Congenital lesions of larynx

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Congenital lesions of larynx

  1. 1. CONGENITAL LESIONS OF LARYNX AND STRIDOR DEPT OF OTORHINOLARYNGOLOGY JJM M C DAVANAGERE
  2. 2. LARYNGOMALACIA• Most common congenital abnormality of larynx• Condition manifests at birth or soon after and usually disappears by two years of age• Characterized by excessive flaccidity of Supraglottic larynx which is sucked in during inspiration producing stridor and cyanosis• Stridor subsides on placing child in prone position and increases with crying• Direct laryngoscopy elongated and curled up epiglottis (omega shaped), floppy AE folds and prominent arytenoids• Treatment is conservative• In severe stridor tracheostomy
  3. 3. CONGENITAL VOCAL FOLD PARALYSIS• Results from birth trauma when RLN is stretched during breach or forceps delivery• Can also results from anomalies of CNS
  4. 4. CONGENITAL SUBGLOTTIC STENOSIS• Due to abnormal thickening of cricoid cartilage or fibrous tissue seen below the vocal cords• Child may remain asymptomatic till URTI causes dyspnoea and stridor• Diagnosis subglottic diameter less than 4mm in full term neonate (normal 4.5-5.5mm) or 3mm in premature neonate (normal 3.5mm)• Most cases improve as larynx grows but some may require surgery
  5. 5. LARYNGEAL WEB• Due to incomplete recanalization of larynx• Seen between the vocal cords with concave posterior margin• Presents as airway obstruction, weak cry or aphonia dating from birth• Treatment depends on thickness of web• Thin web cut with knife or CO2 laser• Thick web excision via laryngofissure and placement of silicone keel and subsequent dilatation
  6. 6. SUBGLOTTIC HAEMANGIOMA• Though congenital patient is asymptomatic till 3-6 months of age• About 50% have associated cutaneous haemangioma• May present with stridor which increases on agitation and crying due to venous filling• Direct laryngoscopy shows reddish blue mass below vocal cords• Biopsy is sometimes, not always associated with hemorrhage• Treatment depends on individual case Tracheostomy and observation Steroid therapy CO2 laser excision
  7. 7. SUBGLOTTICHAEMANGIOMA
  8. 8. 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
  9. 9. LARYNGEAL CYST• Arises in the AE folds and appears as bluish fluid filled smooth swelling in Supraglottic larynx• Respiratory obstruction tracheostomy• Needle aspiration or incision and drainage provides emergency airway• Treatment is deroofing the cyst or excision with CO2 laser
  10. 10. STRIDOR• Defined as noisy respiration produced by turbulent airflow through narrowed air passage• Classified as Inspiratory, expiratory and biphasic
  11. 11. STRIDOR• Inspiratory stridor produced in obstructive lesion of Supraglottic or pharynx• Expiratory stridor lesions of thoracic trachea, primary and secondary bronchi• Biphasic lesions of glottis, subglottis and cervical trachea
  12. 12. STRIDOR• CONGENITAL • AQUIRED LARYNGOMALACIA 1. FEBRILE  EPIGLOTITTIS LARYNGEAL WEB  LARYNGO-TRACHEITIS  DIPHTHERIA SUBGLOTTIC STENOSIS  INFECTIOUS MONONUCLEOSUS HAEMANGIOMA  RETROPHARYNGEAL ABSCESS VOCAL CORD PARALYSIS  QUINSY TONGUE AND JAW 2. AFEBRILE ABNORMALITIES  PAPILLOMATOSIS  FOREIGN BODY  LARYNGEAL OEDEMA  ADENO TONSILLAR HYPERTROPHY
  13. 13. STRIDOR-CAUSES• Nose: choanal atresia in newborn• Tongue: macroglossia, haemangioma, lymphangioma, lingual thyroid• Mandible: micrognathia, Pierre-Robin syndrome• Pharynx: congenital dermoid, retropharyngeal abscess, tumors, adenotonsillar hypertrophy• 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
  14. 14. STRIDOR-CAUSES• Trachea and bronchi: Congenital: atresia, stenosis, malacia Inflammatory: tracheobronchitis Neoplastic: tumors Traumatic: foreign body and stenosis• Lesions 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
  15. 15. STRIDOR-MANAGEMENT• History: onset, progression, duration, relation to feeding, cyanotic spell, aspiration or ingestion of foreign body, laryngeal trauma• Physical examination: signs of respiratory distress, stridor with phase of respiration, associated features like fever, wheeze, snoring, hoarseness, muffled voice
  16. 16. STRIDOR-MANAGEMENT• Investigations X-ray chest and soft tissue neck AP and lateral view Fluoroscopy CT of neck and chest Oesophagogram Angiography Xeroradiography Direct laryngoscopy Pan endoscopy
  17. 17. STRIDOR-MANAGEMENT• Treatment: treat the exact cause depending on the diagnosis

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