{‫لعاملني‬‫ا‬ ‫رب‬ ‫األرض‬ ‫ورب‬ ‫لسموات‬‫ا‬ ‫رب‬ ‫احلمد‬ ‫فلله‬}‫اجلاثية‬:36
{‫وسلم‬ ‫وصحبه‬ ‫اله‬ ‫وعلى‬ ‫محمد‬ ‫على‬ ‫صلى‬ ‫اللهم‬}
{‫يعلمون‬ ‫ال‬ ‫الناس‬ ‫أكثر‬ ‫ولكن‬ ‫الناس‬ ‫خلق‬ ‫من‬ ‫اكبر‬ ‫واألرض‬ ‫السموات‬ ‫لخلق‬}‫غافر‬:57
(‫أحُاها‬ ٌ‫الر‬ ‫إن‬ ‫وزبث‬ ‫اهحزت‬ ‫الماء‬ ‫علُها‬ ‫أوزلىا‬ ‫فإذا‬ ‫خاشعة‬ ‫األزض‬ ‫جسي‬ ‫اوك‬ ‫آَاجه‬ ‫ومه‬
‫قدَس‬ ‫شٍء...
Cancer of the larynx
By
Dr, IBRAHIM H. AHMED
M.D.
otorhinolaryngology
introduction
Incidence : 10,000 cases per year in U S A .
Most frequent upper aerodigestive tract cancer
The integration o...
Anatomy of larynx
area extending from :
tip of epiglottis to
lower border of cricoid cartilage .
divided into 3 anatomical...
supraglottis
Lingual & laryngeal surfaces of the
epiglottis .
Arytenoid fold .
Arytenoid cartilages .
False vocal folds .
...
glottis
- true vocal cord .
- Anterior commisure .
- post . Commisure .
Upper border : floor of ventricle .
Lower border :...
subglottis
• Upper border :
• lower limit of glottis .
• Lower limit :
• inferior rim of cricoid cartilage.
embryology
Supraglottic
Buccopharyngeal
anlagen of branchial
arches 3&4 .
Glottis &subglottis
Tracheobroncial anlagen
of b...
Histology of supraglottis
• Ciliated columnar epithelium except
free edges of epiglottis &
aryepiglottic fold
( stratified...
Histology of glottis
Vocal cord : stratified squamous epithelium
(edges) .
peudostratified ciliated
epithelium ( sup. & in...
Blood supply of the larynx
Arterial supply of larynx
•1- sup. Laryngeal a.
( branch of sup. Thyroid a. )
2- inf. Laryngeal...
Nerve supply of the larynx
Motor supply :
supplies all laryngeal musclesrecurrent laryngeal nerve
externalexcept cricothyr...
Lymphatics of larynx
1- The vocal cords & upper part of the larynx
drain into the upper deep cervical lymph
nodes .
2- The...
Cancer of the larynx
epidemiology
•10,000 new cases per year
in U S A
etiology
Excessive tobacco use &
alcohol consumption...
Epidemiology of cancer larynx
- 1% of all cancer related deaths in U S A .
- 10,000 new cases / year in U S A .
- 5 year s...
Risk factors
- tobacco .
- Synergistic effect with heavy alcohol intake in
Smokers .
- occupational exposure
Painter – met...
Clinical presentation
symptoms :
1 – hoarseness .
2 – dysnea & stridor .
3 – pain .
4 – dysphagia .
5 – swelling in the ne...
Clinical presentation
Hoarseness
Hot potato voice
Hemoptysis
Weight loss & dysphagia
Referred otalgia
Palpable neck lump
D...
Clinical evaluation
- complete history of the disease
- weight and weight loss
- performance status
- fiberoptic examinati...
Complete examination of
the head and neck
Includes examination
• oral cavity,
• pharynx,
• indirect laryngoscopy.
• fibero...
videostroposcopy
- proper assessment of glottic lesion :
1- Detailed vibrator behavior of vocal cord .
- amplitude of vibr...
The examination
status of the dentition,
the status of the airway,
vocal cord mobility ,
laryngeal crepitus,
tumor extensi...
Palpation of the neck bilaterally,
Recording
1- the location (Group or Level II - IV),
- size,
- mobility,
- relationship ...
Pattern of lymphatic spread
Supraglottic ca:
Primary glottic ca :
Subglottic ca :
Lymph node
Metastases 44%
L. N. metastas...
Mobility of larynx
Vocal cord mobility .
Arytenoid mobility .
Hemilarynx mobility .
Laryngeal mobility over prevertebral
f...
The staging of the primary
and of the cervical lymph
nodes must be documented
Radiological examination of
cancer larynx
To reveal tumour invasion of laryngeal
cartilages & extra laryngeal tissues .
Wi...
Imaging Studies:
•Chest radiographs, PA and lateral
To rule out
(1) A synchronous pulmonary tumor,
(2) Acute or chronic pu...
imaging
.
Thickness , invasion ,
Lymph node metastasis .
Under estimate cartilage invasion .
More accurate than C T scan ....
a mass is seen eroding the thyroid
cartilage and spreading into the
soft tissue of the neck.
the thyroid cartilage is seen to be
eroded. The airway also appears
to be compromised.
The tumor appears to be eroding the
anterior commissure area of the thyroid
cartilage. The tumor appears large and
predomi...
Laboratory Tests:
•C .B .C , B . T . , C . T . , serum calcium.
• Pulmonary function and arterial blood
gases in the patie...
ENDOSCOPIC EXAMINATION & BIOPSY UNDER
ANESTHESIA
Direct laryngoscope :
1 - confirmation .
2 - site , size , extent of the ...
Pathology of cancer larynx
1- keratosis :
2- dysplasia :
Keratin layer in a normally non
keratinized epithelium .
Involves...
Leukoplakia of right vocal cord
Pathology of cancer larynx
3- carcinoma in situ Atypical changes throughout the
epithelium without evidence
of surface mat...
Invasive squamous cell carcinoma
Incidence
Grades :
Variants :
> 90% of laryngeal carcinoma .
- Well differentiated .
- mo...
Verrucous carcinoma
A slow – growing , locally aggressive
tumor with an exophytic , fungating ,
warty , gray – white appea...
Non squamous tumors
Mucous gland tumors.
Cartilaginous tumors .
Neuroendocrine tumors
Adenocarcinoma .
Adenoid cystic carc...
Consultations
•Radiation therapy
In anticipation of possible need for post-operative
radiation therapy or to use radiation...
Consultations:
•Dental
To assess the status of the teeth and make
recommendations considering that radiation
therapy may b...
Consultations
•Speech pathology
For pre-operative counseling regarding possible
post-operative speech and swallowing
rehab...
TMN / PRIMARY TUMOR ( T )
TX : Primary tumor cannot be assessed .
To : No evidence of primary tumor .
Tis : Carcinoma in s...
SUPRGLOTTIS ( T )
T1 : Tumor limited to one subsite of supraglottis with
normal vocal cord mobility .
T2 : Tumor invades m...
supraglottic squamous cell
carcinoma of the larynx
GLOTTIS
T1 : Tumor limited to the vocal cord(s) ( may involve
anterior or posterior commisure ) with normal mobility
.
T1a...
Cancer of the left vocal cord
Picture of
glottic squamous cell carcinoma of the
larynx. The tumor involves the anterior half of the left
vocal cord.
SUBGLOTTIS
T1 : Tumor limited to the subglottis .
T2 : Tumor extended to vocal cord(s) with
normal or impaired mobility .
...
Picture of an extensive squamous cell carcinoma of
the larynx. The tumor involves the subglottic region,
the glottis and t...
TNM STAGING
No : no regional node metastasis .
Nx : regional nodes cannot be assessed .
N1 : single ipsilateral node,≤3cm
...
≤
TNM staging
Mx: Distant metastasis can’t be assessed
M0: No distant metastasis
M1: Distant metastasis
Treatment of glottic ca.
1- carcinoma in situ .
2 - Stage 1 .
3 – stage II ..
Micro laryngeal surgery –
Radiotherapy .
Rad...
T1 squamous cell carcinoma of vocal cord
Immediate post operative , after biopsy & surgical
removal of leukoplakia .This patient will be treated
with full course o...
Pre and post biopsy views of a patient
with two T1 SCC of true vocal cords .
The patient was treated with vocal
cord strip...
Treatment of glottic ca
4 – stage III .
5 – stage IV .
1 – radiotherapy . or
chemo&radiotherapy .
2 - trans oral co2 laser...
Management of neck in glottic ca.
1- No .
2 – NI , NII .
3 – N III.
1 – radiotherapy .
2 – elective neck dissection .
1 – ...
Treatment of supraglottic ca.
1- TI .
2- TII .
1- radiotherapy .
2- open epiglottictomy .
3- co2 laser epiglottictomy
1- r...
Treatment of supraglottic ca.
3- TIII .
4- TIV .
1- accelerated
radiotherapy .
2- co2 laser resection .
3- near total lary...
Management of neck in supraglottic ca.
1- No
2- N1 , N2 , N3 ,
Ipsilateral selective neck
dissection . IF +ve ----- contra...
Treatment of subglottic ca .
T1 .
T2 .
T3 .
Radiotherapy .
Radiotherapy or total laryngectomy.
Radiotherapy or total laryn...
Management of neck in
subglottic ca.
Ipsilateral level VI dissection . If
lymph node +ve , post
operative radiotherapy .
{....‫عظُما‬ ‫علُك‬ ‫هللا‬ ‫فضل‬ ‫وكان‬ ‫جعلم‬ ‫جكه‬ ‫لم‬ ‫ما‬ ‫وعلمك‬}‫النساء‬:113
HABIBIBRAHIM,DRThank you
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Cancer  of  the larynx
Upcoming SlideShare
Loading in …5
×

Cancer of the larynx

6,246
-1

Published on

presentation of cancer larynx By Dr Ibrahim Habib Barakat (E.N.T) (M.D)
E-mail:salamatuall@yahoo.com

Published in: Health & Medicine
1 Comment
5 Likes
Statistics
Notes
No Downloads
Views
Total Views
6,246
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
417
Comments
1
Likes
5
Embeds 0
No embeds

No notes for slide

Cancer of the larynx

  1. 1. {‫لعاملني‬‫ا‬ ‫رب‬ ‫األرض‬ ‫ورب‬ ‫لسموات‬‫ا‬ ‫رب‬ ‫احلمد‬ ‫فلله‬}‫اجلاثية‬:36
  2. 2. {‫وسلم‬ ‫وصحبه‬ ‫اله‬ ‫وعلى‬ ‫محمد‬ ‫على‬ ‫صلى‬ ‫اللهم‬}
  3. 3. {‫يعلمون‬ ‫ال‬ ‫الناس‬ ‫أكثر‬ ‫ولكن‬ ‫الناس‬ ‫خلق‬ ‫من‬ ‫اكبر‬ ‫واألرض‬ ‫السموات‬ ‫لخلق‬}‫غافر‬:57
  4. 4. (‫أحُاها‬ ٌ‫الر‬ ‫إن‬ ‫وزبث‬ ‫اهحزت‬ ‫الماء‬ ‫علُها‬ ‫أوزلىا‬ ‫فإذا‬ ‫خاشعة‬ ‫األزض‬ ‫جسي‬ ‫اوك‬ ‫آَاجه‬ ‫ومه‬ ‫قدَس‬ ‫شٍء‬ ‫كل‬ ً‫عل‬ ‫اوه‬ ً‫المىج‬ ًُ‫لمح‬)–‫فصلت‬:39.
  5. 5. Cancer of the larynx By Dr, IBRAHIM H. AHMED M.D. otorhinolaryngology
  6. 6. introduction Incidence : 10,000 cases per year in U S A . Most frequent upper aerodigestive tract cancer The integration of chemotherapy and radiation therapy has expanded organ preservation options . The patient’s perspective , with emphasis on retention of speech , swallowing , & quality of life has affected the decision making process.
  7. 7. Anatomy of larynx area extending from : tip of epiglottis to lower border of cricoid cartilage . divided into 3 anatomical subsites : Supraglottis glottis, subglottis.
  8. 8. supraglottis Lingual & laryngeal surfaces of the epiglottis . Arytenoid fold . Arytenoid cartilages . False vocal folds . Ventricle .
  9. 9. glottis - true vocal cord . - Anterior commisure . - post . Commisure . Upper border : floor of ventricle . Lower border : 1 cm below apex of ventricle
  10. 10. subglottis • Upper border : • lower limit of glottis . • Lower limit : • inferior rim of cricoid cartilage.
  11. 11. embryology Supraglottic Buccopharyngeal anlagen of branchial arches 3&4 . Glottis &subglottis Tracheobroncial anlagen of branchial arches 5&6 branchial arches
  12. 12. Histology of supraglottis • Ciliated columnar epithelium except free edges of epiglottis & aryepiglottic fold ( stratified squamous mucosa ) . • Mucous gland are abundant esp. ( saccule & periarytenoid areas ) . • Rich vascularity & lymphatic .
  13. 13. Histology of glottis Vocal cord : stratified squamous epithelium (edges) . peudostratified ciliated epithelium ( sup. & inf. Aspect ) Lamina propria : superficial ( Reink’s space ) intermediate & deep ( vocal lig. * blood vessels & lymphatics are almost absent in Reinke’s space. * no mucous glands on free edge of vocal cord .
  14. 14. Blood supply of the larynx Arterial supply of larynx •1- sup. Laryngeal a. ( branch of sup. Thyroid a. ) 2- inf. Laryngeal a. ( branch of inf. Thyroid a. ) Venous drainage 1- Sup. Thyroid v . , ends in I . J . V . 2- inf. Thyroid v . , ends in innominate v .
  15. 15. Nerve supply of the larynx Motor supply : supplies all laryngeal musclesrecurrent laryngeal nerve externalexcept cricothyroid muscle which supplied by laryngeal n. ( branch of sup. Laryngeal nerve ) . Sensory supply : .internal laryngeal n. ( branch of sup. Laryngeal n ) supply mucous membrane above the vocal cords . suppliesRecurrent laryngeal n. mucous membrane below the vocal cords.
  16. 16. Lymphatics of larynx 1- The vocal cords & upper part of the larynx drain into the upper deep cervical lymph nodes . 2- The lower part of the larynx drain into the lower deep cervical lymph nodes & prelaryngeal lymph nodes . .
  17. 17. Cancer of the larynx epidemiology •10,000 new cases per year in U S A etiology Excessive tobacco use & alcohol consumption .
  18. 18. Epidemiology of cancer larynx - 1% of all cancer related deaths in U S A . - 10,000 new cases / year in U S A . - 5 year survival is 65 % . - Male to female ratio : 9,2 : 1 for glottic ca. 3-5 : 1 for supraglottic. - Age : affect elderly . The peak incidence is 6th & 7th decades . < 1% in < 30 years of age . - No rational predominance in U S A .
  19. 19. Risk factors - tobacco . - Synergistic effect with heavy alcohol intake in Smokers . - occupational exposure Painter – metal working – plastic working – diesel & gasoline fumes .wood dust & asbestos . - G O R . - Infectious agents especially papilloma virus .
  20. 20. Clinical presentation symptoms : 1 – hoarseness . 2 – dysnea & stridor . 3 – pain . 4 – dysphagia . 5 – swelling in the neck . 6 – cough & irritation in the throat . 7- hemoptysis . 8 – fetor & anorexia .
  21. 21. Clinical presentation Hoarseness Hot potato voice Hemoptysis Weight loss & dysphagia Referred otalgia Palpable neck lump Dysnea & stridure Vocal cord involvement . Progressive & unremitting . supraglottic ca. Large fungating or ulcerated lesion (epiglottic lesion ) Malnutrition . (advanced lesion _pharyngeal involvement ) Cartilage invasion . Direct extension in soft tissue neck 1st presentation -subglottic or supraglottic ca 2nd presentation in glottic ca .
  22. 22. Clinical evaluation - complete history of the disease - weight and weight loss - performance status - fiberoptic examination of H&N mucosa - neck examination - drawing of any lesions
  23. 23. Complete examination of the head and neck Includes examination • oral cavity, • pharynx, • indirect laryngoscopy. • fiberoptic examination of the larynx and pharynx - videostroboscopy .
  24. 24. videostroposcopy - proper assessment of glottic lesion : 1- Detailed vibrator behavior of vocal cord . - amplitude of vibration - mucosal wave - non vibrating portion 2- Outpatient procedure . 3- Documentation . 4- Selection of patient for biopsy .
  25. 25. The examination status of the dentition, the status of the airway, vocal cord mobility , laryngeal crepitus, tumor extension
  26. 26. Palpation of the neck bilaterally, Recording 1- the location (Group or Level II - IV), - size, - mobility, - relationship of the node(s) to adjacent structures. 2- widening of thyroid angle . 3- direct extention of the lesion . 4- Fixation of the larynx. 5- carotid pulsation .
  27. 27. Pattern of lymphatic spread Supraglottic ca: Primary glottic ca : Subglottic ca : Lymph node Metastases 44% L. N. metastases 5% L. N. metastases 6%
  28. 28. Mobility of larynx Vocal cord mobility . Arytenoid mobility . Hemilarynx mobility . Laryngeal mobility over prevertebral fascia (More’s sign )
  29. 29. The staging of the primary and of the cervical lymph nodes must be documented
  30. 30. Radiological examination of cancer larynx To reveal tumour invasion of laryngeal cartilages & extra laryngeal tissues . With clinical / endoscopic examination result in proper staging accuracy .
  31. 31. Imaging Studies: •Chest radiographs, PA and lateral To rule out (1) A synchronous pulmonary tumor, (2) Acute or chronic pulmonary disease (3) Metastatic tumor.
  32. 32. imaging . Thickness , invasion , Lymph node metastasis . Under estimate cartilage invasion . More accurate than C T scan . Soft tissue details & fat planes , Tissue edema & tumor extention . Over estimate cartilage invasion . Viability of a tumor . Residual , recurrent tumor after Radiotherapy & or chemotherapy . Sensitive for detection of lymph node metastasis. C T scan Spiral C T scan M R I P E T
  33. 33. a mass is seen eroding the thyroid cartilage and spreading into the soft tissue of the neck.
  34. 34. the thyroid cartilage is seen to be eroded. The airway also appears to be compromised.
  35. 35. The tumor appears to be eroding the anterior commissure area of the thyroid cartilage. The tumor appears large and predominately on the right side of the larynx. The airway also appears to be compromised.
  36. 36. Laboratory Tests: •C .B .C , B . T . , C . T . , serum calcium. • Pulmonary function and arterial blood gases in the patients with COPD or who are candidates for surgery . •Liver & kidney function tests (optional).
  37. 37. ENDOSCOPIC EXAMINATION & BIOPSY UNDER ANESTHESIA Direct laryngoscope : 1 - confirmation . 2 - site , size , extent of the tumour . 3 - vocal cord mobility . 4 - arytenoid mobility . 5 - type of lesion . 6 - neck is felt . 7 - biopsy . 8 - drawing in axial & sagittal plane . Pan endoscopy to exclude 2nd primary .
  38. 38. Pathology of cancer larynx 1- keratosis : 2- dysplasia : Keratin layer in a normally non keratinized epithelium . Involves true vocal cords & interarytenoid area . Cellular atypia , loss of maturity , and loss of stratification in some cases of keratosis . 1- mild . 2- moderate . 3- severe .
  39. 39. Leukoplakia of right vocal cord
  40. 40. Pathology of cancer larynx 3- carcinoma in situ Atypical changes throughout the epithelium without evidence of surface maturation or invasion trough the basement membrane .
  41. 41. Invasive squamous cell carcinoma Incidence Grades : Variants : > 90% of laryngeal carcinoma . - Well differentiated . - moderately differentiated - poorly differentiated . 1- papillary SCC . 2- Sarcomatoid carcinoma . 3- Basaloid SCC .
  42. 42. Verrucous carcinoma A slow – growing , locally aggressive tumor with an exophytic , fungating , warty , gray – white appearance and well defined margins .
  43. 43. Non squamous tumors Mucous gland tumors. Cartilaginous tumors . Neuroendocrine tumors Adenocarcinoma . Adenoid cystic carcinoma . Mucoepidermoid carcinoma. Chondrosarcoma . Paraganglioma . Large cell tumor . Atypical carcinoid . Small cell tumor .
  44. 44. Consultations •Radiation therapy In anticipation of possible need for post-operative radiation therapy or to use radiation therapy as a definitive primary modality of treatment in early stage tumors.
  45. 45. Consultations: •Dental To assess the status of the teeth and make recommendations considering that radiation therapy may be indicated. The evaluating dentist should be versed in the effects of radiotherapy on dentition. This evaluation should be done with knowledge of the treatment portals planned for the radiotherapy.
  46. 46. Consultations •Speech pathology For pre-operative counseling regarding possible post-operative speech and swallowing rehabilitation.
  47. 47. TMN / PRIMARY TUMOR ( T ) TX : Primary tumor cannot be assessed . To : No evidence of primary tumor . Tis : Carcinoma in situ . Supraglottis . Glottis . Subglottis .
  48. 48. SUPRGLOTTIS ( T ) T1 : Tumor limited to one subsite of supraglottis with normal vocal cord mobility . T2 : Tumor invades mucosa of more than one subsite of supraglottis or region outside the supraglottis ( e.g., mucosa of base of tongue , vallecula , medial wall of pyriform sinus ) without fixation of the larynx . T3 : Tumor limited to the larynx with vocal cord fixation and/or invade any of the following : postcricoid area , pre-epiglottic tissues . T4 : tumor invade through the thyroid cartilage and/or extends into soft tissue of the neck , thyroid and/or esophagus .
  49. 49. supraglottic squamous cell carcinoma of the larynx
  50. 50. GLOTTIS T1 : Tumor limited to the vocal cord(s) ( may involve anterior or posterior commisure ) with normal mobility . T1a : Tumor limited to one vocal cord . T1b : Tumor involves both vocal cords . T2 : Tumor extends to supraglottis and/or subglottis and/or occurs with impaired vocal cord mobility . T3 : Tumor limited to the larynx with vocal cord fixation . T4 : Tumor invades through the thyroid cartilage and/or to other tissues beyond the larynx ( e.g., trachea , soft tissue of neck , including thyroid and pharynx .
  51. 51. Cancer of the left vocal cord
  52. 52. Picture of glottic squamous cell carcinoma of the larynx. The tumor involves the anterior half of the left vocal cord.
  53. 53. SUBGLOTTIS T1 : Tumor limited to the subglottis . T2 : Tumor extended to vocal cord(s) with normal or impaired mobility . T3 : Tumor limited to the larynx with vocal cord fixation . T4 : Tumor invade through the cricoid or thyroid cartilage and/or to other tissues beyond the larynx ( e.g., trachea , soft tissues of neck , including the thyroid and pharynx )
  54. 54. Picture of an extensive squamous cell carcinoma of the larynx. The tumor involves the subglottic region, the glottis and the supraglottic area.
  55. 55. TNM STAGING No : no regional node metastasis . Nx : regional nodes cannot be assessed . N1 : single ipsilateral node,≤3cm N2a : single ipsilateral nodes, > 3cm and ≤ 6cm N2b : multiple ipsilateral nodes , ≤ 6cm N2c : controlateral or bilateral nodes , ≤ 6cm N3 : node > 6cm
  56. 56. ≤ TNM staging Mx: Distant metastasis can’t be assessed M0: No distant metastasis M1: Distant metastasis
  57. 57. Treatment of glottic ca. 1- carcinoma in situ . 2 - Stage 1 . 3 – stage II .. Micro laryngeal surgery – Radiotherapy . Radiotherapy . Partial surgery . Trans oral co2 laser . Radiotherapy . Chemotherapy & radiotherapy . Partial surgery . Trans oral laser excision ..
  58. 58. T1 squamous cell carcinoma of vocal cord
  59. 59. Immediate post operative , after biopsy & surgical removal of leukoplakia .This patient will be treated with full course of radiotherapy .
  60. 60. Pre and post biopsy views of a patient with two T1 SCC of true vocal cords . The patient was treated with vocal cord stripping and radiation therapy
  61. 61. Treatment of glottic ca 4 – stage III . 5 – stage IV . 1 – radiotherapy . or chemo&radiotherapy . 2 - trans oral co2 laser excision 3 - surgery . 1- total laryngectomy + Post operative radiotherapy .
  62. 62. Management of neck in glottic ca. 1- No . 2 – NI , NII . 3 – N III. 1 – radiotherapy . 2 – elective neck dissection . 1 – selective neck dissection . 1 – modified or radicalneck dissection + radiotherapy .
  63. 63. Treatment of supraglottic ca. 1- TI . 2- TII . 1- radiotherapy . 2- open epiglottictomy . 3- co2 laser epiglottictomy 1- radiotherapy . 2- supraglottic laryngectomy . 3- trans oral co2 laser resection .
  64. 64. Treatment of supraglottic ca. 3- TIII . 4- TIV . 1- accelerated radiotherapy . 2- co2 laser resection . 3- near total laryngectomy 4- cicohyoidopexy . 1- 1ry radiotherapy . 2- total laryngectomy & post . op . radiotherapy
  65. 65. Management of neck in supraglottic ca. 1- No 2- N1 , N2 , N3 , Ipsilateral selective neck dissection . IF +ve ----- contra lateral selective neck dissection level II , III , IV . Radical neck dissection + post operative radiotherapy .
  66. 66. Treatment of subglottic ca . T1 . T2 . T3 . Radiotherapy . Radiotherapy or total laryngectomy. Radiotherapy or total laryngectomy .
  67. 67. Management of neck in subglottic ca. Ipsilateral level VI dissection . If lymph node +ve , post operative radiotherapy .
  68. 68. {....‫عظُما‬ ‫علُك‬ ‫هللا‬ ‫فضل‬ ‫وكان‬ ‫جعلم‬ ‫جكه‬ ‫لم‬ ‫ما‬ ‫وعلمك‬}‫النساء‬:113
  69. 69. HABIBIBRAHIM,DRThank you
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×