Congenital lesions of larynx

CONGENITAL LESIONS OF LARYNX AND STRIDOR

CONGENITAL LESIONS OF LARYNX AND STRIDOR

DEPT OF OTORHINOLARYNGOLOGY

J J M M CDAVANAGERE

DEPT OF OTORHINOLARYNGOLOGY

J J M M CDAVANAGERE

LARYNGOMALACIALARYNGOMALACIA• Most common congenital abnormality of

larynx• Condition manifests at birth or soon after

and usually disappears by two years of age• Characterized by excessive flaccidity of

Supraglottic larynx which is sucked in during inspiration producing stridor and cyanosis

• Stridor subsides on placing child in prone position and increases with crying

• Direct laryngoscopy elongated and curled up epiglottis (omega shaped), floppy AE folds and prominent arytenoids

• Treatment is conservative• In severe stridor tracheostomy

• Most common congenital abnormality of larynx

• Condition manifests at birth or soon after and usually disappears by two years of age

• Characterized by excessive flaccidity of Supraglottic larynx which is sucked in during inspiration producing stridor and cyanosis

• Stridor subsides on placing child in prone position and increases with crying

• Direct laryngoscopy elongated and curled up epiglottis (omega shaped), floppy AE folds and prominent arytenoids

• Treatment is conservative• In severe stridor tracheostomy

CONGENITAL VOCAL FOLD PARALYSIS

CONGENITAL VOCAL FOLD PARALYSIS

• Results from birth trauma when RLN is stretched during breach or forceps delivery

• Can also results from anomalies of CNS

• Results from birth trauma when RLN is stretched during breach or forceps delivery

• Can also results from anomalies of CNS

CONGENITAL SUBGLOTTIC STENOSIS

CONGENITAL SUBGLOTTIC STENOSIS

• Due to abnormal thickening of cricoid cartilage or fibrous tissue seen below the vocal cords

• Child may remain asymptomatic till URTI causes dyspnoea and stridor

• Diagnosis subglottic diameter less than 4mm in full term neonate (normal 4.5-5.5mm) or 3mm in premature neonate (normal 3.5mm)

• Most cases improve as larynx grows but some may require surgery

• Due to abnormal thickening of cricoid cartilage or fibrous tissue seen below the vocal cords

• Child may remain asymptomatic till URTI causes dyspnoea and stridor

• Diagnosis subglottic diameter less than 4mm in full term neonate (normal 4.5-5.5mm) or 3mm in premature neonate (normal 3.5mm)

• Most cases improve as larynx grows but some may require surgery

LARYNGEAL WEBLARYNGEAL WEB• Due to incomplete recanalization of

larynx• Seen between the vocal cords with

concave posterior margin• Presents as airway obstruction, weak

cry or aphonia dating from birth• Treatment depends on thickness of

web• Thin web cut with knife or CO2 laser• Thick web excision via laryngofissure

and placement of silicone keel and subsequent dilatation

• Due to incomplete recanalization of larynx

• Seen between the vocal cords with concave posterior margin

• Presents as airway obstruction, weak cry or aphonia dating from birth

• Treatment depends on thickness of web

• Thin web cut with knife or CO2 laser• Thick web excision via laryngofissure

and placement of silicone keel and subsequent dilatation

SUBGLOTTIC HAEMANGIOMASUBGLOTTIC HAEMANGIOMA

• Though congenital patient is asymptomatic till 3-6 months of age

• About 50% have associated cutaneous haemangioma

• May present with stridor which increases on agitation and crying due to venous filling

• Direct laryngoscopy shows reddish blue mass below vocal cords

• Biopsy is sometimes, not always associated with hemorrhage

• Treatment depends on individual case Tracheostomy and observation Steroid therapy CO2 laser excision

• Though congenital patient is asymptomatic till 3-6 months of age

• About 50% have associated cutaneous haemangioma

• May present with stridor which increases on agitation and crying due to venous filling

• Direct laryngoscopy shows reddish blue mass below vocal cords

• Biopsy is sometimes, not always associated with hemorrhage

• Treatment depends on individual case Tracheostomy and observation Steroid therapy CO2 laser excision

SUBGLOTTIC HAEMANGIOMA

SUBGLOTTIC HAEMANGIOMA

LARYNGO-OESOPHAGEAL CLEFT

LARYNGO-OESOPHAGEAL CLEFT

• Due to failure of fusion of cricoid lamina

• Presents with repeated aspiration and pneumonitis

• Coughing, choking and cyanosis are present at the time of feeding

• Surgically treated

• Due to failure of fusion of cricoid lamina

• Presents with repeated aspiration and pneumonitis

• Coughing, choking and cyanosis are present at the time of feeding

• Surgically treated

LARYNGEAL CYSTLARYNGEAL CYST

• Arises in the AE folds and appears as bluish fluid filled smooth swelling in Supraglottic larynx

• Respiratory obstruction tracheostomy

• Needle aspiration or incision and drainage provides emergency airway

• Treatment is deroofing the cyst or excision with CO2 laser

• Arises in the AE folds and appears as bluish fluid filled smooth swelling in Supraglottic larynx

• Respiratory obstruction tracheostomy

• Needle aspiration or incision and drainage provides emergency airway

• Treatment is deroofing the cyst or excision with CO2 laser

STRIDORSTRIDOR

• Defined as noisy respiration produced by turbulent airflow through narrowed air passage

• Classified as Inspiratory, expiratory and biphasic

• Defined as noisy respiration produced by turbulent airflow through narrowed air passage

• Classified as Inspiratory, expiratory and biphasic

STRIDORSTRIDOR

• Inspiratory stridor produced in obstructive lesion of Supraglottic or pharynx

• Expiratory stridor lesions of thoracic trachea, primary and secondary bronchi

• Biphasic lesions of glottis, subglottis and cervical trachea

• Inspiratory stridor produced in obstructive lesion of Supraglottic or pharynx

• Expiratory stridor lesions of thoracic trachea, primary and secondary bronchi

• Biphasic lesions of glottis, subglottis and cervical trachea

STRIDORSTRIDOR

• CONGENITAL

LARYNGOMALACIA

LARYNGEAL WEB

SUBGLOTTIC STENOSIS

HAEMANGIOMA

VOCAL CORD PARALYSIS

TONGUE AND JAW ABNORMALITIES

• CONGENITAL

LARYNGOMALACIA

LARYNGEAL WEB

SUBGLOTTIC STENOSIS

HAEMANGIOMA

VOCAL CORD PARALYSIS

TONGUE AND JAW ABNORMALITIES

• AQUIRED

1. FEBRILE EPIGLOTITTIS LARYNGO-TRACHEITIS DIPHTHERIA INFECTIOUS

MONONUCLEOSUS RETROPHARYNGEAL

ABSCESS QUINSY

2. AFEBRILE PAPILLOMATOSIS FOREIGN BODY LARYNGEAL OEDEMA ADENO TONSILLAR

HYPERTROPHY

• AQUIRED

1. FEBRILE EPIGLOTITTIS LARYNGO-TRACHEITIS DIPHTHERIA INFECTIOUS

MONONUCLEOSUS RETROPHARYNGEAL

ABSCESS QUINSY

2. AFEBRILE PAPILLOMATOSIS FOREIGN BODY LARYNGEAL OEDEMA ADENO TONSILLAR

HYPERTROPHY

STRIDOR-CAUSESSTRIDOR-CAUSES• Nose: choanal atresia in newborn• Tongue: macroglossia, haemangioma,

lymphangioma, lingual thyroid• Mandible: micrognathia, Pierre-Robin syndrome• Pharynx: congenital dermoid, retropharyngeal

abscess, tumors, adenotonsillar hypertrophy• Larynx: Congenital: web, laryngomalacia, cyst, subglottic

stenosis Inflammatory: epiglottitis, laryngotracheitis,

diphtheria Neoplastic: haemangioma, juvenile papilloma,

carcinoma in adults Traumatic: injuries to larynx, foreign bodies,

prolonged intubation Neurogenic: laryngeal paralysis Miscellaneous: tetanus, tetany, laryngismus

stridulus

• Nose: choanal atresia in newborn• Tongue: macroglossia, haemangioma,

lymphangioma, lingual thyroid• Mandible: micrognathia, Pierre-Robin syndrome• Pharynx: congenital dermoid, retropharyngeal

abscess, tumors, adenotonsillar hypertrophy• Larynx: Congenital: web, laryngomalacia, cyst, subglottic

stenosis Inflammatory: epiglottitis, laryngotracheitis,

diphtheria Neoplastic: haemangioma, juvenile papilloma,

carcinoma in adults Traumatic: injuries to larynx, foreign bodies,

prolonged intubation Neurogenic: laryngeal paralysis Miscellaneous: tetanus, tetany, laryngismus

stridulus

STRIDOR-CAUSESSTRIDOR-CAUSES• Trachea and bronchi:

Congenital: atresia, stenosis, malacia Inflammatory: tracheobronchitis Neoplastic: tumors Traumatic: foreign body and stenosis

• Lesions outside respiratory tract

Congenital: vascular rings, oesophageal atresia, tracheo-oesophageal fistula, cystic hygroma

Inflammatory: retroeosophageal abscess Traumatic: foreign body oesophagus Tumors: masses in the neck

• Trachea and bronchi:

Congenital: atresia, stenosis, malacia Inflammatory: tracheobronchitis Neoplastic: tumors Traumatic: foreign body and stenosis

• Lesions outside respiratory tract

Congenital: vascular rings, oesophageal atresia, tracheo-oesophageal fistula, cystic hygroma

Inflammatory: retroeosophageal abscess Traumatic: foreign body oesophagus Tumors: masses in the neck

STRIDOR-MANAGEMENTSTRIDOR-MANAGEMENT

• History: onset, progression, duration, relation to feeding, cyanotic spell, aspiration or ingestion of foreign body, laryngeal trauma

• Physical examination: signs of respiratory distress, stridor with phase of respiration, associated features like fever, wheeze, snoring, hoarseness, muffled voice

• History: onset, progression, duration, relation to feeding, cyanotic spell, aspiration or ingestion of foreign body, laryngeal trauma

• Physical examination: signs of respiratory distress, stridor with phase of respiration, associated features like fever, wheeze, snoring, hoarseness, muffled voice

STRIDOR-MANAGEMENTSTRIDOR-MANAGEMENT

• InvestigationsX-ray chest and soft tissue neck AP

and lateral viewFluoroscopyCT of neck and chestOesophagogramAngiographyXeroradiographyDirect laryngoscopyPan endoscopy

• InvestigationsX-ray chest and soft tissue neck AP

and lateral viewFluoroscopyCT of neck and chestOesophagogramAngiographyXeroradiographyDirect laryngoscopyPan endoscopy

STRIDOR-MANAGEMENTSTRIDOR-MANAGEMENT

• Treatment: treat the exact cause depending on the diagnosis

• Treatment: treat the exact cause depending on the diagnosis