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Chapter: Medicine Study Notes : Respiratory

Tumours of the Larynx

Thyroglossal cysts: cysts in embryological track from tongue to thyroid (usually at level of hyoid)

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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