ACUTE

LARYNGO-TRACHEO-BRONCHITIS
 It is an inflammatory condition of the larynx, trachea and
bronchi; more common than acute epiglottitis.

Aetiology
 Mostly, it is viral infection (parainfluenza type I and II)
affecting children between 6 months to 3 years of age.
 Male children are more often affected.
 Secondary bacterial infection by Gram positive cocci soon
supervenes.
ACUTE
LARYNGO-TRACHEO-BRONCHITIS
Pathology
 The loose areolar tissue in the subglottic region
swells up and causes respiratory obstruction
and stridor.
 This, coupled with thick tenacious secretions
and crusts, may completely occlude the airway.
ACUTE
LARYNGO-TRACHEO-BRONCHITIS
Symptomatology
 Disease starts as upper respiratory infection with
hoarseness and croupy cough.
 There is fever of 39-40°C.
 This may be followed by difficulty in breathing and
inspiratory type of stridor.
ACUTE
LARYNGO-TRACHEO-BRONCHITIS
Treatment
 Hospitalisation is often essential because of the increasing difficulty in
breathing.
 Antibiotics .
 Humidification helps to soften crusts and tenacious secretions
 Parenteral fluids are essential to combat dehydration.
 Glucocorticoid, e.g. hydrocortisone 100mg iv. may be useful to relieve
oedema.
 Tracheostomy done if intubation required beyond 72 hours.
 LAYNGOTRACHEAL TRAUMA
---Aetiology
 Most common cause is car accidents.
 Blow or kick on the neck.
 Neck striking against a stretched wire or cable.
 Penetrating injuries with sharp instruments or
gun shot wounds.
LAYNGOTRACHEAL TRAUMA
---pathology
 The degree and severity of damage will vary from slight
bruises to a comminuted fracture of the laryngeal framework.
 The wound may be compounded externally, due to break in
the skin, or internally by mucosal tears.
 Laryngeal fractures are common after 40 years of age,
because of calcification of the laryngeal framework. Less
injury in child due to resilient cartilages.
 Haematoma and oedema of supraglottic or subglottic region.
LAYNGOTRACHEAL TRAUMA
---pathology
 Tears in laryngeal or pharyngeal mucosa leading to
subcutaneous emphysema.
 Dislocation of cricoarytenoid joints. The arytenoid
cartilage may be displaced anteriorly, dislocated or
avulsed.
 Dislocation of cricothyroid joint. This may cause
recurrent laryngeal nerve paralysis which traverses
just behind this joint.
LAYNGOTRACHEAL TRAUMA
---pathology
 Fractures of the hyoid bone.
 Fractures of thyroid cartilage. They may be vertical or
transverse. Fracture of upper part of thyroid cartilage may
result in avulsion of epiglottis and one or both false cords.
 Fractures of cricoid cartilage.
 Fractures of upper tracheal rings.
 Trachea may separate from the cricoid cartilage and retract
into upper mediastinum.
 LAYNGOTRACHEAL TRAUMA
---Clinical Features
Symptoms of laryngotracheal injury would vary, greatly
depending on the structures damaged and the severity
of damage.
 Respiratory distress.
 Hoarseness of voice or aphonia.
 Painful and difficult swallowing. This is
accompanied by aspiration of food.
 Local pain in the larynx. More marked on speaking
or swallowing.
 Haemoptysis, usually the result of tears in laryngeal or
tracheal mucosa.
 LAYNGOTRACHEAL TRAUMA
---Clinical Features
External Signs include:
 Bruises or abrasions over the skin.
 Palpation of the laryngeal area is painful.
 Subcutaneous emphysema due to mucosal tears. It may
increase on coughing.
 Flattening of thyroid prominence and contour of anterior
cervical region. Thyroid notch may not be palpable.
 Fracture displacements of thyroid or cricoid cartilage or
hyoid bon.
 Bony crepitus between fragments of hyoid bone, thyroid or
cricoid cartilages.
 Separation of cricoid cartilage from larynx or trachea.
 LAYNGOTRACHEAL TRAUMA
----Treatment
Conservative
 Patient should be hospitalised and observed for respiratory
distress.
 Voice rest is essential.
 Humidification of inspired air is essential.
 Glucocorticoid should be started immediately and in full dose
to resolve oedema and haematoma and prevent scarring and
stenosis.
 Antibiotics are given to prevent perichondritis and cartilage
necrosis.
 LAYNGOTRACHEAL TRAUMA
----Treatment
Surgical
 Tracheostomy: Because intubation may be difficult.
 Open reduction: Done 3-5 days later,not to be
delayed byond 10 days.
 Fracures of hyoid bone, thyroid or cricoid can be wired and
placed in their anatomical position
 Mucosal lacerations are repaired with catgut and
fragments of cartilage removed.
LAYNGOTRACHEAL TRAUMA
----Treatment

 Epiglottis is anchored in its normal position

and if already avulsed, may be excised.
 Arytenoid cartilages can be repositioned in
their normal position or may be removed.
LAYNGOTRACHEAL TRAUMA
----Treatment
 In laryngotracheal separation, end to end
anastomosis can be done.
 Internal splintage of laryngeal structures may be
required. It is done with a laryngeal stent, or
silicone tube which may have to be left for 2 to 6
weeks on an average.
 Webbing of anterior commissure can be prevented
by a silastic keel.
LAYNGOTRACHEAL TRAUMA
--- Complications

 Laryngeal stenosis, which may be

supraglottic, glottic or subglottic.
 Perichondritis and laryngeal abscess.
 Vocal cord paralysis.
Chronic laryngitis
Chronic laryngitis is a nonspecific
inflammation of the laryngeal
mucosa.
It can be classified as three types in
clinical:
 chronic simple laryngitis
 chronic hypertrophic laryngitis
 chronic atrophic laryngitis
 Cause
 Voice abuse can be pertinent to professional
singers and to occasional shouters.
 Environmental factor: such as dust, fumes,
smoking, drinking, chemical and toxins, etc.
 Chronic inflammation of nasal cavity, sinus
and throat:
 Acute laryngitis attacks repeatedly or retains
for a long time.
 Chronic infection in the lower respiratory
tract, cough for a long-term and purulent
secretion stimulating the laryngeal mucosa.
Clinical manifestation
 Hoarse voice and dysphonia. Voice
quality and quantity may fluctuate,
although complete recovery never
occurs.
 Discomfort and dryness of the larynx,
odynophagia
 Chronic cough: usually is dry cough.
 Laryngeal secretion is increasingly,
speech is strain.
Sign

 Redness and thickening of the entire laryngeal

mucosa in a diffuse form.
Treatment
Treatment depends upon cause
and often involves the patient
completely altering their
lifestyle.
Nebulization: gentamicin and
dexamethasone
Chinese herbs:
Vocal cord nodulus and polyp

 They are nonneoplastic lesions of the vocal

cords and special forms of chronic laryngitis.
Symptom
Hoarseness or voice change
Sign
Nodule: bilateral opposing “knot”

occure at mid-vocal cord

Polyp: erythematous, smooth, mobile

vocal cord lesion

larger than Nodules, but similiar location

nodule
polyp
 Treatment
Strict voice rest
No whispering (causes as much strain
as yelling)

Surgical excision under suspension

laryngoscope and biopsy.
Surgical teatment
of laryngeal polyp
Tumor of larynx
Benign tumor Malignant tumor
papiloma carcinoma
hemangioma
fibroma
neurofibroma
Carcinoma of Larynx
 Squamous cell carcinomas comprise 95-98%
of all malignant neoplasms of the larynx.
 Carcinoma of larynx is a highly curable
disease.
 Approximately 90% carcinoma of larynx
occur in men, with peak incidence between
the ages of 55 to 65.
Causes
Smoking
Alcohol abuse
Air pollution
Viral infection :HPV16,18
Precancerous lesion: such as
leukoplakia, hyperkeratosis.
Sex hormones
Precancerous lesion of larynx

 Leukoplasia hyperkeranosis
Pathology
 98%→squamous cell carcinoma
 Carcima in situ Invasive

carcinoma
(6 ～ 9%) ( ＞ 90%)

 Supraglottic Glottic Infraglottic

(30%) (60%) (6%)
Supraglottic carcinoma
 In early stage: discomfortable
or foreign body sensation in
throat, etc.
 In advanced stage: hoarseness,
dysphagia, odynophagia,
dyspnea,
ipsilateral otalgia, halitosis due
to tumor necrosis, metastasis
cervical lymph node.
 Incline to cervical
metastasis(40%)!
Glottic carcinoma
 In early stage:
Hoarseness
Chronic cough
Bloody expectoration
 In advanced stage:
Dyspnea and Stridor
Rare metastasis!
Subglottic carcinoma
 In early stage:
Without symptom
 In advanecd stage:
Hoarseness
Dyspnea
Hemoptysis
Lump in the neck
Irritate cough
Not easily be discovered in early!
The morbidity is low.
Treatment
Surgical treatment is the first choice.

1. Partial laryngectomy
A. laryngeal micro CO2 laser surgery:

B.Thyrotomy for cordectomy

C.Vertical hemilaryngectomy

D.Frontal partial laryngectomy

E.Horizontal hemilaryngectomy

F.Subtotal laryngectomy
2.Total laryngectomy
3.Vocal rehabilitation after total
laryngectomy
4.Neck dissection: radical,
functional, selective
Total laryngectomy Coronary laryngectomy
 Total
laryngectomy
Horizontal laryngectomy Vertical laryngectpmy
Radiotherapy
Indications:
1.Early carcinoma:
2.The total constitution is bad:
3.Before or after operation:

Other therapy
Chemotherapy, biotherapy
Laryngeal obstruction

Emergency!
Causes
 Inflammation
 Trauma
 Foreign body
 Tumor
 Edema
 Malformation
 Vocal cord paralysis
Clinical manifestation
 Inspiratory dyspnea
 Inspiratory stridor
 Insipiratory excavation of soft tissues: suprasternal fossa,
infra and supraclavicular fossa, infraxiphoid process of
sternum, intercostal space
 Hoarseness
 Cyanosis
Inspiratory dyspnea
Examination
 Depending on the severity, the laryngeal
obstruction can be classified into 4 degrees:
First degree: no dyspnea in rest state
Second degree: have low-grade dyspnea
in rest state.
Third degree: dyspnea is obviously +
anoxia symptom
Fourth degree: extreme dyspnea
Treatment
 First degree: causative treatment
If because of infection: full dose antibiotics
+ glucocorticoid
 Second degree:
If because of infection: full dose antibiotics
+ glucocorticoid
If because of foreign body : surgery
If because of tumor, trauma or bilateral
vocal cord paralysis: tracheomoty
 Third degree:
If because of infection and the
obstructive time is short: drug
treatment under close observation and
get ready for tracheotomy.
If bad general constitution or because of
tumor: tracheotomy immediately.
 Fourth degree:
tracheotomy immediately.
Tracheotomy
A tracheotomy is a
surgical procedure in
which a cut or opening
is made in the trachea.
technique
Indications
To relieve upper airway obstruction:
Foreign body
Trauma
Acute infection-Acute epiglottitis,Diphtheria
Glottic edema
Bilateral abductor paralysis of the vocal
cords
Tumors of larynx
Congenital web or atresia
Indications
To improve respiratory function:
Fulminating bronchopneumonia
Chronic bronchitis and emphysema
Chest injury
Respiratory paralysis:
Unconscious head injury
Bulbar poliomyelitis
Tetanus
For some operations of larynx and
pharynx