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LARYNX

LARYNX. Anatomy . Skeleton Thyroid cartilage Cricoid cartilage Arytenoid cartilage Epiglottis Corniculate cartilage Cuneiform acrtilage. Nerve supply. -from the VAGUS NERVE Superior laryngeal nerve

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LARYNX

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  1. LARYNX

  2. Anatomy Skeleton • Thyroid cartilage • Cricoid cartilage • Arytenoid cartilage • Epiglottis • Corniculate cartilage • Cuneiform acrtilage

  3. Nerve supply -from the VAGUS NERVE • Superior laryngeal nerve motor: extrinsic laryngeal muscle (anterior cricothyroid) and its external branches sensory: mucosa of the upper larynx including glottic plane • Recurrent laryngeal nerve motor: supplies all the intrinsic muscles of the larynx sensory: fibers to the layngeal mucosa below the glottis and to the tracheal mucosa

  4. Blood supply: Arterial • Supraglottic and glottic levels: superior laryngeal artery from ECA • Subglottic: inferior layngeal coming from the subclavian and thyrocervical trunk

  5. Blood supply: venous • Superior thyroid vein drains into IJV • Inferior thyroid vein drain into Branchiocephalic vein

  6. Croup symtoms Croup syndrome: inspriratorystridor caused ny inflammation of the latyngeal or subglotticstenosis. Respiratory distress, cough, and hoarseness True droup: diptheria Pseudocroup: viral, bacterial, spastic forms of the subglottic laryngitis

  7. Vocal Cord Nodules • Usually bilateral • Anterior or middle third of true vocal cord • Any age group • Prevent the vocal folds from meeting in the midline and thus produce hourglass deformity on closure resulting in a raspy breathing voice • Hoarseness or voice changes • Related to chronic voice abuse • Microlaryngeal surgery

  8. Vocal Cord Polyps • Usually single • Middle third of true vocal cord, but may originate from the ventricular area • Locating in the phonating margin of the vocal folds and prevent the vocal folds from meeting in the midline • Male • Sessile, raspberry-like, pedunculated • Related to chronic voice abuse, infection, ETOH, smoking, hypothyroidism • Hoarseness or voice changes

  9. Vocal Cord Polyp

  10. Laryngocele • Abnormal dilatation of the saccule (appendix of the ventricle) containing air and maintaining an open communication with laryngeal lumen • Men >women • Bilateral - 25% • Hoarseness, lateral neck mass, dyspnea, dysphagia, laryngopyocele (pain)

  11. Laryngocele: Types • Internal: laryngocele confined to the intrinsic larynx • External: dilated sac projects upward and laterally • Combined

  12. Laryngocele: Etiology • Acquired: increased intralaryngeal pressure (glassblowers, musicians, weight lifters) • Congenital • SCC in 15% of cases

  13. Laryngocele • Smooth -surfaced, sac-like structure usually filled with air

  14. Laryngocele • Respiratory epithelial-lined (ciliated, columnar) cyst with a fibrous wall • Squamous metaplasia • Oncocytic metaplasia

  15. Contact Ulcers of the Larynx (Pyogenic Granuloma of the Larynx) • Benign, tumor-like condition, occurring most commonly along the posterior aspect of one or both vocal cords • Men>Women, usually adults • Hoarseness, dysphagia, sore throat, dysphonia, difficulty breathing, choking, pain • Etiology: vocal abuse, acid regurgitation, postintubation trauma

  16. Contact Ulcers of the Larynx (Pyogenic Granuloma of the Larynx) • Ulcerated, polypoid, nodular, or fungating mass with a beefy red to tan-white appearance, up to 3 cm in diameter

  17. Laryngeal Amyloidosis • Extracellular, eosinophilic, amorphous material deposited randomly throughout submucosa; depositions around or within the walls • Disappearance of the seromucous glands, • Mixed chronic inflammatory infiltrate

  18. Laryngeal Amyloidosis • Congo red: apple-green birefringence under polarized light

  19. Subglottic Stenosis • Congenital or acquired • Rare; acquired > congenital • Progressive respiratory difficulty, stridor, dyspnea, air hunger, hoarseness, abnormal cry, aphonia, dysphagia • Etiology: trauma, neoplasms, infectious or autoimmune diseases, idiopathic

  20. Subglottic Stenosis • Narrowing of the endolaryngeal diameter with mucosal or submucosal mass or bulging • Histologic picture depends on the cause • Idiopathic stenosis: submucosal fibrous proliferation with associated non-specific chronic inflammation • Differential diagnosis: infectious diseases, Wegener’s granulomatosis, collagen vascular diseases, neoplasms

  21. Benign Neoplasms of the Larynx

  22. Laryngeal Papilloma • Benign, exophytic neoplastic growth composed of branching fronds of squamous epithelium with fibrovascular cores • The most common benign laryngeal neoplasm • No sex predilection • Changes in phonation, dyspnea, cough, dysphagia, stridor • HPV types 6 and 11

  23. Laryngeal Papilloma • Juvenile type: multiple lesions with extensive growth and rapid recurrence, may remit spontaneously or persist into old age • Adult type: more often single, recurs less often, less likely to spread

  24. Exophytic, warty, friable, tan-white to red growths

  25. Papillary fronds of multilayered benign squamous epithelium containing fibrovascular cores • Little or no keratin production

  26. Laryngeal Papilloma • Absence of stromal invasion • Certain degree of cellular atypia • Koilocytic changes

  27. Laryngeal Granular Cell Tumor • Men > women • Hoarseness • Along the posterior aspect of true vocal cord ( but also in supraglotic and infraglotic areas)

  28. Granular Cell Tumor • Solitary, polypoid, sessile, papillary, or cystic lesion, measuring up to 3.0 cm in diameter

  29. Granular Cell Tumor • Poorly circumscribed subepithelial lesion with syncytial, trabecular, or nested growth pattern • Round to polygonal cells with round to vesicular nuclei and coarsely granular cytoplasm. Poorly defined cell borders. • Variable degree of cellular pleomorphism • Absence of mitoses or necroses

  30. Granular Cell Tumor • Cytoplasmic granules: PAS/d +, Alcian blue pH 2.5 +, trichrome + (red) • Angulate bodies: needle shaped, PAS + bodies in the interstitial cells • Tumor cells: S-100+, NSE + • Interstitial cells with angulate bodies: S-100 - and myelin protein + • EM: membrane bound autophagic vacuoles containing mitochondria, RER, myelin, axon-like structures

  31. Malignant Granular Cell Tumor • Rare ( 1% of all GCT) • Do not occur in newborns • Size > 4 cm • Increased cellularity, pleomorphism, necrosis, prominent nucleoli, spindle shaped cells and > 2 mitoses/10 HPF • Metastasize via lymphatics and blood vessels

  32. Chordoma • Uncommon • Males > females • Dyspnea, strydor, and hoarseness • May originates from epiglottis, cricoid, arytenoid, or thyroid cartilages • May arise in Reinke’s space • Lobulated, firm to hard, blue-gray, submucosal mass, usually < 1 cm

  33. Chordoma • Lobulated, normally looking chondrocytes • Absence of pleomorphism, binucleated chondrocytes, or mitotic activity

  34. Malignant Laryngeal Neoplasms

  35. In Situ Squamous Cell Carcinoma • Males > females • 6th – 7th decades • Most often involves anterior portion of true vocal cord • Hoarseness • May coexist with invasive SCC • May be isolated or multifocal • Circumscribed or diffuse lesion with a white, red, or gray color and smooth or granular appearance

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