KARSINOMA_LARING-

8/13/2019 KARSINOMA_LARING-

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Carcinoma Larynx

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Preliminary

Larynx Ca frequent malignancies in ENT:The second most common malignancy of the headand nec

!merica: the order of 1 "#$ Ci%to &angunusumo 'os%ital ("#C&) and

the "#$ *r$ #utomo: sequence + after the N,C and%aranasal sinus tumors

-n the "#$ 'asan #adiin (2..+): 12$0


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!N!T& !N* ,'#-L3larynx


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CARTILAGE LARYNX


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EXTRINSIC MUSCLE


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INTRINSIC MUSCLE


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6asculariation


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-nner8ation Lym%hatic #ystem


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LARYNX


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&en ;omen "atio < +$: 1 "#C& (19.=19) < 144 cases> 7: 1 Canada < 5: 1

-taly < +2: 1 0 ? smoing @ alcohol ,! 6ieAs: 90 squamous cell carcinoma

EPIDEMIOLOGY


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Common: the glottis Northern Euro%ean countries:

? 50 (glottis)B +0 (su%ra / suglotis)$

#outhern Euro%ean countries:? 50 (glottis)B +20 (su%ra / suglotis)$!merica:? 5.0 (glottis)B 4.0 (su%ra / suglotis)$

Predilection


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= NT ET DN;N

= "is factors:

#moing Consum%tion of alcohol "adioacti8e rays *eficiency of 8itamins 6irus infection (',6)

ETIOLOGY


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Clinical Symtom!

'oarseness loAn Taste %ro%

-m%aired sAalloAing Lum%s Nec


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3eneral ENT examination Nec %al%ation F%%er airAay ostruction

Local examination: laryngosco%yB traeoso%iBronchosco%y

P"YSICAL EXAMINATION


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16/84direc Laryn#o!$oy


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RADIOLOGIS

#oft Tissue Nec

!ssess airAay CT=#can

!ccurately assess the extension of tumor (thyroidcartilageB %re e%iglottisB lim%he)*etecting secondary %rimary tumors

&"-

!ssessing s%ecial extensionsugloti from %rimary to on 6ocal Cords


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"ISTOPATOLOGY


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STAGING TNM %A&CC'

TSUPRAGLOTIS

T( Limited 1 side su%raglotisB 8ocalist normal cord mo8ement

T) Exit from 1 side su%raglotisB 8ocalist normal cord mo8ement

T*limited in the larynxB chordae fixation 8ocalist / %ost rioidextensionB the medial Aall of the sinus %iriformis or %re=e%iglottisB and erosion innercortex thyroid cartilage

T+aThe in8asion came out through the thyroid cartilage and larynxor out

,re8ertera s%ace in8asionB carotid arteryB or mediastinal structures

T+,


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T( Limited to 8ocalist cordB can in8ol8e the commissures

T) Estensi e su%raglotis/suglotis/anormal cord mo8ement

T* Limited in the larynx Aith cord fixation 8ocalist

T+aThe in8asion came out of the glottis through the thyroidcartilage and / or exit larynx

,re8ertera s%ace in8asionB the carotid arteryBor mediastinal structures

TGLOTIS

T+,

STAGING TNM %A&CC'


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T( Limited to suglotisB 8ocalist cord mo8ement Aas normal

T) Extensions to the cord singerB 8ocalist cord mo8ement isnormal or slightly distured

T* Limited in the larynxB 8ocalist cord fixation

T+a The in8asion came out suglotis through thyroidcartilage and larynx or out

,re8ertera s%ace in8asionB the carotid arteryBor mediastinal structures

T SU-GLOTIS

T+,

STAGING TNM %A&CC'


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STAGING TNM %A&CC'

can not %al%ale lym%h nodes

no lym%h node metastases in the nec region

#ingle i%silateral lym%h nodesB sie G+cm

- N2a: metastasis in 1 side of the lym%h nodesB sie G5 cm- N2: &ulti%le i%silateral metastasesB sie G5 cm- N2c: ilateral or contra lateral metastasisB sie G5 cm

lym%h nodes Aith sies larger than 5 cm

Nx

N.N(

N)

N*


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STAGING TNM %A&CC'

-t Aas found distant metastasesM(

No distant metastasesMo


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STAGE

Sta#e T N M

- T1 No &o

-- T2 N. &.

--- T+T1=+

N.N1

&.&.

-6! T1=+

T4a

N2

N.

&.

&

-6 T4!ny T

!ny NN+

&.&.

-6C !ny T !ny N &1


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MANAGEMENT

Fnlie e8ery flashlight*e%ending on the location of %rimary tumorB stage

-n general: surgeryB radiationB chemothera%yB andchemoradiation (comination)$

stage -: radiationB if it fails L, / LT #tage --: L, / LT #tage ---: Aith / Aithout N1: LT Aith or Aithout the HN* /

"N* folloAed y radiation

#tage -6: Aithout N / &: LT I HN* folloAed y radiationther: radiothera%y and chemothera%y


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Oerati/e T0eray

,artial Laryngectomy1$ Laryngectomy %artial 8ertical /

'emilaryngectomy (L,6)2$ Laryngectomy %artial horiontal (Js *3")

Laryngectomy Total


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Partial Laryn#ectomy


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!n act of %artial resection of one or oth 8ocalcords Aith or Aithout anterior commissures andthyroid cartilage

This o%erating technique egan less used afteran increase in radiothera%y technique andcomination Aith chemothera%y and theintroduction of techniques laryngectomysu%racricoid

Larin#e$tomy artial /erti$al 1 0emilarin#e$tomi %LP2'


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Larin#e$tomi ar!ial /erti$al 1

0emilarin#e$tomi %LP2'1$ Cordectomy

2$ Laryngectomy %arsial frontal

+$ Laryngectomy %arsial lateral4$ Laryngectomy %arsial frontolateral

$ Laryngectomy %arsial frontolateral ex%anded


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1$ !ction cordectomyB laringectomy %artial frontalB%artial lateral laringectomy= Tumors larynx on one side of the 8ocal cords

= The tumor has not reached the anteriorcommissures

= #u%raglotis tumor stage -2$ !ction laryngectomy %artial frontolateral:

= Ex%ansion into the anterior commissures= Ex%ansion into the contralateral 8ocal cordB Aithoutfixation

Laryn#ectomi ar!ial /erti$al 1

0emilaryn#ectomy %LP2'


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+$ !ction laryngectomy frontolateral %artial ex%anded: = Ex%ansion suglotis (G2=+ mm)

= The ex%ansion to one of the %rocessus 8ocalis cart$

aritenoid

Laryn#ectomi ar!ial /erti$al 1

0emilaryn#ectomy %LP2'


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Comlication

- reathy 8oice- Laryngeal stenosis-

Histula-!s%iration- *islocation- Edema treated Aith C2 laser

- #ucutaneous em%hysema installation ofdrains


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Laryn#ectomy artial 0ori3ontal

%LP"'- E%iglotectomy- ,artial Laringectomy su%raglotis

- ,artial Laringectomy su%racricoid AithCricohyoidoe%igloto%lexy$


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E%yglotectomy !ctions:Tumor limited to the e%iglottis$

!ction L, su%raglotis:Tumor su%raglotis @ glottis (not yet on the anterior

commissures) !ction L, su%racricoid Aith Cricohyoide%igloto%lexy:

= 3lottis ilateral tumorsB T1B ant$ commissures (I/=)= 3lottis unilateral tumorB T1B ant$ commissures (I)

= Tumor glottis uni / ilateralB T2B im%aired 8ocal cordmo8ement (I/=)

Laryn#ectomy artial 0ori3ontal

%LP"'


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Contraindication!

-!ritenoid i%silateral cartilage fixation- Ex%ansion of the tumor to suglotis

- ,atients Aith %ost=radiation- ,resurgery res%iratory disturance


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Laryn#ectomy S4ra#loti$


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Laryn#ectomy S4racricoid 5it0

crico0yoidei#lotole$!i


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Ad/anta#e! Laryn#ectomy

S4racricoid

1$ ;ider o%erating field

2$ etter outcome in ilateral glottis tumors

+$ The %atient can reathe Aithout atracheostomy


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Comlication

-!s%iration- Histula-

The difficulty of e8aluation of recurrence- Condritis Cricoid cartilage- *ys%hagia


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Total

Laryn#ectomy


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DE6INITION

lift the entire structureof the larynx from theu%%er limit (e%iglottis @ os

hioid) until the loAer limit(tracheal rings)


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Indication

- Laryngeal tumor stage --- @ -6- #tage - @ -- are recurrentB the failure of

radiation thera%y- Can e conducted Aith radical nec dissectionor functional- Limit cutting ring ex%ansion of tumor into the

trachea suglotis area


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Oeration! roced4re total

Laryn#ectomy


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Inci!ion


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Di!ection 6la S4,lati!ma


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Incition 7a!cia o/er M8 SCM


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Incition Stra m4!cle


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C4ttin# I!t0m4! and !earation T0yroid


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Searation o! 0yoid


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C4ttin# trac0ea


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P0aryn#eal m4co!a i! !earated 7rom t0e t4mor97ree

!ide


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De7ect a7ter remo/al o7 larynx


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Se5in# Oe!o0a#4!


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Se5in# !toma


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:o4nd Clo!4re


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Po!toerati/e care

1$ ,atients do not sAalloA2$ 3i8ing antiiotics+$ Eating @ drining through N3T4$ The test drin %rior to the release of N3T$ !8oid the occurrence of infection (ase%sis

and antise%sis)


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Comlication

- Histula and surgical Aound infections- Tracheostomal recurrence- 'y%othyroidism @ hi%o%aratiroidism- ,e%tic ulcer- ,haringoeso%hagus stenosis- Tracheitis


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2oice Re0a,ilitation

There are + ty%es of s%eech rehailitation is%ossile to do:

1. Esophageal speech

2. Electrolaryngeal speech

3. Tracheoesophageal speech

(tracheoesophageal puncture technique)


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,atient deli8ers air into the eso%hagus due tothe %ressure of intra thoraal

&edical "ehailitation Fnit neededlong time to train

70 ex%erienced failure

Esophageal speech


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,rothesis that connects the trachea andeso%hagus

The sound %roduced y means of 8iratingsegments faringoesofageal

Then the 8oice on the articulated Aith the tonguein the oral ca8ity

TE, insertion techniques are %rimarily tAo Aays:

(simultaneously or in a secondary laryngectomy 5Aees after laryngectomy

Tracheoesophageal speech



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1 The ad8antage of su%%ly air from the lungsB fonasinatural sounding and rehailitation carried out 2Aees %ost surgery

2$ The disad8antage

= !dditional o%erations= ,rosthesis must e maintained= !s%irations Ahen leaing= Ex%ensi8e (K 1+.=19.)

Tracheoesophageal speech



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Transcer8ial and intraoral Electromechanical 8iration to generate sound -ntra oral i a small tue %laced in the %osterior

ca8ity oris and sound deli8ered later articulated

Electrolaryn#eal !eec0


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Nec Ty%eEqui%ment %laced on the nec sin under the chinor the chees channeled into oro%aring 8oiceand articulated in a normal

Electrolaryngeal speech


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!d8antages:= "a%id rehailitation= Easy maintenance= *urale (2=1. years)

= Commercially a8ailale *isad8antages :

= Less natural sound quality= *e%ending on attery %oAer= Ex%ensi8e 42 dollars= -ntra oral ty%e must maintain hygiene

Electrolaryngeal speech


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TE"-&! D!#-'

#emoga ermanfaat

C!"! ,E&!#!N3!N


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C!"! ,E&!#!N3!N


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L A R Y N X


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(8 EM-RIOLOGI ;

Tei cranial < Laryn#otraceal #roo/e < !edan#$an tei di!tal

,ronc04! dan $iri %* (1) min##4 '

Laryn#otrac0eal o,litera!i dan re$an4li!a!

oe!o0a#4! dan adit4! larynx rimiti7 len#$4n#

,ranc0ial I2 dan 28

Adit4! larynx cela0 ,er,ent4$ < T < ;9 < "yo,rac0ial eminence < ei#loti!

9 Arytenoid yan# mem,ent4$ =4#a ton=olan C4nei7orme dan

Cornic4lata

Otot larynx ertama ; interarytenoid eryei#lottica> ericoarytenoid

o!terior dan ericot0yroid


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P0 i l L


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Hunction Honasi ,rotection Hunction "es%iratory Hunction Circulation Hunction Hunction Hixation #AalloAing Hunction Hunction Cough

Hunction Es%etorasi Hunction Emotion

P0y!iolo#y Larynx

t0 0 i l


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imalance etAeen stimulating and inhiit cell groAth %+ tumor su%%ressor gene mutation Toacco smoe contains aromatic hydrocarons formed

nitro%olycyclic 7 methyl guanine and 4 aminoi%henyl on

guanine nucleotide gi8es carcinoma ty%e and descri%tion

at0o0y!iolo#y

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