د.حسين جاسم
L.3 Neoplasms of the larynx

Benign tumors:
A. epithelial tumors:
Single papilloma:
It is more common in adults and rare in children, may be sessile or pedunculated in the region of the anterior commissure and half of the vocal cords. Treatment is done by endoscopic removal.
Multiple papilloma
It is more common in infants and young children, involving the vocal cords, the ventricular bands & may extend to the epiglottis, trachea and bronchi, caused by a virus; treatment is done by endoscopic removal by CO2 Caser.
B. connective tissue tumors:
1. Fibroma of the vocal cords.
2. Chondroma.
3. Angioma.
4. Lipoma.

Malignant tumors of the larynx:
         For practical purposes all malignant tumors of the larynx are squamous cell carcinoma, other tumors are extremely rare.
Squamous cell carcinoma
The tumor can be classified according to the site of origin and its extension.
Supraglottic carcinoma
Arising in the upper part of the vestibule; this extends down to a line above the ventricular band.   Those tumors arising on the ventricular Bands itself & its underlying ventricle and saccule.
Clinical features:
1. Hoarseness may be late but discomfort in the larynx is early.
2. Metastasis to the upper deep cervical lymph nodes may be early and extensive because of rich lymphatic drainage of this area.
Glottic carcinoma
Carcinoma of the cords is the commonest form of interlaryngeal growth; usually the site of origin of a cordal carcinoma is the free edge of the flat upper surface of the cord in its central portion or the anterior half.
*direct spread of glottic carcinoma: is forward to the anterior commissure and backwards to the vocal process, may occur early, and from the anterior commissure it may spread across the midline to the anterior end of the opposite cord and upwards to the pre-epiglottic space while downward spread occurs into the subglottic space on the same side and it may reach the trachea. 
* Lymphatic spread of glottic carcinoma: owing to the paucity of lymphatics the early growth limited to the cord & do not show lymphatic metastases in more than 4% of the cases.
Clinical features
1.  Patients are most commonly seen in the fifth and sixth decades.
2. Hoarseness gradually increasing is the earliest symptom and the only sign until stridor occurs from the increased size of the growth and oedema.
3. Nodular or generalized swelling of the cord may be seen on indirect laryngoscopy may present as an ulcer or papilliferous growth.
4. Fixation of the vocal cord due to infiltration of the cord by tumor.
5.  Dyspnoea & dysphagia.
6. Metastasis to the lymph nodes of the neck as a hard painless mass.
  Subglottic carcinoma
The primary site is usually the subglottic surface of the cord but sometimes it is immediately below the anterior commissure.
*Direct spread of the subglottic carcinoma:
-   Upwards the cord edge.
-   Downward to the trachea.
-   Circumferential spread.
*lymphatic spread: to the lower deep cervical, pretracheal, and mediastinal lymph nodes.
Clinical features
1.  Due to its hidden area; the tumor should reach large size to produce the symptoms and seen by mirror.
2. Hoarseness results from infiltration of the cord.
3. Immobility of the cord results from neoplastic infiltration or from paralysis of the nearby recurrent laryngeal nerve.
4. Stridor.
Diagnosis:
1. Endoscopy & biopsy of the tumor.
2. CT scan or MRI to delineate the tumor.
Treatment:
1.  Radiotherapy.
2. Surgery: partial or total laryngectomy with or without neck dissection.