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SCCA of the Larynx

Feb 23, 2018

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Rold Brio Sos
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    History and P.E.

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    This is the case o !. B, "# years old$ale, $arried, %ilipino, Ro$anCatholic, born on &ove$ber '',()*+, currently residin at -ela

    %uente St, Sa$paloc , anila and/as ad$itted in our institution on0anuary ", '1("

    2eneral -ata

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    3o$ittin o Blood

    Chie Co$plaint

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    4 $onths prior to ad$ission, patientnoticed a radually enlarin $arbleli5e $ass on both lateral nec5, non6tender, $ovable associated /ith non6

    productive couh 7/hitish phle$8,odynophaia and hoarseness. Patientsouht consult at San Lazaro Hospital,Chest 96ray /as done /hich revealed

    pul$onary tuberculosis thus reerred

    History o Present :llness

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    still /ith above sin and sy$pto$s,no/ associated /ith di;culty obreathin. Patient souht consult inour institution /here a$$ation.

    Trachesto$y /as also done.

    ' $onths PT!

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    Persistence o the above sin andsy$pto$s pro$pted the patient toonce aain see5 consult in ourinstitution. Repeat

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    7?8 Hypertension6 since ())@, Losartan @1

    $Atab - 7?8 Pul$onary Tuberculosis6 unrecalled year,

    inco$plete $edication 7 ' $onths8

    768 5idney -isease

    768 !sth$a

    768 C3-

    7?8 previous surery6 !ppendecto$y,unrecalled year

    Past edical History

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    7?8 Hypertension6 $aternal side

    7?8 -iabetes ellitus6 $aternal side

    7?8 Pul$onary Tuberculosis6 $aternalside

    768 idney disease 768 Cancer

    %a$ily History

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    7?8 s$o5er6 41 pac5 years

    768 alchoholic beverae drin5er

    768 illicit dru use

    Personal and Social History

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    Physical E9a$ination

    7?8 patent e9ternal auditory canal,both ears

    7?8 patent ty$phanic $e$brane,both ears

    idline nasal septu$&o nasal dischare

    &o tonsillipharyneal conestion

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    "D4D' c$ $ultilobulated tracheosto$y 4D'D' c$ nontender $ovable ovable $ass

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    41 pac5 years s$o5in history

    dynophaia

    Hoarseness

    2radually enlarin nec5 $ass

    ale

    Salient %eatures

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    -ierential -ianosis

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    ESOPHAGEAL CARCINOMA(lower portion)

    RULE IN

    ?ore co$$on in $ale

    ?-ysphaiaAodynophaia

    ?Hoarseness o voice

    ?S$o5er

    ?He$ate$esis

    ?Easy atiability

    ?Fea5ness

    RULE OUT

    GFeiht loss

    GChest pain

    GForsenin indiestionor heartburn

    G&o history o acid

    re>u9

    G&o history o alcoholinta5e

    Gbese

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    L!RY&2CELE

    ! rare, benin dilatation o the laryneal

    saccule that $ay e9tend internally into theair/ay or e9ternally throuh the thyrohyoid$e$brane.

    :t $ay be conenital or ac=uired and $ay

    occur at any ae

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    LARYNGOCELE

    RULE IN

    ?Hoarseness?-yspnea

    ?-ysphaia

    ?ass

    ?Couh

    RULE OUT

    GCo$$on to $iddle aeGHe$ate$esis

    GEasy atiability

    GFea5ness

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    Rare neuroendocrine neoplas$ that $ay

    develop at various sites o the body, and$ay present as a painless $ass.

    !ppear rossly as sharply circu$scribedpolypoid $asses, /ith

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    PARAGANGLIOMA

    RULE IN

    ?*16+1 years old

    ?ass

    ?Hoarseness

    ?-ysphaiaA

    odynophaia?Hypertension

    RULE OUT

    Gore co$$on in/o$en

    G!ural sins andsy$pto$s

    GHe$ate$esis

    GEasy atiability

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    EXTRAPULMONARY TB

    RULE IN

    ?%ilipino

    ?Couh

    ?S$o5er?Hoarseness

    ?Easy atiability

    ?Fea5ness

    ?-yspnea?-ysphaia

    ?He$ate$esis

    ?Cervically$phadenopathy

    RULE OUT

    G&iht s/eatsGFeiht loss

    GChills

    GLoss o appetite

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    S=ua$ous Cell Carcino$a, Laryn9,

    Translottic 7T*a, &'b, 18

    %inal -ianosis

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    ANATOMYothe

    A R Y N X

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    Protectie!p"incter #tt"e inlet o$

    t"e #irp#!!#%e!

    &oicepro'ction

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    CARTILAGES O THE

    LARYNX

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    &OCALPROCES

    SMUSCULA

    R

    PROCESS

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    MEMBRANES *

    LIGAMENTS O THELARYNX

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    MUSCLES O THE

    LARYNX

    EXTRINSIC MUSCLES

    ELE&ATIO

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    MUSCLES O THE

    LARYNX

    EXTRINSIC MUSCLES

    +EPRESSI

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    32/65INTRINSIC MUSCLES

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  • 7/24/2019 SCCA of the Larynx

    34/65INTRINSIC MUSCLES

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    Superior laryngealveins drain into thesuperior thyroid veins,

    /hich e$pty into theinternal uular veins.

    The inferior laryngeal

    veins drain into theinerior thyroid veins,/hich both e$pty intothe let brachiocephalic

    vein

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    LYMPHATIC +RAINAGE

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    SUPERIORLARYNGEALNER&E

    otor innervation o thee9trinsic $uscles7e9ternal branch8

    :nternal sensory branchsupplies the $ucosa o

    the upper laryn9

    NER&E SUPPLY

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    RECURRENT LARYNGEAL NER&E Supplies all the intrinsic $uscles

    Sensory

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    The PRE-EPIGLOTTICSPACE (PES) and thePARAGLOTTIC SPACE(PGS) provide path/ays

    or spread o larynealtu$ors.

    TUMOR SPREA+

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    Case -iscussion

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    ost co$$on

    I)@J o Laryneal carcino$as

    aleK%e$ale *6@K(

    !ccounts or '@J o head and nec5 cancers

    !ppro9. (A4 eventually die

    ost prevalent in the "thand +thdecades

    S=ua$ous Cell Carcino$ao the Laryn9

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    S,o-in%

    E.ce!!ie #lco"ol con!,ption E9posure to Hu$an Papillo$a 3irus (" M(#

    Chronic 2astric Re>u9

    ccupational e9posures

    Prior history o head and nec5 irradiation

    Ris5 %actors

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    Environ$ental e9posure, viral inection, spontaneous

    $utation.

    !lteration in the P@4

    Loss o cellular sinalin $echanis$s

    alinant transor$ation

    Carcinoenesis

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    Glottic Spr#%lottic S/%lottic Tr#n!%lottic

    :nvolves truevocal cords Con

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    2lotticK $oority o laryneal cancers 7@1J6

    "1J8 SupratlotticK 41J6*1J

    SublotticK N@J

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    Spr#%lottic Glottic S/%lottic

    6 ore !ressive6 -irect e9tensioninto pre6epilottic

    space Ly$ph node$etastasis -irect e9tensioninto lateralhypopharny9,

    lossoepilottic old,and tonue base

    6 ro/ slo/er and tendto $etastasize lateo/in to a paucity o

    ly$phatic drainae6 $etastasize ater theyhave invaded adacentstructures /ith better-rainae6 E9tend superiorly into

    ventricular /alls orineriorly into sublotticspace6 Can cause vocal cord

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    Spr#%lottic Glottic S/%lottic

    Chronic sorethroat-ysphonia-ysphaia&ec5 $ass

    secondary toreional$etastasis

    Hoarseness!ir/ayobstruction

    late sy$pto$

    3ocal cordparalysis!ir/ayco$pro$ise

    aniestations

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    !ssess$ent o vocal cord $obility as /ell as

    local tu$or e9tension Larynoscopy

    used to assess the e9tent o local spread.

    Radioraphic i$ain by CT andAor R:

    Cartilae erosion or invasion and e9tensioninto the preepilottic or paralottic spaces.

    -ianosis and Stain

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    TD 6 ini$u$ re=uire$ents to assess

    pri$ary tu$or cannot be $etT1 6 &o evidence o pri$ary tu$or

    Tis 6 Carcino$a in situ

    T& Stain

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    T( li$ited to one subsite o supralottis /ith nor$al vocal cord$obility

    T' involves $ucosa o $ore than one adacent subsite osupralottis or lottis, or reion outside the supralottis/ithout

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    T( Tu$or li$ited to the vocal cord 7s8 7$ay involve anterioror posterior co$$issure8 /ith nor$al $obilty

    T(a

    Tu$or li$ited to one vocal cord

    T(b

    Tu$or involves both vocal cords

    T' Tu$or e9tends to supralottis andAor sublottis, andAor

    /ithi$paired vocal cord $obility

    T4 Tu$or li$ited to the laryn9 /ith vocal cord

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    T0 Tu$or li$ited to the sublottis

    T' Tu$or e9tends to vocal cord 7s8 /ith nor$al ori$paired$obility

    T4 Tu$or li$ited the laryn9 /ith vocal cord

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    &1 &o cervical ly$ph nodes positive

    &( Sinle ipsilateral ly$ph node 4c$

    &'a Sinle ipsilateral node I 4c$ and "c$

    &'b &'b ultiple ipsilateral ly$ph nodes, each"c$

    &'c &'c Bilateral or contralateral ly$ph nodes,each "c$

    &4 &4 Sinle or $ultiple ly$ph nodes I "c$

    Stain 6 &odes

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    1 &o distant $etastases

    ( -istant $etastasespresent

    Stain 6 etastasis

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    Stae 2roupin

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    C' Laser

    ResectionK severedysplasia andcarcino$a in situ

    Radiotherapy

    Che$otherapy PartialATotal

    Larynecto$yKadvanced tu$ors

    Treat$ent

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    Radiotherapy or surery alone

    #@6)@J cure rate

    T(6T'

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    Total Larynecto$y

    S$all T4 and lesser sized tu$ors can betreated /ith partial larynecto$y

    T46T* Lesions

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    :ndicationsK

    T* pri$ary BoneAcartilae invasion

    3ascular invasion

    ultiple positive nodes

    &odal e9tracapsular e9tension

    Sublottic e9tension o pri$ary tu$or

    Post6op Radiation

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    !dvanced stae cancers

    Cisplatinu$ and @6>ourouracil

    Che$otherapy

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    :nection

    3oice alterations Loss o taste and s$ell

    Tracheosto$y dependence

    Co$plications

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    1 2e#r

    !ri#lStae ( I)@J

    Stae ' #@6)1J

    Stae 4 +16#1MStae * @16"1J

    Pronosis

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    Patients considered cured ater bein

    disease ree or

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    Than5 youQ