CONGENITAL ANOMALIES OF LARYNX CORRECT.pptx

anomlies of lyranx

1. Nishtar Medical University, Multan CONGENITAL ANOMALIES OF LARYNX DR. Salman Ali Assistant Professor ENT

2. Learning objective At the end of lecture students will be able to know about Congenital anomalies of larynx Diagnosis and their management

3. Commom Symptoms Of Congenital laryngeal Disorders Stridor Hoarseness Aspiration

4. CONGENITAL ANOMALIES OF LARYNX Laryngo-malacia Hemangioma Vocal cord paralysis Laryngeal web Subglottic stenosis Tracheo-esophageal fistula Laryngocele

5. scenario A Mother brought her newly born child in ENT DEPARTMENT with History of stridor which become more prominent on crying and subsides when baby is in prone postion other vise normal cry .on Direct laryngoscopy you see omega shaped EPIGLOTTIS WHATS YOUR DIAGNOSIS IN THIS CASE WHAT ARE CLINICAL FEATURES WHATS ITS MANAGEMENT

6. CONGENITAL ANOMALIES OF LARYNX Laryngo-malacia Hemangioma Vocal cord paralysis Laryngeal web Subglottic stenosis Tracheo-esophageal fistula Laryngocele

7. LARYNGOMALACIA This is excessive softening( flaccidity)of suprglottic larynx Most common congenital abnormality Stridor increase on crying, decreases in prone position This is commonest cause of stridor in children Condition is seen at birth or soon after birth It disappear at the at of 2 year usually

8. CAUSES Relaxation or a lack of muscle tone in the upper airway may be a factor. It is often worse when the infant is on his or her back, because the floppy tissues can fall over the airway opening more easily in this position.

9. Normal larynx

10. PATHOLOGY Excessive softness and flabbiness Thinning and hypo cellularity of laryngeal cartilages Wrinkled loose edematous mucosa The exaggerated inspiratory effort increases blood return to the pulmonary vascular bed. This could account for the increased likelihood of pulmonary artery hypertension in infants with hypoxemia

11. CLINICAL FEATURES Stridor is main symptoms that appears at or soon after birth is mainly inspiratory Tubular or omega shaped epiglottis Laryngeal inlet is of cruciate appearance Stridor is more while sleeping Stridor disappears in second or fifth year of life Cyanosis is rare Voice is unchanged

12. laryngomalacia

13. DIAGNOSIS Careful history and examination Flexible fiberoptic laryngoscopy Direct laryngoscopy

14. OMEGA SHAPE EPIGLOTTIS

15. TREATMENT Re-assurence Symptoms subside after 2-5 year Treatment of URTI often relieves stridor Tracheostomy If needed

16. SURGICAL TREATMENT Most commonly, this involves cutting the aryepiglottic folds to let the supraglottic airway spring open Supraglottoplasty

17. supraglottoplasty

18. Scenario A new born baby with history of forceps delivery presented to ENT department with history of stridor and horsiness cry. What is your diagnosis What your management plan

19. CONGENITAL ANOMALIES OF LARYNX Laryngo-malacia Hemangioma Vocal cord paralysis Laryngeal web Subglottic stenosis Tracheo-esophageal fistula Laryngocele

20. Congenital vocal cord paralysis True vocal cord card paralysis is second most common cause of laryngeal anomalies 10-15 % of congenital laryngeal problems is vocal paralysis Symptoms of vocal cord paralysis often show up by 2 months of age It occurs due to birth trauma when recurrent laryngeal nerve stretched during forcep s delivery

21. UNILATERAL (ONE-SIDED) PARALYSIS Aspiration Occasional stridor (noisy breathing) Weak, breathy cry

22. UNILATERAL VOCAL CARD PARALYSIS

23. BILATERAL (TWO-SIDED) PARALYSIS High pitched, noisy breathing Blue spells Aspiration Shortness of breath with activity

24. TREATMENT In most circumstances, no immediate treatment is needed for one-sided vocal cord paralysis. Treatment is needed when your child is having breathing difficulty or is aspirating fluid into the lungs.

25. SCENARIO A MOTHER BROUGHT HER 2 months OLD MALE CHILD WITH HISTORY OF PREMATURE DELIVER AND REMAINED ON VENTILATION FOR 1 MONTH IN ENT DEPARTMENT WITH HISTORY OF RESPIRATORY DISTRESS,STRIDOR ON XRAY NECK SOFT TISSUE ,THERE IS NARROWING OF SUB GLOTTIS WHATS YOUR DIAGNOSIS WHATS MOST COMMON CLINICAL FEATURES WHAT WILL BE YOUR MANAGEMENT PLAN

26. CONGENITAL ANOMALIES OF LARYNX Laryngo-malacia Hemangioma Vocal cord paralysis Laryngeal web Subglottic stenosis Tracheo-esophageal fistula Laryngocele

27. CONGENITAL SUBGLOTTIC STENOSIS 3 rd most common congenital anomaly Common cause may due to tracheostomy Pathology Sub mucosal tissue thickness Small cricoid or abnormal cricoid cartilage 1 st tracheal ring displacement

28. CLINICAL FEATURES 1 st week to 1 st month Recurrent or persistent croup Male female ratio 2:1 Stridor Dyspnea

29. INVESTIGATION AND TREATMENT D L Scopy Bronchoscopy X-Ray soft tissue may show smooth narrowing of subglottis

30. Preoperative view of 4 month infant aquired stenosis

31. TREATMENT Tracheostomy if severe distress Dilatation of stenosis repeated Laryngo-tracheo-plasty Laser excision stenting

32. Split cricoid for sub glottic- stenosis

33. Post operative view after laser

34. SCENARIO A MOTHER BROUGHT HER 2 YRS CHILD IN ENT DEPARTMENT WITH HISTORY OF NOISY BREATHING ,RESPIRATORY DISTRESS ,STRIDOR ,OFF AND ON HISTORY OF CYNOSIS ON DIRECT LARYNGOSCOPY U SEE A RED PURPLISH MASS IN SUB GLOTTIS WHATS YOUR CLINICAL DIAGNOSIS WHATS ARE MOST COMMON CLINICAL FEATURES WHATS YOUR MANAGENT PLAN

35. CONGENITAL ANOMALIES OF LARYNX Laryngo-malacia Hemangioma Vocal cord paralysis Laryngeal web Subglottic stenosis Tracheo-esophageal fistula Laryngocele

36. HEMENGIOMA OF LARYNX Benign over growth of small blood vessels in subglottis Cavernous type of hemangioma 50% patients also have cutaneous hemangioma Most commonly in females

37. SYMPTOMS Stridor is biphasic (inspiratory and expiratory) Dyspnea Cyanosis Retraction of intercostal space Symptoms may be absent at birth or appear after URTI Presence of cutaneous hemangioma When small may be asymptomatic

38. SYMPTOMS Croup-like cough Noisy breathing stridor Difficulty breathing Bleeding

39. INVESTIGATION CT Scan or MRI show mass in subglottic region Direct laryngoscopy examination Shows RED PURPLRE MASS Cotton soaked gauze with adrenalin causes shrinkage of mass Biopsy is dangerous

40. TREATMENT Hemengioma have rapid growth from 2-6 month After which regress spontaneously If regression does not take place propranolol Steroids Surgery Laser excision

41. scenario Mother brought her one month old baby with complaint of shortness of breath,week cry ,and stridor from birth on direct laryngoscopy there is thick membrane between vocal cords Whats your clinical diagnose in this case What are clinical finding,s Whats will be your management plan

42. CONGENITAL ANOMALIES OF LARYNX Laryngo-malacia Hemangioma Vocal cord paralysis Laryngeal web Subglottic stenosis Tracheo-esophageal fistula Laryngocele

43. CONGENITAL LARYNGEAL WEB Condition is due to incomplete splitting of vocal cords( incomplete recanalization of larynx) 75% cases web is in the glottic region TYPES Membranous Fibrous

44. LARYNGEAL WEB

45. SYMPTOMS AND SIGNS Symptoms vary with size of web Hoarseness Stridor Dyspnea SIGNS Stridor Obstruction IDL Pink thin or thick membrane between vocal cords

46. TREATMENT Tracheostomy Excision by laryngo-fissure M.C.- Knought- keel between the vocal cords Small web can be excised by MLS Co2 laser therapy Cut with knife

47. scenario A mother brought her new born pre mature baby in ent department with complaint of feeding difficulty , persistant cough,choking and cyanosis at time of feeding Whats your provisional diagnosis What will be your management plan in this case

48. CONGENITAL ANOMALIES OF LARYNX Laryngo-malacia Hemangioma Vocal cord paralysis Laryngeal web Subglottic stenosis Tracheo-esophageal fistula Laryngocele

49. TRACHEOESOPHAGEAL FISTULA Tracheoesphageal septum is deficient(failure of fusion of cricoid lamina) Communication of air and food passage Seen in Premature birth

50. CLINICAL FEATURES Barking cough Aspiration Choking Feeding difficulty cyanosis

51. DIAGNOSIS Flexible laryngoscopy Direct laryngoscopy Barium study may show contrast in airway

52. TREATMENT Intubation or tracheostomy N/G Intubation Antibiotics Surgical repair

53. SCENARIO A MOTHER WITH HISTORY OF COPD BROUGHT HER MALE BABY BOY WITH HISTORY OF SHORTNESS OF BREATHE ,CYNOSIS OFF AND ON AND STRIDOR WHATS WILL BE YOUR DIAGNOSIS IN THIS CASE WHAT WILL BE TREATMENT PLAN

54. CONGENITAL ANOMALIES OF LARYNX Laryngo-malacia Hemangioma Vocal cord paralysis Laryngeal web Subglottic stenosis Tracheo-esophageal fistula Laryngocele

55. LARYNGOCELE An air filled dilatation in saccule of laryngeal ventricle Occures in males Deformity is rare in adults Refers to a congenital anomalous air sac communicating with the cavity of the larynx , which may bulge outward on the neck.

56. PREDISPOSING FACTORS It may be aquired and seen in Glass blowers In patients with COPD Strainig Coughing Playing with wind instruments The activity which increases intralaryngeal pressure

57. TYPES External cystic mass lateral to thyro-hyoid membrane Internal air containing sac confined to area of false vocal cords mixed

58. Laryngeocele /cyst

59. TREATMENT MLS micro-laryngeal surgery Laser excision Open surgical excision Lateral Midline aproach