Laryngeal Mass

Laryngeal Mass
Presentation by:John F. McGuire, MD, MBA

Case Presentation
History
Exam
Differential Dx
Topic of this Presentation
OCT Today
OCT tomorrow???
Laryngeal Cancer
Clinical Pearls
Anatomy: Think Spaces

* Quadrangular membrane: Fibrous drape from epiglottis over arytenoids.
* Conus elasticus: See diagram.
* Anterior commissure tendon (Broyles ligament):
- No perichondrium.
* Hyoepiglottic ligament:
* Paraglottic space:
* Superior border : quadrangular membrane
* Inferior border: conus elasticus
* Lateral border: inner surface of the thyroid cartilage
* Medial border: ventricle

T3 supraglottic cancer spreading into glottis through the paraglottic space.
* Preepiglottic space
* Superior border : hyoepiglottic ligament
* Anterior border: thyrohyoid membrane and ligament
* Posterior border: anterior surface of the epiglottis and thyroepiglottic ligament
* Clinical note:

Is this T1 or T2???
Anatomy and Cancer
* Weak points for the spread of laryngeal cancer
Anatomy: Lymph Drainage
* Clinical notes:
Path of subglottic tumor spread
Supraglottic nodal spread patterns
Radiology
Staging: Glottic
Staging: Supraglottic
Staging: Nodal Disease
Overall Stage
Carcinoma in situ
Organ Sparing Surgery
Vertical Hemilaryngectomy
Supracricoid Partial Laryngectomy (SCLP)
Exclusion Criteria:
Transoral Laser Resection
Laryngeal Preservation
Neck Dissection in No Neck getting XRT?
Complications of TL
Chyle Fistula
Stomal Recurrence

Laryngeal Mass

Read more...

Management of Patients with Upper Respiratory Tract Disorders

Management of Patients with Upper Respiratory Tract Disorders

Rhinitis
Sinusitis
Pharyngitis
Tonsillitis
Peritonsillar Abscess
Laryngitis
Upper Airway Infections
Upper Airway Infections : Nursing Interventions
Obstructive Sleep Apnea
Epistaxis
Upper Airway Obstruction
Upper Airway Obstruction Inverventions
Nasal Polyps
Facial Trauma Interventions
Fracture of the Nose
Disorders of the Larynx
Cancer of the Nose and Sinuses
Neck Trauma
Head and Neck Cancer
Ineffective Breathing Pattern
Surgical Management
Preoperative Care
Postoperative Care
Airway Maintenance and Ventilation
Wound, Flap, and Reconstructive Tissue Care
Hemorrhage
Wound Breakdown
Pain Management
Nutrition
Speech Rehabilitation
Risk for Aspiration
Anxiety Interventions
Disturbed Body Image
Stoma Care

Management of Patients with Upper Respiratory Tract Disorders.ppt

Read more...

Laryngeal Cancer

Laryngeal Cancer
Presentation by:Anh Q. Truong
University of Washington, SOM

Anatomy
Anatomy – subdivision
Incidence by Site
Supraglottic
Glottic
Subglottic
Epidemiology
Risk Factors
* Signs and symptoms
Clinical Presentation
* Physical Exam
o Complete head and neck exam
+ Palpation for nodes; restricted laryngeal crepitus.
o Quality of voice
+ Breathy voice = cord paralysis
+ Muffled voice = supraglottic lesion
o Laryngoscopy
+ Laryngeal mirror
+ Fiberoptic exam (lack depth perception)
+ Note: contour, color, vibration, cord mobility, lesions.
o Stroboscopic video laryngoscopy
+ Highlights subtle irregularities: vibration, periodicity, cord closure
Differential Diagnosis
* Infectious
* Inflammatory
* Granulomatous disease (TB, sarcoidosis)
* Papillomatosis
* Lymphoma
Imaging
* CT or MRI
* PET
* Ultrasound
Biopsy and Histology
* Glottis
* Subglottis
Staging
* Nodes
* Mets
Stage Grouping
Advanced stage
* Surgery
o Microlaryngeal surgery
o Hemilargyngectomy
o Supraglottic laryngectomy
o Near-total laryngectomy
o Total laryngectomy
* Photodynamic Therapy
* Radiation
* Chemothrapy
Treatments – Options
Treatment – Early Stage (I/II)
Dose Fractionation
Treatment – Advanced Stage (III/IV) – VA Study
Overall Survival
Treatment – Advanced Stage (III/IV) – RTOG 91-11 Study
Laryngeal Preservation
Concurrent chemoXRT
Anticipated Toxicities
Take Home Points
An Actual Picture of a Laryngeal Cancer

Laryngeal Cancer.ppt

Read more...