COCLIA 73 Benign Laryngeal Lesions


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1 : Benign Laryngeal Lesions Joshua David Rosenberg, MD
2 :
3 : 1. Vocal Fold Anatomy
4 : 2. Lamina Propia/TVC Physiology Cover Body Theory
5 : 3. Reinke’s Edema: Bilateral Diffuse Polyposis Smoking, talking Edema, vascular congestion, venous stasis Called “Sir” on phone
6 : 3. Reinke’s Cont Smoking Cessation Thyroid function (rare) Vocal Therapy Surgery Mucosal preservation
7 : 4. The Saccule AKA: the laryngeal appendix Anterior aspect of laryngeal ventricle Significant size variation 6 to >15 mm Mucous glands No known function
8 : Terminology Saccular cyst Laryngocele Laryngopyocele
9 : Pathophysiology High transglottic pressure Wood/brass players Glass blowers Yellers! Saccule outflow obstruction Malignancy Prior surgery
10 : Classification Laryngocele Internal External Combined
11 : Classification Saccular Cyst Anterior Lateral
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17 : Treatment Laryngocele External vs. Internal Laryngofissue Micolaryngoscopy Via thyro-hyoid membrame Saccular cyst endoscopy
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19 : 7. Intracordal Cysts Mucous Retention Plugged mucous gland Less dysfunction than expected Epidermoid Accumulated keratin Congenital vs. trauma Diplophonia at specific frequnecies More dysfunction than expected Rupture can lead to Sulcus
20 : 7. Intracordal Cysts
21 : 8. Sulcus Vocalis Type 1: Physiologic Sulcus Type 2/3: Pathologic Sulcus Mucosa anchored to vocal ligament Vocal Stiffness (reduced mucosal wave) Type 2: along medial TVC edge Type 3: medial pit (sulcus vocalis)
22 : Sulcus Vocalis
23 : Sulcus Vocalis
24 : Sulcus Vocalis Medical Intercurrent medical conditions Voice Therapy Surgery Injection: Autologous fat, collagen Lysis and Excision technically difficult
25 : Sulcus Vocalis
26 : 9. Post Intubation Consult Contact Granuloma mucosal disruption Medical Antibiotic Antireflux Voice Therapy Surgery Corticosteriod Injection Minimal mucosal disruption Mitomycin C
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28 : 10, 11. HPV Adults and children Association w/ maternal genital infection (1:400) HPV 6, 11 SCCa – type 11 Tracheal bronchial involvemtn correlated w/ repeat procedures , laryngeal involvement Laser vs. Microdebrider
29 : 12. Cidofovir Antiviral medication CMV retinitis Inhibits DNA polymerase Intralesional injection Mixed results 30-75% cure significant decrease in disease severity Risks of scarring. atrophy No neutropenia or nephrotoxicity
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31 : 13. RRP Medical Therapy Interfuron Celebrex HPV Vaccine 6, 11, 16, 18 Photodynamic Therapy Indole-3-Carbinol cruciferous vegetables
32 : 14. Post-Op Dysphonia Diagnosis History Video Stroboscopy Medical Management Voice Therapy Voice Building Surgery Injection Medialization
33 : 15. Post-op Phonosurgery Hydration Medications: Antireflux, Antibiotics, Corticosteriods Voice Rest No solid data, no uniform protocol 5-8 days followed by gentle voice building Singing 3-6 weeks Consider stroboscopy Professional singers: Speech Pathologist!

 

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