3. Larynx

Question 1

Diseases of the larynx

Answer 1

1. Inflammatory conditions
   a. Laryngitis
   b. Laryngoepiglottitis
2. Reactive nodules
   a. Singer’s nodule
3. Neoplasms
   a. Squamous cell papilloma
   b. Squamous cell carcinoma (most common)
   c. Other malignancies
   - Spindle cell carcinoma
   - Verrucous carcinoma
   - Mucoepidermoid carcinoma
   - Adenoid cystic carcinoma

Question 2

Causes of laryngitis

Answer 2

1. Viral
2. Bacterial (Corynebacterium diphtheriae which produces
   membranous inflammation)
3. Tuberculosis

Question 3

Causes of laryngoepiglottitis

Answer 3

1. Haemophilus influenzae
2. Respiratory syncytial virus
3. Beta-hemolytic streptococci

Question 4

Complications of laryngoepiglottitis

Answer 4

Sudden swelling of epiglottis & vocal cords obstructing airway (mainly in young children)

Question 5

Singer’s nodules

Answer 5

1. Occurs in individuals who use their voices extensively
2. A polypoidal lesion on true vocal cords
3. Characteristically changes character of the voice & often
   cause progressive hoarseness
4. Non-neoplastic (do not give rise to cancers)

Question 6

Squamous cell papilloma

Answer 6

1. Benign tumour, may be single or multiple
2. Caused by human papillomavirus (HPV) types 6 & 11
   (especially recurrent multiple papillomas)
3. Complications: obstruction, progression to squamous cell carcinoma (rare)

Question 7

Epidemiology of Squamous cell carcinoma

Answer 7

1. Common over the age of 40

2. Strong association with cigarette smoking

Question 8

Pathogenesis of Squamous cell carcinoma

Answer 8

Step-wise progression of tumour: epithelial dysplasia of varying degree → carcinoma-in-situ → invasive carcinoma

Question 9

Classification of Squamous cell carcinoma based on location

Answer 9

1. Glottic: confined to one or both cords (slow to metastasize, good prognosis)
2. Supraglottic: involves the epiglottis, false but not
   true cords (metastasis more common than glottic)
3. Subglottic: located below the cords (late presentation, poor prognosis, extensive growth leading to stridor & voice loss)

Question 10

Growth patterns of Squamous cell carcinoma

Answer 10

Polypoidal &/or ulcerative growth patterns, commonly demonstrating local invasion

Question 11

Spead of Squamous cell carcinoma

Answer 11

Spread to regional lymph nodes & distant metastases can occur

Question 12

Other malignancies of the larynx

Answer 12

1. Spindle cell carcinoma (resembles a sarcoma)
2. Verrucous carcinoma
   - Variant of squamous cell carcinoma
   - Locally destructive, may cause obstruction
3. Mucoepidermoid carcinoma
4. Adenoid cystic carcinoma