Benign and malignant Benign and malignant Laryngeal diseasesLaryngeal diseases

Prof. Dr. Répássy GáborProf. Dr. Répássy Gábor

Diagnostic examinationDiagnostic examination

•• Indirect mirror examination, which we Indirect mirror examination, which we routinely performroutinely perform

•• Fiberoptic laryngoscopy and Fiberoptic laryngoscopy and videostroboscopyvideostroboscopyvideostroboscopyvideostroboscopy

•• Direct examination under general Direct examination under general anesthesiaanesthesia

•• Microlaryngoscopy (endolaryngeal Microlaryngoscopy (endolaryngeal microscopy)microscopy)

Benign lesions of the larynxBenign lesions of the larynx

•• NodulesNodules•• PolypsPolyps•• Reinke’s edemaReinke’s edema•• CystsCysts•• GranulomaGranuloma•• GranulomaGranuloma•• PapillomatosisPapillomatosis•• Rare:Rare: lymphatic and venous malformationslymphatic and venous malformations

granular cell tumorgranular cell tumorchondromachondromaneurogenic tumorneurogenic tumoramyloidosisamyloidosissarcoidosissarcoidosis

NodulesNodules

•• Vocal fold nodules are usually bilateralVocal fold nodules are usually bilateral

•• Involve the anterior or middle third of the Involve the anterior or middle third of the true vocal foldtrue vocal foldtrue vocal foldtrue vocal fold

•• Therapy: microsurgeryTherapy: microsurgery

PolypsPolyps

•• The most common benign lesions of the The most common benign lesions of the adult larynxadult larynx

•• Usually unilateralUsually unilateral•• Usually unilateralUsually unilateral

•• Appear at the free edge of the vocal foldAppear at the free edge of the vocal fold

•• Therapy: microsurgeryTherapy: microsurgery

Reinke’s edemaReinke’s edema

•• Edema in the superficial layer of the Edema in the superficial layer of the lamina propria (Reinke’s space)lamina propria (Reinke’s space)

•• Not cause of suffocation (not simple Not cause of suffocation (not simple •• Not cause of suffocation (not simple Not cause of suffocation (not simple larygeal edema)larygeal edema)

•• More common in the gipsy populationMore common in the gipsy population

CystsCysts

•• Supraglottic larynx is the most common Supraglottic larynx is the most common site of laryngeal cystssite of laryngeal cysts

•• Most frequently mucusMost frequently mucus--secreting glandssecreting glands•• Most frequently mucusMost frequently mucus--secreting glandssecreting glands

•• Therapy: excision, laserTherapy: excision, laser

GranulomaGranuloma

•• Usually arise in the region of the vocal Usually arise in the region of the vocal process of the arytenoidprocess of the arytenoid

•• Causing by: prolonged endotracheal Causing by: prolonged endotracheal •• Causing by: prolonged endotracheal Causing by: prolonged endotracheal intubationintubation

•• Surgical treatment: CO2 laser is ideal for Surgical treatment: CO2 laser is ideal for excisionexcision

Laryngeal papillomatosisLaryngeal papillomatosis

•• The most common benign laryngeal tumorThe most common benign laryngeal tumor

•• More prevalent in childrenMore prevalent in children

•• Etiology: viral (HPV)Etiology: viral (HPV)

•••• Causing hoarseness, respiratory obstructionCausing hoarseness, respiratory obstruction

•• Precancerous conditionPrecancerous condition

•• Therapy: surgical Therapy: surgical -- laser excisionlaser excision

interferoninterferon

Other premalignant conditionsOther premalignant conditions

•• LeukoplakiaLeukoplakia

•• PachydermiaPachydermia

•• Chronic hyperplastic laryngitisChronic hyperplastic laryngitis•• Chronic hyperplastic laryngitisChronic hyperplastic laryngitis

Histopathology: Hyperplastic and dysplastic Histopathology: Hyperplastic and dysplastic lesions lesions

Malignant lesions of the larynxMalignant lesions of the larynx

•• Laryngeal cancerLaryngeal cancer

•• Supraglottic Supraglottic –– Glottic Glottic –– SubglotticSubglottic

•• History: tobacco, alcohol, high risk HPV’s, etc.History: tobacco, alcohol, high risk HPV’s, etc.

•••• Symptoms: hoarseness, dysphagia, otalgia Symptoms: hoarseness, dysphagia, otalgia irradiatairradiata

•• Examination: direct/indirect laryngoscopyExamination: direct/indirect laryngoscopy

CT scanCT scan

biopsy the lesionbiopsy the lesion

Larynx cancerLarynx cancer

•• Therapy:Therapy:

•• Supraglottic cc.Supraglottic cc.

SurgicalSurgical -- horizontal supraglottic resection horizontal supraglottic resection SurgicalSurgical -- horizontal supraglottic resection horizontal supraglottic resection -- subtotal resectionsubtotal resection

-- horizontal supracricoid resectionhorizontal supracricoid resection

-- total laryngectomy total laryngectomy

ChemoradiotherapyChemoradiotherapy

Larynx cancerLarynx cancer

•• Glottic cancer: comissura anteriorGlottic cancer: comissura anterior

vocal cordvocal cord

comissura posteriorcomissura posterior

Therapy: IrradiationTherapy: IrradiationTherapy: IrradiationTherapy: IrradiationSurgery: Endolaryngeal cordecomySurgery: Endolaryngeal cordecomy

Laser cordectomyLaser cordectomy

Frontolateral resectionFrontolateral resection

HemilaryngectomyHemilaryngectomy

Horisontal supracricoid resectionHorisontal supracricoid resection

Total laryngectomyTotal laryngectomy

Larynx cancerLarynx cancer

•• Subglottic cancer:Subglottic cancer:

•• RareRare

•• Poor prognosisPoor prognosis•• Poor prognosisPoor prognosis

•• Therapy: Surgical and chemoradiotherapy Therapy: Surgical and chemoradiotherapy