Larynx
·
Function: protect airway from
saliva and food, voice production
·
Vocal chords shut during
coughing, straining, lifting ® maximal splinting from thoracic muscles
·
Anatomy:
o Recurrent laryngeal: maintains open vocal chords via abductor muscle. If
damaged ® stridor. Rest of muscles supplied by superior laryngeal nerve
o Pharynx: superior, middle and inferior constrictor muscles attach on the
cervical spine at medium raphae
· Paediatric problems:
o Signs: stridor, feeding difficulties
o Failure of canalisation ® severe (normally dies)
o Laryngomalatica: Supra glottic structures floppy ® collapse
on inspiration ® inspiratory stridor. Improves with muscle tone/innovation
o Subglottic stenosis: congenital or trauma (eg too big a ventilation
tube)
o Croup:
§ = Laryngo-tracheo bronchitis.
§ Inspiratory and expiratory stridor, barking cough
§ If frequent, may have anatomical narrowing
§ Usually viral infection. If
severe, steroids ® ¯inflammation
o Obstructive sleep apnoea:
§ Very different to adults: usually due to enlarged adenoids/tonsils –
snore loudly
§ ®Failure
to thrive, behavioural problems, etc
§ Obstructive apnoea up to age 7 ® take adenoids out
o Epiglottis:
§ Symptoms: obstruction, sore throat, drooling, toxic/septicaemia
§ Cause: bacterial infection (eg H. Influenzae)
§ Medical emergency: can deteriorate quickly. Don‟t examine throat – may
cause spasm and obstruct
§ Emergency treatment: Geudal airway and ambubag. If unsuccessful get a
very experienced person to intubate. If unsuccessful cricothyroidotomy with 14
gauge needles
·
Tonsillitis:
o Tonsils are not normal lymph nodes: don‟t have capsule or afferent
vessels
o Bulk of lymphoid tissue is in base of tongue
o Decrease in size with age. At 40
half the size as when 15
·
Foreign bodies:
o Can‟t eat or drink.
o In kids: 10-cent pieces, inhaled peanuts. Differential: asthma (cough
and wheeze). If < 2 years old, do CXR and look for collapse distal to
obstruction
o In elderly with dentures: can‟t chew or feel unwell
o Must take out: if stuck in gullet, will perforate within 7 days. Can linger for months in lung
·
Vocal chords:
o Papillomas: usually solitary. Very low incidence of malignant change.
Laser them (usually repeatedly)
o Nodules: usually bilateral. Keratinised lesions from chords banging
together. Treatment: vocal rest, correct voice abuse
o Polyps: usually unilateral.
Granulation tissue/inflammatory
o Reincher‟s disease: in middle aged female smokers. Degenerative,
gelatinous polyps of surrounding mucosa ® hoarse voice, obstruction. Cause
unknown
·
Recurrent Laryngeal Palsy:
o Usually left nerve: longer. Right
only goes round subclavian
o 40% idiopathic
o Exclude: bronchogeneic cancer, mediastinal lymph nodes (eg lung or
breast Ca), Ca of larynx, mononeuropathic infection
·
Voice disorders (Dysphonia,
Aphonia):
o Obstruction to vocal chord closure: vocal chord thickening/oedema,
nodules, papilloma, ulcers, polyps
o Larynx growths: leukoplakia, hyperkeratosis
o Trauma: intubation, external
o Paralysis: superior or recurrent laryngeal nerve
o Vocal hyperfunction: spastic dysphonia, tension due to voice abuse
(singers, teachers)
o Presbyphonia: in the elderly
o Other: chronic laryngitis ® mucosal atrophy, Parkinson‟s,
Motor neuron disease, following laryngectomy
·
In all cases refer to
speech-language therapy for assessment/management
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)
·
Choanal Atresia: failure of
formation of nasal passages. Baby goes blue until someone opens the mouth.
Can‟t pass NG tube. Can be unilateral
·
Congenital masses: nasal
encephalocele and nasal dermoid. Care with nasal intubation. Beware the midline
lesion
·
Pierre Robin Sequence: short jaw,
cleft palate and tongue falls back and obstructs. Nurse prone. Associated with
oligohydramnios
·
Subglottic Stenosis: due to
intubation trauma in a preterm baby
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.