Congenital laryngeal disorders

  • 1,126 views
Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
1,126
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
54
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 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