congenital laryngeal disorders
TRANSCRIPT
CONGENITAL LARYNGEAL DISORDERS
DR PRASHANTH
CLASSIFICATION
1. SUPRAGLOTTIS LARYNGOMALACIA LARYNGEAL CYST CONGENITAL LARYNGOCELE 2. GLOTTIS LARYNGEAL WEB CRI-DU CHAT SYNDROME VOCAL CORD PARALYSIS
CLASSSIFICATION CONTD….
3. SUBGLOTTIS: SUBGLOTTIC STENOSIS SUBGLOTTIC HEMANGIOMA LARYNGOTRACHEAL CLEFT
LARYNGOMALACIA
MALACIA= SOFTENING (GREEK) JACKSON IN 1942 MOST COMMON CAUSE OF
CONGENITAL STRIDOR. FEATURES: 1. SOFT FLABBY LARYNGEAL TISSUES 2. THIN LARYNGEAL CARTILAGES 3. LOOSE, REDUNDANT MUCOSA OF LARYNX
C/F: M:F= 1:1, CRY IS NORMAL
INSPIRATORY STRIDOR: HIGH PITCH, “FLUTTERING” , WITHIN FEW DAYS OF BIRTH , OR URTI INCREASES TILL FIRST YEAR STARTS RESOLVING.
SUPINE POSITION, SUCKLING, CRYING WORSENS STRIDOR
IMPROVES IN PRONE POSITION
DIAGNOSIS: HISTORY VIDEOLARYNGOSCOPY/FLEXIBLE NASO LARYNGOSCOPY: 1. OMEGA SHAPED EPIGLOTTIS 2. SHORT AE FOLD, PROLAPSES INWARDS 3. PROMINENT ARYTENOIDS, LOOSE MUCOSA, MOVE INWARDS 4. DIFFICULT TO SEE VOCAL CORDS
TREATMENT: 1. 90% CASES RESOLVE BY 2 YEARS 2. TREAT URTI EFFECTIVELY
SEVERE RESPIRATORY DISTRESS, FEEDING DIFFICULTY( HIGH INTRA THORACIC NEGATIVE PRESSURE GERD ) WITH FAILURE TO THRIVE ACTIVE INTERVENTION
EMERGENCY MANAGEMENT:
1. ENDOTRACHEAL INTUBATION 2. TEMPORARY TRACHEOSTOMY
CONSERVATIVE MANAGEMENT
ENDOSCOPIC ARY- EPIGLOTTOPLASTY ( SUPRAGLOTTOPLASTY)
CO2 / COLD KNIFE AE FOLD RELEASED FROM EPIGLOTTIS & REDUNDANT MUCOSA OF ARYTENOID EXCISED IF NEEDED ALONG
WITH CUNEIFORM CARTILAGES
LARYNGOCELE
AIR-FILLED DILATATION OF SACCULUS
ETIOLOGY: 1. CONGENITALLY LARGE SACCULE 2. INCREASED INTRA LARYNGEAL PRESSURE GAS BLOWERS, SAXOPHONE PLAYERS, COUGHING etc
VENTRICLE
TYPES:
INTERNAL- WITHIN THE LARYNX EXTERNAL- PROJECTS THROUGH THE
THYRO-HYOID MEMBRANE AND PRESENTS AS SWELLING IN THE LATERAL NECK
COMBINED
INTERNAL LARYNGOCELE
CLINICAL FEATURES
ASYMPTOMATIC HOARSENESS RESPIRATORY DISTRESS INCREASES ON
CRYING OR STRAINING NECK: CYSTIC, PAINLESS SWELLING,
REDUCIBLE, INCREASES ON VALSALVA ILS: SMOOTH BULGE ON THE
VENTRICULAR BAND, MAY OBSCURE THE VOCAL CORDS
BRYCE’S SIGN: GIRGLING & HISSING SOUND IN THROAT WHEN EXTERNAL MASS IS COMPRESSED
IF SAC OPENING IS OBSTRUCTED MUCOCELE ( SACCULAR CYST )
MANAGEMENT
SOFT TISSUE XRAY NECK/ CT SCAN DURING VALSALVA
DIRECT LARYNGOSCOPY TO RULE OUT UNDERLYING MALIGNANCY
TREATMENT:1. MLS & MARSUPIALIZATION OF SAC
(VENTRICULAR BAND & LARYNGOCELE IS CUT & MARGINS EVERTED)
2. EXTERNAL (TRANSCERVICAL) EXCISION (EITHER CUT THE NECK OF SAC & SUTURE OR LARYNGOFISSURE & SAC EXCISION)
LARYNGEAL WEB
FAILURE OF COMPLETE CANALIZATION OF LARYNX DURING 5TH WEEK OF IU LIFE
MOST COMMON IS GLOTTIC WEB(75%), LESS COMMON ARE SUPRA & SUB GLOTTIC
MOSTLY ANTERIOR GLOTTIC WEBS POSTERIOR INTERARYTENOID WEBS MAY
BE ASSOCIATED WITH CRICOARYTENOID JOINT FIXATION
C/F: WEAK CRY AT BIRTH RECURRENT CROUP INSPIRATORY OR BIPHASIC STRIDOR
DIAGNOSIS: VIDEODIRECT ENDOSCOPY/ FLEXIBLE NASOLARYNGOSCOPY
ANTERIOR GLOTTIC WEB
Rx: ASYMPTOMATIC REASSURANCE
SYMPTOMATIC WEBS
THIN WEBS THICK WEBS
EXCISION WITH COLD KNIFE OR
CO2 LASER
EXCISION & INSERTION OF SILASTIC KEEL
INNER FLANGE GOES IN
BETWEEN THE VOCAL CORDS
OUTER FLANGES SUTURED TO THE THYROID
CARTILAGE
SILASTIC KEEL
PREFERABLY KEEL INSERTED AT AGE OF 3 YRS & ABOVE
TEMPORARY TRACHEOSTOMY WHEN KEEL IN-SITU ( 2- 5 WEEKS)
INSERTED ENDOSCOPICALLY WITH COMBINED LARYNGOFISSURE APPROACH
VERY SEVERE WEB INVOLVING SUBGLOTTIS EMERGENCY TRACHEOSTOMY AT 2 yrs LTR ( Laryngo tracheal reconstruction)
WITH ANTERIOR CARTILAGE GRAFTING
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