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Larynx Flashcards

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1
Q

Larynx extends from ……to …..
Laryngeal cartilage are ……in number.
How many are paired, how many unpaired?

A

C3-C6

9

3paired, 3 unpaired .

3 paired: 3unpaired
1. Arytenoid. Thyroid
2. Corniculate. Cricoid
3. Cuneiform. Epiglottis

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2
Q

…….(3) made up on hyaline cartilage

A

Thyroid
Cricoid
Basal part of arytenoid cartilage

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3
Q

Difference between hyaline and elastic cartilage

A

Hyaline: ossify after 25 years
Elastic : do not ossify.

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4
Q

Only complete ring of cartilage around trachea

Largest laryngeal cartilages

A

Cricoid cartilage

Thyroid cartilage

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5
Q

Thyrohyoid pierced by ….&……

2 synovial joints of laryngeal cartilages

A

SL vessels & ILN

Cricoarytenoid
Cricothyroid joints

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6
Q

Narrowest part of larynx in adults
In children

Prelaryngeal LN called ….

A
  1. Rima glottidis
  2. Subglottic region

Delphic nodes

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7
Q

Pre epiglottic space is ….

A

Space of boyer

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8
Q

Larynx in infants is different. How?

A
  1. Larynx is higher-C2-C4 and anterior
  2. Funnel shaped
  3. Tongue is larger
  4. Trachea is shorter
  5. Laryngeal cartilage are soft
  6. Epiglottis is omega shaped
  7. Arytenoids larger
  8. Thyroid cartilage flat
  9. Submucosal tissues- loose.
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9
Q

Different muscles of larynx

Cartilage that doesn’t alter with age;

A

Vocal cords: stratified squamous
Mucosa: ciliated columnar.

Epiglottis

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10
Q

Only intrinsic muscle in external aspect of larynx
It is ……
Supplied by ….

A

Cricothyroid

Tensor muscle

ELN- br of SLN

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11
Q

Only abductor of vocal cords

Safety muscle of larynx

A

Posterior cricoarytenoid

Posterior cricoarytenoid

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12
Q

Whispering muscle is …..
It is a ……..(abductor/adductor)

All muscles of larynx are paired except…

A

Transverse arytenoids.
Adductor muscle

Transverse arytenoid.

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13
Q

Sensory and motor nerve supply of larynx

A

Sensory :
1. Supraglottis- internal br of SLN-ILN
2. Subglottis: RLN
3. Glottis: both ILN & RLN

Motor supply of larynx:
All muscles :RLN except:
cricothyroid (ext br of SLN)

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14
Q

Right and left RLN

A

Right: turn around subclavian a
Left: turn around arch of aorta.
Left longer than right; paralysis of left 4times more than right.

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15
Q

Galen anastomosis is …..
Which is the human communicating nerve?

A

Connection between RLN and internal branch of SLN.

Anastomosis between external branch of SLN and distal RLN

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16
Q

Both SLN and RLN are branches of ……

Indirect laryngoscopy is done using ……..
How is process done?

A

Vagus nerve

Laryngeal mirror
Mirror warmed before use by placing glass surface on a flame.

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17
Q

Direct laryngoscopy is done using …….
Position used is …..

A

Rigid laryngoscopy

Boyce position or barking dog position.

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18
Q

What is micro laryngoscopy?

A

Combination of laryngoscopy and operating microscopy started by Kleinasser.

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19
Q

Blind areas that can’t be visualized on indirect laryngoscopy are : (5)

A
  1. Laryngeal surface of epiglottis/ infrahyoid epiglottis
  2. Ventricle of larynx
  3. Subglottis
  4. Anterior commissure
  5. Apex of pyriform fossa
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20
Q

Left is longer than right coz of ……

U/L RLN (abductor paralysis) sms.

A

Persistence of 6th arch artery- as ductus arteriosus which later fibrosis as ligamnetum arteriosum.

Affected cord lie close to midline- slight hoarseness of voice which improves over days.

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21
Q

Left RLN palsy caused by …(4)
Rx:

A
  1. Pancoast Tumor of lung
  2. Mitral stenosis
  3. Aneurysm of arch of aorta
  4. Apical TB

No Rx required.

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22
Q

What is ortner’s syndrome?
What happens in B/L RLN abductor paralysis? Rx

A

Paralysis of left RLN in cases of cardiomegaly.

Vocal cords come to the midline.
Normally we breathe with VC open and speak with VC closed.
So, in b/L abductor paralysis, speech is ok, but can’t breathe.

Rx: immediate tracheostomy —>6mo later:—-> type 2 thyroplasty.

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23
Q

What happens in B/L adductor paralysis ? Rx.

A

Both VC are in open / cadaveric position.
Sms: breathe is ok,but can’t speak,
Aspiration also.

Rx: wait for 6 months —> type 1 thyroplasty.

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24
Q

What is Bovine cough?

A

Cow-like cough- normal loss of explosive phase of normal coughing —> upon failure of cords to close the glottis.

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25
Mc cause of vocal cord paralysis is…. Properties of cricothyroid. (2)
Iatrogenic (surgical ) 1. Adductor 2. Tensor property Cricothyroid is the main tensor, which gives quality of voice.
26
Branches of SLN
SLN: external br: cricothyroid internal br: sensory supply - supraglottis
27
If SLN is damaged. Features (2)
1. Poor quality of voice - main tensor of VC 2. Aspiration- loss of sensory supply to supraglottis.
28
Thyroplasty types:
Type1: Medialization of Vc Type 2: Lateralization of VC Type 3: shortening of VC- lower pitch Type 4: lengthening of VC- increase pitch
29
Gentle abduction of VC seen in …… Full abduction of VC seen in ….
Quiet respiration, paralysis of adductors Deep inspiration
30
Position of Vc in strong whisper Types of Thyroplasty is introduced by …..
Paramedian position Isshiki
31
Mc congenital abnormality of larynx is ….. In laryngomalacia, extensive flaccidity is in …..
Laryngomalacia Supraglottic larynx
32
Stridor of laryngomalacia is …. Rx.
1. Since birth 2. Increased crying - crying sounds normal 3. Decreased stridor in prone position 4. Inspiratory stridor Rx: conservative , reassurance.
33
Conservative Rx for laryngomalacia is seen in ……(4)
1. Laryngomalacia 2. U/L vocal cord palsy 3. CSF rhinorrhea 4. Traumatic perforation of ear drum.
34
Direct laryngoscopy shows laryngomalacia is ……shaped Tracheomalacia associated with ….. …..cough seen
Omega TEF Barking cough
35
What is laryngocele? Affects …..professions
Dilatation of laryngeal saccule- arise from raised transglottic air pressure. 1. Trumpet blowers Glass blowers Weight lifters
36
External laryngocele herniates through ….. What is Bryce’s sign?
Thyrohyoid membrane Gurgling sound produced on pressing external laryngocele
37
Dx of laryngocele? Rx
Xray neck with valsalva Rx: surgery
38
Mc cause of vocal nodules is … 2nd mc cause is …. Always …… Junction of …….
Vocal abuse GERD B/L Jn of anterior 1/3 & posterior 2/3
39
Chief complaint of vocal nodules Rx. (3)
Hoarseness of voice Rx: voice rest + speech rx + PPI
40
What is keratosis larynx? Rx. (3)
Seen in smokers Vocal cord epithelium starts shedding faster —> keratinous debris on vocal cords Surgery- 1. stripping vocal cord mucosa/decortication 2. Quit smoking 3. CO2 laser cordectomy.
41
Define Reinke’s space What is Reinke’s edema? Rx.
Vocal cord lined by stratified squamous epithelium. Below stratified squamous epithelium, there is submucosal connective tissue- Reinke’s space. B/L diffuse swelling of VC- seen in smokers Rx: surgery- decortication
42
Tb larynx is most commonly in ….. Mc affected part is …
Posterior VC than anterior Inter arytenoid fold
43
Earliest symptom of tb vocal cord First sign is …
Weakness of voice Impaired adduction
44
Laryngoscopy finding of TB larynx (3)
1. Mamillated appearance- swelling in inter arytenoid region 2. Mouse nibbled appearance -ulceration of VC 3. Turban epiglottis: pseudoedema of epiglottis
45
Acute laryngotracheobronchitis seen in …. Cause is … Age: X-ray of acute laryngotracheobronchitis Rx.
Croup Viral parainfluenza Age: 3 months to 3 years Steeple sign- narrowing of subglottic area Rx : Humidifier O2+ bronchodilator + steroid + antibiotic — prevent secondary bacterial infection.
46
When false VC take over the function of true VC; it’s called? Voice is ….
Dysphonia plica ventricularis Rough, low pitched,unpleasant
47
Supraglottic larynx includes ….(5)
Epiglottis False vocal cords Ventricles Aryepiglottic folds Arytenoids
48
The glottis includes ….(2) The subglottic region is ….
True VC Anterior and posterior commissure 1cm below true vocal cords Extends to cricoid cartilage or first tracheal ring.
49
Juvenile papilloma of larynx is …. Seen in …… cause…. Sms.
Premalignant disease Children HPV 6,11. Sms: warts on vocal fold —>trachea and bronchi—>chronic hoarseness +_ respiratory difficulty.
50
Rx for juvenile papilloma of larynx Prognosis
CO2 laser surgery Recurrence. Patient has multiple surgeries.
51
How to decrease recurrence rate of juvenile papilloma of larynx? (3)
1. Intralesional Cidofovir 2. IFN-gamma 3. Bevacizumab
52
Mc site of juvenile papilloma of larynx Risk factors for ca larynx (7)
Vocal folds 1. Smoking 2. Alcohol 3. GERD 4. Asbestos 5. Wood dust 6. Nitrogen mustard 7. Ionizing radiation .
53
Age group of carcinoma larynx Mc in …. Mc type of ca larynx
40-70 yrs Males Squamous cell cancer
54
Mc type of cancer of larynx is …..next is …. Least is …..
Glottic cancer Supraglottic Subglottic
55
Early presentation of glottic cancer is …. Prognosis
Hoarseness Best prognosis as LN involvement is late
56
Mc site for Supraglottic cancer is …. Sms… Sign… Prognosis
Epiglottis Pain on swallowing Mass on neck Poor-patient reports late and LN involvement occurs early.
57
Worst prognosis of ca larynx is …. Presents with …. Verrucous cancer caused by ….
Subglottis Stridor HPV 16,18
58
Highest incidence of distant mets with ca larynx is with … Laryngofissure means….
Lungs Opening of larynx/ thyroid cartilage in midline.
59
Stages of ca larynx
Type 1: only 1 named structure. 1 VC: T1A, 2 Vc= T1B Rx: CO2 laser Rx > radiotherapy Type 2: >1 named structure Rx: radiotherapy 2nd option: if lung fn normal: Partial laryngotomy Type 3: VC is immobile and fixed. Invasion of preglottic and paraglottic space Rx: total laryngectomy +_ radical neck dissection—> radiotherapy 2nd option: concurrent chemoradio Type 4: invasion of thyroid /extralaryngeal neck structures Rx: total latyngectony +_radical neck dissection —>radiotherapy 2nd: concurrent chemoradiotherapy. Best option for T3,T4: Tracheoesophageo puncture device
60
Rehab for speech in ca larynx …….helps restoration of olfactory sensation after larynectomy
Asai laryngoplasty technique Best now : TEF speech Polite yawning -yawning with mouth closed
61
Level or site of tracheostomy
High level: at first tracheal ring Mid level: at 2&3 tracheal rings -preferred method Low level: at 4&5 tracheal rings
62
Structures seen while bronchoscopy: (6)
1. Uvula 2. Epiglottis 3. Vocal cords 4. Larynx 5. Trachea , carina 6. Segmental/ subsegmental bronchi
63
Intubation in child is done with …..
Straight blade and cuff tube- to decrease aspiration.
64
Complications of tracheostomy (3)
1. Hemorrhage 2. Surgical emphysema- collection of air beneath skin Coz of tight skin suture 3. Immediate complication Apnea—>CO2 washout —> drive for respiratory centre gone.
65
………is associated with pan masala/ supari 2. Mc type of oral cancer 3. Mc site of oral cancer
Oral submucosal fibrosis of larynx 2. Squamous cell ca 3. Tongue
66
Mc site of oral cancer in india Mc site of tongue cancer
Buccal mucosa Lateral border
67
Mc site of lip cancer ……is investigation of choice for ca oral cavity
Vermilion of lower lip MRI
68
Pathology of Ludwig’s angina
Molar/premolar caries —> infection to chin( cellulitis of submandibular space) This causes glottic edema and painful airway compromise
69
Rx for Ludwig’s angina
Immediate antibiotic : cefuroxime+ metrogyl If no response-drain submandibular triangles under local anesthesia
70
Infection from molar /premolar affecting angle of mouth, but no chin swelling. D/o Egg shell crackling seen with …. Cyst in mandibular are is ….
Parapharyngeal abscess Dental cysts-at maxilla Follicular cyst-dentigerous cyst
71
Xray s/o soap bubble /honeycomb appearance is …… What is intubation granuloma? Rx:
Adamanitoma Results from traumatic endotracheal intubation-large granuloma arising from arytenoid Prolonged intubation in ICU patients. B/L disease Surgery: microlaryngeal surgery
72
Cotton Meyer staging done for ….. What are the stages ?
Subglottic stenosis Type1: 0-50% conservative Type 2: 51-70% obst- laser /dilatation Type 3: 71-90% obst- Type 4: no lumen detected . Type 3&4- rx : laryngotracheal reconstruction—> Montgomery’s silicon tracheal T tube.
73
Uses of mitomycin C (3)
1. Laryngotracheal stenosis 2. Prevent formation of synechiae in nose after surgery 3. Surgery: choanal atresia mgt
74
1. Site of vocal cord nodule: 2. Site of intubation granuloma
1. Ant 1/3, post 2/3 2. Ant 2/3, post 1/3

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