Surgery for the voice. Flashcards
Name the reasons for refferal.
Hoarseness for over 3 weeks
To exclude a malignancy (make sure it isn’t cancer)
To correct the dysphonia
What is dysphonia another word for?
Hoarseness of voice.
name the steps of assessment of condition.
- outpatient consultation and gather case history
2. larynx examined - flexible endoscopy through the nose or rigid endoscopy through mouth.
Why is an endoscopy through the nose preferred?
As through mouth endoscopy is not as comfortable for the patient ad often causes them to gag.
What allows you to look down the larynx?
A flexible Nasendoscopy.
Explain what electrolaryngography does.
Paired electrodes either side of the thyroid cartilage.
It records the changes in electrical conductance with vocal fold vibration.
This shows us how well the vocal folds are opening and closing.
Abnormal vocal folds can be ______ than normal.
Thicker (probs thinner too).
Describe theatre set up.
Operating table with microscope.
A ______ goes down into the mouth and shines a light down for visibility.
Laryngoscope.
When doing any surgery involving the mouth, what is it important to wear?
Teeth protection.
Why is suspension laryngoscopy good?
It is a hands free laryngoscope so it allows the surgeon to use both hands.
In surgery, what is used by the anaethesist to put the patient to sleep?
A Micro-laryngoscopy tube is used to put the patient to sleep but still allow surgeons to perform surgery on the larynx.
What debulks a tumour in the larynx?
The Mallinckrodt Laser Tube.
What does the mallinckrodt laser tube do?
It lasers the tumour which debulks it, this allows a better airway (but it won’t necessarily remove the whole tumour).
Because the mallinckrodt laser doesn’t remove the whole tumour, what is sometimes used after this?
Radiotherapy.
What is an endoscope?
Camera on the end of a stick that goes down the vocal tract. It is hooked up to the computer so the surgeon and nurses etc. can look on screen instead of down the whole.
The Hunsaker tube allows ______ during microlaryngoscopy.
Ventilation.
In surgery what can be used to look at the larynx?
A Laryngeal telescope.
Why are micro-laryngeal instruments really small?
Because the larynx is really small.
Name 2 examples of micro- laryngeal instruments.
micro-laryngeal scissors and crocs.
What are the aims of surgery?
To improve voice.
To diagnose/exclude malignancy
To treat malignancy
What are vocal fold polyps?
Fluid -filled lesions located on the vocal cord.
Where do polyps normally occur?
The mid portion of the vocal folds.
What causes vocal cord polyps?
It can be caused by a single traumatic event e.g. shouting
Normally caused by vocal misuse or abuse
Long term smoking may be a cause- but non-smokers get it too.
How are vocal polyps treated?
Microlaryngoscopy with excision- special fine instruments are used to remove the polyp.
What is Reinke’s Oedema?
Reinke’s edema is the swelling of the vocal cords due to fluid collected within the Reinke’s space. (between mucosa and vocal ligament).
Reinke’s Oedema is commoner in _____.
Women.
What can cause Reinke’s Oedema?
Smoking
Hypothyroidism.
How is Reinke’s Oedema treated?
Microlaryngoscopy with excision of excess mucosa and apiration of fluid.
What does the fluid cause?
The vocal folds to swell.
_______ is characterized by the “sac-like” appearance of the fluid-filled vocal cords.
Reinke’s Oedema.
Treatment of Reinke’s Oedema clears up the _____.
Airway.
What is the proper name for nodes?
Vocal Cord Nodules.
Vocal cord nodules are spotted by a _____ area on the vocal folds.
whiteish.
What are vocal fold nodules caused by?
Voice Abuse
_________________are bilaterally symmetrical benign white masses that form at the midpoint of the vocal folds
Vocal fold nodules.
People with vocal nodules require ________ therapy.
Voice.
Voice therapy means that few patients with nodes have to get _________.
surgery (which would be excision)
How are nodes prevented/treated?
Vocal Rest
vocal fold hydration- lots of water, no caffeine.
What is vocal cord palsy?
Vocal fold paralysis where when one or both of the vocal folds don’t open or close properly.
What are the causes of vocal cord palsy?
Lung Cancer (most common) Smokers.
Why is vocal fold palsy most common in people who have lung cancer?
As a tumour in the lungs puts pressure and wear and tear on laryngeal muscles.
Name some symptoms of vocal cord palsy.
Breathy Voice
Noisy breathing
Tiring to speak
Cannot cough properly
How can vocal cord palsy be treated?
Surgical techniques e.g. Sometimes it is injected with bulking to make it bigger so it moves a bit or vocal cord medialization.
Speech and Language Therapy
What is vocal cord medialization?
Surgery to provide support to a vocal fold that lacks bulk and/or mobility to help get back closure of the vocal folds.
What is another name for vocal cord medialization?
Thyroplasty.
Name an injection that injects bulking material into the vocal fold.
Percutaneous Injection.
What are the advantages of general anaesthetic?
- Greater accuracy
- Better patient comfort
- Fewer complications.
What is the risk to percutaeneous injection?
Over-injection would block the airway.
What are advantages to butterfly needles?
Ubiquitous Cheap small, so easily positioned less damage to mucosa less leakage of injectate.
What are the advantages to the plunger of syringe?
Easily depressed
Greater Dexterity
No movement of needle
What is external thyroplasty?
A widow is cut out of thyrocartilage and replaced with a silicon block or gortex :)
What is laryngeal Papillomatosis?
Benign warts on the larynx.
what is laryngeal papillomatosis caused by?
HPV 6 and 11.
What does laryngeal papillomatosis affect?
Airway and voice.
How is layngeal papillomatosis treated?
Treated by CO2 laser or microdebrider (handheld cutting tool).
What is prevented by a gardasil vaccination?
Cervical cancer, therefore laryngeal papillomatosis.
What is a vocal cord cyst?
Vocal fold lining breaks down and heals but entrapped cells cause a cyst.
Think of nodules as _____ and polyps as _____.
Thickening
Blisters.
How is a vocal cord cyst treated?
By creating a mucosal bridge.
What are 3 signs of laryngeal malignancy?
Irregular Vocal cords
Altered colour
Altered mobility
Chronic Laryngitis is _________.
Viral.
How else can chronic laryngitis be caused?
by misuse aka. shouting.
by Smoking
Chronic Laryngitis needs a ______ and if it’s confirmed what should be done?
Biopsy.
Must stop smoking!
Possible _____ treatment may be needed for chronic laryngitis.
Reflux (as reflux at night can irritate the larynx).
_____ therapy is used to treat chronic laryngitis.
Voice.
What is dysplasia?
Pre cancer of the vocal folds.
A _____ is also needed for dysplasia diagnosis.
Biopsy.
Who is more at risk of dsyplasia?
Smokers.
Dysplasia is treated the same as _______.
Chronic Laryngitis.
Dysplasia is pre-_______.
Malignant.
If untreated at the pre-malignant stage, what happens?
It is likely to become malignant.
How is pre-malignancy treated?
- Stop smoking
- Excision of area
- Use fine instruments or CO2 laser
In laryngeal malignancy, firstly they obtain a ______ and the the tumour is ________.
biopsy
mapped out.
How is laryngeal malignancy treated?
-CO2 laser resection
This debulks tumour to allow other treatments e.g. radiotherapy.
-If they don’t work = Laryngectomy :)
How are voice outcomes measured?
- Acoustic measures
- perceptual assessment by SLT e.g. GRABAS
- patient report/questionnaires e.g. VoiSS
Surgery is an important part of a range of ______ and cooperates closely with ______.
Treatments.
SLT.
