Congenital laryngeal disorders
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Congenital laryngeal disorders

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    Congenital laryngeal disorders Congenital laryngeal disorders Presentation Transcript

    • CONGENITAL LARYNGEAL DISORDERS
      DR PRASHANTH
    • CLASSIFICATION
      1. SUPRAGLOTTIS
      LARYNGOMALACIA
      LARYNGEAL CYST
      CONGENITAL LARYNGOCELE
      2. GLOTTIS
      LARYNGEAL WEB
      CRI-DU CHAT SYNDROME
      VOCAL CORD PARALYSIS
    • CLASSSIFICATION CONTD….
      3. SUBGLOTTIS:
      SUBGLOTTIC STENOSIS
      SUBGLOTTIC HEMANGIOMA
      LARYNGOTRACHEAL CLEFT
    • 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
    • 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
    • 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
    • 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
    • EMERGENCY MANAGEMENT:
      1. ENDOTRACHEAL INTUBATION
      2. TEMPORARY TRACHEOSTOMY
    • 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
    • LARYNGOCELE
      AIR-FILLED DILATATION OF SACCULUS
      ETIOLOGY:
      1. CONGENITALLY LARGE SACCULE
      2. INCREASED INTRA LARYNGEAL
      PRESSURE  GAS BLOWERS,
      SAXOPHONE PLAYERS, COUGHING etc
    • TYPES:
      Internal- within the larynx
      External- Projects through the thyro-hyoid membrane and presents as swelling in the lateral neck
      Combined
    • 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
    • BRYCE’S SIGN:
      GIRGLING & HISSING SOUND IN
      THROAT WHEN EXTERNAL MASS
      IS COMPRESSED
      IF SAC OPENING IS OBSTRUCTED 
      MUCOCELE ( SACCULAR CYST )
    • 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)
    • 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
    • C/F:
      WEAK CRY AT BIRTH
      RECURRENT CROUP
      INSPIRATORY OR BIPHASIC STRIDOR
      DIAGNOSIS:
      VIDEODIRECT ENDOSCOPY/ FLEXIBLE
      NASOLARYNGOSCOPY
    • Rx: ASYMPTOMATIC  REASSURANCE
    • 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
    • THANK YOU