Larynx
Foreign Body -- Fish
Bone: Foreign bodies lodged in the
larynx
is a medical emergency. The patient has extreme discomfort and airway
compromise from
laryngeal
obstruction or spasm may occur. Click
on picture to enlarge
Vocal
Cord
Leukoplakia: This is a condition caused by chronic
irritation which results in abnormal growth
of the top layer of the skin lining the vocal cords. It is
often seen in smokers and is
considered a pre-cancerous condition. The picture on the far right
shows severe leukoplakia which upon biopsy was found to be a squamous cell carcinoma (see
right hand photograph below in cancer section). The picture on the
left shows mild leukoplakia around a small mucosal contact ulcer.
Click
on picture to enlarge
Cancer
of the Voice Box (Larynx):
The picture to the far right is a T1 cancer, confined to the vocal
cord. The left had picture shows a T3 larynx cancer. A T1 glottic
cancer is confined to the vocal cords. A T3 glottic cancer fixes the
mobility of the vocal cord.
Larynx
cancers which start on the vocal cords produce symptoms of hoarseness.
Even very small tumors produce symptoms. They are thus often diagnosed
very early and at this stage have a 90% cure with either conservative
surgery or irradiation with or without chemotherapy. Click
on picture to enlarge
Supraglottic
cancer
is a cancer confined to the top of the
larynx
or
epiglottis. This
cancer is often silent and does not cause symptoms until very late.
Often the patient will present with a neck node. The pictures
shown below are from four patients with Squamous Cell Carcinoma of the
supraglottis
(top part of the voice box).Click
on picture to enlarge
Click on pictures to enlarge
Pyriform
Sinus
Cancer: The picture is from a 77 year old patient
who had a 30
pack year
history of smoking. He quite smoking 26
years ago. The picture shows a large
pyriform sinus
cancer.
The
pyriform sinus
is located in the
hypopharynx
between the throat and the
esophagus(food tube). The cancer can be seen eating into the
patient's voice box.
Vocal
Cord Polyps:
This is a severe case of
true vocal cord
polyps. This
patient was a heavy smoker. Surgical removal was necessary. The
surgery will improve the patient's voice and airway but will not restore the
patient's voice to normal.
Search PubMed for Vocal Cord Polyps
Severe
vocal cord polyps can cause airway obstruction. To the right is a
patient with severe vocal cord polyps. The polyps are blown above
and sucked below the cords as the patient breaths.
Mouse over picture to see polyps as patient exhales
The
patient on the right has massive vocal cord polyps. She was a heavy
smoker. The preoperative vocal cord polyps and the immediate
postoperative result are shown in the pictures to the right. During
surgery, the mucosa of the polyp was incised along the lateral true vocal
cord and the contents of the polyp was removed. The excess mucosa was
trimmed with a pair of micro scissors and the remaining mucosa was draped
over the
true vocal cord.
The
patient on the right has a large laryngeal polyp of the left true vocal
cord. The patient was a 50 year old female who had a 40 pack
year history of smoking.
To
the left is a picture of the post-operative specimen
Click on pictures to enlarge
The pictures below shows the preoperative
view of a large
arytenoid granuloma
and the post-operative specimen. The
granuloma
was removed at surgery and the surrounding tissue injected
with kenalog (a steroid). The patient was treated with an ant-acid
(proton-pump inhibitor). At 3 months
post-op,
there has been no recurrence.
Gastroesophageal
Reflux:
This patient has chronic
hoarseness and mild vocal cord
erythema
(redness)
and edema (swelling). This patient still smokes and had smoked one
pack per day for 30 years and has
gastroesophageal reflux
disease (GERD). Smoking also is a risk
factor for gastroesophageal reflux. Stopping smoking would help her larynx by
eliminating the toxic effects of cigarette smoke and by helping to reduce
the
gastroesophageal reflux.
Vocal
Cord Cyst: This is a rare condition caused by vocal cord trauma.
Microsurgical removal is required to restore the patient's voice.
The
picture to the right shows a large mucosal cyst forming between the
epiglottis and the base of the tongue. These cysts are more common in
smokers and rarely, these cysts can reach a size as to obstruct the airway.
Surgical excision is advisable.
Shown
here is an intra-operative photograph of a
laryngeal
cyst, before and
after removal.
How to treat:
View Article
Laryngeal
Mucosal
Cyst: Cysts can occur on the voice box. The most common
place is on the
epiglottis,
found in the
superior part of the voice box. It they enlarge they can cause
airway obstruction.
Laryngocele:
The picture on the right shows a large cyst in a 6 yr old girl. The
cyst was originating deep in the
larynx, in the laryngeal ventricle.
She was experiencing hoarseness and breathing difficulties on exertion.
The
picture on the right shows a laryngocele in a 45 year old female.
LaryngealMass:
The two patients shown on the right have a
supraglottic
mass caused by a lymphoma ( a blood cell cancer ). In both patients,
the mass was
submucosal
( below the skin ). The photograph on the far
right shows a mass protruding out over the
true vocal cords, coming out of the
laryngeal ventricle. The left
hand picture shows a large
supraglottic
mass which is deep in the tissues of the larynx.
The
picture on the right shows a 60 year old patient with a lymphoma
arising from the left
epiglottis
and
vallecula.
Vocal
Cord Nodules: These nodules are similar to calluses on a worker's
hands. They are caused by chronic straining of the voice. They are
often called singer's or screamer's nodules. Speech therapy to train the
patient to not abuse his/her voice is usually curative.
Severe
vocal cord nodules can develop and become large and
pendular. The
nodule shown in the two photographs to the right flops above and below the
true vocal cords
as the patient talks. The patient was an avid sports fan
and strained his vocal cords during sports events.
Click on pictures to
enlarge
Juvenile
Laryngeal Papillomatosis:
This is a
laryngeal
growth caused by a
virus. It is passed to the child as he passes through the mother's
birth canal. Its growth can be very aggressive and can suffocate the
child. Many operative procedures are often required for their
removal. In this patient, he was finally stabilized after receiving
Indol-3-Carbinol. Several authors have reported success in treating
papillomaswith the antiviral agent Cidofovir
View Article
View Article. In 2004, chraff et.a.
reviewed the various therapies for juvenile laryngeal papillomatous.
View Article Search PubMed for Juvenile Laryngeal Papillomatous
Search PubMed for Indol-3-Carbinol
Papillomas
can also occur in adults.
Papillomas
in adults tend to grow slower but still need
operative removal. Like there "juvenile" counterpart they are caused
by a virus. The pictures on the right are take form a 58 year old who
has progressive difficulty breathing. She had a previous surgery to
remove
papillomas
three years ago.
LaryngealTrauma: This patient fell and hit
her neck. She developed a hoarse voice. On
laryngeal
exam a
hematoma
was noted of the true and false vocal cords.
The
photograph on the right is taken from a 40 year old who experienced
hoarseness and throat pain while weight lifting. Note the swelling and
mild hemorrhage of the left
true vocal cord.
Vocal
Cord Ecchymosis: This is a picture of a larynx form a patient who
had traumatic intubation one week prior to the picture. Note the
residual hemorrhage under the mucosa of the vocal cords.
Collapse
of the
Hypopharynx: This picture shows a very narrow
hypopharynx
with collapse of the lateral walls with forced
negative pressure (Muller's Maneuver). The picture is taken at the
moment of greatest observed airway. This patient had severe
sleep apnea.
Epiglottitis:
This is an infection of the
epiglottitis, or top part of the
larynx
(voice
box). In children, this infection, can be very dangerous and cause
complete airway obstruction. In children, the causative bacteria is
Haemophilus
Influenza but since the advent
of the
Haemophilus Influenzae B vaccine
the disease is seldom seen. It can still occur in adults, where a number of different bacteria can cause the
infection. Symptoms include, rapid progression, high fever, drooling,
inspiratory
strider, and difficulty breathing when supine (on ones back).
The picture on the right shows a mildly swollen
epiglottitis
in a 17 year old
male who presented with a sore throat and mild difficulty breathing when he
laid down.
Epiglottitis in an adult.
Epiglottitis
is inflammation and swelling of the upper part of the
larynx
(voice box). This disease is rare in children since the advent of the
H. Influenza vaccine. However, it can still occur. In the adult,
epiglottis
can be caused by a variety of bacteria. This patient was a
50 year old male who had symptoms for about 12 hours. He was treated
with cephuroxime and steroids and was discharged from the hospital 48 hours
later.
Hemangioma
of the
larynx:
Shown in this photograph is a
hemangioma
on the posterior
cricoid.
A
hemangioma
is a benign growth of blood vessels. The
patient was an adult and the
hemangioma
had not changed its size in years. No
treatment was necessary. In children,
hemangiomas
most often occur in the
subglottis
area between the
larynx
and
trachea.
In this region they can present an airway emergency. They are usually
removed using a laser.
Tracheal
Granulation Tissue:
Shown in the left picture is a patient's
trachea
(the windpipe below the
larynx). Chronic trauma from a
breathing tube has formed granulation tissue. If let untreated,
narrowing of the
trachea
can occur. The photograph on the right
shows the patient's trachea after treatment with antibiotics and removal
of the breathing tube.
Google Ad space finances and sponsors
ENT USAtm Websites. ENT USAtm,
Cumberland Otolaryngology or Dr Kevin Kavanagh, MD do not endorse,
recommend, referrer to or are responsible for the Advertisements or
for the content or claims made in the Advertisements.
