Professional Documents
Culture Documents
Larynx
-Aka .voice box
-organ in the neck ,involved in breathing
-houses the vocal cord responsible
-located below level where tract(laryngopharynx) split into trachea and
oesophagus
Having 9 cartilage
3 paired
-arytenoid
-corniculate
-cuneiform
3 unpaired
-thyroid cartilage
-cricoid
-epiglottis
Muscle of larynx
Intrinsic muscle
-cricothyroid
-posterior crico
arytenoid
-lateral crico arytenoid
-transverse arytenoid
- oblique arytenoid
-thyroarytenoid
Extrinsic muscle
-thyrohyoid
-hyoglossus
-stylohyoid
-myloid
-geniohyoid
-digastric
-sternohyoid
-sternothyroid
-omohyoid
Carcinoma of larynx
Male:female (10:1)
Age group:40-70 yrs
Etiology
-smoking and alcohol
-previous radiation of neck
-genetic
1.Supraglottic carcinoma
-common site:epiglottis,false cord,aryepiglottic folds
Spread through
a)local:tongue,pyriform fossa
b)nodes:upper middle cervical nodes
Symptoms:
-throat pain
-dysphagia
-weight loss
-respiratory obstruction
-halitosis
2.Glottic Carcinoma
-common in anterior middle 1/3 rd
on its free edge and upper surface
-spread through
a)local
-anterior commissure
-posterior to vocal process and
arythenoids
-upwards ventricle and false cords
-downwards subglottis
b)nodal involvment
symptoms:hoarsness of voice
and stridor
3.Subglottic carcinoma
-very rare
Spread through:
1.circumferential spread
-involve inner surface of subglottis wall
-involve to cricothyroid membrane and thyroid gland
2.pre and paratracheal
-lower deep cervical
-mediastinal lymph nodes
Symptoms:
-stridor and hoarsness of voice
Investigation
-chest x ray
-laryngogram
-CT scan
-laryngoscopy
Treatment:
-radiotherapy for early lesion
-surgery for late lesion
Pharynx
Type
Situation
Nerve
supply
Lining
epithelium
Function
Nasopharynx
Behind nose
-pharyngeal
branches of
pterygopalatine
ganglion
Ciliated columnar
Oropharynx
Behind oral cavity
IX and X nerve
Laryngopharynx
Behind larynx
IX and X nerve
Stratified squamous
non keratinized
Respiration
Respiration and
Stratified
squamous non
keratinized
Food
food
Boundaries:
Superior:base of skull (post,patient of body of sphenoid+basilar patient of
occipital bone)
Interior:continuous with oesophagus at c6 level)
Lower border of cricoid cartilage
Posterior:pharynx glides freely on prevertebral fascia
Anterior:communicates with nasal cavity,oral cavity and larynx
On each side:
a)pharynx is attached to:
-medical pterygoid plate
-pterygomandibular raphe
-tongue
-thyroid and cricoid
b)communicate with middle ear cavity
-via auditory tube
c)pharynx related to
-styloid process and muscle
3.Carcinoma of lip
-Incidence 10-12%
-common in elderly
-sunlight->actinic rays>cheilitis->erythema->cracks>carcinoma in situ
-predisposing
2.Carcinoma of tongue
features:smoking,alcohol,geneti
-2nd most common oral cancer
c factors
-premalignant lesion:leukoplakia,erythroplakia
-common side:lateral border of tongue Clinical features:
-elderly males
Risk factor
-non healing ulcer
-tobacco,alcohol,betel nut
-mobility:fixed to subcutaneous
-fungal/viral infection
structures of lip
Clinical presentation:
Treatment:
-non healing/bleeding ulcer
-surgery
-ankyloglossia:restricted mobility of tongue
-radiotherapy
-disarticulation:speech disruption
-dysphagia
Clinical examination:
Inspection and palpation:
-ulcer bleed with central slough
-test for mobility of tongue
1.forward protusion-genioglossus
2.backward movement-styloglossus
3.elevation-palatoglossus
4.depression-hyoglossus
Lymphatic spread:
-apical vessel
-lateral vessel
-central vessel
-basal vessel
Investigation:
1.biopsy
2.OPG
Treatment:
-glossectomy
Complication:
-recurrent aspiration pneumonia
-ulcer and hemorrhage
Dysphagia
1.congenital
-stenosis of esophagus
-tracheo esophagus fistula
-congenital web
2.Acquired
Causes within esophageal lumen (intraluminal)
-foreign body
Causes in esophageal wall (intramural)
-diverticulum
-achalasia cardia
-carcinoma
Causes outside esophageal (extramural)
-thyroid swelling
-mediastinal nodes
-mediastinal abscess
-aortic aneurysm
Painful disease of mouth and pharynx
-stomatitis
-tonsilitis
-pharyngitis
-retropharyngeal abscess
Neuromuscular disorder
-myasthenia gravis
Miscellaneous
-tetanus
-sjogren
-rabies
Zenkers diverticulum
-pouch/sac that is created by a herniation of a muscle wall
-pouches develop in pharynx,just above upper esophageal sphincter
When there is excessive pressure within the lower pharynx,the weakest
portion of pharyngeal wall balloons out,forming a diverticulum
Symptoms:
-dysphagia
-regurgitation of undigested food
Achalasia cardia
Etiology
-idiopathic
-absence or degeneration of auerbachs plexus
-chagas disease:organism destroy ganglion cells
Clinical features:
-woman:30-40 yrs
-dysphagia:solid(gravity),liquids(regurgitation)
-recurrent respiratory tract infection;due to spillage of liquids
-anemia:glossitis,stomatitis,pallor bald tongue
-retrosternal discomfort
Investigation:
-barium swallow
Barretts esophagus
Def:when columnar mucosa extends at least 3cm into esophagus and shows
intestinal metaplasia
Pathogenesis
1.repeated reflux
2.shifting of esophago-gastric junction upwards
3.further increase reflux
4.intestinal metaplasia of lower and middle esophagus
Risk factors
-columnar lined esophagus >8cm
-smoking
-reflux due to previous gastric surgery
-high grade dysplasia
Treatment:
-laser photodynamic therapy
-argon beam plasma coagulation