Post on 12-Feb-2017
Laryngology Case Report Laila NourSupervised by Dr.A.Khoury
Introductory Information• Name: S.K• Age : 53• Gender : Male• Marital Status : Married • Family : 4 sons & 4 daughters• Habitation : Ar-raqa – City• Occupation: Driver
Presenting Complaints
Acute Inspiratory Dyspnea
Complaint Details
• ER:was severely breathless and bluishWas given a doze of hydrocortisone Oxygenation improved no need for
tracheotomy
Systems Review• Alimentary: normal• Genitourinary: normal• Endocrine: normal• Nervous: normal• Hematological: normal• Rheumatoid: normal• Integumental: normal• Cardiovascular: normal
Systems Review• Pulmonary: Sputum: Mucous,
yellowish, excessive Cough
ENT• Otolgy : No deafness, No Tinnitus, No Vertigo, No
Discharge, No Pain• Rhinology: No Obstruction, No Discharge, No Pain,
No Dysosmia, No Epistaxis• Laryngology: No Pain, No Stridor,
Dysphagia :For Solid Materials, Not Liquids Dysphonia (Hoarseness) : progressive for 5
months
• Past Medical History : None• Past Surgical History : None• Family History : No History of current complaint in the family Siblings and Children are Healthy Parents are dead Father died of TB 15 years ago.
• Social History: The patient is a heavy smoker for a long time
that could not be determined• He is a teetotoal • Drug History Over the counter drugs
Clinical Examination
• alert and oriented, sitting on the bed• Well, Tall, Thin, No Skin Coloration, No Forced
Position ENT Examination:• Ears and Nose Examinations weren’t done.
Clinical Examination
• Throat Examination: Indirect Laryngoscopy (using the laryngeal
mirror): showed a large left vocal cord mass.• Neck Examination: No apparent masses. No Enlarged lymph nodes.
Work Up
Investigations• Fiberoptic Laryngoscopy
• Content
Work Up
Investigations
• Histopathology• Papilloma, Hyperplasia, No Dysplasia & No
signs of Malignancy• The Patient Refused Re-biopsy
Work Up
Differential Diagnosis
PapillomatosisCancer
Laryngeal Cancer
Incidence• 2 to 5 % of all cancers world wide• The most common cancer in the head and
neck in the U.S• Urban/Highly industrialized areas inhabitants:
Rural Inhabitants 2 or 3 : 1 The lowest reported incidence was in Syria, Singapore,
Armenia, Australia and Japan.
Laryngeal Cancer
Age• 80% of cases over the fifth decade• In Scandinavian countries tend to occur in
older ages• Rare in Children and Adolescents
Laryngeal Cancer
Etiologic Factors• Smoking only 1% of larynx cancer occur among non
smokers
Laryngeal Cancer
Etiologic Factors• Alcohol especially in smoker who drink heavily Supraglottic more than Glottic carcinomas Alcoholists who smoke 25- 50 fold increase in
risk over nonsmokers
Laryngeal CancerEtiologic Factors
GERD Environmental Pollution Radiation of head and neck Genetic Factors (African-American : White 2:1)
HPV infections 16 – 18 Certain Anatomic Conditions (laryngocoeles
18% of laryngeal cancers)
Association With Second Primary Malignant Tumors
• Synchronously in 1%• Metachronously in 5% to 10% The Most common Bronchogenic carcinoma 10% synchronously30% during the first year30% by five years30% within the first 20 years• Supraglottic : Glottic 3:1
Laryngeal Cancer
• 90% SCC
Laryngeal CancerClinical Manifestations
HoarsenessDyspneaDysphagiaPainOther Cough, Hemoptysis, Bad Breath and Weight
Loss
Papillomatosis• Rare after the age of 30.• Multiple warty lesions of "true" and
"false" vocal cords.• HPV-6 and HPV-11 are most closely
associated with papillomatosis• small but definite risk of malignant
change (2%)• Tracheoesophageal lesions are found in
2–15% of cases.
Papillomatosis
Treatmentuse of the CO2 laser
Granulomatous DisordresTuberculosis
• The most common• Clinical Presentation mimic neoplastic disorders• Third to forth decade of life• ¼ patients presents initially with respiratory
obstruction• The True vocal folds are the most common involved
sites• If left untreated Cicatricial stenosis with vocal fold
fixation
Thank You