Congential Conditions Of Larynx Flashcards
Most common congenital conditions of larynx
LARYNGOMALACIA
2nd most common - vocal cord palsy
3rd most common - subglottic stenosis
Other name for laryngomalacia
Congenital laryngeal stridor
What happens in laryngomalacia ?
Excessive flaccidity of supraglottic larynx will be there which is sucked in during inspiration that produces STRIDOR and sometimes causes CYANOSIS
Clinical features of laryngomalacia
INSPIRATORY STRIDOR
Increases in supine position , crying , playing ; stridor increases on crying and playing because during these activities breathing Is more and hence stridor is more
Decreases in prone position
No odynophagia , Dysphagia , drooling of saliva as it is not an infective condition
So the only concern if the parents will be some kind noise coming from the child during breathing
Diagnosis / investigation of laryngomalacia
Done by rigid / flexible laryngoscope
Features seen : enlarged , curled up epiglottis (omega shaped)
Enlarged arytenoids
Floppy and short Aryepiglottic folds
Excessive flaccidity / laxity at the supraglottis
Treatment of laryngomalacia
Manifest either at birth or soon after birth and will usually disappear by itself at the end of 2 years of age ; so conservative treatment will be sufficient
If it is not getting corrected by two years of age , it is because of excessive lax tissue in the supra glottis that can be removed by supraglottoplasty
When it is called as congenital subglottic stenosis ?
If the subglottic diameter is less than
4mm in full term neonate
3mm in preterm neonate
Can subglottic stenosis be acquired ?
Yes . In cases of prolonged intubation as seen in premature infants due to acute respiratory distress syndrome . Prolonged intubation will cause pressure necrosis of the cricoid cartilage and this necrosis heals by fibrosis causing stenosis ( pressure necrosis is due to the inflated balloon at the level of cricoid )
How subglottic stenosis as a result of prolonged intubation can be prevented ?
By shifting to tracheostomy after 2-3 weeks of intubation
Clinical presentation of the patient ?
Biphasic stridor
Best investigation for subglottic stenosis
Rigid endoscopy
Grading of subglottic stenosis
Meyer - cotton grading ; management depends on grading
Meyer - cotton grading of subglottic stenosis
Grade 1 = 0-50% obstruction of lumen - no management needed
Grade 2 = 50-70% obstruction of lumen
Grade 3 = 70-99% obstruction of lumen
Grade 4 = no lumen is found
Treatment for grade 2 and early grade 3
Graft is placed Anteriorly in the cricoid cartilage and space is left posteriorly
Graft is mostly coastal cartilage
Treatment for late grade 3 and grade 4
Graft is placed both Anteriorly and posteriorly in the cricoid cartilage
When is cricotracheal resection is done ?
This is done only when there’s no improvement after all the graft have been tried
Here the stenosed part is completely removed and the free ends are anastomosed
How to prevent restenosis after surgery for subglottic stenosis ?
By prescribing mitomycin - c
Also Montgomery tube is used as a stent and also for respiration following surgery
What is laryngeal web ?
This is due to incomplete recanalisation of the larynx
Most commonly in the anterior part of glottis
Clinical features of laryngeal web
Inspiratory stridor / biphasic stridor
Weak cry / aphonia - mother usually complaints that she can’t hear the cry of her baby
Management of laryngeal web
Investigate by endoscope / laryngoscope
Treatment is excision either by knife or laser (co2)
In order to prevent adhesions , that can happen due to adduction of vocal cords as a result if crying LARYNGEAL KEEL can be placed for 2 weeks so that the epithelium heals
How a child presents in subglottic hemangioma ?
Stridor + lesions over the face
Treatment for subglottic hemangioma
First line treatment : propranolol
Submucous resection :laryngofissure
Other name for laryngeal papillomatosis
Recurrent respiratory papillomatosis
Is laryngeal papillomatosis a congenital condition?
No it is acquired condition
Causative agent for laryngeal papillomatosis
Human papilloma virus ; strain - 6 and 11
Strain 11 - more virulent
Bimodal distribution of laryngeal papillomatosis
Adults - due to smoking
Infants - due to vaginal delivery (aka juvenile laryngeal papillomatosis)
Has predilection has to grow at squamociliary junction (nasopharynx , oropharynx )
Clinical features in laryngeal papillomatosis
Hoarseness
Stridor - Inspiratory / biphasic
Diagnosis of laryngeal papillomatosis
Endoscopy
Biopsy
Premalignant nature of laryngeal papillomatosis is more in
Adults , as they smoke and are exposed to radiation
Why tracheostomy not done in laryngeal papillomatosis?
Since it’s creating another hole which has squamous and columnar epithelium junction tracheostomy is contraindicated
Excision with microdebrider is done
Laser (co2) is not done as it will recur
Posoperatively to decrease the chance of recurrence of laryngeal papillomatosis what is given ?
A - alpha interferon = immunomodulator
B - Bevacizumab = reduces angiogenesis
C - cedofovir = given intralesionally
Prevented by vaccinating the mother = cervarix , gardasil - 9
