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Congenital lesions of larynx and Stridor in Neonates

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Laryngomalacia, Congenital Vocal Fold Paralysis, Congenital Subglottic Stenosis, Laryngeal Web, Subglottic Haemangioma, Laryngo-Oesophageal Cleft, Laryngeal Cyst, Stridor, Pierre-Robin Syndrome, Laryngeal Papillomatous, Stridor-Causes, Laryngeal Atresia, Pakistan

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Congenital lesions of larynx and Stridor in Neonates

  1. 1. Brig Anwar ul Haq ENTSpecialist CMH Lahore
  2. 2. Brig Anwar ul Haq ENTSpecialist CMH Lahore
  3. 3. Congenital lesions of larynx Laryngomalacia (Congenital Laryngeal Stridor) Congenital Vocal Cord Paralysis Congenital Subglottic Stenosis Laryngeal Web Subglottic Haemangioma Laryngo-oesophageal Cleft Laryngocele Laryngeal Cyst
  4. 4. Laryngomalacia Most common congenital abnormality of larynx Manifests Birth Soon after and Disappears by two years of age Characterized Excessive flaccidity of supraglottic larynx Larynx ix sucked in during inspiration Stridor and cyanosis
  5. 5. Laryngomalacia Stridor subsides in prone position  Stridor increases with crying
  6. 6. Laryngomalacia Direct laryngoscopy Elongated and curled up epiglottis (omega shaped) Floppy AE folds Prominent arytenoids
  7. 7. Laryngomalacia Treatment Conservative Usually Tracheostomy Severe stridor
  8. 8. Congenital Vocal Fold Paralysis Birth trauma RLN is stretched during breach or forceps delivery Anomalies of CNS
  9. 9. Congenital Subglottic Stenosis Abnormal thickening of cricoid cartilage Fibrous tissue seen below the vocal cords
  10. 10. Congenital Subglottic Stenosis Asymptomatic Dyspnoea - URTI Stridor - URTI
  11. 11. Congenital Subglottic Stenosis Diagnosis Subglottic diameter <4mm in full term neonate  Normal 4.5-5.5mm <3mm in premature neonate  Normal 3.5mm  Spontaneous improvement  as larynx grows oSurgery only some patients
  12. 12. Laryngeal Web Incomplete recanalization of larynx Seen between the vocal cords with concave posterior margin
  13. 13. Laryngeal Web Symptoms Airway obstruction Dysponea Stridor Weak Cry Aphonia dating from birth
  14. 14. Laryngeal Web Treatment depends on thickness of web Thin web Cut with knife Cut with CO2 laser Thick web Excision via laryngofissure Placement of silicone keel Subsequent dilatation
  15. 15. Subglottic Haemangioma Asymptomatic till 3-6 months of age 50% have associated cutaneous haemangioma Presentation Stridor which increases on agitation Stridor on crying due to venous filling
  16. 16. Subglottic Haemangioma Direct laryngoscopy Reddish blue mass below vocal cords Biopsy is sometimes, not always associated with hemorrhage
  17. 17. Subglottic Haemangioma Treatment depends on individual case Observation Tracheostomy Steroid therapy Dexamethasone 1 mg/kg/day for 1 week Then prednisolone 3 mg/kg in divided doses for one year. Co2 laser excision
  18. 18. Laryngo-Oesophageal Cleft Due to failure of fusion of cricoid lamina Presents with repeated aspiration and pneumonitis Coughing, choking and cyanosis are present at the time of feeding Surgically treated
  19. 19. Laryngeal Cyst Site - AE folds Appearance as bluish fluid filled smooth swelling in supraglottic larynx Respiratory obstruction Stridor Dysponea
  20. 20. Laryngeal Cyst Treatment Tracheostomy Needle aspiration Incision and drainage Treatment is de roofing the cyst Excision with CO2 laser
  21. 21. Stridor Defined as noisy respiration produced by turbulent airflow through narrowed air passage Classified as Inspiratory Expiratory Biphasic
  22. 22. Stridor Inspiratory stridor Produced in obstructive lesion of supraglottic or pharynx Expiratory stridor Lesions of thoracic  Trachea  Primary brocnhi  Secondary bronchi Biphasic Lesions of glottis Subglottis Cervical trachea
  23. 23. Stridor Congenital Laryngomalacia Laryngeal web Subglottic stenosis Haemangioma Vocal cord paralysis Tongue and jaw abnormalities Aquired 1. Febrile  Epiglotittis  Laryngo-tracheitis  Diphtheria  Infectious mononucleosus  Retropharyngeal abscess  Quinsy 2. Afebrile  Papillomatosis  Foreign body  Laryngeal oedema  Adeno tonsillar hypertrophy
  24. 24. Stridor-Causes (accordig to the site) Nose  Choanal atresia in newborn Tongue  Macroglossia,  Haemangioma  Lymphangioma  Lingual thyroid Mandible  Micrognathia  Pierre-robin syndrome Pharynx  Congenital dermoid  Retropharyngeal abscess  Tumours  Adenotonsillar hypertrophy
  25. 25. Stridor-causes - Larynx Congenital Web Laryngomalacia Cyst Subglottic stenosis Inflammatory  Epiglottitis  Laryngotracheitis  Diphtheria Neoplastic  Haemangioma  Juvenile papilloma  Carcinoma in adults Traumatic: • Injuries to larynx • Foreign bodies • Prolonged intubation Neurogenic: • Laryngeal paralysis Miscellaneous: • Tetanus • Tetany • Laryngismus stridulus
  26. 26. Pierre-Robin Syndrome PRS Charactriscts  Cleft palate Retrognathia(abnormal positioning of the jaw or maxilla) Glossoptosis Downward displacement Retraction of the tongue
  27. 27. Laryngeal Papillomatous
  28. 28. Laryngeal Papillomatous
  29. 29. Stridor-Causes- Trachea and bronchi Congenital  Atresia  Stenosis  Tracheomalacia Inflammatory  Tracheobronchitis Neoplastic  Tumors Traumatic  Foreign body  Stenosis
  30. 30. Stridor- Causes Outside Respiratory Tract Congenital  Vascular rings  Oesophageal atresia  Tracheo-oesophageal fistula  Cystic hygroma Inflammatory  Retroeosophageal abscess Traumatic  Foreign body oesophagus Tumors  Masses in the neck
  31. 31. Laryngeal Atresia
  32. 32. Stridor- Causes Outside Respiratory Tract Congenital  Vascular rings  Oesophageal atresia  Tracheo-oesophageal fistula  Cystic hygroma Inflammatory  Retroeosophageal abscess Traumatic  Foreign body oesophagus Tumors  Masses in the neck
  33. 33. Stridor- Causes Outside Respiratory Tract Congenital  Vascular rings  Oesophageal atresia  Tracheo-oesophageal fistula  Cystic hygroma Inflammatory  Retroeosophageal abscess Traumatic  Foreign body oesophagus Tumors  Masses in the neck
  34. 34. Stridor-Management History: Onset Progression Duration Relation to feeding Cyanotic spell Aspiration or ingestion of foreign body Laryngeal trauma
  35. 35. Stridor-Management Physical Examination Signs of respiratory distress Stridor with phase of respiration Associated features  Fever  Wheeze  Snoring  Hoarseness  Muffled voice
  36. 36. Stridor-Management Investigations X-ray chest X Ray soft tissue neck AP and lateral view Fluoroscopy CT of neck and chest Oesophagogram Angiography Xeroradiography
  37. 37. Stridor-Management Investigations X-ray chest X Ray soft tissue neck AP and lateral view Fluoroscopy (Radiological Examination) CT of neck and chest Oesophagogram / Ba Swallow Angiography Xeroradiography
  38. 38. Stridor-Management Investigations X-ray chest X Ray soft tissue neck AP and lateral view Fluoroscopy CT of neck and chest Oesophagogram Angiography Xeroradiography
  39. 39. Stridor-Management Examination of Nose Examination of Pharynx Direct laryngoscopy Pan endoscopy
  40. 40. Stridor-management Treat the exact cause Depending on Diagnosis
  41. 41. ?
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Laryngomalacia, Congenital Vocal Fold Paralysis, Congenital Subglottic Stenosis, Laryngeal Web, Subglottic Haemangioma, Laryngo-Oesophageal Cleft, Laryngeal Cyst, Stridor, Pierre-Robin Syndrome, Laryngeal Papillomatous, Stridor-Causes, Laryngeal Atresia, Pakistan

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