larynx: clinical Flashcards

1
Q

how do the vocal cords appear when seen in laryngoscopy? why?

A

pearly white avascular appearance

the mucosa is firmly attached to the vocal ligament without any intervening submucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

do the vocal cords become oedematous during upper respiratory tract infections? why?

A

no

absence of intervening submucosa = no fluid can accumulate underneath the vocal cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what will damage to recurrent laryngeal nerve result in? why?

A

recurrent laryngeal nerve innervates muscles moving vocal cords
damage = paralysis to vocal cords + hoarseness of voice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how do patients with UNIlateral recurrent laryngeal nerve palsy present?

A

initially: voice weak, paralysed vocal cords can’t ADduct fully to meet normal unaffected vocal cord on the other side
within a few weeks: contralateral fold (chord) crosses the midline to meet (paralysed) vocal cord and compensates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how do patients with bilateral paralysis of the vocal chords present?

A

causes voice to be almost absent

vocal chords take up more ADducted position than normal resting position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

why do patients with bilateral paralysis of vocal chords result in stridor?

A

vocal cords cannot be ABducted for respiration (can’t pull vocal chords apart, so rima glottis becomes severely reduced)
high-pitched, turbulent air flow in larynx / LOWER down in bronchial tree
usually inspiratory, but can be expiratory or biphasic
both vocal cords assume PARAMEDIAN position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

with progression of recurrent laryngeal nerve lesion, which movement is loss first?

A

ABduction of vocal ligaments lost before ADduction
(harder to pull vocal ligaments apart by Posterior cricoarytenoid muscles, adduction by lateral cricoarytenoid)
both innervated by recurrent laryngeal branch of vagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

following surgery, does adduction or abduction of vocal chords return first?

A

ADduction before abduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what does paralysis of superior laryngeal nerve result in?

A

anaesthesia of superior laryngeal mucosa and cricothyroid muscle
loss of protective mechanism designed to keep foreign bodies out of larynx and produces a monotonous voice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

why does a superior laryngeal nerve palsy cause monotonous voice?

A

palsy changes the pitch of the voice and causes an inability to make explosive sounds due to paralysis of the cricothyroid muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how do surgeons avoid injury to the external branch of superior laryngeal nerve during thyroidectomy?

A

the superior laryngeal artery is ligated superior to the gland where it is not closely related to the nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the piriform fossa a common site for?

A

where foreign bodies entering the pharynx can become lodged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how can the piriform fossa be viewed and what does it look like / act?

A

larynx tilting up and epiglottis down

fossa is pear shaped and acts as a funnel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what happens if sharp objects pierce the mucous membrane of piriform fossa (lateral to laryngeal inlet)?

A

nerve damage can occur:

superior laryngeal nerve (especially internal laryngeal branch - sensory to supraglottic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the epiglottic vallecula?

A

a depression from folds (vallecula) just behind the root of the tongue, but in front of epiglottis
(These depressions serve as “spit traps”; saliva is temporarily held in the valleculae to prevent initiation of the swallowing reflex)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the clinical significance of vallecula?

A

objects can frequently become lodged

17
Q

aside from the vallecula, where else can objects become lodged?

A
  1. piriform fossa (lateral to laryngeal inlet)

2. inferior end of the laryngopharynx (narrowest part of pharynx) - commonly to be removed by pharyngoscope

18
Q

how can a pharyngeal pouch develop?

A

when there is posterior herniation of pharyngeal mucosa between the 2 parts of the inferior pharyngeal constrictor (thyropharyngeus + cricopharyngeus) at their posterior margin (Killian’s dehiscence)

19
Q

what causes a pharyngeal pouch?

A

weakened inferior pharyngeal constrictors OR due to incoordination of the pharyngeal phase of swallowing

20
Q

what can a pharyngeal pouch cause?

A
dysphagia
sense of lump in back of neck
regurgitation
cough
halitosis (bad breath)
21
Q

what can be injured in thyroid surgery?

A

superior laryngeal and recurrent laryngeal nerves

removal parathyroid glands - affect Ca2+ regulation

22
Q

which is more common of hypopharyngeal / laryngeal carcinoma?

A

laryngeal carcinoma

23
Q

what happens in hypopharyngeal (laryngopharynx) carcinomas?

A

uncommon disease
pushes forward on the larynx (laryngopharynx posterior to larynx)
often from piriform fossa (lateral to laryngeal inlet on laryngopharynx)

24
Q

what is laryngeal carcinoma related to?

A

smoking and alcohol

25
Q

what is the prognosis for laryngeal carcinoma?

A

poor prognosis in subglottic (inferior to vocal cords, superior to trachea), but good prognosis in glottis (vocal cords)

26
Q

how are patients likely to present with laryngeal carcinoma?

A

dysphagia (pharynx - to oesophagus, compressing larynx)
odynophagia (pain on swallowing - pharyngeal peristalsis to oesophagus)
otalgia (referred pain - vagus)
hoarseness of voice (recurrent laryngeal nerve)
coughing (aspiration, haemoptysis)
weight loss (cachexia)
smoking history (pack/years)

27
Q

how will patients with laryngeal carcinoma present upon examination?

A

loss of laryngeal crepitus (felt rather than heard - from holding onto prominence of epiglottis and moving posterior against cervicla vertebrae)
occurs due to fixed larynx and cervical lymph node metastasis

28
Q

how do you investigate a laryngeal carcinoma?

A

barium swallow
CT/MRI
direct pharyngo-laryngo-oesophagoscopy
biopsy