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1104/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
SURGICAL AIRWAY PROCEDURES
2204/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
Dr. NaushadHouse Officer
ENT Department
Tracheostomy
for impending airway problem in a case of
Carcinoma of Larynx
Case Presentation
4404/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
PERSONAL DATAPERSONAL DATA
NameName :: Mohd ArshadMohd Arshad
AgeAge :: 35 Years male35 Years male
BedBed :: E.N.T 10E.N.T 10
D.O.AD.O.A :: 8.01.20048.01.2004
D.O.DD.O.D :: 9.02.20049.02.2004
5504/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
HISTORYHISTORY
MAIN COMPLAINTS:MAIN COMPLAINTS: Change in voiceChange in voice 6 months6 months Pain in throatPain in throat 6 months6 months
HISTORY OF PRESENTING HISTORY OF PRESENTING ILLNESS:ILLNESS: According to the patient, he was alright 6 According to the patient, he was alright 6
months back when developed change in months back when developed change in voice and pain on swallowing on the right voice and pain on swallowing on the right side of throat. Both the complaints side of throat. Both the complaints developed slowly and were constantly developed slowly and were constantly progressing. He went to a number of progressing. He went to a number of doctors and received different medications doctors and received different medications with only temporary relief. with only temporary relief.
6604/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
PAST HISTORY-PAST HISTORY- No past history of any No past history of any other medical or surgical illness. other medical or surgical illness.
FAMILY HISTORY-FAMILY HISTORY- His father died of His father died of malignancy. Details are not available.malignancy. Details are not available.
PERSONAL HISTORY-PERSONAL HISTORY- Chain Chain Smoker (2 pack per day for last 10 Smoker (2 pack per day for last 10 years) years) with normal bowel habits. with normal bowel habits.
……HISTORYHISTORY
Contd.
7704/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
DRUG HISTORY-DRUG HISTORY- Had been taking antibiotics and Had been taking antibiotics and mouth washes for gargles. No history of any drug mouth washes for gargles. No history of any drug allergy.allergy.
SOCIOECONOMIC HISTORY-SOCIOECONOMIC HISTORY- Belongs to Belongs to lower middle class.lower middle class.
……HISTORYHISTORY
8804/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
GENERAL PHYSICAL GENERAL PHYSICAL EXAMINATIONEXAMINATION
A young man sitting anxiously in bed, well oriented A young man sitting anxiously in bed, well oriented to time, place and person.to time, place and person.
AnaemiaAnaemia JaundiceJaundice ClubbingClubbing Absent Absent CyanosisCyanosis Palpable Nodes:Palpable Nodes: Rt. Middle deep cervical node Rt. Middle deep cervical node
palpable around 2 cm and immobile palpable around 2 cm and immobile
Contd.
9904/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
Temp:Temp: AfebrileAfebrile
Pulse:Pulse: 84 beats per min. Regular,84 beats per min. Regular,
BP:BP: 110/80 mm Hg.110/80 mm Hg.
……GENERAL PHYSICAL GENERAL PHYSICAL EXAMINATIONEXAMINATION
101004/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
SYSTEMIC SYSTEMIC EXAMINATIONEXAMINATION
Resp. System:Resp. System:
CVS:CVS: NAD NAD
CNS:CNS:
GIT:GIT:..
111104/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
E.N.T EXAMINATIONE.N.T EXAMINATION
EAR EXAMINATIONEAR EXAMINATIONNormalNormal
NASAL EXAMINATIONNASAL EXAMINATION
NormalNormal
EXAMINATION OF THROATEXAMINATION OF THROAT
Poor oral hygienePoor oral hygieneGingivitisGingivitis
IDL: Reveals a large growth behind the epiglottis IDL: Reveals a large growth behind the epiglottis covering laryngeal inlet. Cords could not be seen. covering laryngeal inlet. Cords could not be seen.
121204/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
INVESTIGATIONSINVESTIGATIONS
CP:CP: Within normal limits with Hb of 14 g/dl Within normal limits with Hb of 14 g/dl
ESR:ESR: 25 mm within 1st hr. 25 mm within 1st hr.
Renal Profile:Renal Profile: Within Normal Limits Within Normal Limits
Blood Sugar (Random):Blood Sugar (Random): 90 mg/dl 90 mg/dl
Contd.
131304/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
……INVESTIGATIONSINVESTIGATIONS
X-Ray chest :X-Ray chest : NormalNormal
Histopathology:Histopathology: To obtain a specimen for To obtain a specimen for
histopathology Direct histopathology Direct laryngoscpy was planned laryngoscpy was planned along with tracheostomy for the along with tracheostomy for the impending airway problem. impending airway problem.
Contd.
141404/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
Tracheostomy and Direct Laryngoscopy and Tracheostomy and Direct Laryngoscopy and Biopsy was performed under general Biopsy was performed under general anaesthesia on 10.02.04.anaesthesia on 10.02.04.Findings: Extensive growth larynx and Findings: Extensive growth larynx and hypopharynx involving Rt. Arytenoids and hypopharynx involving Rt. Arytenoids and aryepiglottic folds, true and false cords, Rt. aryepiglottic folds, true and false cords, Rt. Pyriform sinus and post cricoid area with Pyriform sinus and post cricoid area with extension onto the posterior pharyngeal wall. extension onto the posterior pharyngeal wall.
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DIAGNOSISDIAGNOSIS
Advanced Squamous Cell Advanced Squamous Cell Carcinoma of LarynxCarcinoma of Larynx
T4 N3 MT4 N3 MXX
161604/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
TREATMENT & FOLLOWUPTREATMENT & FOLLOWUP
Patient referred to NORI for whole body Patient referred to NORI for whole body scanning TC-99 m scaning & Radiotherapy, scanning TC-99 m scaning & Radiotherapy, however patient went to Lahore to get however patient went to Lahore to get Radiotherapy from Shoukat Khanum and Radiotherapy from Shoukat Khanum and expired a month later while he was receiving expired a month later while he was receiving his radiotherapy. his radiotherapy.
171704/11/2304/11/23 Depertment of E.N.TDepertment of E.N.T
Thank you!