larynx Flashcards
development of larynx starts and completes at
4wk to 3rd mnth of intrauterine life
wrisberg cartilage is ??
cuneiform cartilage
cartilage of santorini is ??
corniculate cartilage
angle bw lamina of thyroid is ?
male 90
female 120
oblique line over thyroid lamina gives attachment to ??
thryohyoid
sternohyoid
inferior constrictor
largest laryngeal cartilage
thyroid cartilage
only complete cartilaginous ring is ??
cricoid cartilage
wht is pachydermia laryngitis
due to faulty production of vocal process of arytenoid rub against each other leads to an area of heaped up mucosa on one vocal process which fits into ulcer like depression on side
which part of vocal fold is affected by pacydrermia laryngitis
posterior 1/3
is contact ulcer malignant ??
no they r not malignant
cause of contact ulcers is ??
vocal abuse
TB affects which part of vocal cord
posterior
first sign of laryngeal tb is ??
hyperemia and ulceration of unilateral vocal cord with impairment of abduction
mouse nibbled appearence is seen in ??
tubercular laryngits
turban epiglottis is ??
pseudoedema of epiglottis seen in laryngeal tb
lupus of larynx is seen in which part of larynx
anterior
syphilis effects which part of larynx
anterior
leprosy effects which part of larynx
anterior
lesions of leprosy r ?
dull in color of epiglottis is destroyed and gives appearance of hook over a buttonhole
wht is reinke edema
b/l symmetrical swelling of
vocal cord giving appearance of hook over a button hole
kind of voice in reinke s edema
pt uses false cords therefore voice is low pitched and rough
b/w which layers of vocalcord
lies the reinke edema
b/w superficial lamina propria and intermediate lamina propria
dysphonia plica ventricularis is ??
voice production by false cord
treatment of dysphonia plica ventricularis is ??
psychological counselling if functional cause
key hole appearence of glottis is seen in ??
phonosthenia
cause of keyhole appearance
elliptical space bw the cords is due to paralysis of thyroartenoid and triangular gap is due to weakness of interarytenoid
cause of rhinolalia clausa
nasal allergy
polyp
adenoids nasopharyngeal mass
cause of rhinolalia aperta
velopharyngeal insufficiecy
gutzman test is positive in ?
puberphonia
thyroid prominece is pressed backwards and downwards
muscle responsible for falsetto voice of puberphonia
cricothyroid main tensor
there is hyperkinetic function and spasm of this muscle
intubation granuloma is most commonly found on??
posterior third of vocal cord
glottic cancer is found where
free edge and upper surface of ant 1/3 of true vocal cord
wht is mogiphonia
phonic spasm occurs in professional voice users
initially voice is normal but soon vocal cords get adducted and person cannot speak
lesions of leprosy are ?
dull grey in color
epiglottis idestrgives
most common site affected in pacydermia laryngis
arytenoid cartilage
true abt reinke edema is ? 1usually unilateral 2 common in smoker 3 corticosteroids is mainstay of treatment 4 patient has low pitch voice 5 involves membrnous part of vocal cord
ans
common in smoker
involves whole vocal cord
pt has low pitched voice
wht is functional aphonia
seen in emotionally labile females in age grp 16-30 yrs
laryngoscopy shows vocal cords in abducted position and fails to adduct on phonation however adduction is seen on coughing
indiacting normal adductor function
treatment of functional aphonia
reassurances and psychotherapy
wht is typ1 thyroplasty
medialisation of vocal cord
wht is type 2 thyroplasty
lateralisation of vocal cord
indications spasmodic dysphonia
type 3 thyroplasty
relaxation of vocal cord or shortening of vocal cord
as in puberphonia to lower pitch
type 4 thyroplasty
lengthening of vocal cord
ie in androphonia to elevate the pitch
muscle responsible for change of pitch of voice
cricothyroid
ortners syndrome is ??
cardiomegaly + paralysis of RLN
distance bw vocal cords in full abduction
19 mm
distance bw vocal cord as glottic chink
7 mm ie 3.5 mm from midline
which side of vagus is more prone to injury
left as it has longer
features of unilateral SLN paralysis
voice is not severly effected but pitch of voice cannot be raised
iosilateral cord is bowed and floppy,,increased in length,cords sag down in inspiration and bulge up during expiration
unilateral anaesthesia above the cord
treatment of unilateral
SLN paralysis
no treatment
bilateral SLN PARALYSIS
voice is breathy and weak also there is high chances of aspiration as there is bilateral anaesthesia of supraglottic part
treatment of bilateral SLN paralysis
tracheostomy may be required
epiglottopexy is close laryngeal inlet is done to protect from aspiration
features of unilateral RLN paralysis
ie unilateral abductor paralysis affected cord is in paramedian position does not move laterally on inspiration
slight hoarseness which improves over days
voice tires on repeated use
treatment of unilateral RLN paralysis
speech therapy
features of bilateral RLN paralysis
both cords lie in median ot paramedian position due to unopposed action of cricothyroid muscle
voice is gud
dyspnea stridor may be present
treatment for bilateral RLN
emergency tracheostomy or lateralise the cord
position of cord i both RLN AND SLN paralysis
adductor paralysis causes vocal cord to be in cadaveric position
muscular voice in female is treated by ?
thyroplasty type 4 used to lengthen the vocal cord and elevate the pitch
voice in bilateral abductor paralysis
normal
position of vocal cords in cadaver
intermediate
most common cause of vocal cord palsy is
total thyroidectomy
rht siided vocal cord pasy is seen in
rht RLN arises from vagus at the level of subclavian artery and hooks around it
it is seemin laryngeal carcinoma
course of left RLN
arise from vagus in the mediastinum at level of arch of aorta loops around it and then ascends into neck
treatmemt of unilateral vocal cord palsy
type 1 thryoplasty ie medialisation of vocal cord
most common cause of vocal cord palsy
surgical due to surgery of thyroid , parathyroid carotid
most common malignancy causing vocal cord palsy
bronchial 》esophagus 》nasopharyngeal 》thyroid
most common cause of benign tumor
squamous papillomas
cause of juvenile papillomatosis
HPV types 6,11
treatment of infant hemangiona
involute spontaneously treated by CO2 laser
treatment of adult hemangioma
most are cavernous
can be treated by steroids and radiation therapy
mc type of laryngeal cancer
squamous cell carcinoma
supraglottis and infraglottis drains inti
upper deep cervical
vocal cord lymphatic drainage
no lymphatics
mc site for laryngeal cancer
glottis
worst prognosis of which laryngeal can er
subglottic
best prognosis for which laryngeal cancer
glottic
ackerman tumor treated by ??
verrucus carcinoma is Ackermantumor
treatment is always surgery
structures removed in radical neck dissection
lymph nodes 1-V \+ spinal accessory nerve \+ int jugular vein \+ sternocleidomastoid
modified radical neck dissection
type 1 spinal accessory preserved type2 spinal accessory nerve +internal jugular vein type3 spinal accessory nerve +int jugular vein
levels of neck nodes
level 1 submental 1b submandibular 2 upper jugular 3 middle jugular 4 lower jugular 5 posterior triangle 6 central 7 sup mediastinal
premalignant conditions for laryngeal cancer
leukoplakia papillomas
chronic laryngitis
which is more aggressive hpv 6 and 11
hpv 11
mode of acquiring papillomas in a child
vertical transmissions at time of parturition
most common initial symptoms of supraglottis cancer
pain on swallowing
most common first sign
of supraglottis cancer
mass in neck
treatment of choice for all stage 1 laryngeal cancer which neither impair mobility or invade cartilage or cervical nodes
radiotherapy
TOC FOR stage T1 glottic carcinoma
radiotherapy
treatment for stage T2 of glottic carcinoma with mobile vocal cords
radiotherapy
external bean radiation
treatment of choice for vocal cords with impaired vocal cord mobility
laryngectomy
laser used for laryngeal cancer
CO2 laser
TOC in perichondritis larynx
total laryngectomy
IOC in upper airway obstruction
fiberoptic endoscopies
most definative managemet for upper airway obstruction
tracheostomy
immediate methods for upper airway obstruction
heimlich and jaw thrust
minitracheostomy is ?
cricothyrotomy
site for tracheostomy is ??
2nd,3rd,4th tracheal ring which lie under isthmus of thyroid gland
high tracheostomy disadv
perichondritis of cricoid cartilage can lead to subglottic stenosis
low tracheostomy disadv
injuries to great vessel of neck and ap
prefered material for tracheostomy tube in children
silicon as it is flexible and causes less trauma
should we use cuffed tracheostomy tubes in child
no as it causes subglottic stenosis
mc foreign body
vegetable foreign body
site of impaction of foreign body in upper digestive tract
cricopharynx
treatment for foreign body in larynx
heimlich maneuver
cricothyrotomy
killian incision is for
smr
weber freguson incision
total maxillectomy
freers incision
septoplasty
moures incision
lateral rhinotomy
Which anaesthetic should be avoided in middle ear surgery
N2O as it can cause expansion of ear cavity
High tracheostomy is indicated for ??
Carcinoma
LAM is
Laser assisted myrigotomy
What is brewer luckhardt reflex
Inspiratory closure of Glottis and tracheal adduction of vocal cords which is unresponsive to airways. Manoeuvres
Commonest indication for myringostomy
Serious otitis media
Most common indication for tracheostomy is
Foreign body aspiration
Frequency of cuff deflation
Cuff should be deflated every 2 hrs for 5 min
Structures which can be damaged by emergency tracheostomy
Ishtmus of thyroid and thyroidima artery
Inf thyroid vein
Most common complications of tracheostomy
Hemorrage
Commonest cause of bleeding during tracheostomy
Ant jugular vein
Mc cause of laryngeal stenosis
Endotracheal incubation followed by tracheostomy
Commonest site of aspiration of foreign body
Rht side
If pt is supine 》post segment of upper lobe
Or superior segment of lower lobe
If patient is upright and sitting
》basilar segment of lower lobe
kashim operation is done for ?
cordotomy
Gold std for OSA
Polysomnography
Can we pt of osa will benefit from the surgery
Yes by Muller maneuver
larynx cartilages r hyaline or elastic
thyroid cartilage
cricoid cartilage basal part of arytenoid are hyaline cartilage rest all are elastic cartilage
