Chapter 20: Benign Laryngeal Disorders Flashcards
Normal infant larynx
- Situated higher in the neck than that of the adult
- Softer, less rigid and more compressible by airway pressures
- At the level C2-C4. (Adult: C4-C6)
- 7 mm in the anteroposterior length and opens approximately 4mm in a lateral direction
- Exaggeration of the soft, flabby state that is normal for newborns
- As the infant inhales, the soft larynx falls together, narrowing the inlet and stridor results
- Swallowing is unaffected
Laryngomalacia
Direct examination of laryngmalacia
- Larynx fall together with inhalation
- Subglottic area is normal
- Stridor ceases if the larynx is held open with laryngoscope
Most infants cease to have the stridor by the 12th to 15th month
Laryngomalacia
Can be associated with a 2nd upper airway abnormality
Laryngomalacia
Disorder of the trachea due to lack of rigidity of the tracheal cartilages
Tracheomalacia
- Subglottic diameter less than 4 mm
- Presents with stridor shortly after birth or recurrent episodes of laryngotracheitis
- Mild cases: observation, most cases require tracheotomy
- Growth tends to resolve the relative stenosis, but laser excision or reconstructive surgery may be necessary
Congenital subglottic stenosis
Congenital webs
- Glottic (75%)
2. Subglottic (12%)/Supraglottic (12%)
Both the airway and the cry or voice are affected, with the symptoms beginning at birth
Congenital webs
Congenital webs treatment
- Laser or surgical excision
- Repeated dilatation
- Tracheotomy
- May have airway obstruction or simply do not grow
- Voice and swallowing and normal
- Arise from the base of the tongue, aryepiglottic folds or false cords
- If its possible: excision
- Not possible: aspiration or marsupialization
Congenital cysts
- Occurs primarily in infants under 6 months of age
- Presence of external hemagioma plus stridor
- Tends to regress, usually by the age of 12 months
- Lateral xray: mass in the airway
- Endoscopic: smooth, compressible mass often on the posterior or lateral wall
- Tx: tracheotomy and allowing time for regression, laser excision
Hemagioma
- Special type of congenital cyst that develops as s residual from a small appendix or saccus of the laryngeal ventricle
- Present at any age but its origin is congenital
Laryngocele
- As the cyst begins, it first causes a bulging of the false vocal cord on that side
- With enlargement, the cyst dissects along the superior laryngeal nerve and vessels to present as mass in the neck
- As they enlarge, they encroach on the airway and may cause stridor and airway obstruction
Laryngocele
Treatment for laryngocele
Dissection of the cyst using an external approach accompanied by a temporary tracheostomy
Result of a failure of fusion of the dorsal portions of the cricoid cartilages
Laryngotracheoesophageal cleft
There is an associated failure of closure of the tracheoesophaheal septum, thus creating a groove in the region of the cricoid cartilage
Laryngotracheoesophageal cleft
- Infant may have cyanosis, respiratory distress and recurrent episodes of pneumonia
- Associated changes in the cry as well as inspiratory stridor
- Direct laryngoscopy: normal larynx
Laryngotracheoesophageal cleft
Causes of vocal cord paralysis in infants
- Birth canal trauma
- Meningocele or mediatinal mass
- Increase ICP
Unilateral vocal cord paralysis is more common on the…
Cleft
Children with bilateral vocal cord paralysis can have a…
Normal cry
Recovery of vocal cord paralysis
6-9 months but may take up to 14 months
- Manifested by internal hematomas and occasionally by dislocation of the arytenoid cartilage
- Caused by some blunt object striking an extended neck
- Direct laryngoscopy: reduces the dislocated arytenoid cartilage
Mild contusions of the larynx
Don not cause airway obstruction, since the pharynx is very wide at this level
Hyoid fractures
The greater cornu of the hyoid does not normally unite to the body until…
Age 35
Treatment of hyoid bone fractures
Expectant
Signs of laryngeal fracture
- Hoarseness
- Inspiratory or expiratory stridor
- Hemoptysis
- Subcutaneous emphysema
When laryngotracheal separation occurs, the trachea will retract into the lower neck
Emergency tracheostomy is required
Most likely fracture runs in a…
Vertical plane from the bottom of the thyroid notch to the lower border of the cartilage
Avulsion of the thyroid cartilage from the cricoid and trachea…
- Facial pain
- Aphonia
- Subcutaneous emphysema
Required in anyone with a laryngeal fracture
- Cervical spine films
2. Neurologic exam
Causes of laryngeal stenosis
- Blunt or perforating trauma
- High tracheostomy
- Caustic ingestion
- Gunshot wound
- Irritation from an endotracheal tube cuff
Used to delineate laryngeal and subglottic stenosis
Ct scan
Treatment of chronic laryngeal stenosis is very complicated and must be individualized
- Dilatation
- Excision
- Direct re-anastomosis
- Skin grafting over a mo
- Partial or total laryngectomy
- Endotracheal tube abrades the vocal process of the arytenoid cartilage
- Perichondritis develops and the healing process produces a raised polypoid lesion in the posterior portion of thr glottic chink (rima glottidis)
- Not very hoarse but the voice is changed
- Bilateral
Intubation granuloma
Treatment of intubation granuloma
Endoscopic surgical removal, often using the CO2 laser
- Resulting in stridor and airway obstruction
- Develop at any age even in adults
- Most common in children under 6 years of age
Croup
Contain loose areolar tissue that is prone to swell when inflamed
- Laryngeal surface of the epiglottis
2. Area just below the vocal cords in the larynx
Croup can be divided into:
- Acute supraglottis (epiglottis)
2. Acute subglottic laryngitis
Signs and symptoms of croup
- Restlessness
- Apprehension
- Stridor
- Retraction
- Cyanosis
- More explosive
- Tends to sit up with mouth open and chin forward, is not hoarse
- Tends not to have a croupy a cough, but is more likely to have dysphagia
- Painful to swallow, child may drool
- Dysphagia may be a sign of impending collapse (results from the spread of inflammation into the adjacent esophageal inlet and means that the inflammatory process has swollen the epiglottis markedly)
Acute supraglottis (epiglotitis)
Hoarse with very croupy cough and usually want to lie down
Acute subglottic laryngitis