This document discusses laryngeal cancer, including:
- The most common risk factors are smoking and alcohol consumption.
- It most commonly affects middle-aged or older men.
- The main subtypes are glottic, supraglottic, and subglottic cancers.
- Staging involves the TNM system and considers tumor size, lymph node involvement, and metastasis.
- Treatment options include radiotherapy, surgery such as laryngectomy, or a combination for curative intent or palliative care.
This document discusses evaluation and management of deaf children. It begins by defining different types and degrees of childhood hearing loss. Early diagnosis is important as it allows for early intervention, which research shows improves outcomes for language development and education. Universal newborn hearing screening within the first 3 months of life is now standard practice. Diagnostic tests include otoacoustic emissions testing and auditory brainstem response testing. Causes of childhood hearing loss can be genetic syndromic or non-syndromic causes. Proper evaluation involves history, physical exam, and potential genetic or imaging studies to determine the etiology.
Lateral sinus thrombophlebitis is an inflammation of the inner wall of the lateral venous sinus caused by infection from acute or chronic ear diseases. Bacteria enter the sinus and cause a thrombus formation within the sinus, obstructing drainage. Common symptoms include fever, headache, and papilledema. Diagnosis involves blood tests and imaging like CT or MRI. Treatment requires antibiotics, surgery to drain abscesses and remove clots, and sometimes anticoagulants or jugular vein ligation. Complications can include sepsis, meningitis, abscesses if not treated promptly.
The document discusses various congenital lesions of the larynx that can cause stridor in infants and children, including laryngomalacia, vocal fold paralysis, subglottic stenosis, laryngeal web, and subglottic hemangioma. It describes the clinical presentation, diagnosis, and treatment of each condition. The document also covers acquired causes of stridor and outlines the approach to evaluating and managing a child presenting with stridor.
This document discusses tumors of the larynx, including benign and malignant tumors. It provides details on various benign tumors such as papillomas, paragangliomas, schwannomas, and hemangiomas. It then focuses on malignant tumors, specifically squamous cell carcinoma which is the most common. Details are given on risk factors, pathology, staging, symptoms, workup and various treatment options for laryngeal cancer such as cordectomy, laryngectomy, and chemoradiotherapy.
Tonsils and adenoids
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
The document discusses various causes and types of deafness in children. It describes inner ear abnormalities like Sheibes dysplasia which affects the cochlea and vestibule. It also discusses different types of hearing loss such as conductive, sensory neuronal, and syndromic hearing loss which occurs with other medical problems. The severity of hearing loss is classified from mild to profound based on loudness thresholds. Potential causes include genetic factors, infections during pregnancy, complications at birth, trauma, and certain drugs. Tests used to evaluate hearing include electrocochleography, acoustic reflex testing, tympanometry and audiometry. Management options involve hearing aids, cochlear implants, and developing speech and language skills.
1. Inverted papilloma is a benign epithelial tumor originating from the Schneiderian membrane of the nasal cavity and paranasal sinuses.
2. It most commonly affects males ages 30-50 and presents as a unilateral nasal mass, obstruction, and bleeding.
3. Treatment involves surgical resection, typically an endoscopic medial maxillectomy to remove the entire lateral nasal wall and clear the tumor attachment site.
This document discusses acoustic reflex and tone decay testing. It defines acoustic reflex as a decrease in tympanic membrane compliance in response to sound stimulation that is measured using immittance testing. Acoustic reflex can be tested ipsi-laterally, stimulating and measuring the same ear, or contra-laterally, stimulating one ear and measuring the opposite ear. Tone decay measures the relaxation of the stapedius muscle between contractions in response to sustained tones and can help localize lesions. Abnormal decay at low frequencies suggests lesions of the auditory nerve or brainstem while decay at high frequencies suggests cochlear lesions.
This document discusses evaluation and management of deaf children. It begins by defining different types and degrees of childhood hearing loss. Early diagnosis is important as it allows for early intervention, which research shows improves outcomes for language development and education. Universal newborn hearing screening within the first 3 months of life is now standard practice. Diagnostic tests include otoacoustic emissions testing and auditory brainstem response testing. Causes of childhood hearing loss can be genetic syndromic or non-syndromic causes. Proper evaluation involves history, physical exam, and potential genetic or imaging studies to determine the etiology.
Lateral sinus thrombophlebitis is an inflammation of the inner wall of the lateral venous sinus caused by infection from acute or chronic ear diseases. Bacteria enter the sinus and cause a thrombus formation within the sinus, obstructing drainage. Common symptoms include fever, headache, and papilledema. Diagnosis involves blood tests and imaging like CT or MRI. Treatment requires antibiotics, surgery to drain abscesses and remove clots, and sometimes anticoagulants or jugular vein ligation. Complications can include sepsis, meningitis, abscesses if not treated promptly.
The document discusses various congenital lesions of the larynx that can cause stridor in infants and children, including laryngomalacia, vocal fold paralysis, subglottic stenosis, laryngeal web, and subglottic hemangioma. It describes the clinical presentation, diagnosis, and treatment of each condition. The document also covers acquired causes of stridor and outlines the approach to evaluating and managing a child presenting with stridor.
This document discusses tumors of the larynx, including benign and malignant tumors. It provides details on various benign tumors such as papillomas, paragangliomas, schwannomas, and hemangiomas. It then focuses on malignant tumors, specifically squamous cell carcinoma which is the most common. Details are given on risk factors, pathology, staging, symptoms, workup and various treatment options for laryngeal cancer such as cordectomy, laryngectomy, and chemoradiotherapy.
Tonsils and adenoids
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
The document discusses various causes and types of deafness in children. It describes inner ear abnormalities like Sheibes dysplasia which affects the cochlea and vestibule. It also discusses different types of hearing loss such as conductive, sensory neuronal, and syndromic hearing loss which occurs with other medical problems. The severity of hearing loss is classified from mild to profound based on loudness thresholds. Potential causes include genetic factors, infections during pregnancy, complications at birth, trauma, and certain drugs. Tests used to evaluate hearing include electrocochleography, acoustic reflex testing, tympanometry and audiometry. Management options involve hearing aids, cochlear implants, and developing speech and language skills.
1. Inverted papilloma is a benign epithelial tumor originating from the Schneiderian membrane of the nasal cavity and paranasal sinuses.
2. It most commonly affects males ages 30-50 and presents as a unilateral nasal mass, obstruction, and bleeding.
3. Treatment involves surgical resection, typically an endoscopic medial maxillectomy to remove the entire lateral nasal wall and clear the tumor attachment site.
This document discusses acoustic reflex and tone decay testing. It defines acoustic reflex as a decrease in tympanic membrane compliance in response to sound stimulation that is measured using immittance testing. Acoustic reflex can be tested ipsi-laterally, stimulating and measuring the same ear, or contra-laterally, stimulating one ear and measuring the opposite ear. Tone decay measures the relaxation of the stapedius muscle between contractions in response to sustained tones and can help localize lesions. Abnormal decay at low frequencies suggests lesions of the auditory nerve or brainstem while decay at high frequencies suggests cochlear lesions.
Dr. Sanjay Maharjan's document discusses the history and surgical treatment of otosclerosis. It covers three eras in the evolution of otosclerosis surgery:
1) The mobilization era in the late 1800s, which involved attempts to mobilize the stapes bone.
2) The fenestration era from the 1920s-1950s, marked by the development of techniques like fenestration of the semicircular canals.
3) The stapedectomy era from the 1950s onward, highlighted by the first successful stapedectomy performed by Shea in 1956 using a Teflon prosthesis.
The document provides details on indications, contraindications,
The document discusses vocal nodules and polyps, which are benign growths on the vocal folds caused by vocal abuse or misuse. Vocal nodules are small lesions less than 3mm located at the front of the vocal folds, while polyps are larger lesions. Symptoms include hoarseness, vocal fatigue, and difficulty speaking. Treatment involves voice therapy, medical management, and surgery to remove the growths if they are large or not improving. Surgical complications can include scarring and loss of voice if the layers of the vocal folds are damaged during removal of the nodules or polyps.
The document discusses voice rehabilitation options following total laryngectomy. It describes the physiology of normal voice production and how it is altered after laryngectomy. Esophageal speech involves swallowing air into the esophagus and expelling it to produce vibrations for speech. A tracheoesophageal puncture procedure creates a one-way valve between the trachea and esophagus allowing air intake for esophageal voice, which provides better voice quality than esophageal speech. The document compares rehabilitation methods and provides details on performing primary and secondary tracheoesophageal puncture procedures.
The document discusses tumours of the larynx. It defines benign and malignant laryngeal tumours and describes common benign tumours like vocal nodules, vocal polyps, Reinke's edema, papillomas, and laryngoceles. It also discusses malignant tumours like squamous cell carcinoma. It provides details on the diagnosis, staging, and management of laryngeal cancer including surgery, radiotherapy, and chemotherapy. The document emphasizes that hoarseness is often the earliest symptom of glottic carcinoma and smoking is a major risk factor.
This document provides information about masking techniques used during audiometric testing. It defines masking and explains that the goal is to prevent the non-test ear from participating. Interaural attenuation values are discussed as well as when masking is needed for air and bone conduction tests. Types of masking noise, appropriate levels of noise, and risks of undermasking and overmasking are covered.
This document discusses benign tumours of the larynx. It divides them into non-neoplastic and neoplastic lesions. Non-neoplastic lesions include vocal nodules, vocal polyps, Reinke's edema, and contact ulcers which result from vocal abuse or trauma. Neoplastic lesions include papillomas, chondromas, haemangiomas, granular cell tumours, and rare glandular tumours. Many lesions present with hoarseness and are typically treated with surgical excision and voice therapy.
Congenital malformation of external ear and it’s managementYousuf Choudhury
This document discusses congenital malformations of the external ear. It begins with applied anatomy of the normal ear and embryology of ear development. It then describes various congenital deformities that can occur, including pre-auricular tags, prominent ears, cryptotia, microtia, and congenital aural atresia. For treatment, options include observation, prosthetics, reconstruction with rib cartilage grafts, and surgical correction of atresia. Reconstruction is often done in multiple stages to form the shape of the pinna.
This document discusses voice disorders and their diagnosis and treatment. It covers the basics of normal voice production and the glottal cycle. Key aspects of stroboscopic examination are described, including amplitude of vibration, mucosal wave, symmetry, periodicity, and glottic closure patterns. Common voice disorders like tension dysphonia, laryngitis, vocal nodules, and vocal fold paralysis are mentioned. The document emphasizes taking a thorough history and examining the oral cavity, larynx, breathing, and voice quality during diagnosis of voice disorders. Stroboscopy aids in detecting subtle vocal fold abnormalities. Voice hygiene and lifestyle modifications are important aspects of treatment.
This document discusses various voice disorders including dysphonia, dysarthria, dysarthrophonia, and hoarseness. It describes the main causes of voice disorders as inflammatory, neoplastic/structural, neuromuscular, and muscle tension imbalance. Treatment options discussed include vocal hygiene and lifestyle advice, voice therapy, medical treatment such as for acid reflux, phonosurgery procedures, and in some cases Botulinum toxin injections. Specific voice disorders covered in detail include vocal fold polyps, nodules, Reinke's edema, and muscle tension dysphonia.
Tinnitus retraining therapy (TRT) is a treatment for tinnitus that involves counseling and sound therapy to retrain connections between the auditory, limbic, and autonomic nervous systems. It categorizes patients based on factors like hearing loss and sound sensitivity and prescribes different sound therapy devices at appropriate levels. Counseling teaches patients about tinnitus mechanisms and helps reduce reactions. Studies show TRT improves tinnitus handicap in 78-96% of patients after 8-18 months of treatment.
This document provides information on laryngeal cancer including:
- Epidemiology statistics showing it represents 2.63% of cancers in India and predominantly affects males aged 40-70 years.
- Main risk factors are smoking tobacco and alcohol consumption.
- Details the anatomy, embryology, barriers to spread, and subtypes of laryngeal cancer including supraglottic, glottic, subglottic, and transglottic.
- Discusses the pathology, signs and symptoms, diagnostic tests including imaging, and TNM staging system for laryngeal cancer.
This document discusses various types of phonosurgery procedures. Phonosurgery aims to improve or restore the voice and includes microlaryngeal surgery, injection laryngoplasty, and laryngeal framework surgery. Microlaryngeal surgery allows for fine manipulation of the vocal folds using a microscope. Common procedures discussed include treating vocal nodules, polyps, Reinke's edema, and papillomas using precision excision or laser techniques to preserve vocal fold function. Injection laryngoplasty can be used to medialize an adductor cord in cases of paralysis or paresis.
This document summarizes a seminar on cancer of the larynx presented by Dr. Yousuf F. Choudhury. It begins with an overview of the surgical anatomy and vascular supply of the larynx. It then discusses the different subtypes, risk factors, presentations, diagnosis, staging, and management principles for laryngeal cancer. In particular, it compares the advantages and disadvantages of different treatment modalities for early and advanced laryngeal cancer such as radiotherapy, surgery, and chemoradiotherapy.
This document describes a case of carcinoma of the larynx in a 65-year-old male patient who presented with hoarseness of voice for 6 months and breathing difficulty for 2 weeks. Examination revealed a growth on the left vocal cord. The patient underwent an emergency tracheostomy followed by a total laryngectomy and biopsy, which showed well-differentiated squamous cell carcinoma. The patient recovered well post-operatively and was discharged on adjuvant radiotherapy and voice rehabilitation.
This document discusses tumors of the hypopharynx, including both benign and malignant tumors. It notes that malignant tumors are more common, especially squamous cell carcinomas. The three main subsites that can be affected are the pyriform sinus (60% of cases), postcricoid region (30% of cases), and posterior pharyngeal wall (10% of cases). For each subsite, it describes characteristics like prevalence, spread patterns, clinical features, diagnosis, and treatment options.
This document discusses vocal cord paralysis, including:
1. It reviews the anatomy of the vocal cords and their innervation.
2. It outlines the various etiologies of vocal cord paralysis including neurological, tumor infiltration, systemic disease, medications, trauma, and idiopathic causes. Surgical procedures are a common traumatic cause.
3. It describes the evaluation of a patient with vocal cord paralysis including history, physical exam, imaging, and laryngeal electromyography to determine the location and cause of the paralysis.
- Lymphatic drainage of the larynx depends on the subsite, with the supraglottis draining to levels II and III, the anterior glottis and subglottis draining to levels VI and IV, and the posterior glottis and subglottis draining to levels VI and IV.
- Laryngeal cancer accounts for 2.63% of cancers in Asia and predominantly affects males between 40-70 years of age. Major risk factors include alcohol, smoking, HPV infection, prior radiation exposure, and certain occupations.
- Treatment depends on tumor stage, location, and patient fitness. Early glottic cancer is often treated with transoral laser resection or radiation while
CA larynx Presentation - diag. & treatmentShubham Yadav
This document discusses laryngeal cancer, including:
- Types are mostly squamous cell carcinoma, with some other rare types. Glottic cancer is most common.
- Symptoms depend on location - glottic causes hoarseness, supraglottic causes throat pain and dysphagia, subglottic causes stridor.
- Staging involves examination, imaging, and considers tumor size and spread. Treatment options include radiation, surgery like laryngectomy, and rehabilitation techniques after total laryngectomy like oesophageal speech.
Dr. Sanjay Maharjan's document discusses the history and surgical treatment of otosclerosis. It covers three eras in the evolution of otosclerosis surgery:
1) The mobilization era in the late 1800s, which involved attempts to mobilize the stapes bone.
2) The fenestration era from the 1920s-1950s, marked by the development of techniques like fenestration of the semicircular canals.
3) The stapedectomy era from the 1950s onward, highlighted by the first successful stapedectomy performed by Shea in 1956 using a Teflon prosthesis.
The document provides details on indications, contraindications,
The document discusses vocal nodules and polyps, which are benign growths on the vocal folds caused by vocal abuse or misuse. Vocal nodules are small lesions less than 3mm located at the front of the vocal folds, while polyps are larger lesions. Symptoms include hoarseness, vocal fatigue, and difficulty speaking. Treatment involves voice therapy, medical management, and surgery to remove the growths if they are large or not improving. Surgical complications can include scarring and loss of voice if the layers of the vocal folds are damaged during removal of the nodules or polyps.
The document discusses voice rehabilitation options following total laryngectomy. It describes the physiology of normal voice production and how it is altered after laryngectomy. Esophageal speech involves swallowing air into the esophagus and expelling it to produce vibrations for speech. A tracheoesophageal puncture procedure creates a one-way valve between the trachea and esophagus allowing air intake for esophageal voice, which provides better voice quality than esophageal speech. The document compares rehabilitation methods and provides details on performing primary and secondary tracheoesophageal puncture procedures.
The document discusses tumours of the larynx. It defines benign and malignant laryngeal tumours and describes common benign tumours like vocal nodules, vocal polyps, Reinke's edema, papillomas, and laryngoceles. It also discusses malignant tumours like squamous cell carcinoma. It provides details on the diagnosis, staging, and management of laryngeal cancer including surgery, radiotherapy, and chemotherapy. The document emphasizes that hoarseness is often the earliest symptom of glottic carcinoma and smoking is a major risk factor.
This document provides information about masking techniques used during audiometric testing. It defines masking and explains that the goal is to prevent the non-test ear from participating. Interaural attenuation values are discussed as well as when masking is needed for air and bone conduction tests. Types of masking noise, appropriate levels of noise, and risks of undermasking and overmasking are covered.
This document discusses benign tumours of the larynx. It divides them into non-neoplastic and neoplastic lesions. Non-neoplastic lesions include vocal nodules, vocal polyps, Reinke's edema, and contact ulcers which result from vocal abuse or trauma. Neoplastic lesions include papillomas, chondromas, haemangiomas, granular cell tumours, and rare glandular tumours. Many lesions present with hoarseness and are typically treated with surgical excision and voice therapy.
Congenital malformation of external ear and it’s managementYousuf Choudhury
This document discusses congenital malformations of the external ear. It begins with applied anatomy of the normal ear and embryology of ear development. It then describes various congenital deformities that can occur, including pre-auricular tags, prominent ears, cryptotia, microtia, and congenital aural atresia. For treatment, options include observation, prosthetics, reconstruction with rib cartilage grafts, and surgical correction of atresia. Reconstruction is often done in multiple stages to form the shape of the pinna.
This document discusses voice disorders and their diagnosis and treatment. It covers the basics of normal voice production and the glottal cycle. Key aspects of stroboscopic examination are described, including amplitude of vibration, mucosal wave, symmetry, periodicity, and glottic closure patterns. Common voice disorders like tension dysphonia, laryngitis, vocal nodules, and vocal fold paralysis are mentioned. The document emphasizes taking a thorough history and examining the oral cavity, larynx, breathing, and voice quality during diagnosis of voice disorders. Stroboscopy aids in detecting subtle vocal fold abnormalities. Voice hygiene and lifestyle modifications are important aspects of treatment.
This document discusses various voice disorders including dysphonia, dysarthria, dysarthrophonia, and hoarseness. It describes the main causes of voice disorders as inflammatory, neoplastic/structural, neuromuscular, and muscle tension imbalance. Treatment options discussed include vocal hygiene and lifestyle advice, voice therapy, medical treatment such as for acid reflux, phonosurgery procedures, and in some cases Botulinum toxin injections. Specific voice disorders covered in detail include vocal fold polyps, nodules, Reinke's edema, and muscle tension dysphonia.
Tinnitus retraining therapy (TRT) is a treatment for tinnitus that involves counseling and sound therapy to retrain connections between the auditory, limbic, and autonomic nervous systems. It categorizes patients based on factors like hearing loss and sound sensitivity and prescribes different sound therapy devices at appropriate levels. Counseling teaches patients about tinnitus mechanisms and helps reduce reactions. Studies show TRT improves tinnitus handicap in 78-96% of patients after 8-18 months of treatment.
This document provides information on laryngeal cancer including:
- Epidemiology statistics showing it represents 2.63% of cancers in India and predominantly affects males aged 40-70 years.
- Main risk factors are smoking tobacco and alcohol consumption.
- Details the anatomy, embryology, barriers to spread, and subtypes of laryngeal cancer including supraglottic, glottic, subglottic, and transglottic.
- Discusses the pathology, signs and symptoms, diagnostic tests including imaging, and TNM staging system for laryngeal cancer.
This document discusses various types of phonosurgery procedures. Phonosurgery aims to improve or restore the voice and includes microlaryngeal surgery, injection laryngoplasty, and laryngeal framework surgery. Microlaryngeal surgery allows for fine manipulation of the vocal folds using a microscope. Common procedures discussed include treating vocal nodules, polyps, Reinke's edema, and papillomas using precision excision or laser techniques to preserve vocal fold function. Injection laryngoplasty can be used to medialize an adductor cord in cases of paralysis or paresis.
This document summarizes a seminar on cancer of the larynx presented by Dr. Yousuf F. Choudhury. It begins with an overview of the surgical anatomy and vascular supply of the larynx. It then discusses the different subtypes, risk factors, presentations, diagnosis, staging, and management principles for laryngeal cancer. In particular, it compares the advantages and disadvantages of different treatment modalities for early and advanced laryngeal cancer such as radiotherapy, surgery, and chemoradiotherapy.
This document describes a case of carcinoma of the larynx in a 65-year-old male patient who presented with hoarseness of voice for 6 months and breathing difficulty for 2 weeks. Examination revealed a growth on the left vocal cord. The patient underwent an emergency tracheostomy followed by a total laryngectomy and biopsy, which showed well-differentiated squamous cell carcinoma. The patient recovered well post-operatively and was discharged on adjuvant radiotherapy and voice rehabilitation.
This document discusses tumors of the hypopharynx, including both benign and malignant tumors. It notes that malignant tumors are more common, especially squamous cell carcinomas. The three main subsites that can be affected are the pyriform sinus (60% of cases), postcricoid region (30% of cases), and posterior pharyngeal wall (10% of cases). For each subsite, it describes characteristics like prevalence, spread patterns, clinical features, diagnosis, and treatment options.
This document discusses vocal cord paralysis, including:
1. It reviews the anatomy of the vocal cords and their innervation.
2. It outlines the various etiologies of vocal cord paralysis including neurological, tumor infiltration, systemic disease, medications, trauma, and idiopathic causes. Surgical procedures are a common traumatic cause.
3. It describes the evaluation of a patient with vocal cord paralysis including history, physical exam, imaging, and laryngeal electromyography to determine the location and cause of the paralysis.
- Lymphatic drainage of the larynx depends on the subsite, with the supraglottis draining to levels II and III, the anterior glottis and subglottis draining to levels VI and IV, and the posterior glottis and subglottis draining to levels VI and IV.
- Laryngeal cancer accounts for 2.63% of cancers in Asia and predominantly affects males between 40-70 years of age. Major risk factors include alcohol, smoking, HPV infection, prior radiation exposure, and certain occupations.
- Treatment depends on tumor stage, location, and patient fitness. Early glottic cancer is often treated with transoral laser resection or radiation while
CA larynx Presentation - diag. & treatmentShubham Yadav
This document discusses laryngeal cancer, including:
- Types are mostly squamous cell carcinoma, with some other rare types. Glottic cancer is most common.
- Symptoms depend on location - glottic causes hoarseness, supraglottic causes throat pain and dysphagia, subglottic causes stridor.
- Staging involves examination, imaging, and considers tumor size and spread. Treatment options include radiation, surgery like laryngectomy, and rehabilitation techniques after total laryngectomy like oesophageal speech.
Recent Advances in Management of Laryngeal Cancer
The document discusses the anatomy, embryology, risk factors, diagnosis and staging of laryngeal cancer. It provides details on the different subsites of laryngeal cancer including glottic, supraglottic and subglottic cancers. Treatment options including radiation therapy and various surgical procedures are summarized depending on the stage and site of the tumor. Early stage cancers can often be managed with endoscopic resection while more advanced stages may require open partial laryngectomy or chemoradiation. Ongoing research focuses on optical imaging techniques to detect early cancers.
Laryngeal malignancies are the most common head and neck cancers in adults. They account for 25% of head and neck cancers and 1% of all cancers. The peak age is 55-65 years old with males being affected 7 times more than females. The main risk factors are smoking and smoking combined with alcohol.
Treatment depends on the subsite and stage of the cancer. Early glottic cancers may be treated with radiation or surgery while advanced cancers require total laryngectomy. Surgery, radiation, chemotherapy, and rehabilitation are used to cure cancers while palliative care aims to relieve symptoms for late-stage disease. Voice rehabilitation after laryngectomy can involve esophageal speech, electrolarynx, or trache
The document discusses management of oropharyngeal cancers. The oropharynx includes areas like the base of the tongue, soft palate, tonsils and posterior pharyngeal walls. Oropharyngeal cancers commonly spread to cervical lymph nodes in levels II, III and IV. Risk factors include age, gender, smoking, alcohol and HPV infection. Treatment may involve surgery, radiation therapy or chemotherapy depending on the stage of cancer. Imaging tests like CT, MRI and PET scans are used to stage the cancer and detect metastases.
Management of supraglottic and glottic larynx cancer has been revised lately. This presentation gives an overview of guidelines for management of laryngeal cancer. includes latest NCCN guidelines.
This document provides information about pharyngeal cancers, including nasopharyngeal carcinoma, oropharyngeal cancer, and hypopharyngeal carcinoma. It discusses the relevant anatomy, risk factors, signs and symptoms, diagnostic tests, staging, treatment options including radiation, chemotherapy, and surgery, as well as reconstruction techniques and prognosis. The surgical approaches covered include transoral, transcervical, mandibular swing, and others. Reconstruction options like skin grafts, flaps, and free tissue transfer are also summarized.
Laryngeal cancer occurs when malignant cells form in the larynx and grow uncontrollably. Squamous cell carcinoma is the most common form. Key risk factors include smoking and alcohol consumption. A team of specialists is involved in diagnosing and staging the cancer, and developing a treatment plan. This multidisciplinary team may include ENT surgeons, oncologists, radiologists, speech therapists and others to help address all aspects of care for the patient.
Malignancies of the larynx are most commonly squamous cell carcinomas. They are staged based on tumor size, location within the larynx, and spread to lymph nodes. Treatment depends on the stage and location of the tumor. Early vocal cord lesions are often treated with radiation therapy alone. Moderately advanced tumors may be treated with either radiation or total laryngectomy. Advanced tumors usually require total laryngectomy along with neck dissection and adjuvant treatment. The goal is cure while preserving laryngeal function when possible.
laryngeal malignancies, laryngeal cancer
Presentation prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
1. Carcinoma of the larynx is most commonly squamous cell carcinoma, usually caused by smoking and alcohol consumption. It can occur in the supraglottis, glottis, or subglottis regions.
2. Diagnosis involves laryngoscopy, CT/MRI imaging, and biopsy of visible lesions. Staging uses the TNM system and determines treatment approach and prognosis.
3. Treatment depends on stage but may include surgery such as laryngectomy, radiation therapy alone or with chemotherapy for advanced stages, or organ preservation with radiation/chemoradiation for early stages. The goal is cure of the cancer or organ function preservation.
larynx anatomy, radiology and diagnostic work up.pptxRenuSingh171087
This document provides an overview of larynx anatomy, divisions of the larynx, laryngeal cartilages, spaces in the larynx, blood supply, nerve supply, lymphatics, epidemiology, clinical presentation of laryngeal cancers depending on location (supraglottic, glottic, subglottic), routes of spread, examination techniques including indirect laryngoscopy, direct laryngoscopy, microlaryngoscopy, and diagnostic imaging modalities like CT, MRI, and PET scan used for laryngeal cancer staging and treatment assessment.
INTRODUCTION: Laryngeal cancer is a rare cancer in which malignant cells grow in the larynx, or voice box. Smoking tobacco and drinking alcohol are the main risk factors for laryngeal cancer.
DEFINITION: Laryngeal cancer is a tumor that develops in the larynx, or voice box.
CAUSES: The exact cause of laryngeal cancer is idiopathic (unknown).
RISKS FACTORS
• Smoking: It is the most significant risk factor for laryngeal cancer.
• Moderate or heavy alcohol consumption
• Gender: being male, as men are four times more likely to develop laryngeal cancer than women
• Age: Laryngeal cancer happens more in people age 55 and older.
• Genetic factors
• Poor nutrition and vitamin deficiency
• Human papillomavirus (HPV)
• Previous history of head or neck cancer
• Exposure to certain chemicals in the workplace, such as paint fumes and some chemicals in metalworking
• Low immunity
CLASSIFICATION OF LARYNGEAL CANCER:
1. Supraglottic larynx cancer: Supraglottic carcinoma is cancer that starts in the supraglottis of the larynx. It is the second most common type of laryngeal cancer. (the area above the vocal cords)
2. Glottic larynx cancer: It is a malignancy of the larynx that involves the true vocal cords and anterior and posterior commissures. (the area that includes the vocal cords)
3. Subglottic larynx cancer: It is cancer that starts in the subglottis of the larynx. It is a very rare type of laryngeal cancer. (the area below the vocal cords)
STAGING OF LARYNGEAL CANCER
• Tumor (T): How large is the primary tumor? Where is it located?
• Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?
• Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?
Tumor (T): Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Tumor size is measured in centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil.
Tumors of the larynx
TX: The primary tumor cannot be evaluated.
INTRODUCTION: Laryngeal cancer is a rare cancer in which malignant cells grow in the larynx, or voice box. Smoking tobacco and drinking alcohol are the main risk factors for laryngeal cancer.
DEFINITION: Laryngeal cancer is a tumor that develops in the larynx, or voice box.
CAUSES: The exact cause of laryngeal cancer is idiopathic (unknown).
RISKS FACTORS
• Smoking: It is the most significant risk factor for laryngeal cancer.
• Moderate or heavy alcohol consumption
• Gender: being male, as men are four times more likely to develop laryngeal cancer than women
• Age: Laryngeal cancer happens more in people age 55 and older.
• Genetic factors
• Poor nutrition and vitamin deficiency
• Human papillomavirus (HPV)
• Previous history of head or neck cancer
• Exposure to certain chemicals in the workplace, such as paint fumes and some chemicals in metalworking
• Low immunity
CLASSIFICATION OF LARYNGEAL CANCER:
1. Supraglottic larynx cancer: Supraglottic carcinoma is cancer that starts in the supraglottis of the larynx. It is the second most common type of laryngeal cancer. (the area above the vocal cords)
2. Glottic larynx cancer: It is a malignancy of the larynx that involves the true vocal cords and anterior and posterior commissures. (the area that includes the vocal cords)
3. Subglottic larynx cancer: It is cancer that starts in the subglottis of the larynx. It is a very rare type of laryngeal cancer. (the area below the vocal cords)
STAGING OF LARYNGEAL CANCER
• Tumor (T): How large is the primary tumor? Where is it located?
• Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?
• Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?
Tumor (T): Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Tumor size is measured in centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil.
Tumors of the larynx
TX: The primary tumor cannot be evaluated.
Tis: This is a stage called carcinoma (cancer) in situ. It is a very early cancer where cancer cells are found in only 1 layer of tissue.
SIGNS AND SYMPTOMS OF LARYNGEAL CANCER
The symptoms of laryngeal cancer depend on the size and location of the tumour. Symptoms may include the following:
Hoarseness or other voice changes
A lump in the neck
A sore throat
Persistent cough
Stridor - a high-pitched wheezing sound indicative of a narrowed or obstructed airway
Bad breath
an abnormal lump in the throat or neck
difficulty or pain when swallowing
frequently choking on food
difficult or noisy breathing
persistent ear pain or an unusual sensation in and around the skin of the ear
unplanned, significant weight loss
persistent bad breath
TREATMENT
There are different types of treatment for patients with laryngeal cancer.
Four types of standard treatment are used:
Radiation therapy
This document discusses laryngeal malignancies (cancers). It begins by describing the different subsites of the larynx that can be affected. It then provides an overview, stating that laryngeal cancer is the most common head and neck malignancy in adults, accounting for 25% of head and neck cancers. Risk factors include tobacco, alcohol, radiation exposure, and HPV infection. The TNM classification system for staging laryngeal cancer is described. Treatment options are also summarized, including surgery, radiation therapy, chemotherapy, and palliative care. Vocal rehabilitation methods after laryngectomy such as esophageal speech and electrolarynx are briefly outlined.
The document discusses tumors of the pharynx, including anatomy, histology, risk factors, types, diagnosis, staging, and treatment. The pharynx is divided into nasopharynx, oropharynx, and hypopharynx. Common pharyngeal cancers include squamous cell carcinoma and nasopharyngeal carcinoma. Risk factors include smoking, alcohol, radiation exposure, and viruses. Diagnosis involves medical history, examination, and imaging tests. Treatment depends on cancer type and stage but may include surgery, radiation therapy, or chemoradiation.
The document discusses tumors of the pharynx, including anatomy, histology, risk factors, types, diagnosis, staging, and treatment. The pharynx is divided into nasopharynx, oropharynx, and hypopharynx. Common pharyngeal cancers include squamous cell carcinoma and nasopharyngeal carcinoma. Risk factors include smoking, alcohol, radiation exposure, and viruses. Diagnosis involves medical history, examination, and imaging tests. Treatment depends on cancer type and stage but may include surgery, radiation therapy, or chemoradiation.
Laryngeal malignancy is common in males than females especially due to smoking and drinking habits.
More than three weeks of hoarseness in an adult male who smokes or drinks alcohol should be suspicious of malignancy unless otherwise proven.
Commonest presentation of laryngeal carcinoma of supraglottic larynx is throat pain or discomfort and neck swelling, that of glottic is hoarseness and that of subglottic is stridor as this is the narrowest part of the larynx.
1. The document discusses the anatomy, staging, and gross examination procedure for laryngectomy specimens.
2. It describes the three regions of the larynx - supraglottis, glottis, and subglottis - and notes that tumor location impacts lymphatic spread and symptoms.
3. The gross examination procedure involves examining resection margins, identifying tumor location and extent, and slicing the specimen to assess depth of invasion.
This document discusses the staging and treatment of cancer of the larynx. It begins by outlining the staging of tumors (T1-T4) and corresponding treatment options, which may include radiation therapy, laser excision, or chemotherapy with radiation. For advanced cancers involving cartilage or more than one region of the larynx, a total laryngectomy may be required. Neoadjuvant chemotherapy can help reduce tumor size to make surgery easier but does not improve prognosis. The document then covers the epidemiology, risk factors, anatomy, pathology, clinical evaluation, and management considerations for the neck lymph nodes depending on whether the cancer is early or advanced stage and located in the supraglottis, glottis, or
The mediastinum is the region within the chest between the lungs containing the heart and other thoracic organs. It is divided into superior, anterior, middle and posterior compartments. Common tumors of the mediastinum include thymomas in the anterior-superior compartment, lymphomas throughout and neurogenic tumors in the posterior compartment. Thymomas are often asymptomatic but can cause chest pain, dyspnea and superior vena cava obstruction. Diagnosis is made through imaging like CT and biopsy. Treatment is surgical resection with chemotherapy or radiation for advanced stages. Retrosternal goiters are usually secondary extensions from the neck but can also be primary. They may cause compressive symptoms and require surgical removal.
Day surgery offers advantages for both patients and healthcare providers by reducing disruption and costs compared to overnight stays. Success requires efficient coordination across admission, the procedure itself, recovery, and safe discharge within 12 hours. Selection criteria evaluate medical fitness, social support, and whether the planned procedure is suitable for day surgery. Preoperative assessment optimizes patient health while clear discharge standards ensure recovery before leaving. Common day surgery procedures involve areas like abdominal, breast, orthopedic, and vascular operations. Emergency minor cases can also sometimes be managed with same-day admission and discharge.
This document summarizes different types and causes of deafness. It discusses conductive hearing loss, which results from issues in the external ear, middle ear, or ear bones. Sensorineural hearing loss affects the inner ear or auditory nerve. Mixed hearing loss has both conductive and sensorineural components. Common causes of sensorineural hearing loss include genetic factors, noise exposure, certain medications, autoimmune disorders, sudden hearing loss, presbycusis, and nonorganic hearing loss. The document also covers deafness in children, which can have prenatal, perinatal, or postnatal causes such as genetic anomalies, infections, complications of prematurity, birth injuries, or postnatal illnesses/medications. Assessment methods like
This document defines communication and describes the communication cycle. Communication requires a sender and receiver. It is effective when the receiver understands the intended message. The communication cycle involves the sender encoding a message, sending it through a channel, the receiver decoding it, and providing feedback. There can be channel noise or semantic noise that interferes with understanding. Different types of communication include general, technical, intrapersonal, interpersonal, and mass communication.
This document summarizes the fascial spaces and layers of the neck. It describes three layers of deep cervical fascia: the superficial layer invests muscles and structures of the neck, the middle layer encircles the trachea, thyroid and esophagus, and the deep layer arises from ligaments and vertebrae, splitting to enclose posterior neck muscles. It also describes several potential spaces in the neck, including the submental, submandibular, parapharyngeal, retropharyngeal, pretracheal and perivertebral spaces, noting boundaries, contents and clinical significance of each.
The inner ear, or labyrinth, consists of the bony labyrinth surrounded by the membranous labyrinth. The bony labyrinth contains three parts - the vestibule, semicircular canals, and cochlea. The membranous labyrinth sits within the bony labyrinth and contains the cochlear duct, utricle, saccule, three semicircular ducts, and endolymphatic duct. There are two fluids in the inner ear - perilymph, which is similar to cerebrospinal fluid, and endolymph, which is high in potassium and helps stimulate nerves for hearing and balance.
The document summarizes the physiology of smell and the mucociliary blanket of the nose and paranasal sinuses. It describes the main functions of the nose including respiration, air conditioning, protection of the lower airways via the mucociliary mechanism, vocal resonance, and olfaction. It then discusses the lining membranes of the nose, ciliary action, factors affecting cilia, enzymes and immunoglobulins in nasal secretions, sneezing, olfaction, disorders of smell, and methods of measuring smell. The mucociliary blanket transports mucus and debris out of the nose via ciliary beating and mucus flow, providing a key protective function of the nasal cavity. Olfactory receptors in the nose detect od
1. Surgery carries risks of complications that are increased in patients with preexisting medical conditions like diabetes, hypertension, ischemic heart disease, thyroid disease, and COPD.
2. Preoperative preparation and management of these conditions can reduce surgical risks, including optimizing glucose and blood pressure control, continuing medications, and addressing respiratory status.
3. Close monitoring of vital signs and medical conditions is important during and after surgery to prevent complications like heart issues, infections, and respiratory problems.
This document provides information about anatomy and functions of the throat (oral cavity, pharynx, larynx, salivary glands), as well as common symptoms, signs, and conditions that can affect the throat, including sore throat, abscesses, dysphonia, and stridor. It discusses the causes, symptoms, signs, and management of various throat conditions like peritonsillar abscess, Ludwig's angina, retropharyngeal abscess, parapharyngeal abscess, laryngitis, papillomas, and cancer of the larynx. Tracheostomy indications and techniques are also summarized.
- Malnutrition is common in 30-60% of hospitalized patients, especially those with prolonged stays or postoperative complications, and increases the risk of further complications and death.
- Nutritional assessment involves clinical evaluation of weight loss, lab tests like albumin and lymphocyte count, and anthropometric measurements like BMI, though these have limitations in critically ill patients.
- Nutritional support aims to meet caloric and protein needs through enteral or parenteral nutrition while avoiding overfeeding, with requirements varying based on patient condition and stress level.
The head and neck region receives most of its blood supply from the carotid and subclavian arteries. The common carotid arteries branch into the internal and external carotid arteries. The internal carotid arteries supply the brain while the external carotid arteries supply the neck and face. Venous drainage from the head and neck flows into the internal and external jugular veins and subclavian veins and returns blood to the heart.
The document provides an overview of surgical audit, which involves systematically reviewing surgical care against explicit criteria to improve quality. It discusses the aims of audit including improving patient care and education. The types of audit - structure, process, and outcome - are described. Structure looks at resources, process examines procedures, and outcome assesses results. The audit cycle is outlined as determining scope, selecting standards, collecting data, interpreting results, and taking appropriate action. Surgical audit is presented as an educational process aimed at continuous quality improvement to optimize patient outcomes.
Anatomy of Nose And Paranasal Sinuses - Copy.pptxHtet Ko
The document provides an overview of the anatomy of the nose and paranasal sinuses. It describes the development of the nose from the frontonasal process. It then details the external structures of the nose including the bones and cartilages. It discusses the internal structures including the walls, roof, and floor of the nasal cavities. It also summarizes the blood supply, nerve supply, lymphatic and mucosal drainage of the nose. Finally, it provides details on each of the four paranasal sinuses including their locations, relations to surrounding structures, and functions.
The nose and paranasal sinuses develop from the frontonasal process. The nose has external and internal structures. Externally, cartilage and bone provide structure, while internally the nasal cavities contain three turbinates and three meatuses on each side. The paranasal sinuses include the frontal, ethmoid, maxillary, and sphenoid sinuses. The sinuses are lined with ciliated respiratory epithelium and contain ostia that drain into the nasal cavities. The nose and sinuses receive blood supply from the external and internal carotid arteries and are innervated by branches of the trigeminal and facial nerves. Lymphatic drainage occurs to local cervical nodes.
The oral cavity and oropharynx are described in detail. The oral cavity extends from the lips to the oropharyngeal isthmus and includes structures like the cheeks, gums, hard palate, oral tongue, and floor of mouth. The oropharynx is behind the soft palate and serves as a passageway for food and air. It includes the base of tongue, palatine tonsils, soft palate, and pharyngeal wall. Both areas have detailed descriptions of anatomy, blood supply, nerve supply, lymphatic drainage and functions.
The inner ear consists of the bony labyrinth surrounded by fluid-filled membranous labyrinth containing the cochlea, vestibule and semicircular canals. The cochlea contains the organ of Corti which is the sensory organ for hearing and consists of hair cells. The vestibule and semicircular canals contain maculae and cristae which are sensory organs for balance. The inner ear develops from the otic placode and is complete by 16 weeks of gestation. The vestibulocochlear nerve transmits signals from the inner ear hair cells and sensory epithelia.
The lateral wall of the nose contains three bony projections called conchae or turbinates that increase the surface area for air conditioning. The lateral wall is formed by bones, cartilages, and soft tissues and separates the nose from the ethmoid sinuses above and the maxillary sinus below. The osteomeatal complex is an important drainage pathway consisting of the maxillary sinus ostium, ethmoid infundibulum, middle meatus, ethmoid bulla, and uncinate process. It drains the frontal and maxillary sinuses and anterior ethmoid cells. The lateral wall receives blood supply from the internal and external carotid arteries and drains venously and lymphatically. Sensation is provided by
Anatomy of Nasopharynx and Eustachian Tube.pptxHtet Ko
The nasopharynx connects the nasal cavity to the oropharynx. It contains openings for the eustachian tubes and is lined with lymphoid tissue including the adenoids. The eustachian tubes connect the middle ears to the nasopharynx and equalize pressure on both sides of the eardrum. They open during swallowing and yawning due to the action of surrounding muscles to ventilate the middle ear. Dysfunction of the eustachian tubes can lead to problems like ear infections or pressure differences across the eardrum.
The organ of Corti is located in the cochlea between the scala tympani and scala media. It is the sensory organ for hearing and contains hair cells that transduce sound vibrations into nerve impulses. The organ of Corti sits on the basilar membrane and contains three key cell types - inner and outer hair cells that detect sound, and supporting cells that provide structure. Inner hair cells transmit signals to the brain while outer hair cells modulate their function. Together, movement of the basilar membrane causes the hair cells to bend, opening ion channels and generating nerve impulses that are transmitted to the brain for interpretation as sound. The unique ion composition within the cochlea, maintained by
Wound healing involves three phases - inflammatory, proliferative, and remodeling. Factors like wound classification, morphology, and healing intention (primary vs secondary) determine the healing process. General factors like nutrition, immunity, and associated diseases as well as local factors like site, contamination, and tension affect wound healing. Complications include infection, breakdown, hernia, and abnormal scarring. The principles of wound management are to clean contaminated wounds and close primarily when possible to promote rapid healing with minimal scarring.
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Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
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A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
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3. Etiology
Smoking
• The incidence of laryngeal tumors is closely
correlated with smoking, as head and neck
tumors occur 6 times more often among
cigarette smokers than among
nonsmokers.
.
4. Etiology
Alcohol
• Although alcohol is a less potent
carcinogen than tobacco, alcohol
consumption is a risk factor for laryngeal
tumors.
• In individuals who use both tobacco and
alcohol, these risk factors appear to be
synergistic, and they result in a
multiplicative increase in the risk of
developing laryngeal cancer.
5. Other Risk Factors
• Previous history of head and neck
irradiation
• Chronic Gastric Reflux
• Occupational exposures
• Human Papilloma Virus 16 &18
6. Sex & Age Incidence
• The male-to-female ratio in patients with
laryngeal cancer was 5:1.
• Laryngeal cancer most commonly affects
men middle-aged or older. The peak
incidence is in those aged 50-60 years.
7. Subtypes of Ca larynx
• Glottic Cancer: 59%
• Supraglottic Cancer: 40%
• Subglottic Cancer: 1%
• Most subglottic masses are extension from
glottic carcinomas
8. Histological Types
85-95% of laryngeal tumors are
squamous cell carcinoma.
Cordal lesions are often well-differentiated
SCC while supraglottic lesions are usually
anaplastic.
11. The supraglottic larynx
• It consists of
epiglottis, false vocal
cords, ventricles,
aryepiglottic folds,
and arytenoids
12. The glottic larynx
• It consists of the true
vocal cords and
anterior commissure
and the posterior
commissure
13. The subglottic larynx
• It consists of the
region between the
true vocal cords
and lower border of
cricoid cartilage.
14. Pre-epiglottic space & Para-glottic space
• Pre-epiglottic space
Anterior : thyrohyoid membrane
& thyroid cartilage
Posterior: : epiglottis elastic
cartilage
Inferior : Petiole attachment to
thyroid cartilage
• Paraglottic space
quadrangular membrane inferiorly
conus elasticus anteriorly and
medially
thyroid cartilage laterally Myers: Laryngoscope, Volume 106(5).May 1996.559-567
Cummings: otolaryngology, 4th ed- 2005 - Mosby, Inc.
15. Staging: Primary Tumor of Larynx (T)
Tx Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
16. Staging (T) : Supraglottis CA
T1 Tumor limited to one subsite of the supraglottis with normal vocal
cord mobility
T2 Tumor invades mucosa of more than one adjacent subsite of the
supraglottis or glottis or region outside the supraglottis (eg. mucosa
of base of tongue, vallecula, medial wall of pyriform sinus)without
fixation of the larynx
T3 Tumor limited to the larynx with vocal cord fixation and/or invades any
of the following: postcricoid area, pre-epiglottic tissues, paraglottic
space and/or minor thyroid cartilage invasion
T4a Tumor invades through thyroid cartilage and/or invades tissues
beyond the larynx ( eg. Trachea, soft tissues of neck including deep
extrinsic muscles of tongue , strap muscles , thyroid or oesophagus)
T4b Tumor invades prevertebral space, encases carotid artery or
invades mediastinal structures
17. Staging (T) : Glottis CA
T1 Tumor limited to vocal cord(s) (may involve anterior or posterior
commisures) with normal mobility
T1a Tumor limited to one vocal cord
T1b Tumor involves both vocal cords
T2 Tumor extends to supraglottis and / or subglottis , and /or with
impaired vocal cord morbility
T3 Tumor limited to the larynx with vocal cord fixation and/or invades
paraglottis space and / or minor thyroid cartilage erosion
T4a Tumor invades through thyroid cartilage and/or invades tissues
beyond the larynx ( eg. Trachea, soft tissues of neck including deep
extrinsic muscles of tongue , strap muscles , thyroid or oesophagus)
T4b Tumor invades prevertebral space, encases carotid artery or
invades mediastinal structures
18. Staging (T) : Subglottis CA
T1 Tumor limited to the subglottis
T2 Tumor extends to vocal cord(s) with normal or impaired mobility
T3 Tumor limited to the larynx with vocal cord fixation
T4a Tumor invades cricoid or thyroid cartilage and/or invades tissues
beyond the larynx ( eg. Trachea, soft tissues of neck including deep
extrinsic muscles of tongue , strap muscles , thyroid or oesophagus)
T4b Tumor invades prevertebral space, encases carotid artery or
invades mediastinal structures
19. Staging (N) : Regional Lymph Nodes
N0 No cervical lymph nodes positive
N1 Single ipsilateral lymph node ≤ 3cm
N2a Single ipsilateral node > 3cm and ≤6cm
N2b Multiple ipsilateral lymph nodes, each ≤
6cm
N2c Bilateral or contralateral lymph nodes, each
≤6cm
N3 Single or multiple lymph nodes > 6cm
21. Stage Grouping
0 Tis N0 M0
I T1 N0 M0
II T2 N0 M0
III T3 N0 M0
T1 N1 M0
T2 N1 M0
T3 N1 M0
IV A T4a N0 M0
T4a N1 M0
T1 N2 M0
T2 N2 M0
T3 N2 M0
T4a N2 M0
IV B T4b Any N M0
Any T N3 M0
IV C Any T Any N M1
22. Supraglottic carcinomas
• Supraglottis cancer is less frequent than glottic cancer.
• The epiglottis is the most frequent location for cancers
that arise in the supraglottic larynx. These lesions are
often exophytic and circumferential masses. They can
extend into pre-epiglottis space and penetrate thyroid
cartilage.
• Growth from aryepiglottic fold, false cords and ventricle
can extend to paraglottic space and to true vocal cords.
And this may lead to fixation of supraglottic larynx.
23. Supraglottic carcinomas
• Nodal metastasis occur early. Upper and middle jugular
nodes are often involved. Bilateral nodal metastasis is
seen in cases of epiglottic cancer
• Supraglottic growth are often silent in symptoms in early
stage.
• Presenting symptoms may be throat pain, dysphagia
and referred ear pain and cervical lymphadenopathy..
• Hoarseness and stridor are late symptoms.
24. Glottic carcinomas
• The true vocal cords are the most common site of
laryngeal carcinomas.
• Free edge and upper surface of vocal cord in its
anterior and middle third are the most frequent sites
of glottic carcinomas.
• Anteriorly, the tumor may extend to anterior commissure,
where it may involve the contralateral true vocal cord.
25. Glottic carcinomas
• There are few lymphatics in true vocal cords.
• So lymphatic metastasis is practically rarely seen in
confined cordal lesions , unless the disease spreads
beyond the region of true vocal cords.
• The incidence of lymph node metastasis in T1 lesions is
2%. It increases to 20% in T3 and T4 lesions.
• Hoarseness is an early symptom and thus glottic cancers
can be detected early. Increase in size of glottic cancers
may cause stridor and laryngeal obstruction.
26. Subglottic carcinomas
• Subglottic carcinomas are rare and account for only 1 -2%
of all laryngeal carcinomas.
• Subglottic tumors are characteristically circumferential and
often extend to involve the undersurface of the true vocal
cords .
• Subglottic growth can invade the cricoid cartilage and
extends through the cricothyroid membrane, thyroid
cartilage and strap muscles of neck.
• Lymphatic metastasis go to prelaryngeal , pretracheal ,
paratracheal and lower jugular nodes.
27. Subglottic carcinomas
• The presentation symptom of subglottic carcinoma
may be stridor or laryngeal obstruction but it is
often late.
• Hoarseness of voice is not an early symptom.
• Hoarseness usually indicates that there is spread
of tumor to undersurface of vocal cords , infiltration
of thyroarytenoid muscle or involvement of
recurrent laryngeal nerve at the cricoarytenoid
joint.
28. Diagnosis of Laryngeal Cancers
Detection of presenting Symtoms
Hoarseness
• Most common symptom
• Small irregularities in the vocal fold result in
voice changes
any patient in cancer age group having
persistent or gradually increasing
hoarseness of voice for 3 weeks must
have laryngeal examination to exclude
cancer.
29. • Other symptoms include:
Stridor or laryngeal obstruction
Dysphagia
Hemoptysis
Throat pain
Ear pain
Aspiration
Neck mass
30. (IDL ) or (MPL) or Flexible Laryngoscopy
Examination to detect :
1. Appearance of lesion:
. Vocal cord lesion :
raised nodule or ulcer or thickening
lesions
.Supraglottic/ subglottic lesion :
fungating growth or exophytic or
ulcerative growth
2. Vocal cord mobility
3. Extent of disease
31.
32. Examination of neck
• Proper neck examination for cervical lymphadenopathy
(size, neck node level, numbers, mobility , fixation
and unilateral/ bilateral/ contralaterl) is essential.
• Awareness of midline swelling is needed as growth of
anterior commissure and subglottic growth can spread
through cricothyroid membrane and may produce a
midline neck swelling.
• Restricted laryngeal crepitus may be a sign of post
cricoid or retropharyngeal invasion
33. Radiographic examinations
• X-ray Chest : essential for co-existent lung disease /
pulmonary metastasis / mediastinal nodes
• Lateral neck X-ray: destruction of thyroid cartilage / soft
tissue mass may be seen
• CT scan :
very useful to find extent of tumor, invasion of pre- epiglottic
or paraglottid space , destruction of cartilage and lymph
node involvement
important for staging of laryngeal carcinomas
34. Direct Laryngoscopy and Biopsy
• Biopsy is essential for diagnosis
• Performed in operation theatre with patient
under anesthesia
35. Management of Laryngeal carcinomas
Curative Treatment
Radiotherapy ( organ preservation) with or
without chemotherapy
Surgery : (a) conservative laryngeal surgery
: (b) total laryngectomy
Combined : surgery with postoperative
radiotherapy or chemoradiotherapy
36. Management of Laryngeal carcinomas
Palliative treatment
tracheostomy
palliative surgery
palliative radiotherapy and chemotherapy
general palliative care :
pain control , symptom control and
nutritional support
37. Curative Radiotherapy
• It is used for early stages of ca larynx with normal
vocal cord mobility, or no invasion of cartilage, or no
cervical lymph node metastasis.
• It has a significant advantage of functional
preservation of voice.
• Glottic cancers with normal cord mobility gives 90%
cure rate after radiotherapy.
• Superficial exophytic lesions especially at epiglottic and
AE fold give 70-90% cure rate.
38. Surgery
• Radiotherapy does not give good results in
lesions with fixed cords, subglottic extension ,
cartilage invasion and lymphatic nodal
metastasis. These conditions require surgery.
conservative laryngeal surgery
total laryngectomy with or without neck
dissection
39. Conservative Surgery Types
Cordectomy via laryngofissure
( excision of vocal cord after splitting larynx)
Partial frontolateral laryngectomy
(excision of vocal cord and anterior commisure region)
Partial horizontal laryngectomy/ supraglottic laryngectomy
(excision of supraglottis including epiglottis, AE folds,
false cords and ventricle)
40. Total laryngectomy
The entire larynx including hyoid bone,thyroid and cricoid
cartilages , pre-epiglottic space, strap muscles ,proximal trachea
and ipsilateral thyroid lobe or both thyroid lobes are removed. .
Pharyngeal wall is repaired and lower tracheal stump sutured to
the skin.
It is indicated in conditions as :
• T3 and T4 lesions of ca larynx
• Tumor invasion to thyroid or cricoid cartilage
• Transglottic cancers : tumor involving supraglottis , glottis and
subglottis
• Treatment failure after radiotherapy or conservative surgery
Total laryngectomy is contraindicated in patients with distant
mestastasis
41. Management Options for Glottic Ca
Glottic carcinoma T1 :
Radiotherapy is the treatment of choice.
Excision of cord by CO2 laser can also be useful.
Glottic ca T2N0 :
Radiotherapy gives good result.
But if disease recurs, total laryngectomy is preferred.
Glottic ca T3 &T4:
It is best treated by total laryngectomy.
If cervical lymph node metastasis is palpable , total
laryngectomy may be combined with neck dissection.
Post-operative radiotherapy is used after total layrngectomy.
42. Management Options for Supraglottic Ca
T1 lesion : It responds well to radiotherapy.
It can also be excised with CO2 laser.
T2 lesion : It can be treated by supraglottic
laryngectomy if lung function is good.
Curative radiotherapy can also be used.
T3&T4 lesion : requires total laryngectomy with or
without neck dissection and
postoperative radiotherapy.
43. Management Options for Subglottic ca
• Early lesion T1 &T2 can be treated by curative
radiotherapy.
• T3&T4 lesions require total laryngectomy with or
without neck dissection and postoperative
radiotherapy.
44. Voice rehabilitation after total laryngectomy
• Oesophageal Speech
• Tracheo-oesophageal
speech
• Electrolarynx
45. Conclusion
• The prognosis for small laryngeal cancers that do not
have lymph node metastasis (which mean early
detected Ca) is good, with cure rates of 75-95%.
• Advanced disease has a worse prognosis.
• Supraglottic cancers usually manifest late and have a
poorer prognosis.
• Preoperative Informed Consent of consequences,
complications and rehabilitation is essential to
patients who are selected for total laryngectomy.