Benign lesions of larynx
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Transcript of Benign lesions of larynx
BENIGN LESIONS OF
LARYNXDr Manpreet Singh Nanda
Associate Professor ENTMMMC&H Solan
CLASSIFICATION Non Neoplastic – vocal nodules, vocal
polyps, reinke’s oedema, contact ulcer, intubation granuloma, leukoplakia
Neoplastic - papillomas, chondroma, haemangioma
Saccular – laryngocele, cysts
VOCAL NODULES/SINGER NODULES Etiology Voice abuse (misuse/overuse) –
teachers, bad singers, politicians, school children
GERD Common in boys (children), females
aged 20-30 yrs Pathology Friction - Localised submucosal oedema,
heamorrhage, fibrosis, calcification – hyperplasia at midpoint of ant 2/3rd of vc
C/F Chronic hoarseness/repeated acute hoarseness,
worsens by evening Voice fatigue Pain neck on prolonged phonation (efforts to
improve voice strains muscles) FB sensation O/E B/L soft red nodule later grey/pale mostly
symmetrical at junction of ant 1/3rd and post 2/3rd of vocal cords
Size pin head to pea (1-5mm) Diagnosis – laryngoscopy/videostroboscopy
Treatment Voice rest/speech therapy Avoid smoking Treat allergy/reflux Treat local causes – tonsillitis/sinusitis Proper hydration Steroid inhalers Surgery – if no relief/longer duration –MLS
–precise excision followed by complete voice rest for four days and relative voice rest for six weeks. C/I - children
VOCAL POLYP MC benign lesion of larynx Etiology Extreme voice abuse (sudden shouting) Allergy/GERD Smoking URTI Males age gp 30-50 yrs Pathology Localised oedema in reinke’s space
leading to haematoma and fibrosis
C/F Sudden onset hoarseness Diplophonia (double voice) FB sensation Cough (polyp movement) Stridor/choking/dyspnoea (large polyp) O/E Reddish purple/pale U/L polypoidal mass
> 3 mm at junction of ant 1/3rd and post 2/3rd of free margin of vocal cord. Pedunculated at later stages
Treatment Treat acid reflux Voice therapy Surgery – MLS Superficial surgical excision followed by
speech therapy
REINKE’S OEDEMA/SMOKER’S POLYP Diffuse vocal polyposis Etiology Voice abuse Long term smoking URTI Hypothyroidism Common in middle aged females aged
40-60 yrs Pathology Collection of fluid in reinke’s space
C/F Severe hoarseness Females with male voice (low pitched
monotonous) Intermittent aphonia O/E B/L pale/bright red diffuse symmetrical
swelling over the length of both vocal cords (pale watery bag appearance) obliterating the ant glottis
Treatment Stop smoking Voice therapy MLS – incision of epithelium and suction
of fluid Once cord 1st later after one month (to
prevent glottic web) Followed by speech therapy
CONTACT ULCER Etiology Faulty voice production Chronic cough/throat clearing GERD/late night eating Alcohol/coffee abuse Smoking Pathology Ulceration and granuloma formation in
thin mucosal layer of vocal process of arytenoids (post larynx) due to hammering against each other
C/F U/L pain over thyroid cartilage worst on
phonation referred to ear Low pitch morning voice Hoarseness Heart burn/FB sensation O/E U/L ulcer with whitish exudates or granuloma
on vocal process pf arytenoids. One vc – projected epithelium, other – epithelial depression
Congestion of arytenoid mucosa
Treatment Voice therapy Anti reflux Inj depot corticosteroids into lesion Steroid inhalers Surgical limited removal
INTUBATION GRANULOMA Etiology Rough endotracheal intubation Large tube Prolonged tube Rigid bronchoscopy Pathology Local abrasion of epithelium of vocal process
of arytenoid – mucosal ulcer – granuloma formation
C/F Hoarseness Dyspnoea (large granulomas)
O/E Usually B/L sessile or large
pedunculated granulomas attached to vocal process of arytenoids
Treatment Antibiotics for several weeks Speech therapy Endoscopic corticosteroid injection into
lesion Surgery – leave behind stalk Post op – topical mitomycin application
to prevent recurrence
LEUKOPLAKIA/KERATOSIS Etiology Chronic laryngeal irritants – tobacco, alcohol Syphilis Elderly males Pathology Epithelial hyperplasia -> white plaque/warty
growth C/F Progressively increasing hoarseness FB sensation O/E White plaques or warty growth on one or both vc
Diagnosis Laryngoscopy and biopsy Prognosis – can lead to ca in situ Treatment Voice rest Steam inhalation Anti oxidants/vitamin A Avoid alcohol/smoking MLS – stripping of vc
PAPILLOMAS MC laryngeal tumour in children 80% of benign tumours are papilloma Types – juvenile and adult onset JUVENILE PAPILLOMA/RECURRENT
RESPIRATORY PAPILLOMATOSIS Etiology Viral – HPV 6, 11 (larynx, oropharynx, ano
genital region) – abnormal tissue response Mothers with genital warts (transplacental) Hormonal Age gp 3-4 yrs, boys and girls equal
C/F Manifests clinically few yrs after implantation Hoarseness Stridor O/E Inspiratory/biphasic stridor Glistening white/pinkish white irregular
growths (warts), pedunculated or sessile, seen on true cords, false cords and epiglottis which bleed on removal
Also seen on trachea, bronchi
Prognosis Aggressive Rapid recurrence Can get seeded to other structures Regress after puberty If child survives till puberty – good prognosis Diagnosis X Ray Neck Chest X Ray Excision biopsy Direct laryngoscopy/bronchoscopy
Treatment Repeated endoscopic surgical excision
of papillomas using cup forceps, laser, microdebrider
Interferon therapy/methotrexate/intralesional cidofir/radiation/vaccines/anti viral drugs
If stridor prefer endotracheal intubation Low tracheostomy
ADULT SOLITARY PAPILLOMAS Single Age gp 30-50 yrs M>F C/F Hoarseness Single white to pinkish red polyp limited to
one site of ant ½ of vc, bleeds on removal.. Prognosis – good, less aggressive, no
recurrence Premalignant Treatment – surgical removal
CHONDROMA Arise from cricoid cartilage Seen in subglottic region Men age gp 40-60 yrs C/F Dyspnoea Dysphagia FB sensation throat
HAEMANGIOMA Infantile/capillary Site – subglottic area C/F – stridor during 1st six months of life Also seen in other regions of head and neck Prognosis – involutes spontaneously Treatment – laser/tracheostomy/steroid Adult/cavernous Supraglottic region Asymptomatic Treatment – if symptomatic need steroids
or radiotherapy
LARYNGOCELE Etiology Raised transglottic/intrathoracic
pressure more on coughing and straining seen in trumpet players/wind instrument, glass blowers, weight lifters
M:F 5:1 Pathology Air filled cystic swelling due to dilatation
of saccule due to raised pressure
Types Internal (20%) – within larynx. Cystic swelling
involving false cords and aryepiglottic folds External (30%) – distended saccule herniates
through thyrohyoid membrane into neck Combined/mixed (50%) C/F Hoarseness Sore throat Dysphagia Cough Snoring
O/E Neck swelling in region of thyroid
cartilage, reduces on pressure and reappears on valsalva manoeuvre and coughing
Stridor Bryce’s sign – on compressing the
neck mass, gurgling and hissing sound in throat
Prognosis – in elderly leads to saccule carcinoma
Diagnosis X Ray Neck/CT scan with valsalva DL Scopy Treatment Surgical excision via external neck
approach Internal – endoscopic marsipulization Antibiotics – if pus
RETENTION CYSTS Ductal cysts Etiology – blockage of ducts of
seromucinous glands of laryngeal mucosa
Site – vallecula, aryepiglottic folds, false cords, ventricle and pyriform fossa
C/F Asymptomatic if small Large – hoarseness, cough, throat pain,
dysphagia Treatment – marsipulization/removal
SACCULAR CYSTS Etiology – obstruction of orifice of
saccule leading to retention of secretion causing distension of saccule
Types Anterior – small, seen in ant part of
ventricle Lateral – large, extends into neck through
thyrohyoid membrane. Internally to false cords, aryepiglottic folds, pyriform fossa
C/F – weak cry, stridor, cyanosis, hoarseness (adult)
Diagnosis – X Ray Neck/CT Scan Treatment Endoscopic aspiration/marsipulization External approach through thyrohyoid
membrane