上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件 congenital laryngomalacia

Congenitallaryngomalacia先天性喉軟化癥DongpinCongenitallaryngomalacia先天性喉軟1Cause

Congenitallaryngealstridorisadefectthatispresentatbirth.Duringfetaldevelopment,thestructuresinthelarynxmaynotfullydevelop.Cause

Congenitallaryngealstr2Cause

Asaresult,thereisaweaknessinthesestructuresatbirth,causingthemtocollapseduringbreathing.Inchildren,congenitallaryngealstridoristhemostcommoncauseofchronicstridor.Sixtypercentofinfantsbornwithcongenitallaryngealstridorwillhavesymptomsinthefirstweekoflife.Mostotherinfantswillshowsymptomsby5weeksold.

Cause

Asaresult,thereisa3symptomsThemajorsymptomofthisdisorderisthestridorthatisheardastheinfantbreathes.Thestridorisusuallyheardwhentheinfantbreathesin(inspiration),butcanalsobeheardwhentheinfantbreathesout(expiration).Othercharacteristicsofthestridormayinclude:

Thestridorchangeswithactivity.Thestridorisusuallylessnoisywhenthechildislayingonhis/herstomach.Thestridorgetsworseiftheinfanthasanupperrespiratoryinfection.symptomsThemajorsymptomoft4diagnoseacompletemedicalhistoryandphysicalexaminationbronchoscopyoftheairways-aprocedurewhichinvolvesatubebeingpassedintotheairwaystoallowyourchild'sphysiciantoobservetheairwaysduringbreathing.

diagnoseacompletemedicalhi5TreatmentforcongenitallaryngomalaciaFollowupInmostcases,congenitallaryngealstridorisaharmlessconditionthatresolvesonitsown,withoutmedicalintervention.Theconditionusuallyimprovesbythetimetheinfantis18monthsoldandhasnolong-termcomplications.Insomecases,thestridorisapparentuntilabouttheageof5.Eachchild'scaseisunique.SurgeryAsmallpercentagedevelopsevererespiratoryproblemswhichrequiremedicalandsurgicalinterventions.

Treatmentforcongenitallaryn6上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件congenitallaryngomalacia7Acutelaryngitis

急性喉炎DongpinAcutelaryngitis

急性喉炎8Laryngitisisaninflammationofthevocalcordscausingspeechtobecomehoarseand/orwhisperlike,andofteninaudible.

Laryngitisisaninflammation9上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件congenitallaryngomalacia10Cause

Viruses--InfluenzaAandB,Adenovirus,Parainfluenza,andRhinovirusaresomeofthevirusesthatmaycausethiscondition.

BacteriasuchasHemophilusinfluenzae,beta-hemolyticstreptococcus,and

Moraxellacatarrhalis

Inhalationofsmoke,chemicals,andexcessiveuseofvoice

AcidReflux

Allergies

Aging

Cause

Viruses--InfluenzaAa11symptomsHoarseness

WhisperlikevoicelossofvoicesymptomsHoarseness

12Bacteriallaryngitis:

SorethroatFeverPainfulswallowingCoughHoarsenessBacteriallaryngitis:

Sorethr13Virallaryngitis

GeneralfatigueMalaiseLow-gradefeverGeneralbodyachesCoughHoarsenessSorethroatDrythroatVirallaryngitis

Generalfatig14allergiclaryngitisHoarsenessthatisworseduringandseveralhoursafterexposuretotheallergenItchythroatExcessphlegmormucousinthethroatFeelingofdrythroatCoughItchysensationinthethroatSneezingallergiclaryngitisHoarseness15diagnoseThroatcheckforpharyngitis(infection)

Neckcheckedforstridor(wheezingsoundheardbystethoscope)

diagnoseThroatcheckforphar16TreatmentAvoidloudspeech,suchasshoutingorsinging

Humidifiers(coolmistbetter)andsteam(cooltowarm,nothot)canhelp.

Avoidsmoking,recreationaldrugs,andalcohol

Increasefluids

Ifsevere,physicianswillofteninstructapersonnottospeakatallforthenextfewdays.

IfHemophilusinfluenzaorMoxarellacatarrhalisaresuspected,antibioticswillmostlikelybeprescribed.

Symptomsusuallyresolvein

fewerthansevendaysinmostindividuals.

TreatmentAvoidloudspeech,su17TreatmentIfsevere,physicianswillofteninstructapersonnottospeakatallforthenextfewdays.

IfHemophilusinfluenzaorMoxarellacatarrhalisaresuspected,antibioticswillmostlikelybeprescribed.

Symptomsusuallyresolvein

fewerthansevendaysinmostindividuals.

TreatmentIfsevere,physicians18上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件congenitallaryngomalacia19Choriniclaryngitis

DongpinChoriniclaryngitis

20Defination

Laryngitisisaninflammationofthelarynx,the"voicebox"thatcontainsthevocalcordsintheupperportionoftheneck.Laryngitisoccursintwoforms,acuteandchronic.Acutelaryngitistypicallyisabriefillnessproducinghoarsenessandasorethroat.Inmostcases,anupperrespiratorytractinfectioncausesit.Chroniclaryngitisisamorepersistentdisorderthatproduceslingeringhoarsenessandothervoicechanges.Itusuallyispainlessandhasnosignificantsignofinfection.Defination

Laryngitisisanin21Cause

Cigarettesmokeischronicallyirritatingtothelaryngealmucosa.Attheextreme,itcanprovokecancer.Ethanolcontainsmanyimpurities,suchasmycotoxins,tannins,aldehydes,andpesticides,whichmaycausecancer,eitherbydirectcontactwiththemucosaorthroughasystemiceffect,ormayactasanirritant.

Cause

Cigarettesmokeischron22GastroesophagealrefluxdiseaseInfectionsThebacteriummostcommonlyisolatedinchronicinfectiouslaryngitisisStaphylococcusaureus.Haemophilusinfluenzaeandpneumococcalspeciesmaycomplicatethecourseofvirallaryngitis.Tuberculosis,causedbyinfectionwiththetuberclebacillusMycobacteriumtuberculosishominis,wasacommondiseaseofthelarynx.Overallincidencehasdeclined.Thehematogenousrouteandtheinfectedsputumfrompulmonarytuberculosisarethemostlikelysourcesofinfection.Gastroesophagealrefluxdiseas23Voiceabusecanbepertinenttoprofessionalsingersandtooccasionalshouters.Lesionscanrangefromsimpleedema,intheoccasionalabuser,tohyperplasticreactionsifthestimulipersistovertime.Allergicresponsesofimmediateordelayedhypersensitivitytypescancausechroniclaryngitis.Althoughtheauthorsfoundnodataquantifyingtheexactnumberofpeopleaffected,currentthoughtseemstoindicateanincreasingprevalence.

Voiceabusecanbepertinentt24Environmentalfactors,suchasdust,fumes,chemicals,andtoxins,cancausethiscondition.Systemicdiseases,mostlyautoimmune,maycausechroniclaryngitis.Wegenergranulomatosis.Amyloidosis.Relapsingpolychondritis.Environmentalfactors,suchas25Chroniclaryngitismaybeassociatedwithcutaneousdiseases.Thelarynxandtheskinsharesimilarmicrocharacteristicsandmacrocharacteristics.Chroniclaryngitismaybeasso26Neurologiccausesmaycontributetochroniclaryngitis.Spasticdysphoniaisadiscretevocaldisordercharacterizedbystrained,chokedvocalattacks(laryngealstuttering).Theonsetusuallyfollowsastressfulperiodinmiddlelife.ThisconditionisprobablyavocalexpressionofpsychoneuroticbehaviororaCNSand/orproprioceptivedisorderofthelarynx.Vocalfoldsatrophyandlosetensionwithage,causingchangesinphonation.Lossofthyroarytenoidligamentelasticityresultsinbreathinessandlossofbreathsupportbecauseofbowedvocalfolds.Musculardisordersmaycontributetochroniclaryngitis.Weaknessofthelarynxandthepharynxispresentinonethirdofpatientswithmyastheniagravis.

Neurologiccausesmaycontribu27symptomsHoarsenessSorethroatWeakorabsentvoiceSensationofalumpinthethroatorconstantneedtoclearthethroatDrycoughFeversymptomsHoarseness28diagnoseDiagnosisisbaseduponacombinationoftheclinicalhistoryandaphysicalexam.Somephysiciansmightwishtodoalaryngoscopy(visualizationofthevocalcords).diagnoseDiagnosisisbasedup29TreatmentIflaryngitisiscausedbyabacterialinfection,antibioticswillbeprescribed.Somepalliativemeasuresthatcanbetakeninclude:AvoidpublicspeakingduringrecoveryBeawarethatwhisperingputsgreaterstrainonthevocalcordsthannormalspeakingInhalesteamfromabowlofhotwaterorfromawarmshowerDrinkwarm,soothingliquids(butdonotdrinkalcoholicbeverages)Tryacool-misthumidifier;avoidairconditioningUsethroatlozengestoeasethediscomfortAvoidcigarettesuntilthesymptomshavesubsidedTreatmentIflaryngitisiscaus30上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件congenitallaryngomalacia31VocalCordDisorders

vocalnodules

vocalpolyps

DongpinVocalCordDisorders

vocalno32Vocalcorddisordersareoftencausedbyvocalabuseormisuse,suchasexcessiveuseofthevoicewhensinging,talking,smoking,coughing,yelling,orinhalingirritants.Someofthemorecommonvocalcorddisordersincludelaryngitis,vocalnodules,vocalpolyps,andvocalcordparalysis.Vocalcorddisordersareoften33vocalnodulesANDvocalpolyps

Vocalnodulesarebenign(non-cancerous)growthsonthevocalcordscausedbyvocalabuse.Vocalnodulesareafrequentproblemforprofessionalsingers.Thenodulesaresmallandcallous-likeandusuallygrowinpairs(oneoneachcord).Thenodulesusuallyformonareasofthevocalcordsthatreceivethemostpressurewhenthecordscometogetherandvibrate(similartotheformationofacallous).Voicenodulescausethevoicetobehoarse,low,andbreathy.vocalnodulesANDvocalpolyps34vocalnodulesANDvocalpolyps

Avocalpolypisasoft,benign(non-cancerous)growth,similartoablister.Apolypusuallygrowsaloneononevocalcordandisoftencausedbylong-termcigarettesmoking.Othercausesofvocalpolypsincludehypothyroidism(underactivethyroidgland),gastroesophagealreflux,andcontinuousvoicemisuse.Voicepolypscausethevoicetobehoarse,low,andbreathy.VocalpolypsarealsocalledReinke'sedemasorpolypoiddegeneration.vocalnodulesANDvocalpolyps35CAUSES

vocaltrauma(morespecifically,phonotraumainthecaseofvocalfoldpolypsandvocalfoldnodules)CAUSES

vocaltrauma(morespec36symptomsavoicechange.Typicalpresentingsymptomsincludegeneralizedandpersistenthoarseness,changeinvoicequality,andincreasedeffortinproducingthevoice.Thelaryngealexaminationmayshoweitherunilateralorbilaterallesions.symptomsavoicechange.Typica37diagnoseAnyhoarsenessorchangeinvoicethatlastslongerthantwoweeksshouldbebroughttotheattentionofyourphysician.(Sometimesthehoarsenessmaybeindicativeoflaryngealcancer.)acompletemedicalhistoryandphysicalexaminationexaminethevocalcordsinternallywithasmall,long-handledmirror(indirectlaryngoscopy)orlaryngoscopydiagnoseAnyhoarsenessorcha38Treatmenteliminatingthebehaviorthatcausedthevocalcorddisorderareferraltoaspeech-languagepathologistwhohasspecializedtrainingintreatingvoice,speech,language,orswallowingdisordersthataffectcommunicationmedicationsurgerytoremovegrowthsTreatmenteliminatingthebehav39上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件congenitallaryngomalacia40AcutelaryngitisinchildrenDongpinAcutelaryngitisinchildren41Cause

Laryngitisisagroupofdisordersinwhichtheinflammatoryprocesscoversthemucousmembraneofallorparticularlevelsofthelarynx.Thesedisordershaveadifferentcourseinchildrenunder4yearsoldthaninchildrenabove4yearsold.WHY?Cause

Laryngitisisagroupof42specificvariationsofthestructureofthelarynxinchildrenunder4yearsoldANDabove4yearsold

Thelarynxofasmallchildislocatedhigher,andthemucousisthickerandcontainsalargeamountofsofttissue.Thissofttissueismainlylocatedunderthemucousofthearyepiglotticfolds,andespeciallyinthesubglotticregion.specificvariationsofthestr43Thespecificreactivityofthemucousmembraneinsmallchildrenmakesthempronetoinfections,especiallyviral.Someoftheseinfectionsmaycauseoedemaofthemucus.Therespiratorytractinchildrenisrelativelynarrowinthisregionandthechondrousringlimitsthesizeofthesubglotticregion.So,oedemainthisregionmayhaveadramaticcourse,leadingeventoacuterespiratorydistressThespecificreactivityofthe44Cause

viralinfectionparainfluenzavirusinfluenzavirusrubellavirusandvaricella-zostervirusCause

viralinfection45symptomsdyspnoea,inspiratorystridor,hoarsenesscharacteristicbarkingcoughsymptomsdyspnoea,46diagnosegeneralexaminationslaryngologicalexaminationsdirectvisualizationofthelarynxendoscopy,fiberoscopyandlaryngoscopydiagnosegeneralexaminations47DifferentialdiagnosisForeignbodyofthelarynx:Themostgeneralsymptomsoflaryngitisoccuralsoinotherdisordersofthelarynxwhichoccurwithdyspnoealiketheforeignbodyofthelarynx.Sotheprecisediagnosisisagoodbaseforplanningoffurthertreatment.Congenitaldefectofthelarynx:Whenthesymptomsoflaryngitisoccuratunder6monthsofageorareprolongedorrecurrent,acongenitaldefectofthelarynxshouldbesuspected,i.e.laryngealweborhaemangiomaofthelarynx.Inthesecasesdirectexaminationofthelarynxisanurgentnecessity,becausethetreatmentofthesedisordersvaries.DifferentialdiagnosisForeign48TreatmentHospitalisesystemicanti-inflammatorydrugs,humidificationandcoolingtheairintheroom.hydrocortisoneinhighdose(10mgperkgb.w.),preferablyi.v.,maybenecessary.Intubation:Onlyintubationisagoodmethodwhichprotectsthechildfromasphyxiation.Formerly,tracheotomywasperformed,butnowitisnotoftenperformedinthisdisease.Antibioticsareadministratedinthosepatientsinwhombacterialcomplicationsdevelop.Itshouldbeunderlinedthattheantibioticsgivenforuncomplicatedlaryngitisinsmallchildrendonotbringimprovement,soshouldbeavoided.Inpatientsolderthan4yearsofageetiologicfactorsmaybedifferente.g.allergy.Inthesecasesadministrationofanti-histaminicdrugsandcalciummaybesuitable.TreatmentHospitalise49上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件congenitallaryngomalacia50Acuteepiglottitis

DongpinAcuteepiglottitis

51Definition

Averyrapidlyprogressiveinfectioncausinginflammationoftheepiglottis(theflapthatcoversthetrachea)andtissuesaroundtheepiglottisthatmayleadtoabruptblockageoftheupperairwayanddeath.Definition

Averyrapidlyprog52Cause

Infection:Hinfluenzae

HaemophilusparainfluenzaeStreptococcuspneumoniae,andgroupAstreptococci.Lesscommoninfectious

bacteria(eg,Staphylococcusaureus,mycobacteria,Bacteroidesmelaninogenicus,Enterobactercloacae,Escherichiacoli,Fusobacteriumnecrophorum,Klebsiellapneumoniae,Neisseriameningitidis,Pasteurellamultocida),herpessimplexvirus(HSV),otherviruses,infectiousmononucleosis,Candida(inimmunocompromisedpatients),andAspergillus(inimmunocompromisedpatients).Cause

Infection:53Noninfectiousfactors:thermalcausescrackcocainesmokingmarijuanasmokingthroatburnsaffectingtheepiglottisofbottle-fedinfants)causticinsults(eg,automaticdishwashersoapingestion)foreignbodyingestion

headandneckchemotherapy.BeforewidespreadHibvaccination,Hinfluenzaecausedalmostallpediatriccases.AllergyNoninfectiousfactors:54symptomsSorethroat(95%)Odynophagia/dysphagia(95%)Muffledvoice(54%)Usually,noprodromalsymptomsoccurinchildren.Adultsmayhaveprecedingupperrespiratoryinfection(URI)symptoms.

symptomsSorethroat(95%)55GeneralsymptomsFeverDrooling/inabilitytohandlesecretionsCervicaladenopathyStridor-AlatefindingindicatingadvancedairwayobstructionMuffledvoice(54%)Tripodposition-SittinguponhandswiththetongueoutandtheheadforwardHypoxiaRespiratorydistressSeverepainongentlepalpationoverthelarynxMildcoughFeverIrritabilityTachycardiaToxicappearanceofpatientGeneralsymptomsFever56diagnoseDifferentialDiagnosesPeritonsillarAbscess

RetropharyngealAbscess

Toxicity,CausticIngestions

OtherProblemstoBeConsideredAirwayobstruction

Foreignbodyaspiration

Bacteriallaryngotracheobronchitis

Laryngotracheobronchopneumonitis

Retropharyngealabscess

Peritonsillarabscess

Laryngitis

Laryngealdiphtheria

Causticingestions

Acuteangioedema

Sepsis

diagnoseDifferentialDiagnose57TreatmentAntibioticsAntivirushydrocortisoneadequateairwaynasotrachealintubationintubationtracheostomySkillednursingcare.TreatmentAntibiotics58上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件congenitallaryngomalacia59PapillomaoflarynxDongpinPapillomaoflarynx60Cause

Mostcommonbenigntumorofthelarynxandoccursinpatientsofallage.ThecausativeagentisthoughttobeHPV.Papillomasusuallyregressduringpuberty.Cause

Mostcommonbenigntumor61Cause

Usuallyinvolvingthetruevocalcordsbutmayaffectsupraglotticandsubglotticregions.Mayalsoinvolvethetracheaandbronchus.Cause

Usuallyinvolvingthetr62Cause

Papillomasinjuvenilesismoreoftenmultipleandrecursmorefrequentlythaninadults.Papillomasinadultsareusuallysinglebutmayundergomalignantchange(HPV16，18).Cause

Papillomasinjuveniles63symptomsAphoniaorweakcryisusuallythefirstsignininfants.Dyspneaandstridorareseen.Hoarsenessisthemostcommonsymptominadults.symptomsAphoniaorweakcryis64diagnoseLaryngoscopicexamination：thetumorispinkordarkredincolor.Thesurfaceofthetumorisroughandpapillary.ThetumorislocatedinVC,falseVCorsubglotticarea.diagnoseLaryngoscopicexamina65Treatment⑴excisionundermicrolaryngoscopyisthemostcommonlyemployedtreatmentmodality.Repeatedoperationsareusuallyneededinchildren.Co2laserisfavoredbecauseofitshemostaticpropertiesanditsprecisionallowsforvaporizationofthelesion.Treatment⑴excisionundermicr66Treatment⑵Tracheotomyisoccasionallyindicatedinchildrenwithdyspnea,butshouldbeavoidedduetoconcernaboutsubglotticspread.Treatment⑵Tracheotomyisocca67Treatment⑶transferfactor,interferonandantivirotics.Cidofovir,anewantiviralagentapprovedforocularcytomegalovirusinfections,hasshownpromiseasalocalinjectioninadjuvanttherapy.⑷Autogenousvaccine.Treatment⑶transferfactor,in68上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件congenitallaryngomalacia69CarcinomaofthelarynxDongpinCarcinomaofthelarynx70Epidemiology

Accountsfor1%ofallnewcancersdiagnosedintheU.S.and0.75%ofallcancerdeaths.Accountsfor30%inallheadandneckcancers.Morefrequentlyhappenedinpatientsat50~70yearsofage.M:Fratio:5~10:1(foreigncountry)，6.75:1(shanghai).Epidemiology

Accountsfor1%o71EtiologyCigaretteWine(combinedsmokingandalcoholabuseincreasestheriskby50%overtheadditiverate)airpollutionVirus(HPV)precancerouslesions(Leukoplakia,Papilloma)sexhormonesEtiologyCigarette72Pathology

Nearly98%aresquamouscellcarcinoma.adenocarcinomaandundifferentiatedcarcinomaisrare.Pathology

Nearly98%aresquam73Clinicalclassification:

Glottic(60%)：welldifferentiated,latemetastasisSupraglottic(30%)：poordifferntiated,earlymetastasisSubglottic(6%)：poordifferentiated,earlymetastasisClinicalclassification:

Glott74Spreadoftumor⒈DirectspreadSupraglotticcancer→①epiglottis,pre-epiglotticspace,vallecula,andtonguebase.②piriformsinus,lateralwallofhypopharynx.③paraglotticspace,ventricleortheVC.Spreadoftumor⒈Directspread75SpreadoftumorGlotticcancer→①anteriorly,contralateralVC.②posteriorly,arytenoidcartilage③superiorly,supraglotticarea.④inferiorly,paraglotticspaceandsubglotticarea.SpreadoftumorGlotticcancer→76SpreadoftumorSubglotticcancer→①superiorly,glottis.②anteriorlyandlaterally,strapmuscleandthyroidgland.③posteriorly,esophagus.SpreadoftumorSubglotticcanc77Spreadoftumor⒉LymphnodesmetastasesSupraglotticcancer→haveapropensitytospreadtocervicallymphnodesbilaterallyattheearlystages.Generally,theriskofoccultoractualmetastasesfromT1,T2,T3andT4tumorsis20,40,60,and80%.Spreadoftumor⒉Lymphnodesm78SpreadoftumorGlotticcancer→CVisvirtuallydevoidoflymphatics,involvementofcervicalnodesattheearlystagesisnotcommon.＜8%ofpatientswithT1andT2tumorswillhavenodalinvolvement.SpreadoftumorGlotticcancer79SpreadoftumorGlotticcancer→Onlyatthelaterstages,prelaryngealnodes,paratrachealnodesandothercervicalnodescouldbeinvolved.SpreadoftumorGlotticcancer80SpreadoftumorSubglotticcancer→tendtospreadtoparatracheallymphaticsandthentosuperiormediastinualnodes.SpreadoftumorSubglotticcanc81Spreadoftumor⒊DistantmetstasesviabloodDistantmetastasisonlyoccursintheverylaterstageoflaryngealcarcinoma.Spreadoftumor⒊Distantmetst82symptomsSupraglotticcarcinoma：MightbeasymptomaticForeignbodysensationPainwhileswallowingThroatburnsEnlargementofcervicallymphnodessymptomsSupraglotticcarcinoma83symptomsGlotticcarcinoma：HoarsenenssistheearlysymptomRespiratoryobstructionwillhappeninlatestagesymptomsGlotticcarcinoma：84symptomsSubglotticcarcinoma：Therearenodefinitivesymptomsintheearlystage.DyspneaandlymphnodesmetastasisisthelatesymptomssymptomsSubglotticcarcinoma：85diagnosePhysicalexaminationLaryngoscopicexaminationcanfindamassononeorbothvocalcordsfixationofthevocalcordsiscommonmassintheneckdiagnosePhysicalexamination86DifferentialdiagnosisTuberculosisofthelarynx：chestX-rayfilmPapillomaofthelarynxSyphilisofthelarynxDifferentialdiagnosisTubercul87TreatmentEarlylaryngealcarcinoma(T1/T2)isusuallymanagedwithsinglemodalityoftreatmentandrespondswelltoradiation,transorallaserresection,orpartiallaryngealsurgery.Primarycureratesof80to85%areexpected.TreatmentEarlylaryngealcarci88TreatmentThemanagementofadvancedlaryngealcarcinomaismorecontroversial.Theaimistooptimizedisease-freeandoverallsurvivalwhilepreservingqualityoflife.TreatmentThemanagementofadv89TreatmentGenerally,combinedtherapyiswidelyused,asitshowsbettersurvivalratesthansingle-modalitytreatment.Surgery+radiotherapyorradiotherapy+surgeryaretwocommonlyusedmodalities.TreatmentGenerally,combinedt90TreatmentPartiallaryngectomyTotallaryngectomyRehabilitationofspeechaftertotallaryngectomyBlom-SingervalveEsophagealspeechElectricallarynxNeckdissectionTreatmentPartiallaryngectomy91上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件congenitallaryngomalacia92LaryngealobstructionDongpinLaryngealobstruction93Cause

InfectionTumorsForeignbodiesTraumaAllergyMalformationLaryngealparalysisCause

Infection94symptomsinspiratorydyspneainspiratorystridordepressionofsuprasternalfossa,intercostalandsupraclavicularspaceorepigastriumwhileinspirationhoarsenessandevencyanosissymptomsinspiratorydyspnea95classification:Ⅰ°thereisnosymptomsatrest.Butslightinspiratorydyspneaandstridormayoccurduringcryingoronexertionclassification:Ⅰ°thereisnos96classification:Ⅱ°slightinspiratorydyspneaduringquietrespiration,andexag