1. CONGENITAL LARYNGEAL DISORDERS DR PRASHANTH

2. CLASSIFICATION 1. SUPRAGLOTTIS LARYNGOMALACIA LARYNGEAL CYST CONGENITAL LARYNGOCELE 2. GLOTTIS LARYNGEAL WEB CRI-DU CHAT SYNDROME VOCAL CORD PARALYSIS

3. CLASSSIFICATION CONTD…. 3. SUBGLOTTIS: SUBGLOTTIC STENOSIS SUBGLOTTIC HEMANGIOMA LARYNGOTRACHEAL CLEFT

4. LARYNGOMALACIA MALACIA= SOFTENING (GREEK) JACKSON IN 1942 MOST COMMON CAUSE OF CONGENITAL STRIDOR. FEATURES: 1. SOFT FLABBY LARYNGEAL TISSUES 2. THIN LARYNGEAL CARTILAGES 3. LOOSE, REDUNDANT MUCOSA OF LARYNX

5. C/F: M:F= 1:1, CRY IS NORMAL INSPIRATORY STRIDOR: HIGH PITCH, “FLUTTERING” , WITHIN FEW DAYS OF BIRTH , OR URTI INCREASES TILL FIRST YEAR STARTS RESOLVING. SUPINE POSITION, SUCKLING, CRYING WORSENS STRIDOR IMPROVES IN PRONE POSITION

6. DIAGNOSIS: HISTORY VIDEOLARYNGOSCOPY/FLEXIBLE NASO LARYNGOSCOPY: 1. OMEGA SHAPED EPIGLOTTIS 2. SHORT AE FOLD, PROLAPSES INWARDS 3. PROMINENT ARYTENOIDS, LOOSE MUCOSA, MOVE INWARDS 4. DIFFICULT TO SEE VOCAL CORDS

9. TREATMENT: 1. 90% CASES RESOLVE BY 2 YEARS 2. TREAT URTI EFFECTIVELY SEVERE RESPIRATORY DISTRESS, FEEDING DIFFICULTY( HIGH INTRA THORACIC NEGATIVE PRESSURE GERD ) WITH FAILURE TO THRIVE ACTIVE INTERVENTION

10. EMERGENCY MANAGEMENT: 1. ENDOTRACHEAL INTUBATION 2. TEMPORARY TRACHEOSTOMY

11. CONSERVATIVE MANAGEMENT ENDOSCOPIC ARY- EPIGLOTTOPLASTY ( SUPRAGLOTTOPLASTY) CO2 / COLD KNIFE  AE FOLD RELEASED FROM EPIGLOTTIS & REDUNDANT MUCOSA OF ARYTENOID EXCISED IF NEEDED ALONG WITH CUNEIFORM CARTILAGES

12. LARYNGOCELE AIR-FILLED DILATATION OF SACCULUS ETIOLOGY: 1. CONGENITALLY LARGE SACCULE 2. INCREASED INTRA LARYNGEAL PRESSURE  GAS BLOWERS, SAXOPHONE PLAYERS, COUGHING etc

14. TYPES: Internal- within the larynx External- Projects through the thyro-hyoid membrane and presents as swelling in the lateral neck Combined

16. CLINICAL FEATURES Asymptomatic Hoarseness RESPIRATORY DISTRESS INCREASES ON CRYING OR STRAINING Neck: Cystic, painless swelling, reducible, increases on valsalva ILS: Smooth bulge on the ventricular band, may obscure the vocal cords

17. BRYCE’S SIGN: GIRGLING & HISSING SOUND IN THROAT WHEN EXTERNAL MASS IS COMPRESSED IF SAC OPENING IS OBSTRUCTED  MUCOCELE ( SACCULAR CYST )

18. MANAGEMENT SOFT TISSUE XRAY NECK/ CT SCAN DURING VALSALVA DIRECT LARYNGOSCOPY TO RULE OUT UNDERLYING MALIGNANCY TREATMENT: MLS & MARSUPIALIZATION OF SAC (VENTRICULAR BAND & LARYNGOCELE IS CUT & MARGINS EVERTED) EXTERNAL (TRANSCERVICAL) EXCISION (EITHER CUT THE NECK OF SAC & SUTURE OR LARYNGOFISSURE & SAC EXCISION)

19. LARYNGEAL WEB FAILURE OF COMPLETE CANALIZATION OF LARYNX DURING 5TH WEEK OF IU LIFE MOST COMMON IS GLOTTIC WEB(75%), LESS COMMON ARE SUPRA & SUB GLOTTIC MOSTLY ANTERIOR GLOTTIC WEBS POSTERIOR INTERARYTENOID WEBS MAY BE ASSOCIATED WITH CRICOARYTENOID JOINT FIXATION

20. C/F: WEAK CRY AT BIRTH RECURRENT CROUP INSPIRATORY OR BIPHASIC STRIDOR DIAGNOSIS: VIDEODIRECT ENDOSCOPY/ FLEXIBLE NASOLARYNGOSCOPY

22. Rx: ASYMPTOMATIC  REASSURANCE

26. PREFERABLY KEEL INSERTED AT AGE OF 3 YRS & ABOVE TEMPORARY TRACHEOSTOMY WHEN KEEL IN-SITU ( 2- 5 WEEKS) INSERTED ENDOSCOPICALLY WITH COMBINEDLARYNGOFISSURE APPROACH VERY SEVERE WEB INVOLVING SUBGLOTTIS  EMERGENCY TRACHEOSTOMY AT 2 yrsLTR ( Laryngo tracheal reconstruction) WITH ANTERIOR CARTILAGE GRAFTING

27. THANK YOU