Congenital laryngeal disorders

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Congenital laryngeal disorders

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

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