Laryngeal ca Flashcards
What are some DDx for hoarseness and dysphagia?
Mechanical (difficulty swallowing solids, constant)
o Intraluminal- foreign body
o Luminal
- Oesophageal ca
- Oesophageal varices
- Strictures- GORD, medication-induced (NSAIDs), chemo, radiation
- Oesophageal webbing (mucosal extension)
- Oesophageal rings (smooth m extension)
- Pharygngeal pouch
o Extra-luminal:
- mediastinal mass (lymphadenopathy, goitre, bronchial tumour)
- Enlarged LA or aorta
o Laryngeal
- Benign vocal fold lesion (polyps, nodules)
- Infectious- laryngitis, TB, URTI
- Neurological- stroke, recurrent laryngeal n damage, muscle tension dysphonia)
- Sarcoidosis
- Voice misuse
- Wegner’s Granulomatosis
Neuromuscular (difficulty swallowing solids and liquids, intermittent:
o Primary: achalasia (diffuse oesophageal spasm, myenteric plexus defect), myasthenia gravis
o Secondary: scleroderma, myotonic dysphagia, bulbar palsy, pharyngeal paralysis
Functional- dysphagia in absence of other major motor, structural or mucosal abnormalities
What imaging would you order to investigate dysphagia?
o Barium swallow test- indicated in likely oesophageal lesion or strictures, prior to endoscopy (reduce perforation risk)
- Scleroderma findings: dilated lower oesophagus, difficulty emptying oesophageal contents into stomach
- Achalasia findings: contraction of LES (“bird beak”)
- Oesophageal spasm findings: “cork screw”
o Endoscopy-
- Look for fibrosis, sclerosis, mass, lesion
- Visualize or biopsy any dysplastic region
- See if LES open
- Stent obstructions
o Oesophageal manometry- thin, pressure-sensitive tube placed in whole oesophageal length, pt sips water and device assesses peristaltic movements
- Scleroderma: reduced peristalsis in lower 2/3 (smooth m) and loss of LES tone
- Achalasia: similar to scleroderma, but LES unaffected
- Diffuse oesophageal spasm: uncoordinated contraction
What are the risk factors for laryngeal carcinoma?
Modifiable
o Smoking
o ETOH
o GORD
Non-modifiable o Age increased (>40yo) o Gender (male) o Ethnicity (Black) o FMHx o Genetics- AI (scleroderma), ca o Radiotherapy o Immunocompromised
Describe the epidemiology of laryngeal ca?
• Laryngeal ca accounts of 2% of all ca • Histo: - Glottis tumours 75% (on cords) - Supraglottic tumours 20% (above cords) - Subglottic <5% (below cords) • Clinical: presents w chronic hoarseness
What investigations could be done to stage the laryngeal ca?
Staging: TNM
o Tumour- direct/indirect laryngoscopy, laryngeal biopsy, neck CT w contrast
o Nodes- neck CT with contrast, chest CT with contrast, whole body PET/CT, FNA biopsy neck mass
o Metastases- neck CT w contrast, chest CT with contrast, whole body PET/CT
Name the cartilages of the larynx?
Unpaired (3): - thyroid cartilage - cricoid cartilage - epiglottic cartilage Paired (3): - arytenoid cartilages - corniculate cartilages - cuneiform cartilages
Describe the thyroid cartilage?
Thyroid cartilage:
- two quadrilateral laminae, anterior borders form laryngeal prominence (Adam’s apple)
- Note: laryngeal prominence larger in men (sharper angle)- assoc w longer vocal cords -> deeper voice
Describe the cricoid cartilage?
Cricoid cartilage:
- signet-ring shaped cartilage
- articulates w thyroid cartilage
Describe the arytenoid cartilages?
- PAIRED pyramidal shapes
- 3 faces and a base.
- base: has a muscular process laterally and a vocal process anteriorly
Describe the corniculate cartilages?
Corniculate cartilages:
- PAIRED cartilage posteriorly in aryepiglottic mucosal folds
- > strengthen airway entrance
Describe the cuneiform cartilages?
Cuneiform cartilages:
- PAIRED elongable club-like elastic fibrocartilages in aryepiglottic folds
- anterosuperior to carniculates
- strengthen airway entrance
Describe the epiglottic cartilage?
Epiglottic cartilage:
- elastic fibrocartilage projecting up behind tongue, into front of laryngeal inlet
- sides attached to arytenoid cartilages by aryepiglottic folds
Describe the internal features of the larynx?
• Laryngeal cavity- extends from laryngeal inlet to the cricoid cartilage lower border
• Paired folds of mucosa (vestibular and vocal folds)
- Vestibular folds- dividing fissue is rima vestibuli
- Vocal folds- consists of cricovocal lig, dividing fissue is rima glottides (or glottis)
• Laryngeal sinus- lies between vocal and vestibular folds laterally
• Laryngeal inlet bounded:
- Anteriorly- by upper edge of epiglottis
- Posteriorly- by mucosa between arytenoids on each side
- Laterally- aryepiglottic folds
• Aryepiglottic folds have oval anterosuperior swellings (due to cuneiform cartilage) and posterioinferior swellings (due to comiculate cartilage)
Describe the arterial supply of the larynx?
Arterial supply: superior laryngeal a and inferior thyroid a
- External carotid -> superior thyroid branch -> superior laryngeal a
- Subclavian a -> thyrocervical trunk -> inferior thyroid branch
Describe the innervation of the larynx?
Innervation: superior laryngeal nerve and recurrent laryngeal nerve
• Supraglottic- superior laryngeal nerve
• Infraglottic- recurrent laryngeal n
• Vocal fold (proprioception and touch)- superior laryngeal n
