Benign and malignant Laryngeal diseases
Transcript of Benign and malignant Laryngeal diseases
Benign and malignant Benign and malignant Laryngeal diseasesLaryngeal diseases
Prof. Dr. Répássy GáborProf. Dr. Répássy Gábor
Diagnostic examinationDiagnostic examination
•• Indirect mirror examination, which we Indirect mirror examination, which we routinely performroutinely perform
•• Fiberoptic laryngoscopy and Fiberoptic laryngoscopy and videostroboscopyvideostroboscopyvideostroboscopyvideostroboscopy
•• Direct examination under general Direct examination under general anesthesiaanesthesia
•• Microlaryngoscopy (endolaryngeal Microlaryngoscopy (endolaryngeal microscopy)microscopy)
Benign lesions of the larynxBenign lesions of the larynx
•• NodulesNodules•• PolypsPolyps•• Reinke’s edemaReinke’s edema•• CystsCysts•• GranulomaGranuloma•• GranulomaGranuloma•• PapillomatosisPapillomatosis•• Rare:Rare: lymphatic and venous malformationslymphatic and venous malformations
granular cell tumorgranular cell tumorchondromachondromaneurogenic tumorneurogenic tumoramyloidosisamyloidosissarcoidosissarcoidosis
NodulesNodules
•• Vocal fold nodules are usually bilateralVocal fold nodules are usually bilateral
•• Involve the anterior or middle third of the Involve the anterior or middle third of the true vocal foldtrue vocal foldtrue vocal foldtrue vocal fold
•• Therapy: microsurgeryTherapy: microsurgery
PolypsPolyps
•• The most common benign lesions of the The most common benign lesions of the adult larynxadult larynx
•• Usually unilateralUsually unilateral•• Usually unilateralUsually unilateral
•• Appear at the free edge of the vocal foldAppear at the free edge of the vocal fold
•• Therapy: microsurgeryTherapy: microsurgery
Reinke’s edemaReinke’s edema
•• Edema in the superficial layer of the Edema in the superficial layer of the lamina propria (Reinke’s space)lamina propria (Reinke’s space)
•• Not cause of suffocation (not simple Not cause of suffocation (not simple •• Not cause of suffocation (not simple Not cause of suffocation (not simple larygeal edema)larygeal edema)
•• More common in the gipsy populationMore common in the gipsy population
CystsCysts
•• Supraglottic larynx is the most common Supraglottic larynx is the most common site of laryngeal cystssite of laryngeal cysts
•• Most frequently mucusMost frequently mucus--secreting glandssecreting glands•• Most frequently mucusMost frequently mucus--secreting glandssecreting glands
•• Therapy: excision, laserTherapy: excision, laser
GranulomaGranuloma
•• Usually arise in the region of the vocal Usually arise in the region of the vocal process of the arytenoidprocess of the arytenoid
•• Causing by: prolonged endotracheal Causing by: prolonged endotracheal •• Causing by: prolonged endotracheal Causing by: prolonged endotracheal intubationintubation
•• Surgical treatment: CO2 laser is ideal for Surgical treatment: CO2 laser is ideal for excisionexcision
Laryngeal papillomatosisLaryngeal papillomatosis
•• The most common benign laryngeal tumorThe most common benign laryngeal tumor
•• More prevalent in childrenMore prevalent in children
•• Etiology: viral (HPV)Etiology: viral (HPV)
•••• Causing hoarseness, respiratory obstructionCausing hoarseness, respiratory obstruction
•• Precancerous conditionPrecancerous condition
•• Therapy: surgical Therapy: surgical -- laser excisionlaser excision
interferoninterferon
Other premalignant conditionsOther premalignant conditions
•• LeukoplakiaLeukoplakia
•• PachydermiaPachydermia
•• Chronic hyperplastic laryngitisChronic hyperplastic laryngitis•• Chronic hyperplastic laryngitisChronic hyperplastic laryngitis
Histopathology: Hyperplastic and dysplastic Histopathology: Hyperplastic and dysplastic lesions lesions
Malignant lesions of the larynxMalignant lesions of the larynx
•• Laryngeal cancerLaryngeal cancer
•• Supraglottic Supraglottic –– Glottic Glottic –– SubglotticSubglottic
•• History: tobacco, alcohol, high risk HPV’s, etc.History: tobacco, alcohol, high risk HPV’s, etc.
•••• Symptoms: hoarseness, dysphagia, otalgia Symptoms: hoarseness, dysphagia, otalgia irradiatairradiata
•• Examination: direct/indirect laryngoscopyExamination: direct/indirect laryngoscopy
CT scanCT scan
biopsy the lesionbiopsy the lesion
Larynx cancerLarynx cancer
•• Therapy:Therapy:
•• Supraglottic cc.Supraglottic cc.
SurgicalSurgical -- horizontal supraglottic resection horizontal supraglottic resection SurgicalSurgical -- horizontal supraglottic resection horizontal supraglottic resection -- subtotal resectionsubtotal resection
-- horizontal supracricoid resectionhorizontal supracricoid resection
-- total laryngectomy total laryngectomy
ChemoradiotherapyChemoradiotherapy
Larynx cancerLarynx cancer
•• Glottic cancer: comissura anteriorGlottic cancer: comissura anterior
vocal cordvocal cord
comissura posteriorcomissura posterior
Therapy: IrradiationTherapy: IrradiationTherapy: IrradiationTherapy: IrradiationSurgery: Endolaryngeal cordecomySurgery: Endolaryngeal cordecomy
Laser cordectomyLaser cordectomy
Frontolateral resectionFrontolateral resection
HemilaryngectomyHemilaryngectomy
Horisontal supracricoid resectionHorisontal supracricoid resection
Total laryngectomyTotal laryngectomy
Larynx cancerLarynx cancer
•• Subglottic cancer:Subglottic cancer:
•• RareRare
•• Poor prognosisPoor prognosis•• Poor prognosisPoor prognosis
•• Therapy: Surgical and chemoradiotherapy Therapy: Surgical and chemoradiotherapy