3. SACCULE (appendix of ventricle)
• Diverticulum extending from ventricle
• Between the vestibular fold, thyroarytenoid & thyroid cartilage
• Contains mucous glands , lubricates the vocal folds
CONUS ELASTICUS
Elastic tissue layer extending from vocal ligaments to cricoid arch,
attaches to inner thyroid lamina & arytenoids

5.  anterior & lateral to
epiglottis
 Inferolaterally continuous
with paraglottic space
PRE EPIGLOTTIC SPACE
OF BOYER

6. PARAGLOTTIC SPACE
 Adipose tissue, internal
laryngeal nerve, laryngeal
saccule
 Lat. – thyroid cartilage &
thyrohyoid membrane
 Superomed. – quadrangular
membrane
 Inferomed. - conus
elasticus
 Superiorly continuous with
pre – epiglottic space

7. SITE SUBSITE
Supraglottis Suprahyoid epiglottis
Infrahyoid epiglottis
Aryepiglottic folds
Arytenoids
Ventricular bands (false vocal
cords)
Glottis True vocal cords+ ant and post.
Commissure +rima glottidis(slit)
Subglottis Subglottic space upto lower
border of cricoid

8. 2.63% of all the body cancers in India
M:F = 10:1
40- 70 years
female incidence increasing

10. Black tobacco > light tobacco - aromatic amines and
tobacco specific nitrosamines & Tar content.
 Non filter cigarettes > filter cigarettes - tar content
 Smoking hand-rolled cigarettes > commercially
manufactured cigarettes - 2.7* risk.
Chewing tobacco or inhaling snuff - 50% in risk.
Risk of developing ca larynx decreases with increasing
time since cessation of smoking, indicating tobacco as a
promoter and initiator in carcinogenesis.
SMOKING

11.  Alcohol formaldehyde
( ) vit. A synthesis
mucosal de-epithelisation
mucosa exposed
 Serum IgA levels in patients with
alcoholic liver disease
 Associated malnutrition
15* RISK

12. OCCUPATIONAL EXPOSURE - asbestos, mustard gas, process of
isopropyl alcohol manufacturing, nickel refining, soot, tars, acid mists,
beryllium and bischloromethyl ether & the glass wool production.
GENETIC - Japanese and Russian
VIRUSES - HSV, HPV, EBV ( EBV- specific IgA
antibodies block IgG mediated tumor
destruction).
Previous RADIATION to head & neck
Low SOCIOECONOMIC STATUS - smoking habits

13. SUPRAGLOTTIC CANCER
site - epiglottis > false cords > aryepiglottic folds
Spread - vallecula, base of tongue & pyriform fossa.
Cancer of infrahyoid epiglottis & anterior ventricular band
extend into pre-epiglottic space and penetrate the thyroid cartilage.

14. Symptoms: Early -Throat pain
Dysphagia
Ipsilateral otalgia
LN mass in the neck.
Late - Weight loss
Respiratory obstruction
Halitosis (tumor necrosis)
Nodal mets - upper and middle jugular nodes.
Bilateral mets (epiglottis)

15. Supraglottic growths

16. GLOTTIC CANCER
Most common site - Free edge and upper surface of the vocal cords in its
anterior and middle third
spread- anteriorly - anterior commissure &opposite cord
posteriorly - vocal process and arytenoids
upward – ventricle & false cord
downwards - subglottis

17. Symptoms : Early - Hoarseness Late – Stridor
Laryngeal obstruction
(increased size, edema/ cord fixation)
Nodal mets – practically absent, if early stage

18. Glottic growths

19. SUBGLOTTIC CANCER
spread – anteriorly - anterior wall to the opposite side
downwards - trachea.
Upward spread – late
Mainly invade cricoid & thyroid cartilages
Extralaryngeal spread characteristic
Site - subglottis

20. Symptom: Early - Stridor
Laryngeal obstruction
Late – Hoarseness
Nodal mets - prelaryngeal
pretracheal (delphian)
paratracheal
lower jugular

21. Subglottic growths

23. Broadening of the larynx
Loss of crepitation
Tenderness of larynx
Weight loss
Chronic cough; Hemoptysis
Dysphagia
Odynophagia
Ipsilateral otalgia
Halitosis
Mass in the neck
HISTORY:
“patient in cancer age group having persistent or gradually increasing
hoarseness of voice for 3 weeks must have laryngeal examination to exclude
cancer”
Persistent hoarsenessDyspnea and stridor

24. Hoarseness of voice
Have you heard a patient with hoarseness of voice beforet.mp4 - YouTube - Copy.mp4

25. THANK YOU ALL MY
FRIENDS FOR BEING
PATIENT AND LISTENING
ME

26. Happy
Independence
Day
Jai Hind !!!