CASE PRESENTATION DEPARTMENT: SURGERY (ENT) CASE: LARYNGEAL CARCINOMA PRESENTER: DR ALIHUSSEIN KASSAM SUPERVISER:DR FEI JIE (ENT SPECIALIST) 06/21/2022 1 copywrite@ Dr Alihussein 2016
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CASE PRESENTATION DEPARTMENT: SURGERY (ENT)
CASE: LARYNGEAL CARCINOMA
PRESENTER: DR ALIHUSSEIN KASSAM
SUPERVISER:DR FEI JIE (ENT SPECIALIST)
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DR ALIHUSSEIN KASSAM (MD),
MNAZI MOJA HOSPITAL,ZANZIBAR.
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NAME: K.K.AAGE: 77YRSSEX: MALEADDRESS: DUNGAD0A:17th July 2015
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M/C: DIB 3/12 Started gradually, progressing in nature,
aggravated by lying supine, no relieving factors,no chest tightness, no cough, no LL edema
Patient also noted change in voice which was hoarse progressing in nature, there was hx of loss of significant weight, no hx of night sweats, no hx of fever, no contact with tb patient
This patient was treated as TB & pneumonia in several health facilities including MMH
ENT was consulted for hoarseness of voice
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ROS-NADPMHX: no hx of BT, surgery, no chronic
illness (HTN, DM and HIV)FSHX: Has 4 wives with 20 children, he is
a farmerHeavy Smoker for nearly 30yrs with
accumulated smoking of 15packyear
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General examination:Ill looking, conscious, , hoarse voice, not jaundiced , not
pale, no lower limb edema, no cyanosis, no clubbing, no lymphadenopathy
Oral cavity- Normal
Vital signs:BP: 130/87mmHgRR: 30c/mPR: 96b/mTEMP: 36 c
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Indirect laryngoscopy- left vocal cord fixed which was pale and had a cauliflower like lesion noted
Right vocal cord was normal
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SYSTEMIC EXAMINATIONR/S : STRIDOR
CVSGI GU NADCNS
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Provisional dx: Upper airway obstruction sec to laryngeal carcinoma
Differential dx: laryngeal polyp laryngeal TB laryngeal papilloma
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INVESTIGATIONSFBP-( all parameters under normal range)CXR-( normal)PLANEmergency tracheotomy + biopsy done
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Patient was discharged awaiting biopsy results
And recommended to do CT of the neck with contrast
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READMISSION14/12/2015Patient came with biopsy results which
showed laryngeal ca stage iii squamous cell carcinomapatient was councelled and was prepared
for laryngectomy
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Pre-op investigationCT SCAN OF THE NECKFBP, BT CTLFTRFTHEPATITIS B & CECG
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Cricoid cartilage
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Tumour
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MANAGEMENT OF LARYNGEAL CARCINOMASTAGE TREATMENT OPTION
STAGE 1 RADIOTHERAPY/ ENDOSCOPIC LASER SURGERY
STAGE 2 RADIOTHERAPY/SURGERY
STAGE 3 SURGERY+ RADIOTHERAPY
STAGE 4 SURGERY+CHEMORADIATION
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INTRAOPERATIVE
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POST OPERATIVE ORDERSNIL PER ORAL for 10days (feeding through
NGT)IV Antibiotics : ceftriaxone and
metronidazole for 5daysInj declofenac 75mg IM 8hrly for 48hrsInj pantoprazole 3/12
4days in ICU then the pt was discharged to the ward where he stayed for ten days then discharged home
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Pt came for follow up and is still under councelling for radiotherapy
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STATISTICS AT MMHYEAR CASES2007 02008 02009 02010 02011 02012 52013 02014 22015 1
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From May 2007 to February 2016 a total of number of 8 cases
A rare condition by itself
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TAKE HOME MESSAGE A hoarse voice more than 2/52 and on
antibiotics needs a referral to an ENT specialist
Associating factors may lead to a good diagnosis
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LITERATURE REVIEW
Definition:are mostly, squamous cell carcinoma
reflectingtheir origin from the mucosa of the larynx.
Most laryngeal cancers originate in the glottis. Supraglottic cancers are less common, and subglottic tumours are least frequent
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SIGNS AND SYMPTOMS Hoarseness or other voice changes A mass in the neck A sore throat or feeling that something is
stuck in the throat Persistent cough Stridor - a high-pitched wheezing sound
indicative of a narrowed or obstructed airway
Bad breath Earache ("referred") Difficulty swallowing
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RISK FACTORS Male sex Cigarette smoking Alcohol Age
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DIAGNOSIS AND MANAGEMENT Hx and physical examination
biopsy
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TREATMENT OPTIONS Discussion?