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