have a simple ductal system.

Both categories provide serous or mucus secretions

Acute suppurative sialadanetitis


One of the most common disease affecting the parotid and submandibular glandsBacterial disease. More common in the Parotid GlandThere is Salivary Stasis

Predisposing Factors1. post operative conditions2. sialolithiasis3. duct strictures4. dehydration5. poor oral hygiene

a sore that gets clogged up resulting to stasisusually one sided. With redness

S/sFever, malaise, swollen tender gland;

pus from the duct orifice

TreatmentHydration, gland massage,

antibiotics, incision and drainage

Chronic Recurrent SialadenitisMore common in the parotidDecreased saliva production and stasisThere is recurrent. Mild, painful gland enlargement associated with eating, there is scanty saliva and dry mouth

TreatmentTreat predisposing factors. Sialogogues, gland massage, duct ligation in refraction cases, radiation of the gland when in old individuals (therapeutic doses of radiation)

SialolithiasisInvolves the submandibular gland in 80% of cases because:

saliva is more viscous saliva is more alkaline greater concentration of Ca and PO4

salivation is antigravity

there is recurrent suppurative sialdenitis

TreatmentStone removal and gland excision

Diagnosis

Majority of the stones are radiopaque 90% of stones in submandibular gland. Stones of the parotid gland are 90% radiolucent. Sialography should not be done when

there is acute inflammation

SialadenosisNon inflammatory, non-neoplastic enlargement of the salivary gland due to salivary stasis. Usually in the ParotidNo treatment is usually done

EtiologyObesity, malnutrition, DM, alcoholic acidosis,

Viral InfectionsEpidemic parotitisSalivary inclusion diseaseNon tender enlargement of the parotid gland, bilateral without redness

Cystic LesionsCongenital – dermoid, ductal, branchial arch-groove cystAcquired – mucocele. Opening of the duct closes up allowing accumulation of the saliva within the tissues. Ranula occurs when the submandibular gland becomes clogged up – a special form of mucocele.

Granulomatous DiseasesTBSarcoidosisActinomycosis

Benign Lymphoepithelial LesionEnd-stage of chronic recurrent sialadenitisUsually affects one glandPresents as asymptomatic enlargementA small percentage may become Lymphoma or Carcinomaa.k.a. Godwin’s tumor

TreatmentSymptomatic and supportiveExcision if uncosmetic

Sjogren’s syndrome


Selective destruction of all salivary and lacrimal glands. Lymphocyte0-mediated autoimue attack. 90% of lymphomaBilateral parotid elargemnt. Dry eyes. Dry mouth with halitosis.

Definitive diagnosis is buccal biopsy (lips)

Treatment requires referral to immunologist.

DiagnosisBuccal biopsyMarkers – RF, ANA, SDA, PCA, TGA,

TMA

Benign tumors ChildrenHemangiomaVascular proliferative tumorsLesionsLymphangiomasLympohepitheilaTumorsWarthin’s Tumor

AdultsBenign mixed tumor – most common nowWarthin’s tumorOncocytomaMonomorphic adenoma

7/10 tumors occurs in the parotid. As the gland becomes smaller, the incidence of malignancy increases.

BENIGN TUMORSBenign mixed tumor or the pleomorphic adenomaThe most common benign tumor of all major salivary glandsMost commonly found in the parotid

Warthin’s tumor or papillary lymphomatosumExclusive to the parotid gland. Second most common. Presents as a slow growing mass at the tail of the parotid. May occur bilaterally takes up Tc Tracer.

OncocytomaLess than 1% of all salivary glandsNo other signs and symptomsExclusive in parotid and among the elderly.

How can one tell if a parotid mass is malignant

1. lysis of the mandible2. skin involvement – dimpling,

ulceration, etc.3. involvement of the facial nerve4. rapid growth5. spread to other areas of the face,

indicated by trismus6. cervical lymphadenopathy

TraumaSimple lacerations with gland or duct involvement. May occur with blunt trauma

Benign Laryngeal Disorders3 anatomic regions of the larynx1. glottic area / glottis tip of the epiglottis 1 cm below the vocal cords2. supraglottis from the tip of the epiglottis 1 cm above the vocal cords3. sub / infra glottis area below the glottic area.

Two sphincter like parts of the larynx1. aryepiglottic folds2. false vocal cords3. true vocal cords

3 functions of the laryn1. respiration2. airway protection3. phonation

Intrinsic muscles of the larynx innervated by the recurrent laryngeal nerve

1. posterior cricoarytenoids the only abductor

2. interarrytenoid adductor3. lateral cricoarytenoid adductor4. thyroarytenoid / internal

thyroarytenoid / vocalis minor tensor

innervated by superior laryngeal nerve5. cricothyroid main tensor; passive

adductor

Congenital Disorders laryngomalacia

o most commono immaturity of the laryngeal

skeleton flaccid larynx.


Collapses whenever the child inhales. (subglottis is sucked in)

o omega shaped epiglottis. No need for treatment

o inspiratory stridor (obstruction above vocal cord) and dyspnea

subglottic stenosiso second most common

laryngeal congenital disordero obstruction is right after the

true vocal cordo inspiratory stridoro due to an overdeveloped

cricoid cartilage or membranous formation adjacent to the cricoid cartilage resulting to an obstructed airway

o may be fatalo membranous stenosis requires

laser incisiono over developed cricoid

requires surgery to widen the cricoid. Bone grafts may be inserted in between a “split” cricoid to increase the airway diameter

o no need for a definitive treatment

webso web may occur in any area of

the larynxo no airway obstructiono aphonia may occur if located

in the glottis. There may be a weak cry

o management requires laser incision

o most common site is the Glottis i.e. glottic web

cystso Mucus retention cyst may

occur in any area of the larynx. Dysphagia, muffled voice

o Endoscopic excision for small cysts

o External excision may be required for some cases

Hemangiomao Maintain patient in steroids

o Deformative disorder Laryngocoele

o Inborn but may occur in the adult life during the second or third decade

o May be internal or external or both

o Treatment is through incisiono If the cyst becomes filled with

mucus, it is called a saccular cyst.

o Progressive dyspnea without disturbance in voice

laryngotracheoesophageal clefto failure of the walls between

the larynx and the esophagus does not close

o most common symptom is aspiration pneumonia

o surgery is done by the cardio thoracic surgeons

neurogenetic anomalies

Trauma induced Disorders Fractures

o Dyspnea may occur due to hematoma. Immediate problem is not the trauma itself but the effects that it has on the larynx. There may be hoarseness or dysphonia. Hemoptysis may also occur

o Electroplating is required to restore the capacity of the vocal cords

o Sign would be that of flattening – splaying of the thyroid cartilage

o Airway should be made

Acquired Subglottic Stenosiso Due to prolonged endotracheal

intubationo Prolonged intubation increases

the risk of developing the disease

o Membranous stenosis requires laser incision

o Tracheal incision with end to end anastamosis is made in more severe cases


4 tracheal rings may be resected beyond that, graft must be made

Intubation Granuloma

Infections Acute laryngitis

o Voice abuse is the most common cause

o Hoarseness is the most common presentation

Epiglottitis / supraglottitiso Supraglottitis comes in with

complaints of difficulty of breathing or severe odynophagia.

o Diagnosis may be done by direct observation

o Otherwise there may be the need of the soft tissue rardiography of the neck which shows a thumb sign

o Tracheostomy does not necessarily be; endotracheal intubation is suggested since the disease disappears in a couple of days

o However, if the lesion is large tracheostomy is needed

o Crubet or an oxygen tent is combined with epinephrine and steroids. Voice is not affected since it is a suppraglottic lesion which results to muffled voice

Subglottic laryngitis Laryngotracheobronchitis

o Common sequela from measles / post measles MTB

o Brassy / metallic cough o Condition does not lead to

obstructiono Treated with the same airway

management procedures for supraglottitis except airway by pass

Spasmodic croup

Benign Mucosal Disorders all conditions result to hoarseness; diagnosed by direct / indirect examination; all treatments are coupled with voice rest.

Chronic laryngitiso Long standing changes –

thickening, changes in coloro recurrent

Vocal cord noduleso Most commono Anterior and middle third of

the larynx due to its location as the point of maximum contact. Like a callus

Vocal cord polypo Pedunculated and can move in

and out with respiration Diffuse vocal cord polyposis /

Reinke’s edemao Common among smokers

Contact ulcer / granulomao Located at the posterior chain

of the larynxo Treated by excision biopsy

Vocal Cord Paralysis usually a negative etiology. i.e. all may be called idiopathic. It is important to know which nerve is paralyzed – recurrent laryngeal nerve or supralaryngeal

Unilateralo Left is more affected than the

right, poor voice, good airway. breathy voice

o Voice may be regainedo Medialization may be done to

restore voice if not regained

Bilateralo Poor airway, good voiceo Transaction of the nerve is not

a certainty.o Lateralization may be done to

provide air way and maintain voice

Idiopathic

Superior laryngeal nerve paralysis results to aspiration especially to fluids

Most common benign tumor of the upper airway and the larynx = papilloma


ENT-Lec 4; Diseases of the Salivary Glands and Hypopharynx

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Transcript of ENT-Lec 4; Diseases of the Salivary Glands and Hypopharynx