Diseases of-pharynx-and-larynx

Diseases of Pharynx Diseases of Pharynx and Larynxand Larynx

Anatomy of PharynxAnatomy of Pharynx

Fibromuscular TubeFibromuscular Tube Base of Skull to C6 (12cm)Base of Skull to C6 (12cm) Divided into three partsDivided into three parts

NasopharynxNasopharynx OropharynxOropharynx LaryngopharynxLaryngopharynx

4 Layers4 Layers Mucosal, submucosal (Fibrous), Muscular, Fascial Mucosal, submucosal (Fibrous), Muscular, Fascial

layer (buccal pharyngeal)layer (buccal pharyngeal)

NasopharynxNasopharynx

Base of skull to the soft Base of skull to the soft palatepalate

Key componentsKey components Pharyngeal Tonsil Pharyngeal Tonsil

(Adenoids)(Adenoids) Pharyngeal Recess (ICA)Pharyngeal Recess (ICA) Opening of Auditory tubeOpening of Auditory tube

OropharynxOropharynx Soft Palate to the Soft Palate to the

epiglottisepiglottis Key ComponentsKey Components

Palatopharyngeal and Palatopharyngeal and Palatoglossal archesPalatoglossal arches

Palantine Tonsil – project Palantine Tonsil – project from tonsillar fossafrom tonsillar fossa

Lingual TonsilLingual Tonsil Valleculae – lie between Valleculae – lie between

epiglottis and posterior epiglottis and posterior border of the tongueborder of the tongue

LaryngopharynxLaryngopharynx

Epiglottis to the level Epiglottis to the level of cricoid cartilageof cricoid cartilage

Key featuresKey features Opening to the Opening to the

larynxlarynx Piriform recess Piriform recess

(endoscope)(endoscope)

Anatomy of PharynxAnatomy of Pharynx

Blood supplyBlood supply Branches of many arteries (ascending pharyngeal, Branches of many arteries (ascending pharyngeal,

greater palantine, lingual, tonsilar)greater palantine, lingual, tonsilar)

Nerve SupplyNerve Supply Afferent; maxillary nerve, glossopharyngeal, internal Afferent; maxillary nerve, glossopharyngeal, internal

and recurrent laryngeal nervesand recurrent laryngeal nerves Motor; Pharyngeal Plexus (Vagus, glossopharyngeal, Motor; Pharyngeal Plexus (Vagus, glossopharyngeal,

Cervical Sympathetic)Cervical Sympathetic)

LarynxLarynx

Respiratory OrganRespiratory Organ Lying between pharynx and tracheaLying between pharynx and trachea Becomes continuous with the trachea at the level of Becomes continuous with the trachea at the level of

the cricoid cartilage (C6)the cricoid cartilage (C6)

FunctionFunction Primary – protective sphincter at the inlet of the air Primary – protective sphincter at the inlet of the air

passagespassages PhonationPhonation

LarynxLarynx ComponentsComponents

Cartilages Cartilages Singular; thyroid, cricoid, epigolitticSingular; thyroid, cricoid, epigolittic Paired; Arytenoid, corniculate, cuneiformPaired; Arytenoid, corniculate, cuneiform

Joints Joints Cricothyroid, cricoarytenoidCricothyroid, cricoarytenoid

Ligaments and MembranesLigaments and Membranes Intrinsic; Quandrangular membrane, Cricothyroid Intrinsic; Quandrangular membrane, Cricothyroid

ligament (Vocal folds)ligament (Vocal folds) Extrinsic; Thyrohyoid membrane, cricotracheal, Extrinsic; Thyrohyoid membrane, cricotracheal,

hypoepiglottic, thyroepiglottic ligaments, cricothyroidhypoepiglottic, thyroepiglottic ligaments, cricothyroid

CavitiesCavities

Inlet + Inlet + Vestibule Vestibule

Rima of Rima of glottisglottis

Subglottic Subglottic spacespace

Layrnx - Intrinsic MembranesLayrnx - Intrinsic Membranes

Quadrangular membraneQuadrangular membrane Arytenoid Cartilage and epiglottisArytenoid Cartilage and epiglottis Lower border; vestibular folds (false cord)Lower border; vestibular folds (false cord) Upper border; aryepiglottic foldsUpper border; aryepiglottic folds

Cricovocal MembraneCricovocal Membrane Formed from lateral part of cricothyroid ligamentFormed from lateral part of cricothyroid ligament Upper thickened border forms cricovocal ligaementUpper thickened border forms cricovocal ligaement Vocal folds which bounds the glottis anteriorlyVocal folds which bounds the glottis anteriorly

Laryngeal Muscles - IntrinsicLaryngeal Muscles - Intrinsic

1. Those that alter size and shape of the inlet1. Those that alter size and shape of the inlet Aryepiglottic MusclesAryepiglottic Muscles Oblique arytenoidsOblique arytenoids Thyroepiglottic musclesThyroepiglottic muscles

Act as Sphincter for the inlet Act as Sphincter for the inlet Provide valvular protection from aboveProvide valvular protection from above

Laryngeal Muscles - IntrinsicLaryngeal Muscles - Intrinsic

2. Responsible for Phonation by moving vocal 2. Responsible for Phonation by moving vocal foldsfolds Abduction; Posterior CricoarytenoidsAbduction; Posterior Cricoarytenoids Adduction; Lateral cricoarytenoid and transverse Adduction; Lateral cricoarytenoid and transverse

arytenoidarytenoid Lengthen; CricothryroidLengthen; Cricothryroid Shorten; Thyroarytenoid, vocalisShorten; Thyroarytenoid, vocalis

PhonationPhonation

Pitch; Vibration of the folds through shortening Pitch; Vibration of the folds through shortening and lengthing of the voldsand lengthing of the volds

Intensity; Pressure through the glottisIntensity; Pressure through the glottis Quality; Resonating chambers above the glottisQuality; Resonating chambers above the glottis Articulation; tongue, teeth and lipsArticulation; tongue, teeth and lips

LarynxLarynx

Blood supplyBlood supply Superior and Inferior Laryngeal Branches from Superior and Superior and Inferior Laryngeal Branches from Superior and

Inferior Thyroid ArteryInferior Thyroid Artery

Nerve SupplyNerve Supply Recurrent Laryngeal NerveRecurrent Laryngeal Nerve

All intrinsic Muscles except cricothyroidAll intrinsic Muscles except cricothyroid Mucous Membranes below the foldsMucous Membranes below the folds

External Layngeal NerveExternal Layngeal Nerve Cricothyroid muscleCricothyroid muscle

Internal Laryngeal NerveInternal Laryngeal Nerve Mucous Membranes below the foldsMucous Membranes below the folds

Nerve PalsiesNerve Palsies Recurrent Laryngeal NerveRecurrent Laryngeal Nerve

Number of causesNumber of causes Left;Left;

Carcinoma of bronchus, oesophagus, Aortic anuersym, cardiac surgCarcinoma of bronchus, oesophagus, Aortic anuersym, cardiac surg Left or Right;Left or Right;

Iatrogenic, Trauma, Thyroid diseaseIatrogenic, Trauma, Thyroid disease Complete (Cadaveric Position)Complete (Cadaveric Position)

Half abducted position with arytenoid cartilage slightly in frontHalf abducted position with arytenoid cartilage slightly in front Hoarse VoiceHoarse Voice Bovine coughBovine cough

IncompleteIncomplete Adducted position as posterior cricoarytenoid more susceptibleAdducted position as posterior cricoarytenoid more susceptible

External Laryngeal NerveExternal Laryngeal Nerve Hoarse voice that recoversHoarse voice that recovers Inability to hit high frequenciesInability to hit high frequencies

Extrinsic MusclesExtrinsic Muscles

ElevatorsElevators Indirectly; Indirectly;

Mylohyoid, digastric, stylohyoid, geniohyoidMylohyoid, digastric, stylohyoid, geniohyoid

Directly;Directly; Stlyopharyngeus, salingopharyngeus, palatopharyngeus Stlyopharyngeus, salingopharyngeus, palatopharyngeus

DepressorsDepressors Sternohyoid, omohyoid stenothyroidSternohyoid, omohyoid stenothyroid

4 year old boy4 year old boy Pain in right ear and feversPain in right ear and fevers Recurrent ear infectionsRecurrent ear infections Noisy breather Noisy breather OverweightOverweight Examination – Sore right ear, hyperaemic Examination – Sore right ear, hyperaemic

tympanic membrane, breathing with mouth tympanic membrane, breathing with mouth openopen

Adenoid HypertrophyAdenoid Hypertrophy

Occupies large area of nasopharynx age <6Occupies large area of nasopharynx age <6 Atrophies and by age 15 little remainsAtrophies and by age 15 little remains Recurrent URTI or allergies can lead to Recurrent URTI or allergies can lead to

hypertrophyhypertrophy ClinicalClinical

Nasal Obstruction; Mouth breathing / Adenoid Nasal Obstruction; Mouth breathing / Adenoid Facies, chest infections, pharyngeal infections, Facies, chest infections, pharyngeal infections, sinusitis, snoringsinusitis, snoring

Eustachian Tube; Recurrent Otitis Media, CSOMEustachian Tube; Recurrent Otitis Media, CSOM Choanal Obstruction; OSA, chronic sinusitisChoanal Obstruction; OSA, chronic sinusitis

IxIx Nasopharyngeal ExamNasopharyngeal Exam Nasopharyngoscopic ExamNasopharyngoscopic Exam Lateral XrayLateral Xray

TxTx SupportiveSupportive AdenoidectomyAdenoidectomy

AdenoidectomyAdenoidectomy

Criteria for surgeryCriteria for surgery Chronic upper airway obstruction with OSA +/- cor Chronic upper airway obstruction with OSA +/- cor

pulmonalepulmonale Chronic serous/suppurative otitis media Chronic serous/suppurative otitis media Recurrent acute otitis mediaRecurrent acute otitis media Suspicion of nasopharyngeal malignancySuspicion of nasopharyngeal malignancy Chronic sinusitisChronic sinusitis

ComplicationsComplications Early HaemorrhageEarly Haemorrhage Otitis mediaOtitis media Regrowth of residual adenoid tissueRegrowth of residual adenoid tissue

TonsillitisTonsillitis

Commonest area of infection of head and neckCommonest area of infection of head and neck Clinical; Sore throat and Odynophagia, Otalgia, Clinical; Sore throat and Odynophagia, Otalgia,

headache, malaise, Fever, hyperaemic tonsils, cervical headache, malaise, Fever, hyperaemic tonsils, cervical lymphadenopathylymphadenopathyDDx;DDx; ViralViral Group A Streptococcus (20-30%)Group A Streptococcus (20-30%) EBV; Palatal petechiaEBV; Palatal petechia Diptheria; Unimmunised, grey membraneDiptheria; Unimmunised, grey membrane

Tx; Rest, paracetamol +/- ABxTx; Rest, paracetamol +/- ABx

TonsillitisTonsillitis

Complications;Complications; Acute Otitis Media (most common)Acute Otitis Media (most common) Peritonsillar abscess (Quinsy)Peritonsillar abscess (Quinsy) GASGAS

Post Strep GNPost Strep GN Rhuematic FeverRhuematic Fever Scarlet Fever; Strawberry tongue and scarlitiform rashScarlet Fever; Strawberry tongue and scarlitiform rash

Recurrent TonsillitisRecurrent Tonsillitis Tonsillar HypertrophyTonsillar Hypertrophy

TonsillectomyTonsillectomy

Indications for surgeryIndications for surgery AbsoluteAbsolute

Airway obstructionAirway obstruction Suspicion of malignancySuspicion of malignancy

RelativeRelative Sleep apnoea, mouth breathing, difficulty swallowingSleep apnoea, mouth breathing, difficulty swallowing Recurrent tonsillitis >5 episodesRecurrent tonsillitis >5 episodes Any complicationsAny complications

ComplicationsComplications Reactionary haemorrhageReactionary haemorrhage Secondary haemorrhageSecondary haemorrhage

5-10 days post op5-10 days post op Due to fibrinolysis aggravated by infectionDue to fibrinolysis aggravated by infection

PharyngitisPharyngitis

AcuteAcute >70% Viral Cause, GAS>70% Viral Cause, GAS Supportive TreatmentSupportive Treatment

Chronic Chronic Persistent mild soreness and drynessPersistent mild soreness and dryness Predisoposing factors include; smoking, ETOH, Predisoposing factors include; smoking, ETOH,

mouth breathing, chronic sinusitis, Industrial fumes, mouth breathing, chronic sinusitis, Industrial fumes, antiseptic throat lozengersantiseptic throat lozengers

Enlarged lymphoid tissue can be removedEnlarged lymphoid tissue can be removed

64 Male recently Immigrated from Hong Kong64 Male recently Immigrated from Hong Kong Lump in right side of neckLump in right side of neck Progressive enlarged, non-painfulProgressive enlarged, non-painful Exam; firm, fixed, solid mass lateral to midline Exam; firm, fixed, solid mass lateral to midline

in posterior trianglein posterior triangle

Nasopharyngeal CarcinomaNasopharyngeal Carcinoma

Rare in Europe Rare in Europe Common in Asian countriesCommon in Asian countries

20% of all malignancies in Hong Kong20% of all malignancies in Hong Kong

PathologyPathology Squamous cell/undifferentiatedSquamous cell/undifferentiated

AietologyAietology Unknown, however EBV plays a roleUnknown, however EBV plays a role Others; ingestion of preserved foods Others; ingestion of preserved foods


Clinical;Clinical; Most commonly as lump in the neckMost commonly as lump in the neck Local; Nasal obstruction, blood stained dischargeLocal; Nasal obstruction, blood stained discharge Neurological; Invasion of skull base causing cranial Neurological; Invasion of skull base causing cranial

nerve palsies (V, VI, IX, X, XII)nerve palsies (V, VI, IX, X, XII) Otological; Serous otitis mediaOtological; Serous otitis media Metastasis to bone, lung, liverMetastasis to bone, lung, liver


Ix;Ix; Tissue sampling, CT/MRI, StagingTissue sampling, CT/MRI, Staging

ManagementManagement Radiotherapy with concominant chemotherapyRadiotherapy with concominant chemotherapy Poorly amendable to surgery due to anatomical Poorly amendable to surgery due to anatomical

locationlocation

DDxDDx Lymphoma, cystic adenocarcinoma, InfectionLymphoma, cystic adenocarcinoma, Infection

Pathology of the LarynxPathology of the Larynx

InfectiousInfectious InflammatoryInflammatory CongenitalCongenital MucosalMucosal MalignancyMalignancy

5 Year old boy5 Year old boy Hx ofHx of 3/7 Low grade fever and URTI Sx3/7 Low grade fever and URTI Sx 1/7 history Biphasic Stridor, barking cough1/7 history Biphasic Stridor, barking cough No obvious respiratory distressNo obvious respiratory distress

Laryngotracheitis (Croup)Laryngotracheitis (Croup)

Inflammation of tissues of subglottic space +/- Inflammation of tissues of subglottic space +/- tracheobronchial treetracheobronchial tree

Mucopurulent exudate -> airway obstructionMucopurulent exudate -> airway obstruction Aetiology; Parainfluenza I (most common), Aetiology; Parainfluenza I (most common),

II,III, influenza A,B, RSVII,III, influenza A,B, RSV Presentation; night, inspiratory/biphasic stridor, Presentation; night, inspiratory/biphasic stridor,

barking coughbarking cough Beware loss of stridor, Decr SaO2Beware loss of stridor, Decr SaO2 DDx; FB, subglottic stenosis, EpiglottitisDDx; FB, subglottic stenosis, Epiglottitis

Laryngotracheitis + EpiglottitisLaryngotracheitis + Epiglottitis

FeatureFeature LaryngotracheitisLaryngotracheitis EpiglottitisEpiglottitisInflammation Subglottic space Supraglottic spaceInflammation Subglottic space Supraglottic space

Age Age 4month-5 years4month-5 years 1-4 years1-4 years

OnsetOnset Gradual (days)Gradual (days) Acute (hours)Acute (hours)

Fever Low grade/afebrile High feversFever Low grade/afebrile High fevers

Stridor Biphasic/inspiratory InspiratoryStridor Biphasic/inspiratory Inspiratory

CoughCough BarkyBarky NormalNormal

PosturePosture SupineSupine SittingSitting

DroolingDrooling NoNo YesYes

RadiographRadiograph Steeple sign Steeple sign Thumb sign, enlarged epiglottis Thumb sign, enlarged epiglottis

Appearance Non-toxic Toxic/cyanoticAppearance Non-toxic Toxic/cyanotic

Cause Cause ViralViral BacterialBacterial

TreatmentTreatment Supportive Supportive Keep child calm Keep child calm

O2, Adrenalin nebsO2, Adrenalin nebs Airway management -ETT Airway management -ETT

Steroids ABx, IV hydration, Moist airSteroids ABx, IV hydration, Moist air

18 month girl18 month girl ““Asthma Attack”Asthma Attack” WheezyWheezy ?trigger?trigger Family Hx of Asthma, EczemaFamily Hx of Asthma, Eczema No stridor, but tachypnea, intercostal recessionNo stridor, but tachypnea, intercostal recession Unilateral wheeze on Right with Decreased air Unilateral wheeze on Right with Decreased air

entry in lower zonesentry in lower zones

Foreign BodyForeign Body Usually stuck at right main bronchusUsually stuck at right main bronchus Anything that’s small enoughAnything that’s small enough Presentation;Presentation;

Stridor if at level of tracheaStridor if at level of trachea ““Unilateral asthma” if bronchialUnilateral asthma” if bronchial

ComplicationsComplications Atelectasis, lobar pneumonia, pneumothorax, mediastinal Atelectasis, lobar pneumonia, pneumothorax, mediastinal

shiftshift Dx;Dx;

Inspiratory/Expiratory X-raysInspiratory/Expiratory X-rays BronchoscopyBronchoscopy

Signs of Airway ObstructionSigns of Airway Obstruction Stretor; obstruction in the throat, low pitched choking Stretor; obstruction in the throat, low pitched choking

noisesnoises Stridor; High pitched, inspiratory, biphasic or Stridor; High pitched, inspiratory, biphasic or

expiratory depending on locationexpiratory depending on location Accessory Muscle useAccessory Muscle use Pallor, diaphoresis, restlessnessPallor, diaphoresis, restlessness TachycardiaTachycardia Cyanosis and altered concious stateCyanosis and altered concious state Intercostal recessionIntercostal recession Nasal FlaringNasal Flaring Exhaustion Exhaustion Bradycardia – most dangerous signBradycardia – most dangerous sign

Upper Airway Obstruction - Upper Airway Obstruction - NeonatesNeonates

Subglottic StenosisSubglottic Stenosis Congenital or Acquired (trauma, intubation)Congenital or Acquired (trauma, intubation) Biphasic stridor, resp distress, recurrent croup Biphasic stridor, resp distress, recurrent croup Diagnosis; CT, laryngoscopyDiagnosis; CT, laryngoscopy Tx; Soft tissue – laser and steroidsTx; Soft tissue – laser and steroids

Cartilage – Laryngotracheoplasty or tracheostomy Cartilage – Laryngotracheoplasty or tracheostomy (intubation)(intubation)

LaryngomalaciaLaryngomalacia Soft immature cartilage Children or older patients with NM Soft immature cartilage Children or older patients with NM

disordersdisorders Inspiratory stridor at 1-2 weeks, worse supine + feeding Inspiratory stridor at 1-2 weeks, worse supine + feeding

difficultiesdifficulties Dx; BronchoscopyDx; Bronchoscopy Tx; Usually self resolves after 18-24monthsTx; Usually self resolves after 18-24months

44 Female44 Female 6 week history of hoarse voice6 week history of hoarse voice Irritation and dryness in throatIrritation and dryness in throat History of heartburnHistory of heartburn SmokerSmoker No history of weight loss, fatigueNo history of weight loss, fatigue Examination; UnremarkableExamination; Unremarkable

Chronic LaryngitisChronic Laryngitis

Most common cause is GORDMost common cause is GORD Recurrent Acute laryngitisRecurrent Acute laryngitis Heavy smokingHeavy smoking Chronic infection of nasal sinusesChronic infection of nasal sinuses Mouth breathing from nasal obstructionMouth breathing from nasal obstruction

ClinicallyClinically Hoarseness or loss of voiceHoarseness or loss of voice Spasmodic coughSpasmodic cough DDx; Malignancy, inhaled corticosteroids, laryngeal paralysis, DDx; Malignancy, inhaled corticosteroids, laryngeal paralysis,

TBTB General; Voice resting, avoid smokingGeneral; Voice resting, avoid smoking Specific; eg. Lifestyle modifications, MedicationsSpecific; eg. Lifestyle modifications, Medications

35 year old35 year old Blunt trauma to neck 5 hours agoBlunt trauma to neck 5 hours ago Difficulty swallowing + Voice changesDifficulty swallowing + Voice changes No history of LOC, resp distress, confusionNo history of LOC, resp distress, confusion Examination showed midline tenderness of Examination showed midline tenderness of

neck, subcutaneous emphysemaneck, subcutaneous emphysema

Laryngeal TraumaLaryngeal Trauma RareRare CausesCauses

PenetratingPenetrating Blunt trauma; majority are MVA’s, clothesline injuries, Blunt trauma; majority are MVA’s, clothesline injuries,

sporting injuries sporting injuries Manual strangulationManual strangulation Inhaled flamesInhaled flames Swallowed poisons, foreign bodySwallowed poisons, foreign body ETTETT

Injuries;Injuries; Cricotracheal separation -> AsphyxiaCricotracheal separation -> Asphyxia Fractures of larynx, hyoid bone, joint disruptionFractures of larynx, hyoid bone, joint disruption Open woundsOpen wounds Mucosal TearsMucosal Tears

Laryngeal InjuriesLaryngeal Injuries

PresentationPresentation Significant cervical traumaSignificant cervical trauma Hoarse voice, neck pain, dyspnea, hypoxia, aphonia Hoarse voice, neck pain, dyspnea, hypoxia, aphonia

dysphasiadysphasia Goals of treatmentGoals of treatment

Protect the airway; Intubation, tracheostomyProtect the airway; Intubation, tracheostomy Restoration of function; Surgical repairRestoration of function; Surgical repair

ComplicationsComplications Laryngeal stenosis; permanent tracheostomyLaryngeal stenosis; permanent tracheostomy

33 year old male singing teacher33 year old male singing teacher Progressively hoarse voiceProgressively hoarse voice Normal CoughNormal Cough Non-smoker Non-smoker No weight loss/fatigueNo weight loss/fatigue

Benign Vocal Fold LesionsBenign Vocal Fold Lesions

Reactive nodules (singers nodules)Reactive nodules (singers nodules) Bilateral Bilateral Smooth, rounded/pedunculatedSmooth, rounded/pedunculated Small Small Located on true vocal foldsLocated on true vocal folds Treatment;Treatment;

Voice training, re-educationVoice training, re-education Rarely surgical if fibrosed, chronicRarely surgical if fibrosed, chronic

Virtually never give rise to malignancyVirtually never give rise to malignancy

LaryngoceleLaryngocele

Abnormal dilatation of the laryngeal ventricleAbnormal dilatation of the laryngeal ventricle Contains airContains air Men>WomenMen>Women Bilateral 25%Bilateral 25% Aeitology;Aeitology;

Acquired; Incr. Intraluminal pressure (musicians)Acquired; Incr. Intraluminal pressure (musicians) CongenitalCongenital SCC <15%SCC <15%

Hoarse voice, pain, dysphagia, lateral neck massHoarse voice, pain, dysphagia, lateral neck mass

Squamous PapillomaSquamous Papilloma

Most common benign neoplasm of larynx (84%)Most common benign neoplasm of larynx (84%) Found on true vocal cordsFound on true vocal cords Caused by HPV 6 and 11Caused by HPV 6 and 11 Soft Raspberry like appearanceSoft Raspberry like appearance May ulcerate resulting in haemoptysisMay ulcerate resulting in haemoptysis Usually Single in AdultsUsually Single in Adults Multiple in Children (Laryngeal Papillomatosis) with Multiple in Children (Laryngeal Papillomatosis) with

extended growth and recurrenceextended growth and recurrence Malignant transformation extremely rareMalignant transformation extremely rare

Investigation and TreatmentInvestigation and Treatment

Ix;Ix; LaryngoscopyLaryngoscopy

Tx;Tx; CO2 LaserCO2 Laser Surgical removalSurgical removal ?Antivirals?Antivirals

55 year old male55 year old male History of GORD, cardiac diseaseHistory of GORD, cardiac disease Recurrent hoarse voiceRecurrent hoarse voice Right otalgiaRight otalgia Smoker + ETOH abuseSmoker + ETOH abuse

Squamous Cell CarcinomaSquamous Cell Carcinoma

Most common malignancy of larynxMost common malignancy of larynx Male>Female 6;1xMale>Female 6;1x 2.5% all cancers in men2.5% all cancers in men AeitologyAeitology

Tobacco: Tobacco: ↑↑↑↑ Alcohol: Alcohol: ↑↑ (x 2.2) (x 2.2) Radiation, asbestosRadiation, asbestos GORDGORD HPVHPV


Glottic SCC most common (60%) > Glottic SCC most common (60%) > supraglottic SCC (30%) > subglottic SCC supraglottic SCC (30%) > subglottic SCC (<10%).(<10%).

Sx: hoarseness, throat pain, cough, hemoptysis, Sx: hoarseness, throat pain, cough, hemoptysis, referred otalgia, dysphagiareferred otalgia, dysphagia

Diagnosis;Diagnosis; Laryngoscopy with FNALaryngoscopy with FNA CT/MRICT/MRI


ManagementManagement Eradication of diseaseEradication of disease Restoration of function; swallowing and speechRestoration of function; swallowing and speech Radiation treatmentRadiation treatment

Especially early stage diseaseEspecially early stage disease Cure rates equivalent to surgeryCure rates equivalent to surgery

Surgical ManagementSurgical Management Emphasis on organ preservationEmphasis on organ preservation Partial LarygectomyPartial Larygectomy

www.surgical-www.surgical-tutortutor..orgorg.uk .uk Learning RadiologyLearning Radiology Clinical Cases and Osces in Surgery. Clinical Cases and Osces in Surgery.

Ramachandran, PooleRamachandran, Poole Apleys OrthopaedicsApleys Orthopaedics

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Diseases of-pharynx-and-larynx