16. Tumors of the Larynx. Vocal Cord Polyps / Nodules. LaryngealPapilloma. Laryngeal Squamous / Spindle Cell Carcinoma. Neuroendocrine Carcinoma. Tracheotomy and Cricothyrotomy Flashcards
Explain the TUMORS of Larynx
- Any hoarseness for MORE THAN 2 weeks
- Investigated via Laryngoscopy = In HIGH RISK Px (smokers)
- Persistent Hoarseness = CARDINAL SYMPTOM of ALL Neoplasms of Larynx (Benign / Malignant)
- BENIGN = Majority of Laryngeal Neoplasms in Adult / Children
- MECHANICAL OBSTRUCTION of Upper Airways with Coughing / Hoarseness / Wheezing / Dyspnoea
What are VOCAL CORD POLYPS?
- Chronic Inflammation where the MECHANICAL ALTERATION of Vocal Cords are due to Vocal Cord OVERUSE
0 HISTOLOGY = Polypoid Mucosal Hyperplasia
- Unilateral & located on FREE-EDGE of Anterior 2/3 of Vocal Cord
0 SYMPTOMS
- Cardinal Hoarseness
- Diplophonia, due to Floating Polyps
0 DIAGNOSIS = Telescopic Laryngoscopy
- GREY/RED Sessile
0 TREATMENT
- Microsurgical Removal
- Voice Therapy
What are VOCAL NODULES?
- Occurs in Children / Singers / Speaking Professionals
- Vocal ABUSE causing BILATERAL NODULE FORMATION at Opposite Sites at Junction of Anterior AND Middle 1/3 of Vocal Cords
0 HISTOLOGY
- Fibrosis w/ Epithelial Thickening
- Foreign Body Sensation
0 SYMPTOMS
- Hoarseness
- Diplophonia
- Habitual Throat Clearing
0 TREATMENT
- Voice Therapy
- Surgical Removal in Px w/ LARGE Nodules
What is LARYNGEAL PAPILLOMA?
- BENIGN Laryngeal Tumour in Children (ALSO Adults)
- Multiple Lesions that SPREAD TO Trachea / Bronchial System
- HPV’s 6 + 11
0 SYMPTOMS
- Hoarseness
- Inspiratory Stridor
- Laryngeal / Tracheal LUMINAL Obstruction
0 DIAGNOSIS = Endoscopy
- Multiple
- Soft, RED-PINK
- Villous
- Raspberry-like Lesions covering LARGE Area of Glottis / Supraglottis
- Lesions on Vocal Cords
0 TREATMENT = Carbon Dioxide Laser Surgery
What is LARYNGEAL SQUAMOUS CELL CARCINOMA?
0 DUE to
- Tobacco / Alcohol
- Infx with Human Papillomavirus
- Metal / Plastic Workers
- Exposure to paint / diesel / radiation
0 SYMPTOMS
- Hoarseness
- Dysphagia (Difficulty / Pain Swallowing)
- Dyspnoea
- Fatigue / Weakness
- Lump in Neck / Throat
0 DIAGNOSIS
- Physical Exam of Throat / Neck
- Biopsy
- Laryngoscopy
- CT
0 TREATMENT
- Surgery
- Radiation Therapy / Chemotherapy
- Palliative Care (Metastatic Tumours)
What is SPINDLE CELL CARCINOMA?
- AKA Sarcamatoid Carcinoma
- MALIGNANT Variant of Squamous Cell Carcinoma
- Polypoid
- Detected at EARLY Stage
0 SYMPTOMS
- Hoarseness
- Dysphagia
- Odynophagia
0 DIAGNOSIS = Laryngoscopy
0 TREATMENT
- Polypectomy
- Radiation Therapy
What is NEUROENDOCRINE CARCINOMA?
- Are RARE Tumours
0 CLASSIFIED AS:
- Carcinoid Tumour
- Atypical Carcinoid
- Small Cell Carcinoma
- Paraganglioma
0 DUE to SMOKING
0 DIAGNOSIS
- Laryngoscopy
- Biopsy
- CT
0 TREATMENT
- Partial / Total Laryngectomy
- Radiotherapy
What is the SURGICAL TREATMENT for LARYNGEAL CARCINOMA?
0 Larynx Consists of:
- Supraglottis
- Glottis (Vocal Cords)
- Subglottis
- Cancer may spread to nearby tissues / Thyroid, Trachea, OR Oesophageus
- Cancer may also spread to LN in Neck, Carotid Artery, Upper Part of Spinal Column
0 SURGICAL Tx
- Cordectomy
- Supraglottic Laryngectomy
- Partial / Total Laryngectomy (Hole’s made in front of neck to allow Px to breathe)
- Thyroidectomy
What are LARYNGEAL EFFECTS & VOICE REHAB?
1) Total Laryngectomy SIGNIFICANTLY ALTERS Speech Production
2) Voice Restoration AFTER T.Laryngectomy via:
- Artificial Larynx Speech
- Oesophageal Speech
- Tracheoesophageal Speech
3) Decision to be made by Surgeon / Speech Pathologist / Px
What are TRACHEOSTOMY and CRICOTHYROTOMY?
1) TRACHEOSTOMY
- Incision of ANTERIOR part of Neck
- OPENING Direct airway via incision of Trachea
- Stoma can serve as airway / site for tracheostomy tube
- Tube allows Px to breath WITHOUT Nose / Mouth
2) CRICOTHYROTOMY
- Emergency Procedure!!!
- Placing tube via incision in Cricothyroid Membrane
- TO CREATE airway for oxygenation / ventilation
