SCCA of the Larynx

7/24/2019 SCCA of the Larynx

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History and P.E.


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This is the case o !. B, "# years old$ale, $arried, %ilipino, Ro$anCatholic, born on &ove$ber '',()*+, currently residin at -ela

%uente St, Sa$paloc , anila and/as ad$itted in our institution on0anuary ", '1("

2eneral -ata


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3o$ittin o Blood

Chie Co$plaint


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4 $onths prior to ad$ission, patientnoticed a radually enlarin $arbleli5e $ass on both lateral nec5, non6tender, $ovable associated /ith non6

productive couh 7/hitish phle$8,odynophaia and hoarseness. Patientsouht consult at San Lazaro Hospital,Chest 96ray /as done /hich revealed

pul$onary tuberculosis thus reerred

History o Present :llness


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still /ith above sin and sy$pto$s,no/ associated /ith di;culty obreathin. Patient souht consult inour institution /here a$$ation.

Trachesto$y /as also done.

' $onths PT!


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Persistence o the above sin andsy$pto$s pro$pted the patient toonce aain see5 consult in ourinstitution. Repeat


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7?8 Hypertension6 since ())@, Losartan @1

$Atab - 7?8 Pul$onary Tuberculosis6 unrecalled year,

inco$plete $edication 7 ' $onths8

768 5idney -isease

768 !sth$a

768 C3-

7?8 previous surery6 !ppendecto$y,unrecalled year

Past edical History


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7?8 Hypertension6 $aternal side

7?8 -iabetes ellitus6 $aternal side

7?8 Pul$onary Tuberculosis6 $aternalside

768 idney disease 768 Cancer

%a$ily History


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7?8 s$o5er6 41 pac5 years

768 alchoholic beverae drin5er

768 illicit dru use

Personal and Social History


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Physical E9a$ination

7?8 patent e9ternal auditory canal,both ears

7?8 patent ty$phanic $e$brane,both ears

idline nasal septu$&o nasal dischare

&o tonsillipharyneal conestion


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"D4D' c$ $ultilobulated tracheosto$y 4D'D' c$ nontender $ovable ovable $ass


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41 pac5 years s$o5in history

dynophaia

Hoarseness

2radually enlarin nec5 $ass

ale

Salient %eatures


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-ierential -ianosis


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ESOPHAGEAL CARCINOMA(lower portion)

RULE IN

?ore co$$on in $ale

?-ysphaiaAodynophaia

?Hoarseness o voice

?S$o5er

?He$ate$esis

?Easy atiability

?Fea5ness

RULE OUT

GFeiht loss

GChest pain

GForsenin indiestionor heartburn

G&o history o acid

re>u9

G&o history o alcoholinta5e

Gbese


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L!RY&2CELE

! rare, benin dilatation o the laryneal

saccule that $ay e9tend internally into theair/ay or e9ternally throuh the thyrohyoid$e$brane.

:t $ay be conenital or ac=uired and $ay

occur at any ae


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LARYNGOCELE

RULE IN

?Hoarseness?-yspnea

?-ysphaia

?ass

?Couh

RULE OUT

GCo$$on to $iddle aeGHe$ate$esis

GEasy atiability

GFea5ness


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Rare neuroendocrine neoplas$ that $ay

develop at various sites o the body, and$ay present as a painless $ass.

!ppear rossly as sharply circu$scribedpolypoid $asses, /ith


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PARAGANGLIOMA

RULE IN

?*16+1 years old

?ass

?Hoarseness

?-ysphaiaA

odynophaia?Hypertension

RULE OUT

Gore co$$on in/o$en

G!ural sins andsy$pto$s

GHe$ate$esis

GEasy atiability


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EXTRAPULMONARY TB

RULE IN

?%ilipino

?Couh

?S$o5er?Hoarseness

?Easy atiability

?Fea5ness

?-yspnea?-ysphaia

?He$ate$esis

?Cervically$phadenopathy

RULE OUT

G&iht s/eatsGFeiht loss

GChills

GLoss o appetite


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S=ua$ous Cell Carcino$a, Laryn9,

Translottic 7T*a, &'b, 18

%inal -ianosis


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ANATOMYothe

A R Y N X


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Protectie!p"incter #tt"e inlet o$

t"e #irp#!!#%e!

&oicepro'ction


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CARTILAGES O THE

LARYNX


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&OCALPROCES

SMUSCULA

R

PROCESS


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MEMBRANES *

LIGAMENTS O THELARYNX


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MUSCLES O THE

LARYNX

EXTRINSIC MUSCLES

ELE&ATIO


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MUSCLES O THE

LARYNX

EXTRINSIC MUSCLES

+EPRESSI


31/65INTRINSIC MUSCLES


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Superior laryngealveins drain into thesuperior thyroid veins,

/hich e$pty into theinternal uular veins.

The inferior laryngeal

veins drain into theinerior thyroid veins,/hich both e$pty intothe let brachiocephalic

vein


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LYMPHATIC +RAINAGE


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SUPERIORLARYNGEALNER&E

otor innervation o thee9trinsic $uscles7e9ternal branch8

:nternal sensory branchsupplies the $ucosa o

the upper laryn9

NER&E SUPPLY


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RECURRENT LARYNGEAL NER&E Supplies all the intrinsic $uscles

Sensory


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The PRE-EPIGLOTTICSPACE (PES) and thePARAGLOTTIC SPACE(PGS) provide path/ays

or spread o larynealtu$ors.

TUMOR SPREA+


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Case -iscussion


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ost co$$on

I)@J o Laryneal carcino$as

aleK%e$ale *6@K(

!ccounts or '@J o head and nec5 cancers

!ppro9. (A4 eventually die

ost prevalent in the "thand +thdecades

S=ua$ous Cell Carcino$ao the Laryn9


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S,o-in%

E.ce!!ie #lco"ol con!,ption E9posure to Hu$an Papillo$a 3irus (" M(#

Chronic 2astric Re>u9

ccupational e9posures

Prior history o head and nec5 irradiation

Ris5 %actors


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Environ$ental e9posure, viral inection, spontaneous

$utation.

!lteration in the P@4

Loss o cellular sinalin $echanis$s

alinant transor$ation

Carcinoenesis


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Glottic Spr#%lottic S/%lottic Tr#n!%lottic

:nvolves truevocal cords Con


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2lotticK $oority o laryneal cancers 7@1J6

"1J8 SupratlotticK 41J6*1J

SublotticK N@J


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Spr#%lottic Glottic S/%lottic

6 ore !ressive6 -irect e9tensioninto pre6epilottic

space Ly$ph node$etastasis -irect e9tensioninto lateralhypopharny9,

lossoepilottic old,and tonue base

6 ro/ slo/er and tendto $etastasize lateo/in to a paucity o

ly$phatic drainae6 $etastasize ater theyhave invaded adacentstructures /ith better-rainae6 E9tend superiorly into

ventricular /alls orineriorly into sublotticspace6 Can cause vocal cord


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Spr#%lottic Glottic S/%lottic

Chronic sorethroat-ysphonia-ysphaia&ec5 $ass

secondary toreional$etastasis

Hoarseness!ir/ayobstruction

late sy$pto$

3ocal cordparalysis!ir/ayco$pro$ise

aniestations


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!ssess$ent o vocal cord $obility as /ell as

local tu$or e9tension Larynoscopy

used to assess the e9tent o local spread.

Radioraphic i$ain by CT andAor R:

Cartilae erosion or invasion and e9tensioninto the preepilottic or paralottic spaces.

-ianosis and Stain


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TD 6 ini$u$ re=uire$ents to assess

pri$ary tu$or cannot be $etT1 6 &o evidence o pri$ary tu$or

Tis 6 Carcino$a in situ

T& Stain


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T( li$ited to one subsite o supralottis /ith nor$al vocal cord$obility

T' involves $ucosa o $ore than one adacent subsite osupralottis or lottis, or reion outside the supralottis/ithout


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T( Tu$or li$ited to the vocal cord 7s8 7$ay involve anterioror posterior co$$issure8 /ith nor$al $obilty

T(a

Tu$or li$ited to one vocal cord

T(b

Tu$or involves both vocal cords

T' Tu$or e9tends to supralottis andAor sublottis, andAor

/ithi$paired vocal cord $obility

T4 Tu$or li$ited to the laryn9 /ith vocal cord


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T0 Tu$or li$ited to the sublottis

T' Tu$or e9tends to vocal cord 7s8 /ith nor$al ori$paired$obility

T4 Tu$or li$ited the laryn9 /ith vocal cord


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&1 &o cervical ly$ph nodes positive

&( Sinle ipsilateral ly$ph node 4c$

&'a Sinle ipsilateral node I 4c$ and "c$

&'b &'b ultiple ipsilateral ly$ph nodes, each"c$

&'c &'c Bilateral or contralateral ly$ph nodes,each "c$

&4 &4 Sinle or $ultiple ly$ph nodes I "c$

Stain 6 &odes


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1 &o distant $etastases

( -istant $etastasespresent

Stain 6 etastasis


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Stae 2roupin


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C' Laser

ResectionK severedysplasia andcarcino$a in situ

Radiotherapy

Che$otherapy PartialATotal

Larynecto$yKadvanced tu$ors

Treat$ent


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Radiotherapy or surery alone

#@6)@J cure rate

T(6T'


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Total Larynecto$y

S$all T4 and lesser sized tu$ors can betreated /ith partial larynecto$y

T46T* Lesions


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:ndicationsK

T* pri$ary BoneAcartilae invasion

3ascular invasion

ultiple positive nodes

&odal e9tracapsular e9tension

Sublottic e9tension o pri$ary tu$or

Post6op Radiation


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!dvanced stae cancers

Cisplatinu$ and @6>ourouracil

Che$otherapy


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:nection

3oice alterations Loss o taste and s$ell

Tracheosto$y dependence

Co$plications


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1 2e#r

!ri#lStae ( I)@J

Stae ' #@6)1J

Stae 4 +16#1MStae * @16"1J

Pronosis


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Patients considered cured ater bein

disease ree or


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Than5 youQ

Documents

SCCA of the Larynx