Laryngeal disorders . .

Laryngeal disorders

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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

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

extrinsic Innervation Vessels . Anatomy Framework Muscles intrinsic .1.

Framework .

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

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

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

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

Protection inspiration phonation .

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

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

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

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

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

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

Pencil¶s sign Normal .

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

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

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

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

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

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

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

nodule .Reinke s edema Vocal polyp Both polyp.

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

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

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

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

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

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

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

Laryngopharyngeal reflux (LPR) .

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

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

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

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