DISEASES OF Pharynx and LARYNX

Dr Chandrashekhar Mahakalkar

MS, FACRSI

Department of Surgery,

JNMC, Sawangi Meghe, Wardha

LERNING OBJECTIVES

• To know about anatomy of larynx• To know about various pathological conditions

affecting larynx• To know about etio-pathogenesis of the same• To know about management of the same

Anatomy - The pharynx

• The pharynx is a fibromuscular tube forming the upper part of the respiratory and digestive passages.

• It extends from the base of the skull to the level of the sixth cervical vertebra at the lower border of the cricoid cartilage where it becomes continuous with the oesophagus.

• It is divided into three parts: the nasopharynx,• oropharynx and hypopharynx

Nasopharynx• The nasopharynx lies anterior to the first

cervical vertebra and has the openings of the Eustachian tubes in its lateral wall,

• Behind lie the pharyngeal recesses, the fossae of Rosenmüller.

• The adenoids are situated submucosally at the junction of the roof and posterior wall of the nasopharynx.

Oropharynx• This is bounded above by the soft palate,

below by the upper surface of the epiglottis and anteriorly by the anterior faucial pillars.

Hypopharynx

• The hypopharynx is bounded above and anteriorly by the sloping laryngeal inlet.

• Its inferior border is the lower border of the cricoid cartilage where it continues into the

oesophagus. It divided into three areas: the pyriform

• fossae, the posterior pharyngeal wall and the post-cricoid area.

NORMAL LARYNX.

 

• The true vocal folds are pearly white, they meet in the midline on phonation, and the surrounding structures are light pink.

NODULES• Nodules are calluses on the vocal folds that occur with

improper voice use or overuse. • They are most common in children and females. They prevent

the vocal folds from meeting in the midline and thus produce an hourglass deformity on closure resulting in a raspy, breathy voice.

• Most times, these will respond to appropriate speech therapy. Occasionally (20% of the time), these may persist after intensive speech therapy and will require meticulous microlaryngeal surgery.

NODULES

POLYPS• Polyps are benign lesions of the larynx, occurring

mostly in adult males, that are usually located on the phonating margin (edge) of the vocal folds and prevent the vocal folds from meeting in the midline.

• Polyps can interfere with voice production and may produce a hoarse, breathy voice that tires easily.

• These may respond to conservative medical therapy and intensive speech therapy.

• If the lesion fails to respond, meticulous microsurgery may be indicated.

POLYPS

LARYNGITIS SICCA

• Laryngitis sicca is caused by inadequate hydration of the vocal folds. Thick, sticky mucus prevents the folds from vibrating in a fluid, uniform manner.

VOCAL CORD HEMORRHAGE.

• Vocal fold hemorrhage is a very rare occurrence that usually is caused by aggressive or improper use of vocal folds (e.g. cheerleading). It is a result of rupture of a blood vessel on the true vocal fold, with bleeding into the tissues of the fold.

CANCER

• If these lesions are detected early, they can be treated with either radiation or surgery, with a cure rate approaching 96%.

VOCAL CORD PARALYSIS

• Vocal fold paralysis or paresis results from a lesion of the neural or muscular mechanism .

• It may be:-• Unilateral• Bilateral

UNILATERAL VC.P• It can be caused by a variety of diseases or disorders

that prevent movement in one vocal fold. • When one weakened vocal fold does not move well

enough to meet the other fold in the midline during speech, air leaks out too quickly.

• This causes the voice to sound breathy and weak, making it necessary for the speaker to take more frequent breaths during speech.

• After a full day of talking, someone with a weak vocal fold can feel exhausted due to the frequent breathing, and can experience choking and coughing on food or liquids.

BILATERAL VC.P• When both vocal folds have movement problems,

the situation can be much more serious. • With both vocal folds paralyzed in the midline

position, the person has difficulty breathing and a tracheotomy may be necessary to establish an airway.

• If both folds are paralyzed near the midline, although the voice may be good the airway may be compromised.

• If both folds are paralyzed far apart, there may be no voice.

BILATERAL VC.P

PRESBYLARYNGIS• Presbylaryngis is a condition that is caused by

thinning of the vocal fold muscle and tissues with aging.

• The vocal folds have less bulk than a normal larynx and therefore do not meet in the midline.

• As a result, the patient has a hoarse, weak, or breathy voice.

• This condition can be corrected by injection of fat or other material into both vocal folds to achieve better closure.

PRESBYLARYNGIS

ACID REFLUX• The larynx is red and swollen.

Carcinoma of larynx

Introduction

• Widely prevalent in the Indian Sub-continent in comparison to the west

• M:F::10:1• Age group: 40-70 yrs

Aetiology

Classification and staging

• TNM classification and staging• Classification by AJCC

AJCC classification

Supraglottic cancer

• Less frequent than glottic cancer• Majority of lesions are seen on epiglottis, false cords,

aryepiglottic folds• Spread: vallecula, base of the tongue, pyriform fossa

and even penetrate the thyroid• Symptoms: often silent, may present with throat

pain, dysphagia and referred pain-ear, mass in the neck

Glottic cancer

• Most common- 65% • Spread: anteriorly- anterior commisure posteriorly- vocal process and arytenoid process Upward- ventricle and false cord Downward- Subglottic regionSymptoms: Hoarseness of voice, stridor

Subglottic cancer

• Lesions rare• Spread: Anterior wall, to the opposite side or

downwards to the trachea• May invade cricothyroid membrane, thyroid

gland and muscles of neck• Symptoms: Stridor

Diagnosis

• History: any patient may present with: ..A sore throat that does not go away ..Dysphagia ..A change or hoarseness in voice ..Pain in the ear ..A lump in the neck

• Examination: done to find extra laryngeal spread of disease and nodal metastasis

Investigation

• Laryngoscopy: indirect, direct

• Radiography• CT• Staining and biopsy

Treatment

Depends upon:a)The site of lesionb)The extent of spreadc) Metastasis

Treatment maybe:a) Radiotherapyb) Surgery: conservative laryngeal surgery

or total laryngectomyc) Combined therapy

a) Early supraglottic and glottic tumor of stage I and II----radiotherapy

Five year survival rate: Stage I: 90% Stage II:70%b)Endoscopic CO2 laser

c) Advanced tumor: total or subtotal laryngectomy

RehabilitationBy the following methods: A) Written language B) Oesophageal speech

C) Artificial larynx: i) Electrolarynx ii) Tran oral pneumatic device D) Tracheo-oesphageal speech

Electrolarynx

Tracheo-oesophageal speech

THANK YOU