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Laryngeal Disorders

Laryngeal Disorders

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Published by Faeren Aboiyar

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Published by: Faeren Aboiyar on Jul 24, 2011
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05/21/2012

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Laryngeal disorders . .

Laryngeal disorders

ý .úÿ. è øù ú è úÿ. å ë éâ öú â èì ø åô ÿø ö ø úå úø

Pretest T or F
1. Reurrent laryngeal nerve pure motor fiber 2. larynx 3. Acute laryngitis 4. epiglottitis laryngospasm 5. Thumb¶s sign Thumb¶ croup 6. Vocal nodule unilateral mass 7. Vocal granuloma intubation 8. Laryngeal trauma intubation 9. Most common symptom true vocal carcinoma neck node enlargement 10. 10. acid reflux

úÿ. å ë éâ öú â èì ø åô ÿø ö ø úå úø . è øù ú è úÿ.Laryngeal disorders ý .

Laryngeal disorders Objectives 1. Common disorders 4. Physiology 3. Treatment . Anatomy 2.

1.extrinsic Innervation Vessels . Anatomy Framework Muscles intrinsic .

Framework .

.

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cricothyroid . cricoarytenoid.abductor . interarytenoid . thyroarytenoid (true vocal cord:TVC). post cricoarytenoid Extrinsic .Muscles Intrinsic adductors .

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sensorysensory.Innervation Inferior RLN motor ..all muscles except.below TVC Superior RLN motor sensory cricothyroid muscle above TVC .

laryngeal artery inf.Blood supply Arterial sup. Laryngeal artery Venous sup. & inf. Thyroid veins .

Swallowing 3. Air passage . Airway protection 2. Voice production 4.Physiology 1.

Protection inspiration phonation .

Congenital . Tumor .benign.blunt injury .Acute & chronic laryngitis. croup. Inflammation .Laryngeal disorders 1.laryngopharyngeal reflux (LPR) disease .cord paralysis. subglottic stenosis 5.malignancy 3. nodule. Trauma . 2. granuloma . Laryngeal web. ulcer.penetrating injury . polyp.iatrogenic 4. Miscellaneous . epiglottitis.

Laryngopharyngeal reflux (LPR) . Vocal polyp 6. Laryngeal trauma 9. Croup 3. Vocal granuloma 7. Laryngeal carcinoma 8.Common laryngeal disorders 1. Vocal nodule 5. Acute laryngitis 2. Epiglottitis 4.

+/. malaise Sign .TVC swelling .Acute laryngitis Pathogen . influenza Morexella catarrharis Hemophilus influenza Streptococcus pneumoniae Symptoms .hoarseness cough.adenovirus.fever.

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anticold +/+/.antibiotic Symptoms > 2 week. recurrent DDx .Acute laryngitis Treatment .chronic laryngitis .mucolytic.voice rest .

parainfluenza*influenza. Pathogen . H.barking cough.6 months-2 yrs. stridor .Croup (acute laryngotracheobronchitis) . influenza Symptoms .follow by bacterial esp.Severe respiratory infection .exhausted.2-3 days .early URI symptoms . adenovirus . lying down .

symptoms & signs .x-ray norrowing of subglottis Pencil s sign .Croup (acute laryngotracheobronchitis) Diagnosis .flexible scope .

Pencil¶s sign Normal .

intubation .observe.Croup (acute laryngotracheobronchitis) Treatment .humidification. hydration. admit .early detection . O2 .antibiotic (penicillin) severe .steroid .

infection of supraglottis >> epiglottis . adult Pathogen . influenza type B Symptoms ..high fever.children > change very fast 6-12 hr.early URI symptoms .Epiglottitis .2-10 yr. pain in throat * . .H.

Epiglottitis Signs .** laryngospasm .epiglottis > swelling. inflam .³Thumb¶s sign´ .fiberoptic X-ray .

Epiglottitis Treatment admit.steriod prepare for intubation . humidification +/. closed monitoring broad spectrum penicillin hydration.

fibrous formation Symptoms Sign . over-used . adult .children.Vocal cord nodule .hoarseness .vocal abuse.nodule TVC > bilateral > anterior 1/3 .

recurrent > surgery .failed.voice rest .Nodule Treatment .speech therapy .

Reinke edema > capsule surrounding (polyp) Symptoms Sign Treatment .ant 1/3 TVC.follow by speech therapy .hoarseness > 2 wk .vocal abuse .Vocal polyp . unilateral .surgery .

nodule .Reinke s edema Vocal polyp Both polyp.

intubation .Vocal granuloma inflammation > ulcer > granuloma etiology .hoarseness 2-3 wk after extubation .partial laryngectomy Symptoms .gastroesophageal reflux .

unilateral .arytenoid.Rx acid reflux .surgery .follow by speech therapy .Vocal granuloma Sign Treatment .

pollution.smoking.epithelial hyperplasia > dysplasia > carcinoma insitu > carcinoma . acid reflux Pathology .Carcinoma Chronic irritation . alcohol.

lymphadenopathy.Carcinoma Symptoms > 2-3 weeks . hemoptysis.glottis > hoarseness .supraglottis > dysphagia .referred otalgia. wt.subglottis > airway problems . loss others . chronic cough.

depends on staging TNM . 4 > combined surgery.Carcinoma Diagnosis .metastasis .stage 3.early > surgery or RT alone . MRI . RT. CXR. CT. LFT Treatment .biopsy . indirect or direct laryngoscopy .extension . ChemoRx .

gun-short gunwound S&S >> location. dysphagia. bleeding.athlete.Laryngeal trauma Most common -Car accident Others . crepitation .severe case > coma .stridor. emphysema. severity . penetrating. hemoptysis.

need intubationor tracheostom y .explore ý .Laryngeal trauma ëú õ Mo in r .lary tracheal subluxation ngo .reconstructionof fram w e ork + intubation M r ajo -m ultiplecartilagefracture . tear ofcartilage â â .hem a.em sem atom phy a.rem etureignbody ov .exploration&reconstruction + intralum l stent ina .èdrain .

Laryngopharyngeal reflux (LPR) .

chocolate. alcohol. drugs . spicy. eat late at night ife- . cola.relax sphincter. acid production food . theophylin life-style .Laryngopharyngeal reflux (LPR) Stomach acid > reflux to esophagus + others = gastroesophageal reflux (GER) reflux up to larynx = LPR Etiology .

feel lump in the throat. chronic cough. regurgitation.Laryngopharyngeal reflux (LPR) Symptoms .arytenoid edema. heartburn Signs . ulcer >>> carcinoma . TVC sweling granuloma.

H2 antagonist.Lifestyle modification diet.Laryngopharyngeal reflux (LPR) Treatment . antacid + prokinetic . avoid eating before bedtime . stress.surgery .medication protonpump inhibitor.

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