Term
| What is the appropriate treatment for vocal fold nodules (bilateral, symmetric)? |
|
Definition
Voice restriction, voice therapy (most important), surgery for symptomatic lesions persisting after voice therapy
Decide on treatment based on voice impact, not appearance. |
|
|
Term
| How are laryngeal polyps treated typically? |
|
Definition
1) Voice therapy: polyps will not regress, but voice can improve
2) Surgery: MDL and excision |
|
|
Term
| What is the appropriate management approach for thickened, white or reddish patches on vocal cords? |
|
Definition
Sounds like Epithelial hyperplasia, either keratosis or leukoplakia.
Needs biopsy with MDL and microflap. |
|
|
Term
| What are the major benign laryngeal mass lesions? |
|
Definition
1) Chondroma: posterior plate of cricoid, submucosal mass, treated with surgery (recurrence high)
2) Neurofibroma: Often on AE fold
3) Granular cell myoblastoma on posterior vocal fold (pseudoepitheliomatous metaplasia)
4) Adenomas and Lipomas |
|
|
Term
| What is the major purpose of repairing laryngeal nerve severed? |
|
Definition
| Restore muscular tone. Motion will not be restored |
|
|
Term
| What are the available materials for vocal fold injection and what are the benefits/drawbacks of each? |
|
Definition
1) Teflon: permanent, risk of granulomas
2) Gelfoam: 8-10 weeks, good when short-term recovery expected
3) Hyaluronic acid gell: 6-9 months
4) Calcium hydroxylapatite: >1 year
5) Autologous fat from liposuction: unpredictable |
|
|
Term
| Which patients should not get medicalization laryngoplasty? |
|
Definition
Flaccid paralysis and a large, posterior gap, or with vocal processes on different levels.
In this case consider arytenoid adduction (simulates movement of lateral CA muscle) |
|
|
Term
What type of dysphonia is described?
1) Strained and strangled voice with frequent voice breaks, usually at onset of words beginning with vowels ("eggs")
2) Whispering or breathy voice with breaks between plosive consonents ("Pu-pp-y") |
|
Definition
Spasmodic dysphonias: treat with voice therapy, consideration of RLN transection, Botox in TA for adductor form
1) Adductor (most common)
2) Abductor |
|
|
Term
| COPD patient on inhalers presents with white patches on bright red laryngeal mucosa. What do you do? |
|
Definition
Likely laryngeal candidiasis. Need to rule out leukoplakia.
Give systemic antifungal (topical/swallowed nystatin is ineffective). Hold steroids. Biopsy if persistent. |
|
|
Term
| What are the principles of croup management? |
|
Definition
1) Cool mist to help speed of resolution
2) Steroids
3) Rac epi
4) If fever and/or culture give abx
5) If severe consider airway intervention
**If recurrent, OR endoscopy indicated** |
|
|
Term
| What is the workup for suspected laryngeal sarcoidosis? |
|
Definition
1) Biopsy of supraglottic site to document non-caseating granulomas
2) Exclude infectious causes
3) Systemic steroids (chronic), intralesional steroid injection, sometmeimes excision for large lesions |
|
|
Term
| What is the workup for suspected laryngeal wegeners? |
|
Definition
Usually sub-glottis granulomatous tissue
1) Biopsy showing necrotizing granulomas, C-ANCA
2) Treat with steroids and cytotoxic drugs. Consider trach if necessary |
|
|
Term
Gray/orange waxy lesions on glottis of patient with multiple myeloma.
What do you do? |
|
Definition
1) Biopsy and look for cogno red with apple green birefringence to suggest amyloidosis
2) Endoscopic excision or open surgery to debulk, frequent recurrence, trach may be necessary |
|
|
Term
| What is the correct approach to a suspected laryngeal fracture with stable vs. unstable airway? |
|
Definition
1) Stable airway
- Flexible laryngoscopy to assess VF and exposed cartilage
- If abnormal, get CT, and if fracture displaced go to OR (conservative is steroids, humidified air and observation)
2) Unstable
- Consider emergent trach, go to OR |
|
|
Term
| When can endoscopic excision of subglottic stenosis be considered? When is it inappropriate? |
|
Definition
1) If scar is thin and not circumferential, and if cricoid support is normal
2) Otherwise laryngotracheoplasty or cricotracheal resection are needed |
|
|
Term
| What are the common causes of congenital laryngeal paralysis? |
|
Definition
2nd most common cause of stridor in newborn
Perform scope, imaging to rule out cardiac/neurogenic causes, barium swallow
1) Idiopathic
2) Birth trauma
3) Cardiomegaly
4) AC malformation
5) Ligation of PDA |
|
|
Term
| How is congenital subglottic hemangioma managed? |
|
Definition
Commonly with skin hemangioma as well (50%)
1) Steroids and rac epi for acute stridor
2) Systemic propranolol
3) CO2 laser, external excision or trach if not responding to propronalol |
|
|
Term
| What is the appropriate management of congenital laryngeal web or atresia? |
|
Definition
| Usually trach for relief and correction when child is larger and anatomy more distinct. Sometimes division of web may not improve voice |
|
|
Term
| What are the management strategies for a cricopharyngeal bar? |
|
Definition
Presents with dysphagia to solids>liquids, globus sensation, food sticking
1) Dietary mods
2) Dilation
3) Botox 5-6 months
4) Endoscopic myotomy with CO2 laser. Leave buccopharyngeal fasci aand areolar tissue intact to prevent pharyngeal leak |
|
|
Term
| Describe T staging for supraglottic laryngeal SCCa |
|
Definition
1) T1: Limited to one subsite
2) T2: More than one subsite of supraglottic larynx or outside of supraglottic larynx
3) T3: VF fixation or invasion or adjacent structures (post-cricoid, pre-epiglottic. paraglottic)
4) T4a: invades thyroid cartilage or beyond larynx
T4b: prevertebral fascia, encasing carotid, invades mediastinum |
|
|
Term
| Describe T staging for glottis laryngeal SCCa |
|
Definition
Cervical metastasis less common than with supraglottic SCCa
1) T1: Limited to vocal folds with normal movement (T1b bilateral folds)
2) T2: Subglottic extension or supraglottic extension, impaired mobility
3) T3: Focal fold vixation or invasion of adjacent structures
4) Invades thyroid cartilage or beyond larynx |
|
|
Term
| What is the relevance of the 1991 VA laryngeal study and the RTOG 91-11 2003 study in treatment of laryngeal cancer? |
|
Definition
1) VA study 1991
- Induction chemo with radiation equivalent to TL with XRT for T3-4 cancers
2) RTOG 91-11
- Concurrent chemo-XRT superior to induction chemo or radiation alone
- No surgical arm |
|
|
Term
| When should elective neck dissection be performed in treatment of laryngeal cancer? |
|
Definition
1) Clinical neck disease
2) Glottic T3
3) T4 lesions
5) Transglottic involvement |
|
|
Term
| What are the follow up recommendations for patients with laryngeal cancer after treatment? |
|
Definition
1) q1-3 months year 1
2) q2-4 months year 2
3) q4-6 months years 3-5
4) 6-12 months thereafter |
|
|
