Congential Conditions Of Larynx

Question 1

Most common congenital conditions of larynx

Answer 1

LARYNGOMALACIA

2nd most common - vocal cord palsy

3rd most common - subglottic stenosis

Question 2

Other name for laryngomalacia

Answer 2

Congenital laryngeal stridor

Question 3

What happens in laryngomalacia ?

Answer 3

Excessive flaccidity of supraglottic larynx will be there which is sucked in during inspiration that produces STRIDOR and sometimes causes CYANOSIS

Question 4

Clinical features of laryngomalacia

Answer 4

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

Question 5

Diagnosis / investigation of laryngomalacia

Answer 5

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

Question 6

Treatment of laryngomalacia

Answer 6

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

Question 7

When it is called as congenital subglottic stenosis ?

Answer 7

If the subglottic diameter is less than

4mm in full term neonate
3mm in preterm neonate

Question 8

Can subglottic stenosis be acquired ?

Answer 8

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 )

Question 9

How subglottic stenosis as a result of prolonged intubation can be prevented ?

Answer 9

By shifting to tracheostomy after 2-3 weeks of intubation

Question 10

Clinical presentation of the patient ?

Answer 10

Biphasic stridor

Question 11

Best investigation for subglottic stenosis

Answer 11

Rigid endoscopy

Question 12

Grading of subglottic stenosis

Answer 12

Meyer - cotton grading ; management depends on grading

Question 13

Meyer - cotton grading of subglottic stenosis

Answer 13

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

Question 14

Treatment for grade 2 and early grade 3

Answer 14

Graft is placed Anteriorly in the cricoid cartilage and space is left posteriorly

Graft is mostly coastal cartilage

Question 15

Treatment for late grade 3 and grade 4

Answer 15

Graft is placed both Anteriorly and posteriorly in the cricoid cartilage

Question 16

When is cricotracheal resection is done ?

Answer 16

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

Question 17

How to prevent restenosis after surgery for subglottic stenosis ?

Answer 17

By prescribing mitomycin - c

Also Montgomery tube is used as a stent and also for respiration following surgery

Question 18

What is laryngeal web ?

Answer 18

This is due to incomplete recanalisation of the larynx

Most commonly in the anterior part of glottis

Question 19

Clinical features of laryngeal web

Answer 19

Inspiratory stridor / biphasic stridor

Weak cry / aphonia - mother usually complaints that she can’t hear the cry of her baby

Question 20

Management of laryngeal web

Answer 20

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

Question 21

How a child presents in subglottic hemangioma ?

Answer 21

Stridor + lesions over the face

Question 22

Treatment for subglottic hemangioma

Answer 22

First line treatment : propranolol
Submucous resection :laryngofissure

Question 23

Other name for laryngeal papillomatosis

Answer 23

Recurrent respiratory papillomatosis

Question 24

Is laryngeal papillomatosis a congenital condition?

Answer 24

No it is acquired condition

Question 25

Causative agent for laryngeal papillomatosis

Answer 25

Human papilloma virus ; strain - 6 and 11

Strain 11 - more virulent

Question 26

Bimodal distribution of laryngeal papillomatosis

Answer 26

Adults - due to smoking
Infants - due to vaginal delivery (aka juvenile laryngeal papillomatosis)

Has predilection has to grow at squamociliary junction (nasopharynx , oropharynx )

Question 27

Clinical features in laryngeal papillomatosis

Answer 27

Hoarseness
Stridor - Inspiratory / biphasic

Question 28

Diagnosis of laryngeal papillomatosis

Answer 28

Endoscopy
Biopsy

Question 29

Premalignant nature of laryngeal papillomatosis is more in

Answer 29

Adults , as they smoke and are exposed to radiation

Question 30

Why tracheostomy not done in laryngeal papillomatosis?

Answer 30

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

Question 31

Posoperatively to decrease the chance of recurrence of laryngeal papillomatosis what is given ?

Answer 31

A - alpha interferon = immunomodulator
B - Bevacizumab = reduces angiogenesis
C - cedofovir = given intralesionally

Prevented by vaccinating the mother = cervarix , gardasil - 9