Tumours of the Larynx
· Benign non-neoplastic neck lumps:
o Inflammatory:
§ Lymph nodes: anterior cervical for tonsillitis, jugular digastric for tongue
§ Atypical Tb (especially kids)
§ Deep Neck abscesses: para-pharyngeal or retro-pharyngeal abscesses (can track down into mediastinum)
o Thyroglossal cysts: cysts in embryological track from tongue to thyroid (usually at level of hyoid)
o Branchial cysts: ?embryological. Like enlarged anterior node. Contain lots of cholesterol
o Pharyngeal pouch: Mucosa herniates out through triangle between the cricopharyngeus and thyropharyngeal muscles under pressure from swallowing when upper oesophageal sphincter doesn‟t relax properly. Catches food, becomes infected. Treatment: surgery
· Laryngeal Nodule:
o Due to trauma of vocal chords banging together ® oedema (early) ® scarring/granulation tissue (late)
o Only on anterior 1/3rd of vocal fold
o Completely benign
o Gravely voice
· Laryngeal Papilloma:
o Like sinonasal papillomas
o Most commonly seen in children
o Associated with HPV 6, 11
o Tendency to recur: can become unmanageable ® airway obstruction
o Benign ® squamous overgrowth
· Laryngeal Carcinoma:
o Presentation:
§ Presenting early: if affect vocal chords, invade recurrent pharyngeal nerve, front of mouth
§ Presenting late: supraglottic lesions due to airway obstruction or pain (Þ deeper), sinus (lots of space)
§ Dysphagia rare
· 90% are squamous cell carcinoma (like lung)
· Mostly in males, smoking a major risk factor, also alcohol, radiation, family history, tend to be older (> 50)
· Classification, prognosis and treatment depends on site (prognosis also depends on stage):
o Glottic: 60%, on chords, maintained in larynx by cartilage. Treatment: radiotherapy unless spread through cartilage
o Supraglottic: 30%, above chords, involves false chord. More aggressive, metastasise to cervical lymph nodes
o Transglottic: < 5%, crosses from one chord to another
o Infraglottic < 5%, below chords, more aggressive
· Don‟t usually metastasise elsewhere, but lymph node infiltration common
· Treatment: radiotherapy (® dry mouth) +/- surgery (superficial, hemilaryngectomy, laryngectomy, laryngectomy +/- radical neck resection. Chemo has little effect against SCC (most of them). If laryngectomy then need a tracheostomy (® can‟t cough, infection, ¯humidification, etc)
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