SUPRAGLOTTIS

P. PRITHIKA
PRE FINAL YEAR
CONTENTS
❑ ARTERIAL SUPPLY
❑ VENOUS DRAINAGE
❑ LYMPHATIC DRAINAGE
❑ APPLIED ASPECTS
❑ 1. ACUTE EPIGLOTTITIS

❑ 2. LARYNGOMALACIA

❑ 3. SUPRAGLOTTIC CANCER

❑ EXAMINATION
 ARTERIAL SUPPLY

SUPERIOR INFERIOR
LARYNGEAL LARYNGEAL
ARTERY ARTERY
 EXTERNAL CAROTID ARTERY THYROCERVICAL TRUNK OF THE
SUBCLAVIAN ARTERY

SUPERIOR THYROID ARTERY

INFERIOR THYROID ARTERY

SUPERIOR LARYNGEAL ARTERY

( UPPER MARGIN OF THE THYROID INFERIOR LARYNGEAL ARTERY
CARTILAGE) (LOWER BORDER OF THE
+ THYROID GLAND)
INTERNAL BRANCH OF THE SUPERIOR +
LARYNGEAL NERVE RECURRENT LARYNGEAL NERVE
( BENETH THE LOWER BORDER
OF INFERIOR
CONSTRICTOR)
CRICOTHYROID ARTERY
(PASSES ACROSS THE UPPER PART
PIERCE THYROHYOID MEMBRANE OF CRIOCOTHYROID LIGAMENT

SUPERIOR THYROID ARTERY

 VENOUS DRAINAGE

SUPERIOR INFERIOR
LARYNGEAL LARYNGEAL
VEINS VEINS
SUPERIOR LARYNGEAL VEINS INFERIOR LARYNGEAL VEINS

SUPERIOR THYROID VEINS

INFERIOR THYROID VEINS

INTERNAL JUGULAR VEINS LEFT BRACHIOCEPHALIC VEIN

 NERVE SUPPLY
VAGUS
NERVE

RECURRENT
LARYNGEAL
SUPERIOR
NERVES
LARYNGEAL
(all muscles of
NERVE
larynx except
cricothyroid)

EXTERNAL INTERNAL
LARYNGEAL LARYNGEAL
BRANCH BRANCH
(cricothyroid (sensory
muscle) innervation to
the larynx)
 LYMPHATIC DRAINAGE

❑ THE LYMPHATICS OF THE LARYNX ARE SEPARATED BY THE VOCAL FOLDS INTO AN
UPPER AND LOWER GROUP

❑ THE LARYNX ABOVE THE VOCAL FOLDS IS DRAINED BY VESSELS THAT ACCOMPANY
THE SUPERIOR LARYNGEAL VEIN AND PEIRCE THE THYROHOID MEMBRANE
EMPTYING INTO THE

UPPER DEEP
CERVICAL LYMPH
NODES
❑ THE LARYNX BELOW THE VOCAL FOLDS DRAINS INTO THE , OFTEN THROUGH THE
PRELARYNGEAL AND PRETRACHEAL NODES

LOWER DEEP
CERVICAL
CHAIN

❑ THE VOCAL FOLDS THEMSELVES ARE FIRMLY BOUND TO THE UNDERLYING VOCAL
LIGAMENTS AND THERE ARE NO LYMPHATICS PRESENT IN THIS PLANE.

❑THEREFORE, EARLY CANCERS OF THE VOCAL FOLDS DO NOT READILY SPREAD TO

THE LYMPH NODES
 ACUTE EPIGLOTTITIS
(SUPRAGLOTTITIS)

• IT IS POTENTIALLY LIFE THREATENING INFECTION

DUE TO THE ACUTE INFLAMMATION AND OEDEMA OF
THE SUPRAGLOTTIS ,IN PARTICULAR THE
EPIGLOTTIS CAUSING LARYNGEAL AIRWAY
OBSTRUCTION.

• IT USUALLY AFFECTS CHILDREN OF AGE 2-7 YEARS

BUT CAN ALSO AFFECT ADULTS

• ETIOLOGY : HEMOPHILUS INFLUENZAE TYPE B IS THE

MOST COMMON ORGANISM RESPONSIBKE FOR THIS
CONDITION.
•CLINICAL FEATURES :
•ONSET IS ABRUPT WITH RAPID PROGRESSION
•SORE THROAT AND DYSPHAGIA
•ODYNOPHAGIA (ADULTS)
•DYSPHONIA AND INSPIRATORY STRIDOR (CHILDREN)
•FEVER
•DROOLING OF SALAIVA

•ACUTE EPIGLOTTITIS CAN BE DIFFERNTIATED FROM CROUP WITH THE PRESENCE OF DROOLING OF
SALAIVA ,WHILE COUGHING IS OFTEN A SIGN IN CROUP.
• EXAMINATION FINDINGS :

• RED AND SWOLLEN EPIGLOTTIS RED CHERRY

• INDIRECT LARYNGOSCOPY SHOWS EDEMA AND APPEARANCE
CONGESTIONS OF THE SUPRAGLOTTIC STRUCTURE
•
• THE LATERAL VIEW ON RADIOGRAPHY OF THE SOFT TISSUE OF THE NECK
CAN SHOW A SWOLLEN EPIGLOTTIS , KNOWN AS THE

THUMB
PRINT SIGN

• TREATMENT :
• HOSPITALISATION
• ANTIBIOTICS – AMPLICILLIN OR 3RD GENERATION
CEPHALOSPORINS
• STEROIDS – HYDROCORTISONE OR DEXAMETHASONE
• ADEQUATE HYDRATION
• HUMIDIFICATION AND OXYGEN
• INTUBATION OR TRACHEOSTOMY
 LARNGOMALACIA
(CONGENITAL LARYNGEAL STRIDOR)

• IT IS THE MOST COMMON CONGENITAL

ABNORMALITY OF THE LARYNX

• IT IS CHARACTERISED BY EXCESSIVE FLACIDITY OF

THE SUPRAGLOTTIC LARYNX WHICH IS SUCKED IN
DURING INSPIRATION PRODUCING STRIDOR AND
SOMETIMES CYANOSIS.

• STRIDOR IS INCREASED ON CRYING BUT SUBSIDES

ON PRONE POSITION
•THE CONDITION MANIFESTS AT BIRTH BUT DISAPPEARS BY 2 YEARS OF
AGE
•LARYNGOSCOPIC FINDINGS :
•OMEGA SHAPED EPIGLOTTIS
•FLOPPY ARYEPIGLOTTIC FOLDS
•PROMINENT ARYTENOIDS

• IT CANNOT BE DIAGNOSED IN A PARALYSED PATIENT

• TREATMENT IS CONSERVATIVE , SUPRAGLOTTOPLASTY IS REQUIRED
IN CASES OF SEVERE LARYNGOMALACIA
 SUPRAGLOTTIC CANCER
• IT IS LESS FREQUENT THAN GLOTTIC CANCER
• MAJORITY OF THE LESSIONS ARE SEEN ON
EPIGLOTTIS, FALSE CORDS FOLLOWED BY
ARYEPIGLOTTIC FOLDS

• CANCER OF THE SUPRAGLOTTIC REGION SPREADS

LOCALLY AND INVADES THE
• VALLECULA
• BASE OF THE TONGUE
• PIRIFORM FOSSA
• UPPER AND MIDDLE JUGULAR NODES ARE OFTEN INVOLVED
• BILATERAL METASES ARE SEEN

• CLINICAL FEATURES:
• THEY SRE SILENT GROWTHS
• HOARSENESS IS A LATE SYMPTOM
• THROAT PAIN
• DYSPHAGIA
• REFERRED PAIN IN THE EAR
•
 EXAMINATION OF LARYNX

INDIRECT DIRECT
LARYNGOSCOPY LARYNGOSCOPY

EXTERNAL
EXAMINATION
 EXTERNAL EXAMINATION
❑ REDNESS OF SKIN
❑ BULGE OR SWELLING
❑ WIDENING OF LARYNX
❑ SURGICAL EMPHYSEMA
❑ CHANGE IN CONTOUR OR DISPLACEMENT OF LARYNGEAL
STRUCTURES
❑ MOVEMENTS OF LARYNX
 INDIRECT LARYNGOSCOPY
POSTURE : THE PATIENT IS ASKED HE IS ASKED TO PROTUDE HIS
THE LARYNGEAL MIRROR HAS
TO SIT ERECT WITH THE HEAD TONGUE WHICH IS WRAPPED IN
BEEN WARMED AND TESTED ON
AND CHEST LEANING SLIGHTLY GAUZE AND HELD BY THE
THE BACK OF THE HAND
TOWARDS THE EXAMINER EXAMINER BETWEEN THE THUMB
AND THE MIDDLE FINGER

LIGHT IS FOCUSED ON THE MIRROR

AND THE PATIENT IS ASKED TO
BREATHE QUITELY. TO SEE THE
MOVEMENTS OF THE CORDS THE
PATIENT IS ASKED TO SAY Aa and Eee
 DIRECT LARYNGOSCOPY
IT IS USUALLY HELD IN THE LEFT
HAND. RIGHT HAND IS USED TO
SUPINE POSITION WITH THE HEAD RETRACT THE LIPS AND GUIDE
ELEVATED BY 10-15 cm THE LARYNGOSCOPE
IT IS INTRODUCED BY ONE SIDE
OF THE TONGUE WHICH IS
PUSHED TO THE OPPOSITE SIDE
TILL POSTEROR THIRD OF THE
TONGUE IS REACHED

IT IS NOW ADVANCED BEHIND THE

EPIGLOTTIS AND LIFTED
FORWARD WITHOUT LEVERING IT
ON THE UPPER TEETH OR JAW
STRUCTURES TO BE EXAMINED :
BASE OF TONGUE
RIGHT AND LEFT VALLECULAE
EPIGLOTTIS
RIGHT AND LEFT PIRIFORM SINUS
ARYEPIGLOTTIC FOLDS
RIGHT AND LEFT ARYTENOIDS
RIGHT AND LEFT VENTRICLES
RIGHT AND LEFT VOCAL CORDS

COMPLICATIONS:
INJURY TO THE LIPS AND TONGUE
INJURY TO THE TEETH
BLEEDING
LARYNGEAL OEDEMA
BIBLIOGRAPHY

Diseases of Ear, Nose, Throat, 8th edition by PL Dhingra and Shruti Dhingra

Scott - Browns otorhinolaryngology, head and neck surgery , volume 2 , 8th

edition

Gray’s Anatomy for students ,4th edition

Logan Turner’s disease of ear ,nose and throat , head and neck surgery ,
11th edition
THANK YOU