SACCULE (appendix of ventricle)   • Diverticulum extending from ventricle • Between the vestibular fold, thyroarytenoid & thyroid cartilage• Contains mucous glands , lubricates the vocal folds

CONUS ELASTICUS Elastic tissue layer extending from vocal ligaments to cricoid arch, attaches to inner thyroid lamina & arytenoids

anterior & lateral to epiglottis

Inferolaterally continuous with paraglottic space

PRE EPIGLOTTIC SPACE OF BOYER

PARAGLOTTIC SPACE

Adipose tissue, internal laryngeal nerve, laryngeal saccule

Lat. – thyroid cartilage & thyrohyoid membrane

Superomed. – quadrangular membrane

Inferomed. - conus elasticus

Superiorly continuous with pre – epiglottic space

SITE SUBSITE

Supraglottis Suprahyoid epiglottisInfrahyoid epiglottisAryepiglottic foldsArytenoidsVentricular bands (false vocal cords)

Glottis True vocal cords+ ant and post. Commissure +rima glottidis(slit)

Subglottis Subglottic space upto lower border of cricoid

2.63% of all the body cancers in India

M:F = 10:1

40- 70 years

female incidence increasing

Black tobacco > light tobacco - aromatic amines and tobacco specific nitrosamines & Tar content. Non filter cigarettes > filter cigarettes - tar content Smoking hand-rolled cigarettes > commercially manufactured cigarettes - 2.7* risk. Chewing tobacco or inhaling snuff - 50% in risk. Risk of developing ca larynx decreases with increasing time since cessation of smoking, indicating tobacco as a promoter and initiator in carcinogenesis.

SMOKING

Alcohol formaldehyde

( ) vit. A synthesis

mucosal de-epithelisation

mucosa exposed

Serum IgA levels in patients with alcoholic liver disease

Associated malnutrition

15* RISK

OCCUPATIONAL EXPOSURE - asbestos, mustard gas, process of isopropyl alcohol manufacturing, nickel refining, soot, tars, acid mists, beryllium and bischloromethyl ether & the glass wool production.

GENETIC - Japanese and Russian

VIRUSES - HSV, HPV, EBV ( EBV- specific IgA antibodies block IgG mediated tumor destruction).

Previous RADIATION to head & neck

Low SOCIOECONOMIC STATUS - smoking habits

SUPRAGLOTTIC CANCER

site - epiglottis > false cords > aryepiglottic folds

Spread - vallecula, base of tongue & pyriform fossa. Cancer of infrahyoid epiglottis & anterior ventricular band extend into pre-epiglottic space and penetrate the thyroid cartilage.

Symptoms: Early -Throat pain Dysphagia Ipsilateral otalgia LN mass in the neck.

Late - Weight loss Respiratory obstruction Halitosis (tumor necrosis)

Nodal mets - upper and middle jugular nodes. Bilateral mets (epiglottis)

Supraglottic growths

GLOTTIC CANCER

Most common site - Free edge and upper surface of the vocal cords in its anterior and middle third

spread- anteriorly - anterior commissure &opposite cord posteriorly - vocal process and arytenoids upward – ventricle & false cord downwards - subglottis

Symptoms : Early - Hoarseness

Late – Stridor Laryngeal obstruction (increased size, edema/ cord fixation)

Nodal mets – practically absent, if early stage

Glottic growths

SUBGLOTTIC CANCER

spread – anteriorly - anterior wall to the opposite sidedownwards - trachea.Upward spread – lateMainly invade cricoid & thyroid cartilagesExtralaryngeal spread characteristic

Site - subglottis

Symptom: Early - Stridor Laryngeal obstruction

Late – Hoarseness

Nodal mets - prelaryngeal pretracheal (delphian) paratracheal lower jugular

Subglottic growths

Broadening of the larynx Loss of crepitation Tenderness of larynx Weight loss Chronic cough; Hemoptysis

DysphagiaOdynophagiaIpsilateral otalgia Halitosis Mass in the neck

HISTORY: “patient in cancer age group having persistent or gradually increasing hoarseness of voice for 3 weeks must have laryngeal examination to exclude cancer”

Persistent hoarsenessDyspnea and stridor

Hoarseness of voice

Have you heard a patient with hoarseness of voice beforet.mp4 - YouTube - Copy.mp4

THANK YOU ALL MY FRIENDS FOR BEING PATIENT AND LISTENING ME

Happy Independence Day

Jai Hind !!!