Laryngeal endoscopy / mouth pathology Flashcards
Spot diagnosis + management
Normal larynx - normally contracted vocal cords that are pale + can see epiglottis
Spot diagnosis + management
- progressive hoarseness
- common in singers, teachers, sports coach etc.
Vocal cord nodules - bilateral, small, symmetrical nodules at the midpoint of the vocal cords
Management:
- voice rest + speech therapy
- (surgical excision if persistent)
Spot diagnosis + management
- hoarseness
- common in smokers or voice overuse
Vocal cord polyps - unilateral polyp on the vocal cord
Management:
- smoking cessation
- voice therapy
- microsurgical excision (if symptomatic)
Spot diagnosis + management
- progressive hoarseness
- usually children or young adults
Recurrent Respiratory Papillomatosis - multiple wart-like lesions on vocal cords, caused by HPV (6 or 11)
Management:
- Microsurgical excision - CO2 laser
- Adjuvant therapy - cidofovir injections + HPV vaccination for prevention
Spot diagnosis + management
- persistent hoarseness (> 3 weeks)
- smokers, alcohol use
- dysphagia, haemoptysis, weight loss (in advanced cases)
Laryngeal carcinoma - irregular, wart-like, sometimes ulcerated mass on vocal cords
Management:
- Urgent ENT referral for biopsy
- Radiotherapy/laser excision OR laryngectomy
Spot diagnosis + management
- hoarseness, stridor, and airway compromise
- recent thyroid surgery
Bilateral vocal cord paralysis - not open, not closed
Management:
- voice therapy
- surgical medialisation (if persistent)
Spot diagnosis + management
- chronic throat irritation, hoarseness, and a globus sensation (feeling of lump in throat)
- chronic dry cough
- worse in morning and after meals
Laryngopharyngeal reflux - erythema and oedema of posterior larynx, vocal cord oedema
Management:
- Lifestyle - weight loss, smoking cessation, avoid trigger foods, and avoid lying down straight after meals
- Medical - PPI (omeprazole) OR H2 receptor blockers, gaviscon +/- speech therapy
Spot diagnosis + management
- painless, white patch on tongue, buccal mucosa, or gums
- smokers, alcohol use, betel nut chewing
- cannot be scraped off
Leukoplakia - well-defined white patch/plaque
Management:
- smoking/alcohol cessation
- regular monitoring (risk of malignant transformation)
- If persistent –> biopsy
Spot diagnosis + management
- painless, slow-growing
- no facial nerve involvement
Pleomorphic adenoma - most common benign salivary gland tumour
Management:
- Surgical excision
- monitor for recurrence
Spot diagnosis + management
- white patches in mouth, can be scraped off (leaving a red, raw base)
- common in immunocompromised pts, steroid inhaler use, or antibiotic use
Oral candidiasis (thrush)
Management:
- Topical antifungals - nystatin suspension, miconazole gel
- if severe/recurrent - oral fluconazole
Spot diagnosis + management
- painful, round ulcers in mouth
- associated with stress, trauma, or nutritional deficiencies
Aphthous ulcers
Management:
- self-limiting (1-2 weeks)
- topical corticosteroids (hydrocortisone) - for symptom relief
- (Vit B12/folate replacement if deficiency found)
Spot diagnosis + management
- chronic burning sensation, white patches or ulcers in the mouth
- may affect buccal mucosa, tongue, or gingiva
Oral lichen planus - white lacy (Wickham’s striae) or erosive lesions on the oral mucosa
Management:
- Topical corticosteroids - eg. betamethasone mouthwash
Spot diagnosis + management
- non-healing ulcer or lump in the mouth
- painless initially, then painful
- smokers, alcohol use
Squamous cell carcinoma of the mouth (oral cancer)
Management:
- Urgent ENT referral for biopsy
- Surgical excision ± radiotherapy/chemotherapy
