声嘶和声带良性疾病.ppt

Nodules Fibrovascular tissue secondary to vocal abuse or inappropriate vocal use Strobovideolaryngoscopy is essential in assessment effecting mucosal wave Treatment Vocal rehabilitation is primary Surgery is secondary Varices and Ectasias Varices and Ectasias Result from microvascular trauma Most commonly found at middle musculo-membranous vocal fold Situated at lateral extent of mucosal wave excursion Varices and Ectasias Treatment Cold instruments: epithelial cordotomy followed by vascular lesion removal No post-op deterioration of vocal function or mucosal wave flexibility Microspot CO2 laser ablation Heals more slowly Potential for epithelial stiffness Cysts Cysts Arise in Superficial lamina propia (SLP) Attached to vocal ligament or epithelial basement membrane Freely suspended within SLP Size is variable Asymmetric spheroid mass on medial surface of vocal fold Most arise from obstructed mucus ducts in SLP Cysts Treatment Cold instrument resection Must retreive entire cyst wall to prevent recurrence Preserve normal SLP Cysts Results Mucosal wave usually improves Does not return to normal if cysts has replaced substantial amount of SLP SLP does not regenerate Granulomas Granulomas Granulomas Granulomas Results from hypertrophic inflammatory reaction due to traumatic mucosal disruption Majority found in arytenoid region Usually exophytic with narrow base Seen with endotracheal intubation Granulomas Treatment Vocal therapy including anti reflux management Surgical resection conservative management has failed concern of a neoplastic process airway compromise Reinke’s Edema Reinke’s Edema Extensive swelling of SLP Usually on superior surface of musculo-membranous vocal fold Typically bilateral but asymmetric volume Multifactorial cause Smoking Vocal hyperfunction Polypoid Corditis (Reinke’s Edema) Treatment Smoking cessation Anti reflux medication Preoperative vocal therapy Surgery Papillomatosis Papillomatosis Human papillomavirus 6 and 11 Confined to epithelium