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ENT
Larynx and Hypopharynx
Built from Behrbohm — Ear, Nose and Throat Diseases with Head and Neck Surgery
What’s inside
11 sections · 131 slides
Overview
- What this deck covers
Applied Anatomy and Physiology
How the larynx is built and how it makes sound, breathes, and protects
- Where the larynx comes from (embryology)
- The laryngeal skeleton
- The three compartments of the larynx
- Three floors: supraglottis, glottis, subglottis
- Naming the laryngeal cavity
- Inside a vocal fold
- Layered structure of the vocal fold
- Ligaments and membranes that anchor the larynx
- The muscles: one opener versus many closers
- What each laryngeal muscle does
- Directions of pull of the laryngeal muscles
- Nerve supply: two branches of the vagus
- Innervation of the larynx
- Blood supply and venous drainage
- Lymphatic drainage - why site predicts spread
- The glottal lymph barrier
- The lining and the Reinke space
- Physiology 1: making sound (phonation)
- Physiology 2: breathing and protecting the lungs
- Physiology 3: the larynx as a reflex hazard and a brace
Methods of Examination
Looking at, feeling, and testing the larynx
- What an examination is trying to answer
- Inspection and palpation
- Laryngoscopy: the ways to look inside
- Indirect laryngoscopy with a mirror
- Indirect laryngoscopy - the technique
- Instruments for topical anesthesia of the larynx
- Flexible nasendoscopy
- Rigid endoscopy of the larynx
- Removing a small vocal-fold lesion in clinic
- Microlaryngoscopy - the operating platform
- Setting up microlaryngoscopy
- Instruments for endolaryngeal microsurgery
- Imaging and special voice tests
- Electroglottography (EGG)
Congenital Anomalies
Larynx problems present from birth: the three D's - dyspnea, dysphonia, dysphagia
- The pattern of congenital laryngeal anomalies
- Laryngomalacia - the floppy larynx
- Congenital neurogenic disorders and atresias/webs
- Laryngoceles
- Internal laryngocele bulging the vocal fold
- Subglottic stenosis and hemangioma
Organic Functional Disorders
When the nerves and muscles of the larynx fail
- Dysphonia and dyspnea - the two failure modes
- Reading vocal-fold position
- Positions of the vocal fold
- The normal larynx in phonation and respiration
- Vagus nerve lesions along their course
- Vagus nerve lesion sites and their vocal-fold effects
- Recurrent laryngeal nerve palsy - causes by region
- Unilateral recurrent nerve palsy
- Bilateral recurrent nerve palsy - an airway emergency
- Partial arytenoidectomy and posterior cordectomy
- Left vocal-fold palsy in respiration and phonation
- Superior laryngeal nerve palsy and combined lesions
- Superior laryngeal neuralgia
- Blocking the superior laryngeal nerve
Trauma
Vocal overuse, intubation, external blows, toxins and foreign bodies
- Acute and chronic vocal trauma
- Vocal nodules - why they sit where they do
- Vocal-fold nodules and the hourglass glottis
- Contact granuloma
- Contact granuloma of the vocal process
- Intubation injury - acute and chronic
- Bilateral intubation granulomas
- Laryngotracheal stenosis and external trauma
- Patterns of laryngeal cartilage fracture
- Internal laryngeal hematoma after trauma
- Inhalational trauma and foreign bodies
Inflammation
Acute and chronic laryngitis, and the airway emergencies of childhood
- Acute laryngitis
- Acute laryngitis with fibrinous exudate
- Acute subglottic laryngitis (croup / pseudocroup)
- Acute epiglottitis - drooling, dysphagia, distress
- Epiglottitis with abscess formation
- Chronic nonspecific laryngitis
- Chronic laryngitis with keratosis
- Specific chronic laryngitis 1: GPA and tuberculosis
- Laryngeal tuberculosis
- Specific chronic laryngitis 2: the rarer forms
- Laryngeal amyloid and perichondritis
- Amyloidosis of the larynx
Benign Tumors and Precancer
Polyps, Reinke edema, papillomatosis, cysts, and the dysplasia spectrum
- Vocal fold polyps
- A large polyp on the left vocal fold
- Reinke edema
- Reinke edema of both vocal folds
- Surgical steps for Reinke edema
- Recurrent respiratory papillomatosis
- Laryngeal papilloma
- Retention cysts and chondromas
- Retention cyst of the epiglottis
- Leukoplakia, dysplasia and carcinoma in situ
Laryngeal Carcinoma
The commonest head and neck cancer - staging, spread and treatment
- Laryngeal carcinoma at a glance
- Laryngeal carcinoma - the essentials
- How it spreads - anatomy is destiny
- Supraglottic carcinoma
- Glottic carcinoma of the vocal fold
- Glottic carcinoma T-stage (after Brierley 2017)
- Nodal (N) stage - all laryngeal sites (Brierley 2017)
- Principles of treatment
- Endoscopic cordectomies: the ELS grades
- The classification of cordectomies
- Partial laryngectomies
- Vertical frontolateral partial resection
- Horizontal supraglottic partial resection
- Total laryngectomy
- The area removed in total laryngectomy
- Freeing the larynx in laryngectomy
- Closing the pharynx after larynx removal
- The reconstructed airway and food passage
- Laryngectomy with radical neck dissection
- Five-year survival in laryngeal carcinoma
- Rehabilitating the laryngectomee
Hypopharynx
The food channel wrapped around the larynx, and its cancers
- The hypopharynx and its problems
- Carcinoma of the left piriform recess
- Hypopharyngeal carcinoma - presentation
- Sites and lymphatic spread of hypopharyngeal cancer
- Postcricoid carcinoma at the esophageal inlet
- Hypopharyngeal carcinoma - diagnosis and treatment
Summary and Key Takeaways
- Three ideas to keep
- Emergencies not to miss
- Why does early glottic cancer rarely metastasise to the neck, while supraglottic cancer often does?
- References and Sources
- Ear, Nose, and Throat Diseases: With Head and Neck Surgery