4 laryngeal disorders

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4 laryngeal disorders

  1. 1. Laryngeal Disorders Aiyun jiang
  2. 2. Laryngeal Disorders <ul><li>*Acute epiglottitis </li></ul><ul><li>Acute laryngitis </li></ul><ul><li>*Acute laryngitis in children </li></ul><ul><li>Chronic laryngitis, vocal polyp, vocal nodules </li></ul><ul><li>Paralysis of vocal fold </li></ul><ul><li>Laryngeal papilloma </li></ul><ul><li>Laryngeal carcinoma </li></ul>
  3. 3. . <ul><li>Acute epiglottitis </li></ul>
  4. 4. Case study <ul><li>Male, 42, businessman , </li></ul><ul><li>Comlain : severe sore throat with a low fever for 10 </li></ul><ul><li>hours. </li></ul><ul><li>History: 10 hours ago the patient felt a slight pain in his </li></ul><ul><li>larynx, and the pain became severe rapidly that </li></ul><ul><li>he daren’t swallow. He has a slight fever and fells </li></ul><ul><li>fatigue. 2 hours ago he felt it difficult to breath in. </li></ul><ul><li>Examination: stridor, retraction of supraclavicular and </li></ul><ul><ul><li>intercostal spaces , inspiratory d yspnea; Cyanos ;the epiglottis becomes hyperemia and swelling ”,and looks like a ball </li></ul></ul><ul><ul><li>Question: (1)what’s the diagnosis? </li></ul></ul><ul><ul><li>(2) How to treat the patient? </li></ul></ul>
  5. 5. Acute epiglottitis <ul><li>Acute epilgottitis is a most dangerous condition . It is characterized by the abrupt onset of rapidly progressive respiratory obstruction due to a swollen, cherry-red epiglottis. Complete airway obstruction may occur in a few hours and cause death. </li></ul><ul><li>Definition: </li></ul><ul><ul><li>it is a localized inflammation of the supraglottic larynx ,usually involve the mucous membranes of epiglottis. </li></ul></ul>
  6. 6. Etiology <ul><ul><li>Infection usually Haemophilus nfluenzae </li></ul></ul><ul><ul><li>allergic </li></ul></ul><ul><ul><li>others: trauma( physical or chemical), etc. </li></ul></ul>
  7. 7. pathology <ul><li>severe swelling of the epiglotic mucosa +/- phlegmon </li></ul><ul><li>3 pathologic types: </li></ul><ul><li>acute catarrh epiglottitis </li></ul><ul><ul><li>Only involve mucosa, diffuse hyperemia and swelling . The epiglottis becomes thicker than normal ones. </li></ul></ul><ul><li>acute edema epiglottitis </li></ul><ul><ul><li>usually for allergy; epiglottis becomes “ball-like”, and obstruct the laryngeal inlet for severity , causing laryngeal obstruction </li></ul></ul><ul><li>acute anabrotic epiglottitis </li></ul><ul><ul><li>Inflammation is severe in this condition.The underlayer of the mucosa and the glands are involved. may cause laryngeal obstruction </li></ul></ul>
  8. 8. Clinical manifestation <ul><li>general symptoms ( fever, fatigue, anorexia, etc. ) </li></ul><ul><li>Local symptoms: </li></ul><ul><ul><li>Rapid onset of a severe sore throat (worse on swallowing, ) the pain is so severe that the patient can’t swallow normally. Oral secretions increase and usually manifested as drooling. </li></ul></ul><ul><ul><li>Unclear speech: This kind of change is different from hoarseness caused by VC diseases. It sounds just like there is Sth in the patient’s mouth. </li></ul></ul><ul><ul><li>Dyspnea: stridor, retraction of supraclavicular and </li></ul></ul><ul><ul><li>intercostal spaces, difficult in inspiratory stage </li></ul></ul><ul><ul><li>( Dyspnea in asthma occurs in exspiratory stage) </li></ul></ul><ul><ul><li>Cyanosis or even death </li></ul></ul><ul><li>for child, </li></ul><ul><ul><li>usually severe and develop rapidly, </li></ul></ul><ul><ul><li>maybe life threatening </li></ul></ul>
  9. 9. Physical examination <ul><li>indirect or direct laryngoscopy : </li></ul><ul><ul><li>the epiglottis becomes hyperemia and swelling ; </li></ul></ul><ul><ul><li>maybe “ball-shape” or anabrotic ; </li></ul></ul><ul><ul><li>L aryn geal obstruction </li></ul></ul><ul><li>For child, laryngoscopy shouldn’t be admitted </li></ul><ul><li>lateral neck radiography --cherry-shaped epiglotti c swelling ( Thumb’s sign ) </li></ul>Induce laryngospasm
  10. 10. laryngoscopy Normal epiglottis Acute epiglottis : Hyperemia and swelling
  11. 11. X-ray - “Thumb’s sign”
  12. 12. Diagnosis and Differential D iagnosis <ul><li>Diagnosis: </li></ul><ul><li>indirect laryngoscopy important!!!!!!!!!!!! </li></ul><ul><li>according to typical history and clinical manifestation, a diagnosis of AE can be confirmed. Remember , if the patient has an abrupt onset of severe sore throat, Don’t simply make a diagnosis of acute tonsillitis or acute pharyngitis. Indirect laryngoscope must be performed to observe the epiglottis. Misdiagnosis of AE may delay proper and prom treatment and may cause death!! </li></ul><ul><li>Differential diagnosis </li></ul><ul><ul><li>foreign body in the larynx </li></ul></ul><ul><ul><li>laryngeal tuberculosis </li></ul></ul><ul><ul><li>laryngeal edema </li></ul></ul>
  13. 13. Treatment <ul><li>Once the diagnosis of AE is confirmed ,the patient must be hospitalized as an emergency measure because laryngeal obstruction may occur rapidly. </li></ul><ul><li>1 C losed monitoring </li></ul><ul><li>2 Antiinflammatory </li></ul><ul><ul><li>broad spectrum antibiotic </li></ul></ul><ul><ul><li>+/- systematic steriod </li></ul></ul><ul><li>3 Local treatment: </li></ul><ul><ul><li>Inhalation of ster io d </li></ul></ul><ul><ul><li>discission if necessary to maintain the airway unobstructed </li></ul></ul><ul><ul><li>tracheostomy if necessary </li></ul></ul><ul><ul><li>restlessness, stridor, cyanosis,and retraction of supraclavicular and intercostal spaces are indications of immediate tracheostomy </li></ul></ul>
  14. 14. Case study <ul><li>Male, 42, businessman , </li></ul><ul><li>Comlain : severe sore throat with a low fever for 10 </li></ul><ul><li>hours. </li></ul><ul><li>History: 10 hours ago the patient felt a slight pain in his </li></ul><ul><li>larynx, and the pain became severe rapidly that </li></ul><ul><li>he daren’t swallow. He has a slight fever and fells </li></ul><ul><li>fatigue. 2 hours ago he felt it difficult to breath in. </li></ul><ul><li>Examination: stridor, retraction of supraclavicular and </li></ul><ul><ul><li>intercostal spaces , inspiratory d yspnea; Cyanos ; the epiglottis becomes hyperemia and swelling ”,and looks like a ball </li></ul></ul><ul><ul><li>Question: (1)what’s the diagnosis? (AE) </li></ul></ul><ul><ul><li>(2) How to treat?( hospitalized, tracheostomy , </li></ul></ul><ul><ul><li>antibiotic, systematic steriod , inhalation of </li></ul></ul><ul><ul><li>steriod) </li></ul></ul>
  15. 15. Acute laryngitis
  16. 16. Case sdudy <ul><li>Female, 35, nurse </li></ul><ul><li>Complain: hoarseness for 3 days,aphonia for 2 hours. </li></ul><ul><li>History: 3 days ago the patient caught a “cold” </li></ul><ul><li>and became hoarse. She had nonproductive </li></ul><ul><li>cough and a tickling sensation in her larynx. </li></ul><ul><li>Two hours ago she shouted very loudly to </li></ul><ul><li>her naughty son and then lost her vioce </li></ul><ul><li>( aphonia ). </li></ul><ul><li>Physical examination: vocal fold s are congestive and swelling with stringy mucus between the cords </li></ul><ul><li>Question: (1)what’s the diagnosis? </li></ul><ul><ul><li>(2) How to treat the patient? </li></ul></ul>
  17. 17. definition <ul><li>acute catarrhal inflammation of the laryngeal mucosa </li></ul><ul><ul><li>usually a mild, self-limited inflammatory condition </li></ul></ul><ul><ul><li>often a manifestion of a more diffuse upper respiratory infection </li></ul></ul><ul><ul><li>More common in winter months </li></ul></ul>
  18. 18. etiology <ul><li>Infection </li></ul><ul><ul><li>the most common cause </li></ul></ul><ul><ul><li>almost always a virus upper respiratory infection, such as: influenza, common cold </li></ul></ul><ul><li>Bacterial invasion may be secondary . </li></ul><ul><li>Predisposed to by: </li></ul><ul><ul><li>vocal over-use. </li></ul></ul><ul><ul><li>smoking. </li></ul></ul><ul><ul><li>drinking of spirit. </li></ul></ul><ul><ul><li>irritant gas inhalation </li></ul></ul>
  19. 19. Clinical manifestation <ul><li>Symptoms </li></ul><ul><ul><li>H oarseness aphonia in severe case </li></ul></ul><ul><ul><li>cough, +/-fever </li></ul></ul><ul><ul><li>Throat pain, tenderness of the larynx </li></ul></ul><ul><ul><li>symptoms of a common cold for some case s </li></ul></ul><ul><li>Signs </li></ul><ul><ul><li>red ness and dry of the larynx, </li></ul></ul><ul><ul><li>vocal fold swelling with stringy mucus between the cords </li></ul></ul>
  20. 20. Acute laryngitis
  21. 21. diagnosis <ul><li>according to : </li></ul><ul><ul><li>the history </li></ul></ul><ul><ul><li>hoarseness </li></ul></ul><ul><ul><li>redness and edema of the mucosa of the vocal cord s . </li></ul></ul><ul><li>Throat culture </li></ul><ul><ul><li>rarely used, </li></ul></ul><ul><ul><li>only for prolong cases or in the face of a possible epidemic. </li></ul></ul><ul><ul><li>Differential diagnosis: hysteria </li></ul></ul>
  22. 22. treatment <ul><li>1 Total voice rest </li></ul><ul><ul><li>supreme i mportant </li></ul></ul><ul><ul><li>e ven whisper should be avoided. </li></ul></ul><ul><li>2 local treatment: Inhalations with steam </li></ul><ul><li>(steriod) </li></ul><ul><li>3 Anti inflammation </li></ul><ul><ul><li>antibiotics + steroid </li></ul></ul>
  23. 23. Case sdudy <ul><li>Female, 35, nurse </li></ul><ul><li>Complain: hoarseness for 3 days,aphonia for 2 hours. </li></ul><ul><li>History: 3 days ago the patient caught a “cold” </li></ul><ul><li>and became hoarse. She had nonproductive </li></ul><ul><li>cough and a tickling sensation in her larynx. </li></ul><ul><li>Two hours ago she shouted very loudly to </li></ul><ul><li>her naughty son and then lost her vioce </li></ul><ul><li>( aphonia ). </li></ul><ul><li>Physical examination: vocal fold s are congestive and swelling with stringy mucus between the cords </li></ul><ul><li>Question: (1)what’s the diagnosis? (AL) </li></ul><ul><ul><li>(2) How to treat?( voice rest , antibiotics + steroid , Inhalations with steam ) </li></ul></ul>
  24. 24. . <ul><li>Acute laryngitis in children </li></ul>
  25. 25. Case study <ul><li>Boy, 2, hoarseness, fever 16 hours. </li></ul><ul><li>History: The boy had a fever and hoarseness </li></ul><ul><li>for16 hours. His mother give him some </li></ul><ul><li>Chinese to take, but his condition wasn’t </li></ul><ul><li>improved. 2 hours ago it became even </li></ul><ul><li>worse. The patient had a barking and </li></ul><ul><li>dyspnea. </li></ul><ul><li>Physical examination: stridor, cyanosis, retraction of supraclavicular and intercostal spaces </li></ul><ul><li>Question: (1)what’s the diagnosis? </li></ul><ul><li>(2) How to treat the patient? </li></ul>
  26. 26. Acute laryngitis in children <ul><ul><li>Dyspnea usually happen , for: </li></ul></ul><ul><li>Anatomic factors </li></ul><ul><ul><li>narrow laryngeal cavity </li></ul></ul><ul><ul><li>soft cartilage </li></ul></ul><ul><ul><li>pultaceous connect tissue </li></ul></ul><ul><ul><li>richly supplied with lymphatic vessels </li></ul></ul><ul><li>Low cough reflex ability </li></ul><ul><ul><li>difficulty in eliminate the secretion </li></ul></ul><ul><li>the immature nerve system </li></ul><ul><ul><li>Laryngospasm happens easily </li></ul></ul><ul><li>the immature immune system </li></ul><ul><ul><li>Severe inflammation </li></ul></ul>
  27. 27. Clinical manifestation <ul><li>Symptoms: </li></ul><ul><ul><li>hoarseness; </li></ul></ul><ul><ul><li>barking cough </li></ul></ul><ul><ul><li>inspiratory dyspnea </li></ul></ul><ul><ul><li>s ymptoms of upper respiratory infection: fever, fatigue, et al </li></ul></ul><ul><li>Signs: </li></ul><ul><ul><li>laryngeal stridor </li></ul></ul><ul><ul><li>retraction of supraclavicular and intercostal spaces </li></ul></ul>
  28. 28. Acute laryngitis in children Acute laryngitis
  29. 29. diagnosis <ul><li>Differential diagnosis </li></ul><ul><ul><li>foreign body in larynx; </li></ul></ul><ul><ul><li>upper respiratory infection or bronchitis; </li></ul></ul><ul><ul><li>Laryngeal spasm; </li></ul></ul><ul><ul><li>laryngeal diphtheria </li></ul></ul>hoarseness barking cough laryngeal stridor dyspnea children consider the diagnosis confirm the diagnosis
  30. 30. treatment <ul><li>Should be treated as soon as possible!!!! </li></ul><ul><ul><li>Sufficient antibiotic, + systemic steroid for severe cases </li></ul></ul><ul><ul><li>Inhalations with steam (steroid + adrenaline) </li></ul></ul><ul><ul><li>Management of laryngeal obstruction: </li></ul></ul><ul><ul><li>stridor, cyanosis,and retraction of supraclavicular and intercostal spaces are indications of immediate tracheostomy </li></ul></ul><ul><li>Supporting therapy </li></ul><ul><ul><li>sedation, </li></ul></ul><ul><ul><li>be sure of water-electrolyte balance </li></ul></ul>
  31. 31. Case study <ul><li>Boy, 2, hoarseness, fever 16 hours. </li></ul><ul><li>History: The boy had a fever and hoarseness </li></ul><ul><li>for16 hours. His mother give him some </li></ul><ul><li>Chinese to take, but his condition wasn’t </li></ul><ul><li>improved. 2 hours ago it became even </li></ul><ul><li>worse. The patient had a barking and </li></ul><ul><li>dyspnea. </li></ul><ul><li>Physical examination: stridor, cyanosis, retraction of supraclavicular and intercostal spaces </li></ul><ul><li>Question: (1)What’s the diagnosis? (AL in children) </li></ul><ul><li>(2) How to treat ? hospitalized, C losed monitoring </li></ul><ul><li>antibiotic, systematic steriod , inhalation of </li></ul><ul><ul><li>steriod) </li></ul></ul>
  32. 32. Chronic laryngitis <ul><li>non-specificity chronic inflammation </li></ul><ul><li>of the larynx </li></ul>
  33. 33. etiology <ul><li>Every factor that can affect the vocal folds (physical, chemical, infection) </li></ul><ul><ul><li>Excessive vocal use </li></ul></ul><ul><ul><li>Vocal misuse, Habitual shouting </li></ul></ul><ul><ul><li>Long-term inhalation of irritative gas( smoking, et al) </li></ul></ul><ul><ul><li>Chronic airway infection( bronchitis, sinusitis) </li></ul></ul><ul><ul><li>Acute laryngitis procrastinating </li></ul></ul>
  34. 34. high risk group <ul><li>Occupation required frequent vocal use </li></ul><ul><li>Irritable character </li></ul><ul><li>Pollution envirenment </li></ul><ul><li>chronic u pper respiratory inflammation </li></ul>
  35. 35. Clinical manifestation <ul><li>Symptoms: </li></ul><ul><ul><li>Hoarseness </li></ul></ul><ul><ul><li>Vocal fatigues easilly </li></ul></ul><ul><ul><li>Discomfort and a tendency to clear the throat constantly </li></ul></ul><ul><ul><li>Cough (with white sputum) </li></ul></ul><ul><li>Signs: three kinds of laryngeal changes </li></ul><ul><ul><li>Chronic simple laryngitis </li></ul></ul><ul><ul><li>Chronic hypertrophy laryngitis </li></ul></ul><ul><ul><li>Chronic atrophy laryngitis </li></ul></ul>
  36. 36. <ul><li>。 </li></ul>
  37. 38. diagnosis <ul><li>NEVER MAKE A DIAGNOSIS OF CHRONIC LARYGITIS UNTIL OTHER LESIONS CAUSING HOARSENESS HAVE BEEN CAREFULLy EXCLUDED!!!!!!!!!!!!!!! </li></ul><ul><li>Differential diagnosis: </li></ul><ul><ul><li>laryngeal tuberculosis and syphilis; </li></ul></ul><ul><ul><li>laryngeal carcinoma; </li></ul></ul><ul><ul><li>vocal cord paresis; </li></ul></ul><ul><ul><li>hysteria </li></ul></ul>
  38. 39. treatment <ul><li>Removal of the cause , </li></ul><ul><ul><li>voice rested, correct vocal use,etc </li></ul></ul><ul><li>Steam inhalation </li></ul><ul><li>Chinese medicine </li></ul>
  39. 40. Vocal fold nodules <ul><li>Etiology: </li></ul><ul><ul><li>excessive or improper vocal use. </li></ul></ul><ul><li>Clinical manifestation: </li></ul><ul><ul><li>Symptoms: </li></ul></ul><ul><ul><ul><li>hoarseness </li></ul></ul></ul><ul><ul><li>Signs: </li></ul></ul><ul><ul><ul><li>small smooth nodule of the anterior 1/3 of the free edge of each cord, </li></ul></ul></ul><ul><ul><ul><li>usually bilateral , </li></ul></ul></ul><ul><ul><ul><li>symmetric </li></ul></ul></ul>
  40. 41. <ul><li>edema types: </li></ul><ul><ul><li>vocal rest </li></ul></ul><ul><ul><li>speech therapy </li></ul></ul><ul><ul><li>medicine </li></ul></ul><ul><li>Fibrosis types </li></ul><ul><ul><li>surgery </li></ul></ul><ul><li>CAUTION: no surgery for children </li></ul>Treatment Vocal fold nodules
  41. 42. surgery for v ocal fold nodules
  42. 43. Vocal polyp <ul><li>Etiology   </li></ul><ul><ul><li>vocal abuse ; </li></ul></ul><ul><ul><li>improper vocal use </li></ul></ul><ul><li>Clinical manifestation: </li></ul><ul><ul><li>symptoms </li></ul></ul><ul><ul><ul><li>– hoarseness(persistent) </li></ul></ul></ul><ul><ul><li>signs </li></ul></ul><ul><ul><ul><li>smooth neoplasm at anterior 1/3 VC, </li></ul></ul></ul><ul><ul><ul><li>unilateral </li></ul></ul></ul>
  43. 44. Vocal polyp
  44. 45. <ul><li>Differential diagnosis   </li></ul><ul><ul><li>laryngeal fibroma , </li></ul></ul><ul><ul><li>neurofibroma ; </li></ul></ul><ul><ul><li>papilloma; </li></ul></ul><ul><ul><li>carcinoma </li></ul></ul><ul><li>Treatment   </li></ul><ul><ul><li>surgery : </li></ul></ul><ul><ul><ul><li>indirect laryngoscope; </li></ul></ul></ul><ul><ul><ul><li>fiber lary n goscope; </li></ul></ul></ul><ul><ul><ul><li>Selfretaining laryngoscope </li></ul></ul></ul><ul><ul><li>follow by speech therapy </li></ul></ul>Vocal polyp
  45. 47. diseases of laryngeal motor nerve ( laryngeal paralysis) <ul><ul><li>disturbance of the motor n. ( superior laryngeal n. and recurrent laryngeal n.) of laryngeal muscle that cause the TVC motion disorder. </li></ul></ul><ul><li>etiology </li></ul><ul><ul><li>centric disorder </li></ul></ul><ul><ul><li>peripheral disorder </li></ul></ul><ul><ul><ul><li>trauma; tumor; inflammation; intoxication; </li></ul></ul></ul><ul><li>left﹥rignt </li></ul>
  46. 48. Clinical manifestation <ul><li>voiced function disorder </li></ul><ul><li>4 types: </li></ul><ul><ul><li>Incomplete recurrent laryngeal n. paralysis </li></ul></ul><ul><ul><li>Complete recurrent laryngeal n. paralysis </li></ul></ul><ul><ul><li>Superior laryngeal n. paralysis </li></ul></ul><ul><ul><li>Mix laryngeal n. paralysis </li></ul></ul>
  47. 49. . <ul><li>. </li></ul><ul><li>. </li></ul>Mix left laryngeal n. paralysis
  48. 50. treatment <ul><li>Etiological treatment </li></ul><ul><li>Symptomatic treatment: </li></ul><ul><ul><li>local injection, </li></ul></ul><ul><ul><li>surgery( neuro-muscular-pedical grafting, neuroanastomosis, medial or lateral cordopexy, partial cricoidectomy) </li></ul></ul><ul><li>Voice training </li></ul><ul><li>Tracheotomy (bilateral incomplete recurrent laryngeal n. paralysis) </li></ul>
  49. 51. CASE bilateral incomplete recurrent n. paralysis male, 41yrs bilateral incomplete recurrent n. paralysis for laryngeal trauma,with laryngeal obstruction Tracheotomy Satisfied vioce Endotracheal anethesia Arytenoidectomy Successfully extubate
  50. 52. . <ul><li>. </li></ul><ul><li>. </li></ul>incomplete bilateral recurrent laryngeal n. paralysis
  51. 53. . Neoplasms of the larynx
  52. 54. . Benign : amyloid tumor papilloma angioma fibroma
  53. 55. Laryngeal papilloma <ul><li>Cause: HPV-6 , HPV-11 infection </li></ul><ul><li>Pathology: </li></ul><ul><ul><li>epithelioma, </li></ul></ul><ul><ul><li>no basic membrane infiltrated </li></ul></ul><ul><li>Clinical manifestation: </li></ul><ul><ul><li>Progressive hoarseness, inspiratory dyspnea </li></ul></ul><ul><ul><li>(1)Adults: unifocal, may recurrent , cancerate </li></ul></ul><ul><ul><li>(2)Children: </li></ul></ul><ul><ul><ul><li>multifocal, any position of the larynx, may in trachea </li></ul></ul></ul><ul><ul><ul><li>Fast grow, easily recurrent, seldom cancerate </li></ul></ul></ul>
  54. 56. treatment <ul><li>surgery </li></ul><ul><ul><li>mostly via edoscopy, often need more than once </li></ul></ul><ul><ul><li>Laryngofissure for some adults </li></ul></ul><ul><li>Antivirus </li></ul><ul><li>Immunotherapy </li></ul><ul><ul><li>Transfer factor </li></ul></ul><ul><ul><li>interferon </li></ul></ul>
  55. 57. Laryngeal papilloma of children
  56. 58. Laryngeal papilloma of adult
  57. 59. 谢谢~~
  58. 60. Carcinoma of larynx
  59. 61. Carcinoma of larynx <ul><li>Etiology </li></ul><ul><ul><li>Smoking,alcohol abuse </li></ul></ul><ul><ul><li>Virus infection </li></ul></ul><ul><ul><li>Enviroment factors </li></ul></ul><ul><ul><li>Sexual hormone </li></ul></ul><ul><li>Pathology </li></ul><ul><ul><li>93~99% squamous cell carcinoma </li></ul></ul><ul><li>Classification of tumor sides: </li></ul><ul><ul><li>supraglottic carcinoma </li></ul></ul><ul><ul><li>Glottic carcinoma </li></ul></ul><ul><ul><li>Subglottic carcinoma </li></ul></ul><ul><ul><li>Transglottic carcinoma </li></ul></ul>classification
  60. 62. Clinical manifestation <ul><li>Supraglottic carcinoma </li></ul><ul><ul><li>Maybe no symptoms for early stage </li></ul></ul><ul><ul><li>Layngalgia, bloody sputum for some cases </li></ul></ul><ul><li>Glottic carcinoma </li></ul><ul><ul><li>Hoarseness       at early stage </li></ul></ul><ul><ul><li>Apnea </li></ul></ul><ul><li>Subglottic carcinoma </li></ul><ul><ul><li>No symptoms for early stage </li></ul></ul><ul><ul><li>Difficult to detect </li></ul></ul><ul><li>Trans-glottic carcinoma </li></ul><ul><ul><li>No symptoms for early stage </li></ul></ul><ul><ul><li>Hoarseness following </li></ul></ul>Missed diagnosis
  61. 63. Carcinoma of larynx
  62. 64. route of metastasis(1) <ul><li>1 、 direct metastasis </li></ul><ul><li>Barrier for restricting metastasis </li></ul><ul><ul><li>Tendon of anterior commissure </li></ul></ul><ul><ul><li>The space between supraglottic and infraglottic area </li></ul></ul><ul><ul><li>Vocal process of arytenoid cartilage </li></ul></ul><ul><ul><li>Pyriform sinus </li></ul></ul><ul><ul><li>Thyroid cartilage </li></ul></ul>
  63. 65. route of metastasis(1) <ul><li>Supraglottic carcinoma </li></ul><ul><ul><li>Anteriad preepiglottic space,   extrinsic muscles </li></ul></ul><ul><ul><li>Astern layngopharynx </li></ul></ul><ul><ul><li>Downward vocal folds </li></ul></ul><ul><li>glottic carcinoma </li></ul><ul><ul><li>Anteriad preepiglottic space,   contralateral vocal </li></ul></ul><ul><ul><li>thyroid cartilage </li></ul></ul><ul><ul><li>upward vestibule, ventricle </li></ul></ul><ul><ul><li>Downward infraglottic area </li></ul></ul><ul><li>Subglottic carcinoma </li></ul><ul><ul><li>Upward vocal folds </li></ul></ul><ul><ul><li>Downward trachea </li></ul></ul><ul><ul><li>Anteriad thyroid </li></ul></ul><ul><ul><li>Astern esophagus </li></ul></ul>direct metastasis
  64. 66. route of metastasis(2) <ul><li>Lymphatic metastasis </li></ul><ul><ul><li>Supraglottic carcinoma: easy </li></ul></ul><ul><ul><li>Glottic carcinoma: seldom </li></ul></ul><ul><ul><li>Subglottic carcinoma: </li></ul></ul><ul><li>Hematogenous metastasis </li></ul><ul><ul><li>For some advaned stage cases </li></ul></ul>
  65. 67. Carcinoma of larynx <ul><li>diagnosis </li></ul>hoarseness Laryngoscopy Laryngeal mass biopsy <ul><li>Differential diagnosis: </li></ul><ul><li>laryngeal tuberculosis </li></ul><ul><li>Laryngeal syphilis </li></ul><ul><li>Laryngeal papilloma </li></ul>
  66. 68. treatment <ul><li>Surgery </li></ul><ul><li>Radiotherapy </li></ul><ul><li>Others </li></ul><ul><ul><li>Chemotherapy </li></ul></ul><ul><ul><li>Hyperthermia </li></ul></ul><ul><ul><li>Photoradiative Therapy </li></ul></ul><ul><ul><li>Immune modulation </li></ul></ul>
  67. 69. surgery <ul><li>Via laryngendoscope or microscope for early stage </li></ul><ul><li>Partial laryngectomy </li></ul><ul><ul><li>Acording to the location and the bound of the tumor </li></ul></ul><ul><ul><li>The principle is: 1 、 to remove the tumor completely </li></ul></ul><ul><ul><li>2 、 function reservation </li></ul></ul><ul><li>Total Laryngectomy </li></ul><ul><li>Neck dissection </li></ul>treatment
  68. 70. radiotherapy <ul><li>Radical radiotherapy </li></ul><ul><ul><li>Carcinoma in situ or T1 </li></ul></ul><ul><li>Combine with surgery </li></ul><ul><ul><li>Before or after the surgery </li></ul></ul><ul><li>Radiotherapy alone as palliation </li></ul>treatment
  69. 71. 谢谢~~

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