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Laryng-anom-cong-slides-051102

Laryng-anom-cong-slides-051102 - Congenital Laryngeal...

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Congenital Laryngeal Anomalies Jean Paul Font, MD Seckin Ulualp, MD University of Texas Medical Branch Department of Otolaryngology November 2, 2005
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Outline Laryngeal Anatomy, Embryology & Function Laryngomalacia Laryngoceles & Saccular Cyst Vocal Cord Paralysis Congenital Laryngeal Web & Atresia Congenital Subglottic Stenosis Laryngeal & laryngotracheoesophageal clefts Subglottic Hemangiomas
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Laryngeal Anatomy Differences in Adults vs Infants 1/3 size at birth Narrow dimensions of subglottis and glottis subglottis is the narrowest (4-5mm in diameter) Higher in the neck C4 at birth vs C6-7 at 15 y/o Epiglottis is narrower
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Laryngeal Embryology Laryngeal development 3 rd week Respiratory primordium is derived from primitive foregut 4 th -5 th weeks Tracheoesophageal (TE) septum forms by fusion of (TE) folds
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Laryngeal Embryology Larynx develops from the 4 th & 5 th arches Primitive laryngeal aditus is T-shaped with 3 eminences Hyobranchial eminence becomes the epiglottis 2 nd & 3 rd eminence develops into the arytenoids Laryngeal lumen obliterates & then recanalize by the 10 th week
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Laryngeal Function Laryngeal Function Breathing Passage Airway protection Aid in the clearance of secretion Vocalization Symptoms of Laryngeal Anomalies Airway obstruction Feeding difficulties Abnormalities of Phonation
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Airway Obstruction Symptoms Stridor Increase work of breathing with retraction, nasal flaring & tachypnea apnea episodes, cyanosis & sudden death Stridor Inspiratory stridor (Supraglottic & glottic) Collapse during negative inspiratory pressure Biphasic stridor (Subglottic) Expiratory stridor (lower tracheobronchial tree)
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Airway protection First level- Epiglottis, aryepiglottic folds & arytenoids Second level- False vocal folds Third level- True vocal folds Anomalies of any of this structures lead to aspiration and swallowing dysfunction Symptoms- coughing, choking and gagging episodes, stasis of secretion, and recurrent pneumonia
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Phonatory abnormality Dependent on the level of abnormality Muffled cry suggest supraglottic obstruction High pitch or absent cry is associated with glottic abnormalities
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Laryngomalacia Most common congenital laryngeal anomaly (50-75%) Most frequent cause of stridor in children Male predominance 2:1 Flaccidity of supraglottic laryngeal tissues Characterized by inward collapse of supraglottic structures during inspiration
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Anatomic Abnormalities Anatomic Abnormalities Epiglottis Long tubular Displaced posteriorly on inspiration Inferior collapse to the vocal folds Short aryepiglottic folds Inward collapse of aryepiglottic folds (primarily cuneiform cartilages) Anteromedial collapse of the arytenoid cartilages
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Laryngomalacia Symptoms Airway obstruction Mild to moderate obstruction Stridor exacerbated by exertion
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