 |
| Ca larynx |
Ca larynx
Aetiology:
@ male preprondrance (10:1)@ age: 40 to 70 yrs
@ tobacco alcohol: cigarrette smoke contains benzopyrine and other hydrocarbons
@ previous radiation to neck for benign lesions or laryngeal papilloma
@ genetic factor: familial laryngeal malignancy
@ occupational exposure to asbestose, mustard gas and petrolium products
CLASSIFICATION OF SITE AND VARIOUS SUBSITES UNDER EACH SITE IN LARYNX
A) SUPRAGLOTIS:i) lingual and laryngeal surfaces of suprahyoid epiglottis
ii) infrahyoid epiglottis
iii) aryepiglottic folds
iv) arytenoids
v) ventricular bands
B) GLOTTIS
true vocal chords (ant and post. commissure)
C) SUBGLOTTIS
upto lower border of cricoid cartilage
TNM CLASSIFICATION
A) Supraglottis:
T1: tumour limited to one subsite with normal vocal chord mobilityT2: Tumour invades mucosa more than one adjuscent subsite of supraglottis or glottis or region outside sgtis (mucosa of base of tounge vallecula medial wall of pyriform sinus) without fixation of larynx
T3: Limited to larynx with vocal chord fixation and or invades- portcricoid area, preepiglottic tissues paraglottic space and minor thyroid cartilage.
T4a: Invades through thyroid cartilage and or invades tissue beyond larynx (trachea strap muscles thyroid or oesophagus)
T4b: Invades prevertibral space encases carotid artery or mediastenal structures
B) GLOTTIS
T1: limited to vocal chord with normal mobilityT1a: limited to 1 vocal chord
T1b: both
T2: extends to supraglottis and or subglottis and or with vocal chord mobility
T3: lmtd to lx with vocal chord fixation and or invades paraglottic space and or minor thyoid cart. erosion
T4a: invds thyroid cart. and or invds tissues beyond lx
T4b: Invades prevertibral space encases carotid artery or mediastenal structures
C) SUBGLOTTIS
T1: lmtd to subglottisT2: extends to vocal chord with normal mobility
T3: lmtd to lx with vocal cord fixn
T4a: invds cricoid or thyroid cart. and or invds tissues beyond lx
T4b: Invades prevertibral space encases carotid artery or mediastenal structures
Regional lymph nodes(LN)
Nx: LN cnt b assessedNo: no regional LN metastasis
N1: metastasis in single epsilateral LN. 3 cm or less in greatest dimension
N2a: metastasis in single epsilateral LN. more than 3 cm bt less than 6 cm in greatest dimension
N2b: metastasis in multiple epsilateral LN. none more than 6 cm in greatest dimension
N2c: metastasis in bilateral or quantralateral LNs. none more than 6 cm in greatest dimension
N3: metastasis in LN more than 6 cm in greatest dimension
Distant metastasis:(M)
Mx: distant metastasis cnt b assessedMo: no distant metastasis
M1: distant metastasis
VOCAL REHABILITATION AFTER TOTAL LARYNGECTOMY
i) oesoqhageal speach:pt. taught 2 swallow air and hold it in upper oesophagus and then slowly ejject it into pharyx
ii) artificial laryx:
a) electrolarynx
b) transoral pneumatic device
iii) tracheo-oesophageal speach
an attepmt is made to carry air frm trachea to oesoqgus or hypopharynx by d creation of skin lined fistula or by basement of an artificial prosthesis
artificial prosthesis:
a) Blom-Singer prosthesis
b) Panje prosthesis
EmoticonEmoticon