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Benign Laryngeal Lesions PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Benign Laryngeal Lesions".

This medical PowerPoint presentation is about benign laryngeal lesions, non-cancerous growths or abnormalities that can develop in the larynx, which is the part of the throat that contains the vocal cords. There are several types of benign laryngeal lesions, including:

Vocal cord nodules: These are small, callus-like growths that develop on the vocal cords due to excessive or improper use of the voice. They can cause hoarseness and difficulty speaking.
Vocal cord polyps: These are fluid-filled sacs that develop on the vocal cords and can cause hoarseness, breathiness, and a change in vocal quality.
Vocal cord cysts: These are fluid-filled sacs that develop on the vocal cords and can cause hoarseness, breathiness, and a change in vocal quality.
Reinkes edema: This is a swelling of the vocal cords due to chronic exposure to irritants like smoking or acid reflux. It can cause a deep, husky voice.
Papillomas: These are small, wart-like growths that can develop on the vocal cords due to a viral infection. They can cause hoarseness and difficulty speaking.

Treatment for benign laryngeal lesions depends on the type and severity of the lesion. Treatment options may include voice therapy, surgery, or medication. Its important to see a doctor if youre experiencing persistent hoarseness or difficulty speaking.

Tags : Benign Laryngeal Lesions, larynx, throat, vocal cords, Vocal cord nodules, Vocal cord polyps, Vocal cord cysts, Reinkes edema, Papillomas

Published on : Jun 23, 2023 | Views : 1011 | Downloads : 1

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Slide 1-

Benign Laryngeal Lesions
Slide 2-

Factors contributing to vocal fold lesions voice overuse or misuse smoking etoh Laryngopharyngeal reflux
Slide 3-

History medical conditions AR, GERD, asthma, bronchitis, sinusitis medications Environmental exposure: smoke, allergens, particulates (dust)
Slide 4-

LPR baseline inflammation predisposes VF to other stresses 78% w/ nodules had LPR
Slide 5-

Allergy pts treated for AR had better outcome for treatment of laryngitis hypersensitivity makes laryngeal mucosa more susceptible to stress
Slide 6-

Pathophysiology mech stress least at midpoint of membranous VF during phonation during hyperfunctioning dysphonia increased stress at midpoint increased stiffness in body of VF at midpoint results in higher shearing stresses, worse if nodule or mass present mass adds wt to VF decreasing vibratory qualities and frequency on stroboscopy
Slide 7-

Pathophysiology decrease in pitch range and impaired closure leads to breathy voice and fatigue. Asymmetry adds grainy quality to voice once initiated, can cause compensatory muscle tension to reduce air flow through glottis
Slide 8-

Anatomy of vocal fold
Slide 9-

Nodules
Slide 10-

Nodules bilateral symmetric epithelial swelling of ant/mid third of TVF More prevalent in children, adolescents, females softer intensity of voice causes hyperfunction Result of abuse or misuse
Slide 11-

Nodule formation junction of anterior to middle VF experience maximal shearing and collision forces. vascular congestion and edema hyalinization of Reinke space and thickening of epithelium with epithelial hyperplasia nodules are acellular with thick epithelium over matrix of abundant fibrin and organized collagen IV in BM
Slide 12-

Symptoms decreased amplitude mucosal wave Symmetric mucosal wave decreased closure: hourglass-shape glottal closure chronic hoarseness singers: frequent voice breaks, breathiness, vocal fatigue
Slide 13-

Treatment of Nodules conservative voice use speech therapy to address technique Microsurgery when speech tx and other contributing factors optimized
Slide 14-

Vocal fold polyps
Slide 15-

Polyps Unilateral Broad-based vs. Pedunculated Formed by capillary break in Reinke space with leakage of blood resulting in local edema and organization with hyalinized stroma Hemorrhagic (feeding vessel) vs. nonhemorrhagic (pseudocyst)
Slide 16-

Vocal fold polyps
Slide 17-

Effect of polyps on mucosal wave Asymmetric mass produces more chaotic vibrations and aperiodic mucosal waves Larger polyps cause decreased wave amplitude Excessive air egress during phonation Fatigue Frequent voice breaks decreased vocal power
Slide 18-

Treatment Conservative for small polyps Microsurgery mainstay of therapy Hemorrhagic polyps Pulsed-dye lasers absorbed by hemoglobin (585 nm) Lasers more effective for smaller polyps
Slide 19-

Vocal fold cysts
Slide 20-

Vocal fold cysts Subepidermal epithelial-lineds sacs within lamina propria Mucus retention cysts Epidermoid cysts congenital cell rests in the subepithelium of 4th and 6th branchial arch or healing injured mucosa burying epithelium
Slide 21-

Vocal fold cysts Ruptured cyst may result in LP scarring or in a sulcus May cause reactive lesion on contralateral VF Size may vary with menstrual cycle Caution when operating on premenstrual females
Slide 22-

Strobolaryngoscopy Asymmetric vocal fold Decreased or absent mucosal wave on cyst side Diplophonia Glottic closure depends on cyst size and reactive lesion on contralateral side Mucosal wave present in 80% of polyps BUT absent in almost 100% of cysts
Slide 23-

Treatment of cysts Does not resolve with conservative management Surgery Dissection in submucosal plane with complete cyst removal Prolonged mucosal wave recovery Discuss risks with pt
Slide 24-

Reactive Lesions
Slide 25-

Reactive lesions Reaction to unilateral VF lesion Contralateral VF reactive callus with epithelial hyperplasia Bilateral like nodules Strobe: asymmetry not seen in nodules Tx: treatment of primary lesion, may resolve with conservative management
Slide 26-

Before and After
Slide 27-

Intracordal Scarring Scarring in Reinke space after repeated inflammation, trauma or vocal hemorrhage Subepithelial scar Disorganized collagen Loss of ECM Distinguish from epithelial scarring or vocal sulcus VF appears stiff, white or opaque Hoarseness, vocal fatigue, breathiness, loss of projection
Slide 28-

Sulcus Vocalis
Slide 29-

Causes of Intracordal scarring Cysts predispose to scar formation (ruptured, epidermoid origin) Trauma Vocal fold surgery involving lamina propria Repeated epithelial procedures Biopsy, stripping Inhalational Intubation CO2 laser Radiation Rheumatologic disease
Slide 30-

Stroboscopy Markedly reduced or absent mucosal wave Asymmetry affects phase closure
Slide 31-

Treatment of vocal scar Microflap to remove cyst elements and adynamic fibrous components Medialization thyroplasty for glottic gaps Replacement soft tissue (Fillers) Collagen Fat Hyaluronic acid
Slide 32-

Reinke Edema
Slide 33-

Reinke edema polypoid corditis proliferation of superficial lamina propria chronic irritant exposure Smoke, LPR, occupational exposures water-balloon outpouching from membranous VF ball-valving effect
Slide 34-

Treatment Surgery Airway compromise Preserve some superficial lamina propria and overlying epithelium to preserve mucosal wave Stage for bilateral disease to prevent anterior web Remove irritants and treat LPR
Slide 35-

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Slide 36-

Feeding varices and hemorrhage Aberrant microvessels in superficial lamina propria Result of shearing forces and trauma Predispose to formation of polyps and hemorrhage
Slide 37-

Treatment Microdissection and CO2 laser Risks of scarring and sulcus Pulsed lasers (KTP, 585nm PDL) No adverse scarring or reduction in mucosal wave
Slide 38-

Vocal Process Granuloma
Slide 39-

Granulomas Response to trauma LPR, throat clearing, chronic cough Intubation Compensatory forceful glottic closure VF paresis Presbylarynges Does not affect mucosal wave or phase closure
Slide 40-

Treatment LPR treatment Speech therapy Botox to thyroarytenoid muscle Surgery Compromise voice, breathing or swallowing Suspicion for malignancy High recurrence rate
Slide 41-

Papillomas
Slide 42-

Papillomas HPV (Strain 6 and 11 most common) 2% malignant transformation (HPV 16 and 18) 10% rate of spread to other sites (trachea, supraglottis, NP) Most commonly found at columnar and squamous junction Host immune recognition HPV 11 growth more aggressive during pregnancy 40% HPV+ larynx without RRP
Slide 43-

Treatment CO2 laser Controversy: depth risks scarring and implantation of HPV Avoided in most centers Microshaver Cidofovir injection (adjuvant tx) Vaccine
Slide 44-

Cidofovir Acyclic nucleoside phosphonate Once phosphorylated, resembles nucleotide incorporated into DNA, halting DNA synthesis ANP’s have greater affinity for viral DNA polmerase and reverse transcriptase than host DNA polymerase Off-label use
Slide 45-

Cidofovir studies limited
Slide 46-

Leukoplakia
Slide 47-

Leukoplakia Spectrum of change in epithelium HyperkeratosisDysplasia (mild, moderate)CIS/ severe dysplasia Pattern of growth Superficial, broad Verrucous, exophytic with surrounding erythema Appearance does not correlate with degree of dysplasia 8% to 14% rate of malignant transformation
Slide 48-

Treatments CO2 laser PDL microflap excision Preservation of normal mucosal wave for mild dysplasia More aggressive excision with increasing dysplasia
Slide 49-

Fungal Laryngitis Disease of both immunocompromised and immunocompetent hosts May mimick leukoplakia or malignancy White or gray pseudomembrane on mucosa Mucosal erythema and edema (focal or diffuse) surrounding white plaques Mucosal ulcerations Contact bleeding
Slide 50-

Fungal laryngitis
Slide 51-

Risk factors Risk factors: LPR, smoking, inhaled steroids, prolonged antibiotic use, XRT DM, immunosuppressants, CA, nutritional deficits Compromise mucosal barrier
Slide 52-

Diagnosis Suspicion and response to empiric therapy Any question can culture by laryngeal brushing or biopsy Dysphagia may also have esophageal involvementTNE
Slide 53-

Candida species most commonly cultured Blastomyces (Eastern US and Midwest) Histoplasma (Ohio and Mississippi River Valleys) Coccidioides (Southwestern US) Bacterial superinfection Honey-colored crusts
Slide 54-

Treatment of fungal laryngitis Fluconazole x 3wks Nystatin swish and swallow (100,000 units/ml, 10ml tid) Prevention spacers for inhaled steroids oral rinse, gargle with water after use