benign tumors of larynx , intervention and treatment.pptx

benign tumors of larynx , explanation, intervention and approach to treating it

1. Benign Tumors Of Larynx Dr. Salman Ali Assistant Professor of ENT Nishtar Medical University, Multan.

2. Benign Tumors Of Larynx . Divided into Non Neoplastic Neoplastic

3. Benign Tumors Of Larynx Neoplastic Squamous Papilloma Juvenile type Adult Onset type Chondroma Hemangioma Granular cell tumor Glandular cell tumor Rhabdomyoma Lipoma Fibroma Non Neoplastic Solid Vocal nodules Vocal polyp Reinke’s oedema Contact ulcer Intubation granuloma Cystic Ductal cysts Saccular cysts laryngolocela

4. scenario A 35 yrs old male patient teacher by profession presented in ent opd with hoarseness of voice from six month also pain in throat after prolong phonation. On indirect laryngoscopy there is symmetrical reddish swelling on vocal cord

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6. Scenario 40 yrs old male known smoker presented in ENT OPD with complaint of hoarseness of voice which developed suddenly after shouting on examination there is soft smooth pedunculated mass (swelling ) on right vocal cord

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8. scenario A 30 yrs old male smoker presented in ent opd with horsness of voice from 3 month on examination there is diffuse symmetrical swelling of vocal cords

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10. scenario A 30 yrs old male patient singer by profession presented in ent with hoarseness of voice , continuous desire of clearing the throat , pain in throat which worsen with phonation .On examination there are some ulcerative lesions on both vocal cords

11. scenario A patient presented in ent department with history of horsness of voice from 3 months ,on examination there is some warty growth(white plaque) on vocal cords but both vocal cors are mobile

12. scenario A 20 yrs old female pt presented in ent opd with horsness of voice throat pain from 20 days .Her mother also gave history that she remain admitted in icu on ventilation due to some medical disease

13. Scenario A mother brought her child in ENT opd with history of shortness of breath and inspiratory stridor and progressive respiratory distress .There is some history of vaginal infection in mother in prenatal period on examination there is white glistening pedunculated growth on vocal cord

14. Juvenile Laryngeal Papilloma

15. Vocal nodules( Singer’s nodules/ Screamers Nodules Appear symmetrically in the free edge of the vocal cord at the junction of anterior 1/3 rd and posterior 2/3 rd , as this is the area of maximum vibration and thus subjected to maximum trauma Usually they measure less than 3mm They are result of vocal trauma Mostly seen in teachers, actors, singer’s vendors

16. Pathology Trauma to the vocal card in the form of vocal abuse or misuse causes oedema and haemorrhage in the submucosal space. This undergoes hyalinization and fibrosis. Underlying epithelium also undergoes hyperplasia forming a nodule.

17. Clinical Features Hoarseness, vocal fatigue and pain in the neck on prolonged phonation. On exmaination , nodule appear soft, reddish and oedematous swelling, later becomes grayish or whitish in colour .

18. Treatment Voice rest Surgery for larger nodules and long standing nodules in adults. Excised by micro laryngeal surgery Speech therapy and re-education in voice production is necessary to prevent recurrence.

19. Vocal Polyp Result of vocal abus or misuse Allergy and smoking are other contributing factors Mostly affects men in age group of 30-50 Typically its unilateral and arising from same position as vocal nodule Its soft , smooth and often pedunculated It may flop up and down during phonation or respiration Its caused by sudden shouting resulting in heamhorrage in the vocal cord and subsequesnt submucosal oedema.

20. Clinical features Hoarseness is a common symptom Large polyp may cause dyspnea, stridor or intermittent chocking Some patients may complain of diplophonia due to different vibratory frequencies of two vocal cords. Treatment : Surgical excision under operating microscope and speech therapy.

21. Reinke’s Oedema This is due to collection of the oedema fluid in the subepithelial spave of reinke Usual cause is vocal abuse and smoking Both vocal cords show diffuse symmetrical swellings Treatmrnt is vocal cord stripping preserving enough mucosa for epithelization Only one cord is operated at a time Cessation of smoking is important to prevent recurrence

22. Contact Ulcer This is again due to faulty voice production Vocal process of arytenoid hammer against each other resulting in ulceration and granuloma formation Some cases are due to laryngopharyngeal reflux Complaints are hoarseness, constant desire to clear the throat and pain in the throat which worsens on phonation Examination reveals unilateral or bilateral ulcers with congestion of arytenoid cartilages There may be granuloma formation

23. Intubation Granulation It results from injury to vocal processes of arytenoids due to rough intubation Use of large tube or prolonged intubation are the common causes Mucosal ulceration followed by granulation formation over exposed cartilage Usually these are bilateral involoving posterior third of true cords They present with hoarseness, if large dyspnea Treatment is voice rest and endoscopic removal of granuloma

24. Leukoplakia ( Keratosis) Larynx This is vocalized form of epithelial hyperplasia involving upper surface of one or both vocal cords It appers as white plaque or warty growth on cord without affecting its mobility Its regarded as pre cancerous condition because carcinoma in situ frequently supervenes Hoarseness is common presenting symptom Treatment is stripping of the vocal cords and histopathological examination to rule out malignancy

25. Neoplastic Laryngeal Lesions Squamous Papillomas can be Juvenile or Adult onset type Juvenile Laryngeal Papilloma: They are viral in origin and multiple, often involving infants and young children who present with hoarseness and stridor. They are mostly seen on the true, false vocal cords and epiglottis, but may involve other sites in larynx and trachea. Clinically appears as glistening white irregular growths, pedunculated os sessile , friable and bleeding easily.

26. Juvenile Laryngeal Papilloma: They are known for recurrence after removal, therefore multiple laryngoscpies may be required. Tend to disappear spontaneously after puberty Treatment: endoscopic removal with cup forceps, Cryotherapy, microelectrocautery . CO2 laser is preferred these days interferon therapy to prevent recurrence

27. Adult Onset Papilloma: Usually single, smaller in size, less aggressive and does not recur after surgical removal. It is common in males in age group of 3-50 years Usually arises from anterior half of the vocal cord or anterior commissure Treatment is same asfor juvenile type

28. Thank You