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Diseases of Pharynx Diseases of Pharynx and Larynxand Larynx
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), Muscular, Fascial Mucosal, submucosal (Fibrous), Muscular, Fascial
layer (buccal pharyngeal)layer (buccal pharyngeal)
NasopharynxNasopharynx
Base of skull to the soft Base of skull to the soft palatepalate
Key componentsKey components Pharyngeal Tonsil Pharyngeal Tonsil
(Adenoids)(Adenoids) Pharyngeal Recess (ICA)Pharyngeal Recess (ICA) Opening of Auditory tubeOpening of Auditory tube
OropharynxOropharynx Soft Palate to the Soft Palate to the
epiglottisepiglottis Key ComponentsKey Components
Palatopharyngeal and Palatopharyngeal and Palatoglossal archesPalatoglossal arches
Palantine Tonsil – project Palantine Tonsil – project from tonsillar fossafrom tonsillar fossa
Lingual TonsilLingual Tonsil Valleculae – lie between Valleculae – lie between
epiglottis and posterior epiglottis and posterior border of the tongueborder of the tongue
LaryngopharynxLaryngopharynx
Epiglottis to the level Epiglottis to the level of cricoid cartilageof cricoid cartilage
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 pharyngeal, Branches of many arteries (ascending pharyngeal,
greater palantine, lingual, tonsilar)greater palantine, lingual, tonsilar)
Nerve SupplyNerve Supply Afferent; maxillary nerve, glossopharyngeal, internal Afferent; maxillary nerve, glossopharyngeal, internal
and recurrent laryngeal nervesand recurrent laryngeal nerves Motor; Pharyngeal Plexus (Vagus, glossopharyngeal, Motor; Pharyngeal Plexus (Vagus, glossopharyngeal,
Cervical Sympathetic)Cervical Sympathetic)
LarynxLarynx
Respiratory OrganRespiratory Organ Lying between pharynx and tracheaLying between pharynx and trachea Becomes continuous with the trachea at the level of Becomes continuous with the trachea at the level of
the cricoid cartilage (C6)the cricoid cartilage (C6)
FunctionFunction Primary – protective sphincter at the inlet of the air Primary – protective sphincter at the inlet of the air
passagespassages 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, Cricothyroid Intrinsic; Quandrangular membrane, Cricothyroid
ligament (Vocal folds)ligament (Vocal folds) Extrinsic; Thyrohyoid membrane, cricotracheal, Extrinsic; Thyrohyoid membrane, cricotracheal,
hypoepiglottic, thyroepiglottic ligaments, cricothyroidhypoepiglottic, thyroepiglottic ligaments, cricothyroid
CavitiesCavities
Inlet + Inlet + Vestibule Vestibule
Rima of Rima of glottisglottis
Subglottic Subglottic spacespace
Layrnx - Intrinsic MembranesLayrnx - Intrinsic Membranes
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 ligamentFormed from lateral part of cricothyroid ligament Upper thickened border forms cricovocal ligaementUpper thickened border forms cricovocal ligaement Vocal folds which bounds the glottis anteriorlyVocal folds which bounds the glottis anteriorly
Laryngeal Muscles - IntrinsicLaryngeal Muscles - Intrinsic
1. Those that alter size and shape of the inlet1. Those that alter size and shape of the 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 aboveProvide valvular protection from above
Laryngeal Muscles - IntrinsicLaryngeal Muscles - Intrinsic
2. Responsible for Phonation by moving vocal 2. Responsible for Phonation by moving vocal foldsfolds Abduction; Posterior CricoarytenoidsAbduction; Posterior Cricoarytenoids Adduction; Lateral cricoarytenoid and transverse Adduction; Lateral cricoarytenoid and transverse
arytenoidarytenoid Lengthen; CricothryroidLengthen; Cricothryroid Shorten; Thyroarytenoid, vocalisShorten; Thyroarytenoid, vocalis
PhonationPhonation
Pitch; Vibration of the folds through shortening Pitch; Vibration of the folds through shortening and lengthing of the voldsand lengthing of the volds
Intensity; Pressure through the glottisIntensity; Pressure through the glottis Quality; Resonating chambers above the glottisQuality; Resonating chambers above the glottis Articulation; tongue, teeth and lipsArticulation; tongue, teeth and lips
LarynxLarynx
Blood supplyBlood supply Superior and Inferior Laryngeal Branches from Superior and Superior and Inferior Laryngeal Branches from Superior and
Inferior Thyroid ArteryInferior 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, cardiac surgCarcinoma of bronchus, oesophagus, Aortic anuersym, cardiac 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 frontHalf abducted position with arytenoid cartilage slightly in front Hoarse VoiceHoarse Voice Bovine coughBovine cough
IncompleteIncomplete Adducted position as posterior cricoarytenoid more susceptibleAdducted position as posterior cricoarytenoid more susceptible
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, palatopharyngeus Stlyopharyngeus, salingopharyngeus, 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, hyperaemic Examination – Sore right ear, hyperaemic
tympanic membrane, breathing with mouth tympanic membrane, breathing with mouth openopen
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, CSOMEustachian Tube; Recurrent Otitis Media, CSOM Choanal Obstruction; OSA, chronic sinusitisChoanal Obstruction; OSA, chronic sinusitis
IxIx Nasopharyngeal ExamNasopharyngeal Exam Nasopharyngoscopic ExamNasopharyngoscopic Exam Lateral XrayLateral Xray
TxTx SupportiveSupportive AdenoidectomyAdenoidectomy
AdenoidectomyAdenoidectomy
Criteria for surgeryCriteria for surgery Chronic upper airway obstruction with OSA +/- cor Chronic upper airway obstruction with OSA +/- cor
pulmonalepulmonale 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, Otalgia, Clinical; Sore throat and Odynophagia, Otalgia,
headache, malaise, Fever, hyperaemic tonsils, cervical headache, malaise, Fever, hyperaemic tonsils, cervical lymphadenopathylymphadenopathyDDx;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 scarlitiform rashScarlet Fever; Strawberry tongue and scarlitiform 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, ETOH, Predisoposing factors include; smoking, ETOH,
mouth breathing, chronic sinusitis, Industrial fumes, mouth breathing, chronic sinusitis, Industrial fumes, antiseptic throat lozengersantiseptic throat lozengers
Enlarged lymphoid tissue can be removedEnlarged lymphoid tissue can be removed
64 Male recently Immigrated from Hong Kong64 Male recently Immigrated from Hong 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 to midline Exam; firm, fixed, solid mass lateral to midline
in posterior trianglein posterior triangle
Nasopharyngeal CarcinomaNasopharyngeal Carcinoma
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 CarcinomaNasopharyngeal Carcinoma
Clinical;Clinical; Most commonly as lump in the neckMost commonly as lump in the neck Local; Nasal obstruction, blood stained dischargeLocal; Nasal obstruction, blood stained discharge Neurological; Invasion of skull base causing cranial Neurological; Invasion of skull base causing cranial
nerve palsies (V, VI, IX, X, XII)nerve palsies (V, VI, IX, X, XII) Otological; Serous otitis mediaOtological; Serous otitis media Metastasis to bone, lung, liverMetastasis to bone, lung, liver
Nasopharyngeal CarcinomaNasopharyngeal Carcinoma
Ix;Ix; Tissue sampling, CT/MRI, StagingTissue sampling, CT/MRI, Staging
ManagementManagement Radiotherapy with concominant chemotherapyRadiotherapy with concominant chemotherapy Poorly amendable to surgery due to anatomical Poorly amendable to surgery due to anatomical
locationlocation
DDxDDx Lymphoma, cystic adenocarcinoma, InfectionLymphoma, cystic adenocarcinoma, Infection
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 cough1/7 history Biphasic Stridor, barking cough No obvious respiratory distressNo obvious respiratory distress
Laryngotracheitis (Croup)Laryngotracheitis (Croup)
Inflammation of tissues of subglottic space +/- Inflammation of tissues of subglottic space +/- tracheobronchial treetracheobronchial tree
Mucopurulent exudate -> airway obstructionMucopurulent exudate -> airway obstruction Aetiology; Parainfluenza I (most common), Aetiology; Parainfluenza I (most common),
II,III, influenza A,B, RSVII,III, influenza A,B, RSV Presentation; night, inspiratory/biphasic stridor, Presentation; night, inspiratory/biphasic stridor,
barking coughbarking cough Beware loss of stridor, Decr SaO2Beware loss of stridor, Decr SaO2 DDx; FB, subglottic stenosis, EpiglottitisDDx; FB, subglottic stenosis, Epiglottitis
Laryngotracheitis + EpiglottitisLaryngotracheitis + Epiglottitis
FeatureFeature LaryngotracheitisLaryngotracheitis EpiglottitisEpiglottitisInflammation 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 epiglottis Thumb sign, enlarged epiglottis
Appearance Non-toxic Toxic/cyanoticAppearance Non-toxic Toxic/cyanotic
Cause Cause ViralViral BacterialBacterial
TreatmentTreatment Supportive Supportive Keep child calm Keep child calm
O2, Adrenalin nebsO2, Adrenalin nebs Airway management -ETT Airway management -ETT
Steroids ABx, IV hydration, Moist airSteroids ABx, IV hydration, Moist 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, intercostal recessionNo stridor, but tachypnea, intercostal recession Unilateral wheeze on Right with Decreased air Unilateral wheeze on Right with Decreased air
entry in lower zonesentry 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, mediastinal Atelectasis, lobar pneumonia, pneumothorax, mediastinal
shiftshift Dx;Dx;
Inspiratory/Expiratory X-raysInspiratory/Expiratory X-rays BronchoscopyBronchoscopy
Signs of Airway ObstructionSigns of Airway Obstruction Stretor; obstruction in the throat, low pitched choking Stretor; obstruction in the throat, low pitched choking
noisesnoises Stridor; High pitched, inspiratory, biphasic or Stridor; High pitched, inspiratory, biphasic or
expiratory depending on locationexpiratory 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 tracheostomy Cartilage – Laryngotracheoplasty or tracheostomy (intubation)(intubation)
LaryngomalaciaLaryngomalacia Soft immature cartilage Children or older patients with NM Soft immature cartilage Children or older patients with NM
disordersdisorders Inspiratory stridor at 1-2 weeks, worse supine + feeding Inspiratory stridor at 1-2 weeks, worse supine + feeding
difficultiesdifficulties 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, laryngeal paralysis, DDx; Malignancy, inhaled corticosteroids, laryngeal paralysis,
TBTB General; Voice resting, avoid smokingGeneral; Voice resting, avoid smoking Specific; eg. Lifestyle modifications, MedicationsSpecific; eg. Lifestyle modifications, Medications
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, confusionNo history of LOC, resp distress, confusion Examination showed midline tenderness of Examination showed midline tenderness of
neck, subcutaneous emphysemaneck, subcutaneous emphysema
Laryngeal TraumaLaryngeal Trauma RareRare CausesCauses
PenetratingPenetrating Blunt trauma; majority are MVA’s, clothesline injuries, Blunt trauma; majority are MVA’s, clothesline injuries,
sporting 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, aphonia Hoarse voice, neck pain, dyspnea, hypoxia, aphonia
dysphasiadysphasia Goals of treatmentGoals of treatment
Protect the airway; Intubation, tracheostomyProtect the airway; Intubation, tracheostomy Restoration of function; Surgical repairRestoration of function; Surgical repair
ComplicationsComplications Laryngeal stenosis; permanent tracheostomyLaryngeal stenosis; permanent tracheostomy
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 LesionsBenign Vocal Fold Lesions
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 massHoarse voice, pain, dysphagia, lateral neck mass
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) with Multiple in Children (Laryngeal Papillomatosis) with
extended growth and recurrenceextended growth and recurrence Malignant transformation extremely rareMalignant transformation extremely rare
Investigation and TreatmentInvestigation and Treatment
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 CarcinomaSquamous Cell Carcinoma
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 CarcinomaSquamous Cell Carcinoma
Glottic SCC most common (60%) > Glottic SCC most common (60%) > supraglottic SCC (30%) > subglottic SCC supraglottic SCC (30%) > subglottic SCC (<10%).(<10%).
Sx: hoarseness, throat pain, cough, hemoptysis, Sx: hoarseness, throat pain, cough, hemoptysis, referred otalgia, dysphagiareferred otalgia, dysphagia
Diagnosis;Diagnosis; Laryngoscopy with FNALaryngoscopy with FNA CT/MRICT/MRI
Squamous Cell CarcinomaSquamous Cell Carcinoma
ManagementManagement Eradication of diseaseEradication of disease Restoration of function; swallowing and speechRestoration of function; swallowing and speech 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