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Congenital laryngeal disorders

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  • 1. CONGENITAL LARYNGEAL DISORDERS
    DR PRASHANTH
  • 2. CLASSIFICATION
    1. SUPRAGLOTTIS
    LARYNGOMALACIA
    LARYNGEAL CYST
    CONGENITAL LARYNGOCELE
    2. GLOTTIS
    LARYNGEAL WEB
    CRI-DU CHAT SYNDROME
    VOCAL CORD PARALYSIS
  • 3. CLASSSIFICATION CONTD….
    3. SUBGLOTTIS:
    SUBGLOTTIC STENOSIS
    SUBGLOTTIC HEMANGIOMA
    LARYNGOTRACHEAL CLEFT
  • 4. LARYNGOMALACIA
    MALACIA= SOFTENING (GREEK)
    JACKSON IN 1942
    MOST COMMON CAUSE OF CONGENITAL STRIDOR.
    FEATURES:
    1. SOFT FLABBY LARYNGEAL TISSUES
    2. THIN LARYNGEAL CARTILAGES
    3. LOOSE, REDUNDANT MUCOSA OF
    LARYNX
  • 5. C/F:
    M:F= 1:1, CRY IS NORMAL
    INSPIRATORY STRIDOR: HIGH PITCH,
    “FLUTTERING” , WITHIN FEW DAYS OF
    BIRTH , OR URTI INCREASES TILL
    FIRST YEAR STARTS RESOLVING.
    SUPINE POSITION, SUCKLING, CRYING
    WORSENS STRIDOR
    IMPROVES IN PRONE POSITION
  • 6. DIAGNOSIS:
    HISTORY
    VIDEOLARYNGOSCOPY/FLEXIBLE NASO
    LARYNGOSCOPY:
    1. OMEGA SHAPED EPIGLOTTIS
    2. SHORT AE FOLD, PROLAPSES
    INWARDS
    3. PROMINENT ARYTENOIDS, LOOSE
    MUCOSA, MOVE INWARDS
    4. DIFFICULT TO SEE VOCAL CORDS
  • 7.
  • 8.
  • 9. TREATMENT:
    1. 90% CASES RESOLVE BY 2 YEARS
    2. TREAT URTI EFFECTIVELY
    SEVERE RESPIRATORY DISTRESS,
    FEEDING DIFFICULTY( HIGH INTRA
    THORACIC NEGATIVE PRESSURE
    GERD ) WITH FAILURE TO THRIVE
    ACTIVE INTERVENTION
  • 10. EMERGENCY MANAGEMENT:
    1. ENDOTRACHEAL INTUBATION
    2. TEMPORARY TRACHEOSTOMY
  • 11. CONSERVATIVE MANAGEMENT
    ENDOSCOPIC ARY- EPIGLOTTOPLASTY
    ( SUPRAGLOTTOPLASTY)
    CO2 / COLD KNIFE  AE FOLD RELEASED FROM EPIGLOTTIS & REDUNDANT MUCOSA OF ARYTENOID EXCISED IF NEEDED ALONG WITH CUNEIFORM CARTILAGES
  • 12. LARYNGOCELE
    AIR-FILLED DILATATION OF SACCULUS
    ETIOLOGY:
    1. CONGENITALLY LARGE SACCULE
    2. INCREASED INTRA LARYNGEAL
    PRESSURE  GAS BLOWERS,
    SAXOPHONE PLAYERS, COUGHING etc
  • 13.
  • 14. TYPES:
    Internal- within the larynx
    External- Projects through the thyro-hyoid membrane and presents as swelling in the lateral neck
    Combined
  • 15.
  • 16. CLINICAL FEATURES
    Asymptomatic
    Hoarseness
    RESPIRATORY DISTRESS INCREASES ON CRYING OR STRAINING
    Neck: Cystic, painless swelling, reducible, increases on valsalva
    ILS: Smooth bulge on the ventricular band, may obscure the vocal cords
  • 17. BRYCE’S SIGN:
    GIRGLING & HISSING SOUND IN
    THROAT WHEN EXTERNAL MASS
    IS COMPRESSED
    IF SAC OPENING IS OBSTRUCTED 
    MUCOCELE ( SACCULAR CYST )
  • 18. MANAGEMENT
    SOFT TISSUE XRAY NECK/ CT SCAN DURING VALSALVA
    DIRECT LARYNGOSCOPY TO RULE OUT UNDERLYING MALIGNANCY
    TREATMENT:
    MLS & MARSUPIALIZATION OF SAC (VENTRICULAR BAND & LARYNGOCELE IS CUT & MARGINS EVERTED)
    EXTERNAL (TRANSCERVICAL) EXCISION
    (EITHER CUT THE NECK OF SAC & SUTURE
    OR LARYNGOFISSURE & SAC EXCISION)
  • 19. LARYNGEAL WEB
    FAILURE OF COMPLETE CANALIZATION OF LARYNX DURING 5TH WEEK OF IU LIFE
    MOST COMMON IS GLOTTIC WEB(75%), LESS COMMON ARE SUPRA & SUB GLOTTIC
    MOSTLY ANTERIOR GLOTTIC WEBS
    POSTERIOR INTERARYTENOID WEBS MAY BE ASSOCIATED WITH CRICOARYTENOID JOINT FIXATION
  • 20. C/F:
    WEAK CRY AT BIRTH
    RECURRENT CROUP
    INSPIRATORY OR BIPHASIC STRIDOR
    DIAGNOSIS:
    VIDEODIRECT ENDOSCOPY/ FLEXIBLE
    NASOLARYNGOSCOPY
  • 21.
  • 22. Rx: ASYMPTOMATIC  REASSURANCE
  • 23.
  • 24.
  • 25.
  • 26. PREFERABLY KEEL INSERTED AT AGE OF 3 YRS & ABOVE
    TEMPORARY TRACHEOSTOMY WHEN KEEL IN-SITU ( 2- 5 WEEKS)
    INSERTED ENDOSCOPICALLY WITH COMBINEDLARYNGOFISSURE APPROACH
    VERY SEVERE WEB INVOLVING SUBGLOTTIS  EMERGENCY TRACHEOSTOMY AT 2 yrsLTR ( Laryngo tracheal reconstruction)
    WITH ANTERIOR CARTILAGE GRAFTING
  • 27. THANK YOU