Gen. Surgery

1. DISEASES OF Pharynx and
LARYNX
Dr Chandrashekhar Mahakalkar
MS, FACRSI
Department of Surgery,
JNMC, Sawangi Meghe, Wardha

2. LERNING OBJECTIVES
• To know about anatomy of larynx
• To know about various pathological conditions
affecting larynx
• To know about etio-pathogenesis of the same
• To know about management of the same

3. Anatomy - The pharynx
• The pharynx is a fibromuscular tube forming
the upper part of the respiratory and digestive
passages.
• It extends from the base of the skull to the
level of the sixth cervical vertebra at the lower
border of the cricoid cartilage where it
becomes continuous with the oesophagus.
• It is divided into three parts: the nasopharynx,
• oropharynx and hypopharynx

5. Nasopharynx
• The nasopharynx lies anterior to the first
cervical vertebra and has the openings of the
Eustachian tubes in its lateral wall,
• Behind lie the pharyngeal recesses, the fossae
of Rosenmüller.
• The adenoids are situated submucosally at the
junction of the roof and posterior wall of the
nasopharynx.

7. Oropharynx
• This is bounded above by the soft
palate, below by the upper surface of the
epiglottis and anteriorly by the anterior faucial
pillars.

9. Hypopharynx
• The hypopharynx is bounded above and
anteriorly by the sloping laryngeal inlet.
• Its inferior border is the lower border of the
cricoid cartilage where it continues into the
oesophagus.
It divided into three areas: the pyriform
• fossae, the posterior pharyngeal wall and the
post-cricoid area.

12. NORMAL LARYNX.
• The true vocal folds are pearly white, they meet in the
midline on phonation, and the surrounding structures
are light pink.

13. NODULES
• Nodules are calluses on the vocal folds that occur with
improper voice use or overuse.
• They are most common in children and females. They prevent
the vocal folds from meeting in the midline and thus produce
an hourglass deformity on closure resulting in a raspy, breathy
voice.
• Most times, these will respond to appropriate speech therapy.
Occasionally (20% of the time), these may persist after
intensive speech therapy and will require meticulous
microlaryngeal surgery.

14. NODULES

16. POLYPS
• Polyps are benign lesions of the larynx, occurring
mostly in adult males, that are usually located on the
phonating margin (edge) of the vocal folds and prevent
the vocal folds from meeting in the midline.
• Polyps can interfere with voice production and may
produce a hoarse, breathy voice that tires easily.
• These may respond to conservative medical therapy
and intensive speech therapy.
• If the lesion fails to respond, meticulous microsurgery
may be indicated.

17. POLYPS

19. LARYNGITIS SICCA
• Laryngitis sicca is caused by inadequate
hydration of the vocal folds. Thick, sticky
mucus prevents the folds from vibrating in a
fluid, uniform manner.

20. VOCAL CORD HEMORRHAGE.
• Vocal fold hemorrhage is a very rare occurrence that
usually is caused by aggressive or improper use of vocal folds
(e.g. cheerleading). It is a result of rupture of a blood vessel
on the true vocal fold, with bleeding into the tissues of the
fold.

22. CANCER
• If these lesions are detected early, they can be
treated with either radiation or surgery, with a
cure rate approaching 96%.

23. VOCAL CORD PARALYSIS
• Vocal fold paralysis or paresis results from a
lesion of the neural or muscular mechanism .
• It may be:-
• Unilateral
• Bilateral

24. UNILATERAL VC.P
• It can be caused by a variety of diseases or disorders
that prevent movement in one vocal fold.
• When one weakened vocal fold does not move well
enough to meet the other fold in the midline during
speech, air leaks out too quickly.
• This causes the voice to sound breathy and weak,
making it necessary for the speaker to take more
frequent breaths during speech.
• After a full day of talking, someone with a weak vocal
fold can feel exhausted due to the frequent
breathing, and can experience choking and coughing
on food or liquids.

25. BILATERAL VC.P
• When both vocal folds have movement
problems, the situation can be much more serious.
• With both vocal folds paralyzed in the midline
position, the person has difficulty breathing and a
tracheotomy may be necessary to establish an
airway.
• If both folds are paralyzed near the midline, although
the voice may be good the airway may be
compromised.
• If both folds are paralyzed far apart, there may be no
voice.

26. BILATERAL VC.P

27. PRESBYLARYNGIS
• Presbylaryngis is a condition that is caused by
thinning of the vocal fold muscle and tissues with
aging.
• The vocal folds have less bulk than a normal larynx
and therefore do not meet in the midline.
• As a result, the patient has a hoarse, weak, or
breathy voice.
• This condition can be corrected by injection of fat or
other material into both vocal folds to achieve better
closure.

28. PRESBYLARYNGIS

29. ACID REFLUX
• The larynx is red and swollen.

30. Carcinoma of larynx

31. Introduction
• Widely prevalent in the Indian Sub-continent
in comparison to the west
• M:F::10:1
• Age group: 40-70 yrs

32. Aetiology

33. Classification and staging
• TNM classification and staging
• Classification by AJCC

34. AJCC classification

35. Supraglottic cancer
• Less frequent than glottic cancer
• Majority of lesions are seen on epiglottis, false
cords, aryepiglottic folds
• Spread: vallecula, base of the tongue, pyriform fossa
and even penetrate the thyroid
• Symptoms: often silent, may present with throat
pain, dysphagia and referred pain-ear, mass in the
neck

37. Glottic cancer
• Most common- 65%
• Spread: anteriorly- anterior commisure
posteriorly- vocal process and
arytenoid process
Upward- ventricle and false cord
Downward- Subglottic region
Symptoms: Hoarseness of voice, stridor

39. Subglottic cancer
• Lesions rare
• Spread: Anterior wall, to the opposite side or
downwards to the trachea
• May invade cricothyroid membrane, thyroid
gland and muscles of neck
• Symptoms: Stridor

41. Diagnosis
• History: any patient may present with:
..A sore throat that does not go away
..Dysphagia
..A change or hoarseness in voice
..Pain in the ear
..A lump in the neck
• Examination: done to find extra laryngeal spread of
disease and nodal metastasis

42. Investigation
• Laryngoscopy:
indirect, direct

43. • Radiography
• CT
• Staining and biopsy

44. Treatment
Depends upon:
a)The site of lesion
b)The extent of spread
c)Metastasis

45. Treatment maybe:
a) Radiotherapy
b) Surgery: conservative laryngeal surgery
or total laryngectomy
c) Combined therapy

47. a) Early supraglottic and glottic tumor of stage I
and II----radiotherapy
Five year survival rate:
Stage I: 90%
Stage II:70%
b)Endoscopic CO2 laser
c) Advanced tumor: total or subtotal
laryngectomy

48. Rehabilitation
By the following methods:
A) Written language
B) Oesophageal speech

49. C) Artificial larynx:
i) Electrolarynx
ii) Tran oral pneumatic device
D) Tracheo-oesphageal speech

50. Electrolarynx

51. Tracheo-oesophageal speech

52. THANK YOU