最新 Injuries of the larynx 課件教學(xué)課件

1、Injuries of the larynxInjury to the larynx is uncommon.The inferior projection of the mandible affords significant protection from anterior blows.Posteriorly, the larynx is protected by the rigid cervical spine. 2021/7/91Injuries of the larynxWithin the neck there are some elements necessary to conn

2、ect and coordinate the head with the body.Injury to the neck can disrupt any of these vital functions and may involve bony, soft tissue, vascular, and CNS elements.2021/7/92Injuries of the larynxAlthough many associated injuries may appear more impressive, correct management of the neck injury with

3、immediate attention to securing the airways is always the first priority.2021/7/93 Injuries of the larynx Classification External laryngeal trauma： closed injury contusion, crush injury open injury incised wound, stab wound, burst wound，bullet trauma. Internal laryngeal injury： burn of the larynx, i

4、ntubation2021/7/94Injuries of the larynxClosed injuries of the larynxCauses：direct attackindustrial accident traffic accident2021/7/95Injuries of the larynxAnterior blunt injuries are most commonly the result of motor vehicle accidents.2021/7/96Injuries of the larynxMandatory seat belt lawslower spe

5、ed limitsbetter education regarding drunk drivingthe use front seat air bags may reduce this accident !2021/7/97Injuries of the larynxClothesline injuries occur when the rider of a motorcycle encounters a fixed horizontal object, such as a clothesline.This type of injury imparts a large amount of en

6、ergy over a relatively small area, resulting in massive trauma. 2021/7/98Injuries of the larynxStrangulation injuries occur from manual compression or from attempted suicides by hanging.These injures may later be associated with marked edema of the larynx and resultant loss of airway. 2021/7/99Injur

7、ies of the larynxClosed injuries of the larynxSymptoms：dyspnea, dysphagia, sore throat, tenderness of the larynx, hoarseness, hemoptysis and shock2021/7/9109、 人的價(jià)值，在招收誘惑的一瞬間被決定。2022/7/122022/7/12Tuesday, July 12, 202210、低頭要有勇氣，抬頭要有低氣。2022/7/122022/7/122022/7/127/12/2022 8:59:10 PM11、人總是珍惜為得到。2022/7/

8、122022/7/122022/7/12Jul-2212-Jul-2212、人亂于心，不寬余請(qǐng)。2022/7/122022/7/122022/7/12Tuesday, July 12, 202213、生氣是拿別人做錯(cuò)的事來懲罰自己。2022/7/122022/7/122022/7/122022/7/127/12/202214、抱最大的希望，作最大的努力。12 七月 20222022/7/122022/7/122022/7/1215、一個(gè)人炫耀什么，說明他內(nèi)心缺少什么。七月 222022/7/122022/7/122022/7/127/12/202216、業(yè)余生活要有意義，不要越軌。2022/7

9、/122022/7/1212 July 202217、一個(gè)人即使已登上頂峰，也仍要自強(qiáng)不息。2022/7/122022/7/122022/7/122022/7/122021/7/911Injuries of the larynxClosed injuries of the larynxPhysical exam：swelling, ecchymosis, subcutaneous emphysema (crepitus)Layngoscopy：edema, malformation of the glottis, disturbance of the vocal mobility2021/7/

10、912Injuries of the larynxClosed injuries of the larynxTreatment： In a patient with major laryngeal injury, the first priority is to establish an airway. If the patient has dyspnea, emergent tracheotomy or cricothyroidotomy should be performed. 2021/7/913Injuries of the larynxClosed injuries of the l

11、arynxTreatment： If the patient is breathing well and the injury does not require surgical care, observation without tracheotomy may be indicated.2021/7/914Injuries of the larynxClosed injuries of the larynxTreatment： Antibiotics and corticosteroid can be useful if administered soon after injury.2021

12、/7/915Injuries of the larynxClosed injuries of the larynxTreatment： Repair of laryngeal cartilage is indicated if multiple or displaced fracture of the thyroid cartilage and the cricoid cartilage happened. 2021/7/916Injuries of the larynxClosed injuries of the larynxTreatment： Feeding via nasogastri

13、c tube is necessary.2021/7/917Injuries of the larynxIncised wound, stab woundPenetrating wound of the larynx usually accompany the injury of the major vessels of the neck 2021/7/918Injuries of the larynxIncised wound, stab woundCauses: fight, traffic accident, explosion， gunshot2021/7/919Injuries of

14、 the larynxIncised wound, stab woundSymptoms: bleedingshock dyspnea dysphagia subcutaneous emphysema hoarseness2021/7/920Injuries of the larynx Incised wound, stab woundTreatment Control the bleeding, antishock, maintain the airway the first priority disinfect and clean the wound, repair the damages

15、, laryngeal stenting nasogastric tube feeding2021/7/921Injuries of the larynxBurn of the larynxThe burn of the larynx is usually associated with burns to the closed areas and other parts of the body. Causes：inspirationhot air, fume, toxic gas, steam etc. by accident swallow strong acid and alkali.20

16、21/7/922 Injuries of the larynxBurn of the larynxClinical manifestations: mild cases: injury limited to the glottic and supraglottic areacongestion and swelling of the mucosapain, dysphagia and hoarseness. 2021/7/923 Injuries of the larynxBurn of the larynxClinical manifestations: moderate cases: in

17、jury extends to the tracheaedema and erosiondyspnea and cough。2021/7/924Injuries of the larynxBurn of the larynxClinical manifestations: severe cases: injury extends to the bronchi and pulmonary alveolaedema, erosion, ulceration, necrosis of the mucosacough, severe dyspnea and coma.2021/7/925Injurie

18、s of the larynxBurn of the larynxtreatment：mild cases：anti-infection, corticosteroids, maintenance of circulation and electrolytes. moderate cases：tracheotomysevere cases：anti- shock2021/7/926Injuries of the larynxIntubation injuriesMost endolaryngeal injuries result as a complication of intubation.

19、This can occur as a result of technique problem or from trauma to the glottis or subglottis from the endotracheal tube.2021/7/927 Injuries of the larynxGranuloma caused by intubationCauses：injury during the intubation, long time intubation Symptom：hoarsness2021/7/928Injuries of the larynxIntubation

20、injuries The best management for intubation trauma is prevention.Correct techniques of intubation.Correctly sized endotracheal tube.Performing all intubation in a controlled manner.2021/7/929Injuries of the larynxTreatment of laryngeal Granuloma ：surgerylaservocal rehabilitation2021/7/930Injuries of

21、 the larynxDislocation of cricoarytenoid jointCauses: trauma, intubationTreatment: reduction of cricoarytenoid joint2021/7/931Inflammatory diseases of the larynx Acute epiglottitisA common disease, often misdiagnosed, can cause dyspnea and threaten patients lifecauses：bacterial or viral infection, a

22、llergy, foreign body, trauma, inspiration of chemicals, spread of inflammation from pharyngitis 2021/7/932Inflammatory diseases of the larynxAcute epiglottitissymptoms：acute onset, high fever, sore throat, dysphagia, unclear articulation, dynpnea2021/7/933Inflammatory diseases of the larynxAcute epi

23、glottitisexam：oropharynx is normal, congestion and edema of the epiglottis, difficult to explore the vocal cords 2021/7/934Acute epiglottitis2021/7/935Inflammatory diseases of the larynxAcute epiglottitistreatment： systemic administration of antibiotics and corticosteroid. tracheotomy if necessary i

24、ncise the epiglottic abscess if it is formed2021/7/936Inflammatory diseases of the larynxAcute laryngitiscauses：infection, vocal overuse, inhalation of toxic gassymptoms：hoarseness, sore throat, cough2021/7/937Inflammatory diseases of the larynxAcute laryngitisexam：diffused congestion and edema of t

25、he vocal cordstreatment：vocal rest, nebulization therapy with antibiotics, steroid and traditional Chinese medicines2021/7/938Inflammatory diseases of the larynxAcute laryngitis in childrenOften occurred in children from 6m3ycauses：caused by infectious diseases or upper respiratory tract infection20

26、21/7/939Inflammatory diseases of the larynxAcute laryngitis in childrensymptoms：1. cough，2. Three-concave sign, inspiratory dyspnea, fever and restlessnessexam：congestion and edema of laryngeal mucosa, especially subglottic mucosa 2021/7/940Inflammatory diseases of the larynx Acute laryngitis in chi

27、ldrendifferential diagnosis：glottic spasm, foreign body of respiratory tract, diphtheriatreatment： antibiotic and steroid tracheotomy if necessary supporting treatment2021/7/941 Inflammatory diseases of the larynx Chronic laryngitiscauses： occupational（teachers, shop employees chronic inflammation o

28、f nose, sinus and pharynx acute laryngitis lower respiratory tract infection long term inspiration of toxic gas2021/7/942Inflammatory diseases of the larynx Chronic laryngitissymptoms：repeated hoarseness, discomfort and foreign body sensation of the throatexam：chronic congestion of laryngeal mucosa

29、with mild edema, VC hypertrophy or atrophytreatment: etiological treatment, traditional Chinese medicine2021/7/943 Inflammatory diseases of the larynxVocal nodules & polypscauses：vocal overuse and abusesymptom：hoarsenessexam: laryngoscopic examination2021/7/944Inflammatory diseases of the larynxtrea

30、tment：complete vocal rest and nebulization therapysurgery：under direct laryngoscope, fiberscope and microscope2021/7/945Vocal nodules and polyps2021/7/946Vocal cord cyst2021/7/947Neurological and functional diseases of the larynxLaryngeal paraesthesiaHypersensitivity of laryngeal mucosa to normal st

31、imulationcauses：persistent laryngeal irritation (food, cigarette, chronic laryngitis and vocal overuse)2021/7/948Neurological and functional diseases of the larynxLaryngeal paraesthesiasymptoms：“pins and needles”sensation, laryngeal discomfort and soreness2021/7/949Neurological and functional diseas

32、es of the larynxLaryngeal paraesthesiaexam：larynx is normal. treatment：etiological treatment and traditional chinese medicine2021/7/950Neurological and functional diseases of the larynxLaryngeal anaesthesiaAnatomyThe larynx is supplied by two branches of vagus nerve: the SLN and RLN.The SLN divides

33、extralaryngeally into the internal branch, which supplies sensory innervation to the laryngeal cavity above the glottis, and the external branch, which supplies the cricothyroid muscle.2021/7/951Neurological and functional diseases of the larynxLaryngeal anaesthesiaLaryngeal anaesthesia is caused by

34、 the disorders of superior laryngeal nerve2021/7/952Neurological and functional diseases of the larynxLaryngeal anaesthesiausually accompanied by laryngeal paralysisCauses: Central: tumors, trauma, hemorrhage, thrombosis, multiple sclerosis, etc. Peripheral: trauma, surgery, tumors , acute inflammat

35、ory diseases.2021/7/953Neurological and functional diseases of the larynxSymptom: Aspiration is the main complain Management: Rehabilitation for mild cases, naso-gastric tube for severe cases2021/7/954Neurological and functional diseases of the larynxLaryngeal paralysisAnatomyThe RLN supplies motor

36、innervation to all the intrinsic laryngeal muscles of the same side except for the cricothyroid muscle.2021/7/955Neurological and functional diseases of the larynxLaryngeal paralysisAnatomyOn its passage back to the larynx the right RLN crosses the right subclavian artery, and the left RLN winds aro

37、und the arch of aorta in close relation to the heart. 2021/7/956Neurological and functional diseases of the larynxLaryngeal paralysisAnatomyThe ascent of the RLN occurs in groove between the trachea and the esophagus. Thus the swelling of any of these structures may cause pressure on RLN. 2021/7/957

38、Neurological and functional diseases of the larynxLaryngeal paralysisParalysis of the laryngeal muscles originated in one of two areas: the CNS or the peripheral motor nerves.In most cases (90%), laryngeal paralysis is the result of peripheral nerve involvement. 2021/7/958Neurological and functional

39、 diseases of the larynxLaryngeal paralysisCauses：Trauma：skull base, neck, thyroid surgery. Tumors：skull base, NPC, thyroid gland, mediastinum, esophagus, or larynx. Infection：virus.2021/7/959Neurological and functional diseases of the larynxLaryngeal paralysisUnilateral or Bilateral2021/7/960Neurolo

40、gical and functional diseases of the larynxLaryngeal paralysisClinical manifestations： Unilateral RLN paralysis Hoarseness is the main complain. Laryngoscopic examination shows the involved VC fixed in the paramedian position.2021/7/961 Vocal paralysis2021/7/962Neurological and functional diseases o

41、f the larynxLaryngeal paralysisClinical manifestations： In bilateral paralytic cases, dyspnea is the main symptom, without hoarseness. Laryngoscopic examination shows both VC are fixed with narrow glottis.2021/7/963Neurological and functional diseases of the larynxLaryngeal paralysisTreatment： Etiol

42、ogical treatment Unilateral paralysis：medicines, physiotherapy, mobilization of arytenoid cartilage, submucosa injection of fax and thyroplasty. 2021/7/964Neurological and functional diseases of the larynxLaryngeal paralysisTreatment： Bilateral paralysis：tracheotomy for patients with dyspnea. If no

43、recovery after 6M of conservative treatment, lateralization of the arytenoid cartilage or reinnervation surgery could be considered.2021/7/965Neurological and functional diseases of the larynxInfantile laryngeal spasmcause：probably related to hypocalcemiasymptoms：often onset at night, having inspira

44、tory dyspnea, often released by deep inspirationtreatment：calcium supplement and vitamin D2021/7/966Neurological and functional diseases of the larynxHysterical aphoniacause：psychological factorsclinical manifestations：sudden onset of aphonia, but the patient can cough. 2021/7/967Neurological and fu

45、nctional diseases of the larynxHysterical aphoniaexam: laryngoscopic examination find slight abducent of VC. VC can adduct during cough and smile.treatment：etiological treatment, suggestive treatment+strong stimulation2021/7/968 Tumors of the larynxBenign tumors Papilloma of the larynxMost common be

46、nign tumor of the larynx and occurs in patients of all age. The causative agent is thought to be HPV.Papillomas usually regress during puberty.2021/7/969Tumors of the larynx Papilloma of the larynxUsually involving the true vocal cords but may affect supraglottic and subglottic regions.May also invo

47、lve the trachea and bronchus. 2021/7/970 Tumors of the larynx papilloma of the larynxPapillomas in juveniles is more often multiple and recurs more frequently than in adults.Papillomas in adults are usually single but may undergo malignant change (HPV 16，18).2021/7/971Tumors of the larynx papilloma

48、of the larynxSymptoms:Aphonia or weak cry is usually the first sign in infants.Dyspnea and stridor are seen.Hoarseness is the most common symptom in adults. 2021/7/972 Tumors of the larynx papilloma of the larynxLaryngoscopic examination：the tumor is pink or dark red in color. The surface of the tum

49、or is rough and papillary. The tumor is located in VC, false VC or subglottic area. 2021/7/973 Papilloma2021/7/974 Tumors of the larynx papilloma of the larynxtreatment： excision under microlaryngoscopy is the most commonly employed treatment modality. Repeated operations are usually needed in child

50、ren. 2021/7/975Tumors of the larynx papilloma of the larynxCo2 laser is favored because of its hemostatic properties and its precision allows for vaporization of the lesion. Tracheotomy is occasionally indicated in children with dyspnea, but should be avoided due to concern about subglottic spread.2

51、021/7/976Tumors of the larynx papilloma of the larynx transfer factor, interferon and antivirotics. Cidofovir , a new antiviral agent approved for ocular cytomegalovirus infections, has shown promise as a local injection in adjuvant therapy. Autogenous vaccine.2021/7/977Tumors of the larynx Hemangio

52、maHemangiomas are more common in children than in adults.They occur on VC, subglottic regions and pyriform sinus.Subglottic hemangioma is the common neoplasm of the infant airway.2021/7/978 Hemangioma of the larynx Hemangiomaclassification： capillary （common，red） cavernous （less common, dark red） sy

53、mptoms：hemorrhage, hoarsenesstreatment：laser, injection of sclerosing agent, and surgical excision.2021/7/979Tumors of the larynx Fibroma and neurofibroma of the larynxsymptoms：hoarseness and dyspneaexam: smooth tumor on the VC, pale or dark red in color. treatment：surgical treatment2021/7/980 Carci

54、noma of the larynxEpidemiologyAccounts for 1% of all new cancers diagnosed in the U.S. and 0.75% of all cancer deaths.Accounts for 30% in all head and neck cancers. More frequently happened in patients at 5070 years of age.M:F ratio: 510:1 (foreign country)，6.75:1(shanghai).2021/7/981Carcinoma of th

55、e larynxEtiologyCigaretteWine (combined smoking and alcohol abuse increases the risk by 50% over the additive rate )air pollutionVirus (HPV)precancerous lesions (Leukoplakia, Papilloma)sex hormones2021/7/982 Leukoplakia of the larynx2021/7/983Carcinoma of the larynxPathologyNearly 98% are squamous c

56、ell carcinoma. adenocarcinoma and undifferentiated carcinoma is rare.2021/7/984 Carcinoma of the larynxClinical classification:Glottic (60%)：well differentiated, late metastasisSupraglottic (30%)：poor differntiated, early metastasis Subglottic (6%)：poor differentiated, early metastasis2021/7/985Anat

57、omic divisions of the larynx2021/7/986Carcinoma of the larynxSpread of tumor Direct spreadSupraglottic cancer epiglottis, pre-epiglottic space, vallecula, and tongue base. piriform sinus, lateral wall of hypopharynx. paraglottic space, ventricle or the VC.2021/7/987Carcinoma of the larynxSpread of t

58、umor Direct spreadGlottic cancer anteriorly, contralateral VC. posteriorly, arytenoid cartilage superiorly, supraglottic area. inferiorly, paraglottic space and subglottic area.2021/7/988Carcinoma of the larynxSpread of tumor Direct spreadSubglottic cancer superiorly, glottis. anteriorly and lateral

59、ly, strap muscle and thyroid gland. posteriorly, esophagus.2021/7/989Carcinoma of the larynxSpread of tumor Lymph nodes metastasesSupraglottic cancer have a propensity to spread to cervical lymph nodes bilaterally at the early stages. Generally, the risk of occult or actual metastases from T1, T2, T

60、3 and T4 tumors is 20, 40, 60, and 80%. 2021/7/990Carcinoma of the larynxSpread of tumor Lymph nodes metastasesGlottic cancer CV is virtually devoid of lymphatics, involvement of cervical nodes at the early stages is not common. 8% of patients with T1 and T2 tumors will have nodal involvement.2021/7