1. Diseases of PharynxDiseases of Pharynx
and Larynxand Larynx

2. Anatomy of PharynxAnatomy of Pharynx
 Fibromuscular TubeFibromuscular Tube
 Base of Skull to C6 (12cm)Base of Skull to C6 (12cm)
 Divided into three partsDivided into three parts
 NasopharynxNasopharynx
 OropharynxOropharynx
 LaryngopharynxLaryngopharynx
 4 Layers4 Layers
 Mucosal, submucosal (Fibrous), Muscular, FascialMucosal, submucosal (Fibrous), Muscular, Fascial
layer (buccal pharyngeal)layer (buccal pharyngeal)

3. NasopharynxNasopharynx
 Base of skull to the softBase of skull to the soft
palatepalate
 Key componentsKey components
 Pharyngeal TonsilPharyngeal Tonsil
(Adenoids)(Adenoids)
 Pharyngeal Recess (ICA)Pharyngeal Recess (ICA)
 Opening of Auditory tubeOpening of Auditory tube

4. OropharynxOropharynx
 Soft Palate to theSoft Palate to the
epiglottisepiglottis
 Key ComponentsKey Components
 Palatopharyngeal andPalatopharyngeal and
Palatoglossal archesPalatoglossal arches
 Palantine Tonsil – projectPalantine Tonsil – project
from tonsillar fossafrom tonsillar fossa
 Lingual TonsilLingual Tonsil
 Valleculae – lie betweenValleculae – lie between
epiglottis and posteriorepiglottis and posterior
border of the tongueborder of the tongue

5. LaryngopharynxLaryngopharynx
 Epiglottis to the levelEpiglottis to the level
of cricoid cartilageof cricoid cartilage
 Key featuresKey features
 Opening to theOpening to the
larynxlarynx
 Piriform recessPiriform recess
(endoscope)(endoscope)

6. Anatomy of PharynxAnatomy of Pharynx
 Blood supplyBlood supply
 Branches of many arteries (ascending pharyngeal,Branches of many arteries (ascending pharyngeal,
greater palantine, lingual, tonsilar)greater palantine, lingual, tonsilar)
 Nerve SupplyNerve Supply
 Afferent; maxillary nerve, glossopharyngeal, internalAfferent; maxillary nerve, glossopharyngeal, internal
and recurrent laryngeal nervesand recurrent laryngeal nerves
 Motor; Pharyngeal Plexus (Vagus, glossopharyngeal,Motor; Pharyngeal Plexus (Vagus, glossopharyngeal,
Cervical Sympathetic)Cervical Sympathetic)

7. LarynxLarynx
 Respiratory OrganRespiratory Organ
 Lying between pharynx and tracheaLying between pharynx and trachea
 Becomes continuous with the trachea at the level ofBecomes continuous with the trachea at the level of
the cricoid cartilage (C6)the cricoid cartilage (C6)
 FunctionFunction
 Primary – protective sphincter at the inlet of the airPrimary – protective sphincter at the inlet of the air
passagespassages
 PhonationPhonation

8. LarynxLarynx
 ComponentsComponents
 CartilagesCartilages
 Singular; thyroid, cricoid, epigolitticSingular; thyroid, cricoid, epigolittic
 Paired; Arytenoid, corniculate, cuneiformPaired; Arytenoid, corniculate, cuneiform
 JointsJoints
 Cricothyroid, cricoarytenoidCricothyroid, cricoarytenoid
 Ligaments and MembranesLigaments and Membranes
 Intrinsic; Quandrangular membrane, CricothyroidIntrinsic; Quandrangular membrane, Cricothyroid
ligament (Vocal folds)ligament (Vocal folds)
 Extrinsic; Thyrohyoid membrane, cricotracheal,Extrinsic; Thyrohyoid membrane, cricotracheal,
hypoepiglottic, thyroepiglottic ligaments, cricothyroidhypoepiglottic, thyroepiglottic ligaments, cricothyroid

9. CavitiesCavities
 Inlet +Inlet +
VestibuleVestibule
 Rima ofRima of
glottisglottis
 SubglotticSubglottic
spacespace

10. Layrnx - Intrinsic MembranesLayrnx - Intrinsic Membranes
 Quadrangular membraneQuadrangular membrane
 Arytenoid Cartilage and epiglottisArytenoid Cartilage and epiglottis
 Lower border; vestibular folds (false cord)Lower border; vestibular folds (false cord)
 Upper border; aryepiglottic foldsUpper border; aryepiglottic folds
 Cricovocal MembraneCricovocal Membrane
 Formed from lateral part of cricothyroid ligamentFormed from lateral part of cricothyroid ligament
 Upper thickened border forms cricovocal ligaementUpper thickened border forms cricovocal ligaement
 Vocal folds which bounds the glottis anteriorlyVocal folds which bounds the glottis anteriorly

12. Laryngeal Muscles - IntrinsicLaryngeal Muscles - Intrinsic
1. Those that alter size and shape of the inlet1. Those that alter size and shape of the inlet
 Aryepiglottic MusclesAryepiglottic Muscles
 Oblique arytenoidsOblique arytenoids
 Thyroepiglottic musclesThyroepiglottic muscles
 Act as Sphincter for the inletAct as Sphincter for the inlet
 Provide valvular protection from aboveProvide valvular protection from above

13. Laryngeal Muscles - IntrinsicLaryngeal Muscles - Intrinsic
2. Responsible for Phonation by moving vocal2. Responsible for Phonation by moving vocal
foldsfolds
 Abduction; Posterior CricoarytenoidsAbduction; Posterior Cricoarytenoids
 Adduction; Lateral cricoarytenoid and transverseAdduction; Lateral cricoarytenoid and transverse
arytenoidarytenoid
 Lengthen; CricothryroidLengthen; Cricothryroid
 Shorten; Thyroarytenoid, vocalisShorten; Thyroarytenoid, vocalis

14. PhonationPhonation
 Pitch; Vibration of the folds through shorteningPitch; Vibration of the folds through shortening
and lengthing of the voldsand lengthing of the volds
 Intensity; Pressure through the glottisIntensity; Pressure through the glottis
 Quality; Resonating chambers above the glottisQuality; Resonating chambers above the glottis
 Articulation; tongue, teeth and lipsArticulation; tongue, teeth and lips

15. LarynxLarynx
 Blood supplyBlood supply
 Superior and Inferior Laryngeal Branches from Superior andSuperior and Inferior Laryngeal Branches from Superior and
Inferior Thyroid ArteryInferior Thyroid Artery
 Nerve SupplyNerve Supply
 Recurrent Laryngeal NerveRecurrent Laryngeal Nerve
 All intrinsic Muscles except cricothyroidAll intrinsic Muscles except cricothyroid
 Mucous Membranes below the foldsMucous Membranes below the folds
 External Layngeal NerveExternal Layngeal Nerve
 Cricothyroid muscleCricothyroid muscle
 Internal Laryngeal NerveInternal Laryngeal Nerve
 Mucous Membranes below the foldsMucous Membranes below the folds

16. Nerve PalsiesNerve Palsies
 Recurrent Laryngeal NerveRecurrent Laryngeal Nerve
 Number of causesNumber of causes
 Left;Left;
 Carcinoma of bronchus, oesophagus, Aortic anuersym, cardiac surgCarcinoma of bronchus, oesophagus, Aortic anuersym, cardiac surg
 Left or Right;Left or Right;
 Iatrogenic, Trauma, Thyroid diseaseIatrogenic, Trauma, Thyroid disease
 Complete (Cadaveric Position)Complete (Cadaveric Position)
 Half abducted position with arytenoid cartilage slightly in frontHalf abducted position with arytenoid cartilage slightly in front
 Hoarse VoiceHoarse Voice
 Bovine coughBovine cough
 IncompleteIncomplete
 Adducted position as posterior cricoarytenoid more susceptibleAdducted position as posterior cricoarytenoid more susceptible
 External Laryngeal NerveExternal Laryngeal Nerve
 Hoarse voice that recoversHoarse voice that recovers
 Inability to hit high frequenciesInability to hit high frequencies

19. Extrinsic MusclesExtrinsic Muscles
 ElevatorsElevators
 Indirectly;Indirectly;
 Mylohyoid, digastric, stylohyoid, geniohyoidMylohyoid, digastric, stylohyoid, geniohyoid
 Directly;Directly;
 Stlyopharyngeus, salingopharyngeus, palatopharyngeusStlyopharyngeus, salingopharyngeus, palatopharyngeus
 DepressorsDepressors
 Sternohyoid, omohyoid stenothyroidSternohyoid, omohyoid stenothyroid

20.  4 year old boy4 year old boy
 Pain in right ear and feversPain in right ear and fevers
 Recurrent ear infectionsRecurrent ear infections
 Noisy breatherNoisy breather
 OverweightOverweight
 Examination – Sore right ear, hyperaemicExamination – Sore right ear, hyperaemic
tympanic membrane, breathing with mouthtympanic membrane, breathing with mouth
openopen

21. Adenoid HypertrophyAdenoid Hypertrophy
 Occupies large area of nasopharynx age <6Occupies large area of nasopharynx age <6
 Atrophies and by age 15 little remainsAtrophies and by age 15 little remains
 Recurrent URTI or allergies can lead toRecurrent URTI or allergies can lead to
hypertrophyhypertrophy
 ClinicalClinical
 Nasal Obstruction; Mouth breathing / AdenoidNasal Obstruction; Mouth breathing / Adenoid
Facies, chest infections, pharyngeal infections,Facies, chest infections, pharyngeal infections,
sinusitis, snoringsinusitis, snoring
 Eustachian Tube; Recurrent Otitis Media, CSOMEustachian Tube; Recurrent Otitis Media, CSOM
 Choanal Obstruction; OSA, chronic sinusitisChoanal Obstruction; OSA, chronic sinusitis

22.  IxIx
 Nasopharyngeal ExamNasopharyngeal Exam
 Nasopharyngoscopic ExamNasopharyngoscopic Exam
 Lateral XrayLateral Xray
 TxTx
 SupportiveSupportive
 AdenoidectomyAdenoidectomy

23. AdenoidectomyAdenoidectomy
 Criteria for surgeryCriteria for surgery
 Chronic upper airway obstruction with OSA +/- corChronic upper airway obstruction with OSA +/- cor
pulmonalepulmonale
 Chronic serous/suppurative otitis mediaChronic serous/suppurative otitis media
 Recurrent acute otitis mediaRecurrent acute otitis media
 Suspicion of nasopharyngeal malignancySuspicion of nasopharyngeal malignancy
 Chronic sinusitisChronic sinusitis
 ComplicationsComplications
 Early HaemorrhageEarly Haemorrhage
 Otitis mediaOtitis media
 Regrowth of residual adenoid tissueRegrowth of residual adenoid tissue

25. TonsillitisTonsillitis
 Commonest area of infection of head and neckCommonest area of infection of head and neck
 Clinical; Sore throat and Odynophagia, Otalgia,Clinical; Sore throat and Odynophagia, Otalgia,
headache, malaise, Fever, hyperaemic tonsils, cervicalheadache, malaise, Fever, hyperaemic tonsils, cervical
lymphadenopathylymphadenopathy
DDx;DDx;
 ViralViral
 Group A Streptococcus (20-30%)Group A Streptococcus (20-30%)
 EBV; Palatal petechiaEBV; Palatal petechia
 Diptheria; Unimmunised, grey membraneDiptheria; Unimmunised, grey membrane
 Tx; Rest, paracetamol +/- ABxTx; Rest, paracetamol +/- ABx

26. TonsillitisTonsillitis
 Complications;Complications;
 Acute Otitis Media (most common)Acute Otitis Media (most common)
 Peritonsillar abscess (Quinsy)Peritonsillar abscess (Quinsy)
 GASGAS
 Post Strep GNPost Strep GN
 Rhuematic FeverRhuematic Fever
 Scarlet Fever; Strawberry tongue and scarlitiform rashScarlet Fever; Strawberry tongue and scarlitiform rash
 Recurrent TonsillitisRecurrent Tonsillitis
 Tonsillar HypertrophyTonsillar Hypertrophy

28. TonsillectomyTonsillectomy
 Indications for surgeryIndications for surgery
 AbsoluteAbsolute
 Airway obstructionAirway obstruction
 Suspicion of malignancySuspicion of malignancy
 RelativeRelative
 Sleep apnoea, mouth breathing, difficulty swallowingSleep apnoea, mouth breathing, difficulty swallowing
 Recurrent tonsillitis >5 episodesRecurrent tonsillitis >5 episodes
 Any complicationsAny complications
 ComplicationsComplications
 Reactionary haemorrhageReactionary haemorrhage
 Secondary haemorrhageSecondary haemorrhage
 5-10 days post op5-10 days post op
 Due to fibrinolysis aggravated by infectionDue to fibrinolysis aggravated by infection

30. PharyngitisPharyngitis
 AcuteAcute
 >70% Viral Cause, GAS>70% Viral Cause, GAS
 Supportive TreatmentSupportive Treatment
 ChronicChronic
 Persistent mild soreness and drynessPersistent mild soreness and dryness
 Predisoposing factors include; smoking, ETOH,Predisoposing factors include; smoking, ETOH,
mouth breathing, chronic sinusitis, Industrial fumes,mouth breathing, chronic sinusitis, Industrial fumes,
antiseptic throat lozengersantiseptic throat lozengers
 Enlarged lymphoid tissue can be removedEnlarged lymphoid tissue can be removed

31.  64 Male recently Immigrated from Hong Kong64 Male recently Immigrated from Hong Kong
 Lump in right side of neckLump in right side of neck
 Progressive enlarged, non-painfulProgressive enlarged, non-painful
 Exam; firm, fixed, solid mass lateral to midlineExam; firm, fixed, solid mass lateral to midline
in posterior trianglein posterior triangle

32. Nasopharyngeal CarcinomaNasopharyngeal Carcinoma
 Rare in EuropeRare in Europe
 Common in Asian countriesCommon in Asian countries
 20% of all malignancies in Hong Kong20% of all malignancies in Hong Kong
 PathologyPathology
 Squamous cell/undifferentiatedSquamous cell/undifferentiated
 AietologyAietology
 Unknown, however EBV plays a roleUnknown, however EBV plays a role
 Others; ingestion of preserved foodsOthers; ingestion of preserved foods

33. Nasopharyngeal CarcinomaNasopharyngeal Carcinoma
 Clinical;Clinical;
 Most commonly as lump in the neckMost commonly as lump in the neck
 Local; Nasal obstruction, blood stained dischargeLocal; Nasal obstruction, blood stained discharge
 Neurological; Invasion of skull base causing cranialNeurological; Invasion of skull base causing cranial
nerve palsies (V, VI, IX, X, XII)nerve palsies (V, VI, IX, X, XII)
 Otological; Serous otitis mediaOtological; Serous otitis media
 Metastasis to bone, lung, liverMetastasis to bone, lung, liver

34. Nasopharyngeal CarcinomaNasopharyngeal Carcinoma
 Ix;Ix;
 Tissue sampling, CT/MRI, StagingTissue sampling, CT/MRI, Staging
 ManagementManagement
 Radiotherapy with concominant chemotherapyRadiotherapy with concominant chemotherapy
 Poorly amendable to surgery due to anatomicalPoorly amendable to surgery due to anatomical
locationlocation
 DDxDDx
 Lymphoma, cystic adenocarcinoma, InfectionLymphoma, cystic adenocarcinoma, Infection

35. Pathology of the LarynxPathology of the Larynx
 InfectiousInfectious
 InflammatoryInflammatory
 CongenitalCongenital
 MucosalMucosal
 MalignancyMalignancy

36.  5 Year old boy5 Year old boy
 Hx ofHx of
 3/7 Low grade fever and URTI Sx3/7 Low grade fever and URTI Sx
 1/7 history Biphasic Stridor, barking cough1/7 history Biphasic Stridor, barking cough
 No obvious respiratory distressNo obvious respiratory distress

37. Laryngotracheitis (Croup)Laryngotracheitis (Croup)
 Inflammation of tissues of subglottic space +/-Inflammation of tissues of subglottic space +/-
tracheobronchial treetracheobronchial tree
 Mucopurulent exudate -> airway obstructionMucopurulent exudate -> airway obstruction
 Aetiology; Parainfluenza I (most common),Aetiology; Parainfluenza I (most common),
II,III, influenza A,B, RSVII,III, influenza A,B, RSV
 Presentation; night, inspiratory/biphasic stridor,Presentation; night, inspiratory/biphasic stridor,
barking coughbarking cough
 Beware loss of stridor, Decr SaO2Beware loss of stridor, Decr SaO2
 DDx; FB, subglottic stenosis, EpiglottitisDDx; FB, subglottic stenosis, Epiglottitis

38. Laryngotracheitis + EpiglottitisLaryngotracheitis + Epiglottitis
FeatureFeature LaryngotracheitisLaryngotracheitis EpiglottitisEpiglottitis
Inflammation Subglottic space Supraglottic spaceInflammation Subglottic space Supraglottic space
AgeAge 4month-5 years4month-5 years 1-4 years1-4 years
OnsetOnset Gradual (days)Gradual (days) Acute (hours)Acute (hours)
Fever Low grade/afebrile High feversFever Low grade/afebrile High fevers
Stridor Biphasic/inspiratory InspiratoryStridor Biphasic/inspiratory Inspiratory
CoughCough BarkyBarky NormalNormal
PosturePosture SupineSupine SittingSitting
DroolingDrooling NoNo YesYes
RadiographRadiograph Steeple signSteeple sign Thumb sign, enlarged epiglottisThumb sign, enlarged epiglottis
Appearance Non-toxic Toxic/cyanoticAppearance Non-toxic Toxic/cyanotic
CauseCause ViralViral BacterialBacterial
TreatmentTreatment SupportiveSupportive Keep child calmKeep child calm
O2, Adrenalin nebsO2, Adrenalin nebs Airway management -ETTAirway management -ETT
Steroids ABx, IV hydration, Moist airSteroids ABx, IV hydration, Moist air

40.  18 month girl18 month girl
 ““Asthma Attack”Asthma Attack”
 WheezyWheezy
 ?trigger?trigger
 Family Hx of Asthma, EczemaFamily Hx of Asthma, Eczema
 No stridor, but tachypnea, intercostal recessionNo stridor, but tachypnea, intercostal recession
 Unilateral wheeze on Right with Decreased airUnilateral wheeze on Right with Decreased air
entry in lower zonesentry in lower zones

42. Foreign BodyForeign Body
 Usually stuck at right main bronchusUsually stuck at right main bronchus
 Anything that’s small enoughAnything that’s small enough
 Presentation;Presentation;
 Stridor if at level of tracheaStridor if at level of trachea
 ““Unilateral asthma” if bronchialUnilateral asthma” if bronchial
 ComplicationsComplications
 Atelectasis, lobar pneumonia, pneumothorax, mediastinalAtelectasis, lobar pneumonia, pneumothorax, mediastinal
shiftshift
 Dx;Dx;
 Inspiratory/Expiratory X-raysInspiratory/Expiratory X-rays
 BronchoscopyBronchoscopy

44. Signs of Airway ObstructionSigns of Airway Obstruction
 Stretor; obstruction in the throat, low pitched chokingStretor; obstruction in the throat, low pitched choking
noisesnoises
 Stridor; High pitched, inspiratory, biphasic orStridor; High pitched, inspiratory, biphasic or
expiratory depending on locationexpiratory depending on location
 Accessory Muscle useAccessory Muscle use
 Pallor, diaphoresis, restlessnessPallor, diaphoresis, restlessness
 TachycardiaTachycardia
 Cyanosis and altered concious stateCyanosis and altered concious state
 Intercostal recessionIntercostal recession
 Nasal FlaringNasal Flaring
 ExhaustionExhaustion
 Bradycardia – most dangerous signBradycardia – most dangerous sign

45. Upper Airway Obstruction -Upper Airway Obstruction -
NeonatesNeonates
 Subglottic StenosisSubglottic Stenosis
 Congenital or Acquired (trauma, intubation)Congenital or Acquired (trauma, intubation)
 Biphasic stridor, resp distress, recurrent croupBiphasic stridor, resp distress, recurrent croup
 Diagnosis; CT, laryngoscopyDiagnosis; CT, laryngoscopy
 Tx; Soft tissue – laser and steroidsTx; Soft tissue – laser and steroids
Cartilage – Laryngotracheoplasty or tracheostomyCartilage – Laryngotracheoplasty or tracheostomy
(intubation)(intubation)
 LaryngomalaciaLaryngomalacia
 Soft immature cartilage Children or older patients with NMSoft immature cartilage Children or older patients with NM
disordersdisorders
 Inspiratory stridor at 1-2 weeks, worse supine + feedingInspiratory stridor at 1-2 weeks, worse supine + feeding
difficultiesdifficulties
 Dx; BronchoscopyDx; Bronchoscopy
 Tx; Usually self resolves after 18-24monthsTx; Usually self resolves after 18-24months

46.  44 Female44 Female
 6 week history of hoarse voice6 week history of hoarse voice
 Irritation and dryness in throatIrritation and dryness in throat
 History of heartburnHistory of heartburn
 SmokerSmoker
 No history of weight loss, fatigueNo history of weight loss, fatigue
 Examination; UnremarkableExamination; Unremarkable

48. Chronic LaryngitisChronic Laryngitis
 Most common cause is GORDMost common cause is GORD
 Recurrent Acute laryngitisRecurrent Acute laryngitis
 Heavy smokingHeavy smoking
 Chronic infection of nasal sinusesChronic infection of nasal sinuses
 Mouth breathing from nasal obstructionMouth breathing from nasal obstruction
 ClinicallyClinically
 Hoarseness or loss of voiceHoarseness or loss of voice
 Spasmodic coughSpasmodic cough
 DDx; Malignancy, inhaled corticosteroids, laryngeal paralysis,DDx; Malignancy, inhaled corticosteroids, laryngeal paralysis,
TBTB
 General; Voice resting, avoid smokingGeneral; Voice resting, avoid smoking
 Specific; eg. Lifestyle modifications, MedicationsSpecific; eg. Lifestyle modifications, Medications

49.  35 year old35 year old
 Blunt trauma to neck 5 hours agoBlunt trauma to neck 5 hours ago
 Difficulty swallowing + Voice changesDifficulty swallowing + Voice changes
 No history of LOC, resp distress, confusionNo history of LOC, resp distress, confusion
 Examination showed midline tenderness ofExamination showed midline tenderness of
neck, subcutaneous emphysemaneck, subcutaneous emphysema

51. Laryngeal TraumaLaryngeal Trauma
 RareRare
 CausesCauses
 PenetratingPenetrating
 Blunt trauma; majority are MVA’s, clothesline injuries,Blunt trauma; majority are MVA’s, clothesline injuries,
sporting injuriessporting injuries
 Manual strangulationManual strangulation
 Inhaled flamesInhaled flames
 Swallowed poisons, foreign bodySwallowed poisons, foreign body
 ETTETT
 Injuries;Injuries;
 Cricotracheal separation -> AsphyxiaCricotracheal separation -> Asphyxia
 Fractures of larynx, hyoid bone, joint disruptionFractures of larynx, hyoid bone, joint disruption
 Open woundsOpen wounds
 Mucosal TearsMucosal Tears

56. Laryngeal InjuriesLaryngeal Injuries
 PresentationPresentation
 Significant cervical traumaSignificant cervical trauma
 Hoarse voice, neck pain, dyspnea, hypoxia, aphoniaHoarse voice, neck pain, dyspnea, hypoxia, aphonia
dysphasiadysphasia
 Goals of treatmentGoals of treatment
 Protect the airway; Intubation, tracheostomyProtect the airway; Intubation, tracheostomy
 Restoration of function; Surgical repairRestoration of function; Surgical repair
 ComplicationsComplications
 Laryngeal stenosis; permanent tracheostomyLaryngeal stenosis; permanent tracheostomy

57.  33 year old male singing teacher33 year old male singing teacher
 Progressively hoarse voiceProgressively hoarse voice
 Normal CoughNormal Cough
 Non-smokerNon-smoker
 No weight loss/fatigueNo weight loss/fatigue

58. Benign Vocal Fold LesionsBenign Vocal Fold Lesions
 Reactive nodules (singers nodules)Reactive nodules (singers nodules)
 BilateralBilateral
 Smooth, rounded/pedunculatedSmooth, rounded/pedunculated
 SmallSmall
 Located on true vocal foldsLocated on true vocal folds
 Treatment;Treatment;
 Voice training, re-educationVoice training, re-education
 Rarely surgical if fibrosed, chronicRarely surgical if fibrosed, chronic
 Virtually never give rise to malignancyVirtually never give rise to malignancy

60. LaryngoceleLaryngocele
 Abnormal dilatation of the laryngeal ventricleAbnormal dilatation of the laryngeal ventricle
 Contains airContains air
 Men>WomenMen>Women
 Bilateral 25%Bilateral 25%
 Aeitology;Aeitology;
 Acquired; Incr. Intraluminal pressure (musicians)Acquired; Incr. Intraluminal pressure (musicians)
 CongenitalCongenital
 SCC <15%SCC <15%
 Hoarse voice, pain, dysphagia, lateral neck massHoarse voice, pain, dysphagia, lateral neck mass

61. Squamous PapillomaSquamous Papilloma
 Most common benign neoplasm of larynx (84%)Most common benign neoplasm of larynx (84%)
 Found on true vocal cordsFound on true vocal cords
 Caused by HPV 6 and 11Caused by HPV 6 and 11
 Soft Raspberry like appearanceSoft Raspberry like appearance
 May ulcerate resulting in haemoptysisMay ulcerate resulting in haemoptysis
 Usually Single in AdultsUsually Single in Adults
 Multiple in Children (Laryngeal Papillomatosis) withMultiple in Children (Laryngeal Papillomatosis) with
extended growth and recurrenceextended growth and recurrence
 Malignant transformation extremely rareMalignant transformation extremely rare

62. Investigation and TreatmentInvestigation and Treatment
 Ix;Ix;
 LaryngoscopyLaryngoscopy
 Tx;Tx;
 CO2 LaserCO2 Laser
 Surgical removalSurgical removal
 ?Antivirals?Antivirals

63.  55 year old male55 year old male
 History of GORD, cardiac diseaseHistory of GORD, cardiac disease
 Recurrent hoarse voiceRecurrent hoarse voice
 Right otalgiaRight otalgia
 Smoker + ETOH abuseSmoker + ETOH abuse

64. Squamous Cell CarcinomaSquamous Cell Carcinoma
 Most common malignancy of larynxMost common malignancy of larynx
 Male>Female 6;1xMale>Female 6;1x
 2.5% all cancers in men2.5% all cancers in men
 AeitologyAeitology
 Tobacco:Tobacco: ↑↑↑↑
 Alcohol:Alcohol: ↑↑ (x 2.2)(x 2.2)
 Radiation, asbestosRadiation, asbestos
 GORDGORD
 HPVHPV

65. Squamous Cell CarcinomaSquamous Cell Carcinoma
 Glottic SCC most common (60%) >Glottic SCC most common (60%) >
supraglottic SCC (30%) > subglottic SCCsupraglottic SCC (30%) > subglottic SCC
(<10%).(<10%).
 Sx: hoarseness, throat pain, cough, hemoptysis,Sx: hoarseness, throat pain, cough, hemoptysis,
referred otalgia, dysphagiareferred otalgia, dysphagia
 Diagnosis;Diagnosis;
 Laryngoscopy with FNALaryngoscopy with FNA
 CT/MRICT/MRI

67. Squamous Cell CarcinomaSquamous Cell Carcinoma
 ManagementManagement
 Eradication of diseaseEradication of disease
 Restoration of function; swallowing and speechRestoration of function; swallowing and speech
 Radiation treatmentRadiation treatment
 Especially early stage diseaseEspecially early stage disease
 Cure rates equivalent to surgeryCure rates equivalent to surgery
 Surgical ManagementSurgical Management
 Emphasis on organ preservationEmphasis on organ preservation
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