喉部受傷教學課件

InjuriesofthelarynxInjurytothelarynxisuncommon.Theinferiorprojectionofthemandibleaffordssignificantprotectionfromanteriorblows.Posteriorly,thelarynxisprotectedbytherigidcervicalspine.2021/7/91InjuriesofthelarynxWithinthenecktherearesomeelementsnecessarytoconnectandcoordinatetheheadwiththebody.Injurytotheneckcandisruptanyofthesevitalfunctionsandmayinvolvebony,softtissue,vascular,andCNSelements.2021/7/92InjuriesofthelarynxAlthoughmanyassociatedinjuriesmayappearmoreimpressive,correctmanagementoftheneckinjurywithimmediateattentiontosecuringtheairwaysisalwaysthefirstpriority.2021/7/93Injuriesofthelarynx

Classification⒈Externallaryngealtrauma：closedinjury—contusion,crushinjuryopeninjury—incisedwound,stabwound,burstwound，bullettrauma.⒉Internallaryngealinjury：

burnofthelarynx,intubation2021/7/94InjuriesofthelarynxClosedinjuriesofthelarynxCauses：directattackindustrialaccidenttrafficaccident2021/7/95InjuriesofthelarynxAnteriorbluntinjuriesaremostcommonlytheresultofmotorvehicleaccidents.2021/7/96InjuriesofthelarynxMandatoryseatbeltlawslowerspeedlimitsbettereducationregardingdrunkdrivingtheusefrontseatairbags

mayreducethisaccident

!2021/7/97InjuriesofthelarynxClotheslineinjuriesoccurwhentheriderofamotorcycleencountersafixedhorizontalobject,suchasaclothesline.Thistypeofinjuryimpartsalargeamountofenergyoverarelativelysmallarea,resultinginmassivetrauma.2021/7/98InjuriesofthelarynxStrangulationinjuriesoccurfrommanualcompressionorfromattemptedsuicidesbyhanging.Theseinjuresmaylaterbeassociatedwithmarkededemaofthelarynxandresultantlossofairway.2021/7/99InjuriesofthelarynxClosedinjuriesofthelarynxSymptoms：dyspnea,dysphagia,sorethroat,tendernessofthelarynx,hoarseness,hemoptysisandshock2021/7/9109、人的價值，在招收誘惑的一瞬間被決定。2023/2/32023/2/3Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。2023/2/32023/2/32023/2/32/3/20234:33:28PM11、人總是珍惜為得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人亂于心，不寬余請。2023/2/32023/2/32023/2/3Friday,February3,202313、生氣是拿別人做錯的事來懲罰自己。2023/2/32023/2/32023/2/32023/2/32/3/202314、抱最大的希望，作最大的努力。03二月20232023/2/32023/2/32023/2/315、一個人炫耀什么，說明他內心缺少什么。。二月232023/2/32023/2/32023/2/32/3/202316、業(yè)余生活要有意義，不要越軌。2023/2/32023/2/303February202317、一個人即使已登上頂峰，也仍要自強不息。2023/2/32023/2/32023/2/32023/2/32021/7/911InjuriesofthelarynxClosedinjuriesofthelarynxPhysicalexam：swelling,ecchymosis,subcutaneousemphysema(crepitus)Layngoscopy：edema,malformationoftheglottis,disturbanceofthevocalmobility2021/7/912InjuriesofthelarynxClosedinjuriesofthelarynxTreatment：

⒈Inapatientwithmajorlaryngealinjury,thefirstpriorityistoestablishanairway.Ifthepatienthasdyspnea,emergenttracheotomyorcricothyroidotomyshouldbeperformed.2021/7/913InjuriesofthelarynxClosedinjuriesofthelarynxTreatment：⒉Ifthepatientisbreathingwellandtheinjurydoesnotrequiresurgicalcare,observationwithouttracheotomymaybeindicated.2021/7/914InjuriesofthelarynxClosedinjuriesofthelarynxTreatment：⒊Antibioticsandcorticosteroidcanbeusefulifadministeredsoonafterinjury.2021/7/915InjuriesofthelarynxClosedinjuriesofthelarynxTreatment：⒋Repairoflaryngealcartilageisindicatedifmultipleordisplacedfractureofthethyroidcartilageandthecricoidcartilagehappened.2021/7/916InjuriesofthelarynxClosedinjuriesofthelarynxTreatment：⒌Feedingvianasogastrictubeisnecessary.2021/7/917InjuriesofthelarynxIncisedwound,stabwoundPenetratingwoundofthelarynxusuallyaccompanytheinjuryofthemajorvesselsoftheneck2021/7/918InjuriesofthelarynxIncisedwound,stabwoundCauses:fight,trafficaccident,explosion，gunshot2021/7/919InjuriesofthelarynxIncisedwound,stabwoundSymptoms:bleeding—shockdyspneadysphagiasubcutaneousemphysemahoarseness2021/7/920Injuriesofthelarynx

Incisedwound,stabwoundTreatment⒈Controlthebleeding,antishock,maintaintheairway—thefirstpriority⒉disinfectandcleanthewound,repairthedamages,laryngealstenting⒊nasogastrictubefeeding2021/7/921InjuriesofthelarynxBurnofthelarynxTheburnofthelarynxisusuallyassociatedwithburnstotheclosedareasandotherpartsofthebody.Causes：inspiration—hotair,fume,toxicgas,steametc.byaccidentswallow—strongacidandalkali.2021/7/922

InjuriesofthelarynxBurnofthelarynxClinicalmanifestations:⒈

mildcases:

injurylimitedtotheglotticandsupraglotticarea—congestionandswellingofthemucosa—pain,dysphagiaandhoarseness.2021/7/923

InjuriesofthelarynxBurnofthelarynxClinicalmanifestations:⒉

moderatecases:injuryextendstothetrachea—edemaanderosion—dyspneaandcough。2021/7/924InjuriesofthelarynxBurnofthelarynxClinicalmanifestations:⒊severecases:injury

extendstothebronchiandpulmonaryalveola—edema,erosion,ulceration,necrosisofthemucosa—cough,severedyspneaandcoma.2021/7/925InjuriesofthelarynxBurnofthelarynxtreatment：mildcases：anti-infection,corticosteroids,maintenanceofcirculationandelectrolytes.moderatecases：tracheotomyseverecases：anti-shock2021/7/926InjuriesofthelarynxIntubationinjuriesMostendolaryngealinjuriesresultasacomplicationofintubation.Thiscanoccurasaresultoftechniqueproblemorfromtraumatotheglottisorsubglottisfromtheendotrachealtube.2021/7/927InjuriesofthelarynxGranulomacausedbyintubationCauses：injuryduringtheintubation,longtimeintubationSymptom：hoarsness2021/7/928InjuriesofthelarynxIntubationinjuries

Thebestmanagementforintubationtraumaisprevention.Correcttechniquesofintubation.Correctlysizedendotrachealtube.Performingallintubationinacontrolledmanner.2021/7/929InjuriesofthelarynxTreatmentoflaryngealGranuloma

：surgerylaservocalrehabilitation2021/7/930

InjuriesofthelarynxDislocationofcricoarytenoidjointCauses:trauma,intubationTreatment:reductionofcricoarytenoidjoint2021/7/931Inflammatorydiseasesofthelarynx

AcuteepiglottitisAcommondisease,oftenmisdiagnosed,cancausedyspneaandthreatenpatient’slifecauses：bacterialorviralinfection,allergy,foreignbody,trauma,inspirationofchemicals,spreadofinflammationfrompharyngitis2021/7/932InflammatorydiseasesofthelarynxAcuteepiglottitissymptoms：acuteonset,highfever,sorethroat,dysphagia,uncleararticulation,dynpnea2021/7/933InflammatorydiseasesofthelarynxAcuteepiglottitisexam：oropharynxisnormal,congestionandedemaoftheepiglottis,difficulttoexplorethevocalcords2021/7/934Acuteepiglottitis2021/7/935InflammatorydiseasesofthelarynxAcuteepiglottitistreatment：⒈systemicadministrationofantibioticsandcorticosteroid.⒉tracheotomyifnecessary⒊incisetheepiglotticabscessifitisformed2021/7/936InflammatorydiseasesofthelarynxAcutelaryngitiscauses：infection,vocaloveruse,inhalationoftoxicgassymptoms：hoarseness,sorethroat,cough2021/7/937InflammatorydiseasesofthelarynxAcutelaryngitisexam：diffusedcongestionandedemaofthevocalcordstreatment：vocalrest,nebulizationtherapywithantibiotics,steroidandtraditionalChinesemedicines2021/7/938InflammatorydiseasesofthelarynxAcutelaryngitisinchildrenOftenoccurredinchildrenfrom6m~3ycauses：causedbyinfectiousdiseasesorupperrespiratorytractinfection2021/7/939InflammatorydiseasesofthelarynxAcutelaryngitisinchildrensymptoms：1.cough，2.Three-concavesign,⒊inspiratorydyspnea,⒋feverandrestlessnessexam：congestionandedemaoflaryngealmucosa,especiallysubglotticmucosa2021/7/940Inflammatorydiseasesofthelarynx

Acutelaryngitisinchildrendifferentialdiagnosis：glotticspasm,foreignbodyofrespiratorytract,diphtheriatreatment：⒈antibioticandsteroid⒉tracheotomyifnecessary⒊supportingtreatment2021/7/941

Inflammatorydiseasesofthelarynx

Chroniclaryngitiscauses：⒈occupational（teachers,shopemployees⒉chronicinflammationofnose,sinusandpharynx⒊acutelaryngitis⒋lowerrespiratorytractinfection⒌longterminspirationoftoxicgas2021/7/942Inflammatorydiseasesofthelarynx

Chroniclaryngitissymptoms：repeatedhoarseness,discomfortandforeignbodysensationofthethroatexam：chroniccongestionoflaryngealmucosawithmildedema,VChypertrophyoratrophytreatment:⒈etiologicaltreatment,⒉traditionalChinesemedicine2021/7/943

InflammatorydiseasesofthelarynxVocalnodules&polypscauses：vocaloveruseandabusesymptom：hoarsenessexam:laryngoscopicexamination2021/7/944Inflammatorydiseasesofthelarynxtreatment：completevocalrestandnebulizationtherapysurgery：underdirectlaryngoscope,fiberscopeandmicroscope2021/7/945Vocalnodulesandpolyps2021/7/946Vocalcordcyst2021/7/947NeurologicalandfunctionaldiseasesofthelarynxLaryngealparaesthesiaHypersensitivityoflaryngealmucosatonormalstimulationcauses：persistentlaryngealirritation(food,cigarette,chroniclaryngitisandvocaloveruse)2021/7/948NeurologicalandfunctionaldiseasesofthelarynxLaryngealparaesthesiasymptoms：“pinsandneedles”sensation,laryngealdiscomfortandsoreness2021/7/949NeurologicalandfunctionaldiseasesofthelarynxLaryngealparaesthesiaexam：larynxisnormal.

treatment：etiologicaltreatmentandtraditionalchinesemedicine2021/7/950NeurologicalandfunctionaldiseasesofthelarynxLaryngealanaesthesiaAnatomyThelarynxissuppliedbytwobranchesofvagusnerve:theSLNandRLN.TheSLNdividesextralaryngeallyintotheinternalbranch,whichsuppliessensoryinnervationtothelaryngealcavityabovetheglottis,andtheexternalbranch,whichsuppliesthecricothyroidmuscle.2021/7/951NeurologicalandfunctionaldiseasesofthelarynxLaryngealanaesthesiaLaryngealanaesthesiaiscausedbythedisordersofsuperiorlaryngealnerve2021/7/952NeurologicalandfunctionaldiseasesofthelarynxLaryngealanaesthesiausuallyaccompaniedbylaryngealparalysisCauses:

Central:tumors,trauma,hemorrhage,thrombosis,multiplesclerosis,etc.

Peripheral:trauma,surgery,tumors,acuteinflammatorydiseases.2021/7/953NeurologicalandfunctionaldiseasesofthelarynxSymptom:

AspirationisthemaincomplainManagement:

Rehabilitationformildcases,naso-gastrictubeforseverecases2021/7/954NeurologicalandfunctionaldiseasesofthelarynxLaryngealparalysisAnatomyTheRLNsuppliesmotorinnervationtoalltheintrinsiclaryngealmusclesofthesamesideexceptforthecricothyroidmuscle.2021/7/955NeurologicalandfunctionaldiseasesofthelarynxLaryngealparalysisAnatomyOnitspassagebacktothelarynxtherightRLNcrossestherightsubclavianartery,andtheleftRLNwindsaroundthearchofaortaincloserelationtotheheart.2021/7/956NeurologicalandfunctionaldiseasesofthelarynxLaryngealparalysisAnatomyTheascentoftheRLNoccursingroovebetweenthetracheaandtheesophagus.ThustheswellingofanyofthesestructuresmaycausepressureonRLN.2021/7/957NeurologicalandfunctionaldiseasesofthelarynxLaryngealparalysisParalysisofthelaryngealmusclesoriginatedinoneoftwoareas:theCNSortheperipheralmotornerves.Inmostcases(90%),laryngealparalysisistheresultofperipheralnerveinvolvement.2021/7/958NeurologicalandfunctionaldiseasesofthelarynxLaryngealparalysisCauses：Trauma：skullbase,neck,thyroidsurgery.Tumors：skullbase,NPC,thyroidgland,mediastinum,esophagus,orlarynx.Infection：virus.2021/7/959NeurologicalandfunctionaldiseasesofthelarynxLaryngealparalysisUnilateralorBilateral2021/7/960NeurologicalandfunctionaldiseasesofthelarynxLaryngealparalysisClinicalmanifestations：⒈UnilateralRLNparalysisHoarsenessisthemaincomplain.LaryngoscopicexaminationshowstheinvolvedVCfixedintheparamedianposition.2021/7/961

Vocalparalysis2021/7/962NeurologicalandfunctionaldiseasesofthelarynxLaryngealparalysisClinicalmanifestations：

⒉Inbilateralparalyticcases,dyspneaisthemainsymptom,withouthoarseness.LaryngoscopicexaminationshowsbothVCarefixedwithnarrowglottis.2021/7/963NeurologicalandfunctionaldiseasesofthelarynxLaryngealparalysisTreatment：⒈Etiologicaltreatment⒉Unilateralparalysis：medicines,physiotherapy,mobilizationofarytenoidcartilage,submucosainjectionoffaxandthyroplasty.

2021/7/964NeurologicalandfunctionaldiseasesofthelarynxLaryngealparalysisTreatment：⒊Bilateralparalysis：tracheotomyforpatientswithdyspnea.Ifnorecoveryafter6Mofconservativetreatment,lateralizationofthearytenoidcartilageorreinnervationsurgerycouldbeconsidered.2021/7/965NeurologicalandfunctionaldiseasesofthelarynxInfantilelaryngealspasmcause：probablyrelatedtohypocalcemiasymptoms：oftenonsetatnight,havinginspiratorydyspnea,oftenreleasedbydeepinspirationtreatment：calciumsupplementandvitaminD2021/7/966NeurologicalandfunctionaldiseasesofthelarynxHystericalaphoniacause：psychologicalfactorsclinicalmanifestations：suddenonsetofaphonia,butthepatientcancough.2021/7/967NeurologicalandfunctionaldiseasesofthelarynxHystericalaphoniaexam:laryngoscopicexaminationfindslightabducentofVC.VCcanadductduringcoughandsmile.treatment：etiologicaltreatment,suggestivetreatment+strongstimulation2021/7/968

TumorsofthelarynxBenigntumors⒈PapillomaofthelarynxMostcommonbenigntumorofthelarynxandoccursinpatientsofallage.ThecausativeagentisthoughttobeHPV.Papillomasusuallyregressduringpuberty.2021/7/969Tumorsofthelarynx⒈PapillomaofthelarynxUsuallyinvolvingthetruevocalcordsbutmayaffectsupraglotticandsubglotticregions.Mayalsoinvolvethetracheaandbronchus.2021/7/970Tumorsofthelarynx⒈papillomaofthelarynxPapillomasinjuvenilesismoreoftenmultipleandrecursmorefrequentlythaninadults.Papillomasinadultsareusuallysinglebutmayundergomalignantchange(HPV16，18).2021/7/971Tumorsofthelarynx⒈papillomaofthelarynxSymptoms:Aphoniaorweakcryisusuallythefirstsignininfants.Dyspneaandstridorareseen.Hoarsenessisthemostcommonsymptominadults.2021/7/972Tumorsofthelarynx⒈papillomaofthelarynxLaryngoscopicexamination：thetumorispinkordarkredincolor.Thesurfaceofthetumorisroughandpapillary.ThetumorislocatedinVC,falseVCorsubglotticarea.2021/7/973

Papilloma2021/7/974Tumorsofthelarynx⒈papillomaofthelarynxtreatment：⑴excisionundermicrolaryngoscopyisthemostcommonlyemployedtreatmentmodality.Repeatedoperationsareusuallyneededinchildren.2021/7/975Tumorsofthelarynx⒈papillomaofthelarynxCo2laserisfavoredbecauseofitshemostaticpropertiesanditsprecisionallowsforvaporizationofthelesion.⑵Tracheotomyisoccasionallyindicatedinchildrenwithdyspnea,butshouldbeavoidedduetoconcernaboutsubglotticspread.2021/7/976Tumorsofthelarynx⒈papillomaofthelarynx⑶transferfactor,interferonandantivirotics.Cidofovir,anewantiviralagentapprovedforocularcytomegalovirusinfections,hasshownpromiseasalocalinjectioninadjuvanttherapy.⑷Autogenousvaccine.2021/7/977Tumorsofthelarynx⒉HemangiomaHemangiomasaremorecommoninchildrenthaninadults.TheyoccuronVC,subglotticregionsandpyriformsinus.Subglottichemangiomaisthecommonneoplasmoftheinfantairway.2021/7/978Hemangiomaofthelarynx⒉Hemangiomaclassification：⑴capillary（common，red）⑵cavernous（lesscommon,darkred） symptoms：hemorrhage,hoarsenesstreatment：laser,injectionofsclerosingagent,andsurgicalexcision.2021/7/979Tumorsofthelarynx⒊Fibromaandneurofibromaofthelarynxsymptoms：hoarsenessanddyspneaexam:smoothtumorontheVC,paleordarkredincolor.treatment：surgicaltreatment2021/7/980

CarcinomaofthelarynxEpidemiologyAccountsfor1%ofallnewcancersdiagnosedintheU.S.and0.75%ofallcancerdeaths.Accountsfor30%inallheadandneckcancers.Morefrequentlyhappenedinpatientsat50~70yearsofage.M:Fratio:5~10:1(foreigncountry)，6.75:1(shanghai).2021/7/981CarcinomaofthelarynxEtiologyCigaretteWine(combinedsmokingandalcoholabuseincreasestheriskby50%overtheadditiverate)airpollutionVirus(HPV)precancerouslesions(Leukoplakia,Papilloma)sexhormones2021/7/982

Leukoplakiaofthelarynx2021/7/983CarcinomaofthelarynxPathologyNearly98%aresquamouscellcarcinoma.adenocarcinomaandundifferentiatedcarcinomaisrare.2021/7/984CarcinomaofthelarynxClinicalclassification:Glottic(60%)：welldifferentiated,latemetastasisSupraglottic(30%)：poordifferntiated,earlymetastasisSubglottic(6%)：poordifferentiated,earlymetastasis2021/7/985Anatomicdivisionsofthelarynx2021/7/986CarcinomaofthelarynxSpreadoftumor⒈DirectspreadSupraglotticcancer→①epiglottis,pre-epiglotticspace,vallecula,andtonguebase.②piriformsinus,lateralwallofhypopharynx.③paraglotticspace,ventricleortheVC.2021/7/987CarcinomaofthelarynxSpreadoftumor⒈DirectspreadGlotticcancer→①anteriorly,contralateralVC.②posteriorly,arytenoidcartilage③superiorly,supraglotticarea.④inferiorly,paraglotticspaceandsubglotticarea.2021/7/988CarcinomaofthelarynxSpreadoftumor⒈DirectspreadSubglotticcancer→①superiorly,glottis.②anteriorlyandlaterally,strapmuscleandthyroidgland.③posteriorly,esophagus.2021/7/989CarcinomaofthelarynxSpreadoftumor⒉LymphnodesmetastasesSupraglotticcancer→haveapropensitytospreadtocervicallymphnodesbilaterallyattheearlystages.Generally,theriskofoccultoractualmetastasesfromT1,T2,T3andT4tumorsis20,40,60,and80%.2021/7/990CarcinomaofthelarynxSpreadoftumor⒉LymphnodesmetastasesGlotticcancer→CVisvirtuallydevoidoflymphatics,involvementofcervicalnodesattheearlystagesisnotcommon.＜8%ofpatientswithT1andT2tumorswillhavenodalinvolvement.2021/7/991CarcinomaofthelarynxSpreadoftumor⒉LymphnodesmetastasesGlotticcancer→Onlyatthelaterstages,prelaryngealnodes,paratrachealnodesandothercervicalnodescouldbeinvolved.2021/7/992CarcinomaofthelarynxSpreadoftumor⒉LymphnodesmetastasesSubglotticcancer→tendtospreadtoparatracheallymphaticsandthentosuperiormediastinualnodes.2021/7/9932021/7/9942021/7/995CarcinomaofthelarynxSpreadoftumor⒊DistantmetstasesviabloodDistantmetastasisonlyoccursintheverylaterstageoflaryngealcarcinoma.2021/7/996CarcinomaofthelarynxClinicalmanifestationsSupraglotticcarcinoma：MightbeasymptomaticForeignbodysensationPainwhileswallowingThroatburnsEnlargementofcervicallymphnodes2021/7/997CarcinomaofthelarynxClinicalmanifestationsGlotticcarcinoma：HoarsenenssistheearlysymptomRespiratoryobstructionwillhappeninlatestage2021/7/998CarcinomaofthelarynxClinicalmanifestationsSubglotticcarcinoma：Therearenodefinitivesymptomsintheearlystage.Dyspneaandlymphnodesmetastasisisthelatesymptoms2021/7/999Supraglotticcarcinoma2021/7/9100Glotticcarcinoma2021/7/9101

CarcinomaofthelarynxPhysicalexaminationLaryngoscopicexaminationcanfindamassononeorbothvocalcordsfixationofthevocalcordsiscommonmassintheneck2021/7/9102Carcinomaofthelarynx2021/7/9103CarcinomaofthelarynxDifferentialdiagnosisTuberculosisofthelarynx：chestX-rayfilmPapillomaofthelarynxSyphilisofthelarynx2021/7/9104

TreatmentThemodalityoftreatmentdependson:theexactsiteofthelesionearlyoradvancedstagepresenceorabsenceofneckmetastasisdistantmetastasisageandsometimesthepatient’swish2021/7/9105TreatmentEarlylaryngealcarcinoma(T1/T2)isusuallymanagedwithsinglemodalityoftreatmentandrespondswelltoradiation,transorallaserresection,orpartiallaryngealsurgery.Primarycureratesof80to85%areexpected.2021/7/9106TreatmentThemanagementofadvancedlaryngealcarcinomaismorecontroversial.Theaimistooptimizedisease-freeandoverallsurvivalwhilepreservingqualityoflife.2021/7/9107TreatmentGenerally,combinedtherapyiswidelyused,asitshowsbettersurvivalratesthansingle-modalitytreatment.Surgery+radiotherapyorradiotherapy+surgeryaretwocommonlyusedmodalities.2021/7/9108

Surgicaltreatment

PartiallaryngectomyLaryngofissurewithcordectomyVerticalpartiallaryngectomyFrontolateralpartiallaryngectomyHorizontalpartiallaryngectomyHorizontalverticalpartiallaryngectomySupracricoidpartiallaryngectomyNeartotallaryngectomy(Pearson’soperation)Transorallaserresection2021/7/9109

SurgicaltreatmentTotallaryngectomyNeckdissectionRadicalneckdissectionFunctionalneckdissectionSelectiveneckdissection2021/7/91102021/7/9111

SurgicaltreatmentRehabilitationofspeechaftertotallaryngectomyBlom-SingervalveEsophagealspeechElectricallarynx2021/7/9112

RadiotherapyT1N0M0tumorslocatedatthemid-portionoftheVCContraindicationforsurgerybecauseofpoorgeneralconditionPre-operativeirradiationforsomeadvancedtumors2021/7/9113

OthertreatmentmodalityChemotherapyGenetherapy2021/7/9114LaryngealobstructionCauses:InfectionTumorsForeignbodiesTraumaAllergyMalformationLaryngealparalysis2021/7/9115Laryngealobstructionsymptoms：inspiratorydyspneainspiratorystridordepressionofsuprasternalfossa,intercostalandsupraclavicularspaceorepigastriumwhileinspirationhoarsenessandevencyanosis2021/7/91162021/7/9117Laryngealobstructionclassification:Ⅰ°thereisnosymptomsatrest.Butslightinspiratorydyspneaandstridormayoccurduringcryingoronexertion2021/7/9118Laryngealobstructionclassification:Ⅱ°slightinspiratorydyspneaduringquietrespiration,andexaggerationonexertion.Sleepingandtakingthemealisnearlynormal,noevidenceofhypoxia.2021/7/9119Laryngealobstructionclassificatio