Applied Head and Neck Module
The Pharynx & Larynx
Disorders
Firas M. Hassan
Assistant Professor
Department of Otolaryngology
College of Medicine , University of Kufa, Iraq
Disorders of the pharynx
Adenoid
Mass of lymphoid tissue
Produce IgA, IgG, IgM
Maximal size 3-8 years (then regress)
Enlargement with viral/bacterial infections
Adenoid
Effects of Enlargement
Nasal obstruction
Mouth breathing
Hyponasal speech
Feeding difficulty (esp. infants)
Snoring/Obstructive Sleep Apnoea
Eustachian tube obstruction
Recurrent acute otitis media (earache)
Chronic otitis media with effusion (glue
ear, reduced hearing)
Adenoid
Assessment
Difficult!
Post-nasal space x-ray
Post-nasal mirror
Fibre-optic endoscope
Theatre
Obstructive Sleep Apnoea
• Spectrum from mild snoring to OSA
• Partial/Complete airway obstruction during sleep – turbulent
airflow
• Over 30 apnoeic episodes in 7 hours of sleep
• 5 apnoeic episodes/hour
• Daytime tiredness
• If severe can cause hypoxia and increase cardiovascular strain
Otitis Media
Acute
Chronic
Ventilation Tube
Adenoidectomy
• Curettage (blind)
• Suction diathermy
(mirror)
Complications
• Bleeding
• Atlanto-occipital joint
dislocation
• Eustachian tube stenosis
Nasopharyngeal Carcinoma
• More common in Chinese
population
• Usually SCC
• TNM staging
• Radiotherapy
• Limited role for chemotherapy & surgery
Tonsillitis
Acute
Recurrent acute
Chronic
Tonsillectomy
Indications
• Recurrent tonsillitis (5/year for at least 2 years)
• Previous peritonsillar abscess
(quinsy)
• Suspected cancer (unilateral
enlargement/ulceration)
• Obstructive sleep apnoea
syndrome
Tonsillectomy
Risks
• GA
• Bleeding (primary or secondary) approx. 3%
• Infection
Technique
• Cold steel instruments
• Electrosurgery
• Laser
Pharyngeal Pouch
• Posterior herniation of pharyngeal mucosa
• Occurs through Killian’s
dehiscence
– Between inferior constrictor and
cricopharyngeus
Reasons
• Weaker area
• Incoordination of pharyngeal
phase of swallowing
• Cricopharyngeal spasm
Disorders of the larynx
Recurrent Laryngeal Nerve Palsy
Idiopathic
Laryngeal cancer
Thyroid disease (benign or malignant)
Trauma (including iatrogenic – ie. thyroidectomy)
Cervical lymphadenopathy
Oesophageal cancer
Apical lung cancer
Aortic aneurysm
Neuropathic (diabetes)
Hypopharyngeal/Laryngeal Carcinoma
Hypopharyngeal
• 90% are SCC
• Uncommon disease
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• Post-cricoid (pharyngooesophageal junction)
• Piriform fossa
• Posterior pharyngeal wall
Laryngeal
Over 95% are SCC
Commonest H+N Ca in
West
M:F 5:1
Smoking and Alcohol
• Supraglottis
• Glottis (good prognosis)
• Subglottis (poor prognosis)
Hypopharyngeal/Laryngeal Carcinoma
History
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FB sensation in throat
Dysphagia
Odynophagia
Otalgia (refered pain – vagus)
Hoarseness (spread to RLN/Larynx)
Coughing (aspiration, haemoptysis)
Weight loss
Smoking history (pack/years)
Hypopharyngeal/Laryngeal Carcinoma
Examination
• Loss of laryngeal crepitus (fixed larynx)
• Cervical lymph node metastasis
• Fibre-optic endoscopy
Investigations
• Barium swallow (for dysphagia symptoms)
• CT/MRI (Head, Neck, Chest)
• Direct pharyngo-laryngo-oespohagoscopy and biopsy
Hypopharyngeal/Laryngeal Carcinoma
• TNM staging
• MDT meeting “multidisciplinary teams for cancer “
Management
• Radiotherapy +/- chemotherapy
• Surgery
– Laryngectomy
– Pharyngo-laryngectomy
– including radical or selective neck dissections
• Palliation
Summary
• Nasopharynx
– Adenoid hypertrophy – snoring/OSA, glue ear
– Carcinoma
• Oropharynx
– Tonsillitis/Tonsillectomy
• Hypopharynx and Larynx
– Pharyngeal Pouch
– Recurrent Laryngeal Nerve Palsy
– Carcinoma
• Thyroid surgery
– Iatrogenic LN injury