Daily Dose ENT

7/5/2013

Answers:

The recurrent laryngeal nerve enters the larynx underneath what muscle?

A) Cricothyroid 

B) Posterior Cricoarytenoid 

C) Inferior Constrictor 

D)Superior Constrictor

How do patient's with bilateral recurrent laryngeal nerve paralysis typically present?

Pts often present in the ED with stridor as minimal laryngeal swelling can occlude the airway. There is often a hx of total thyroidectomy.

MC Question:

What is the most common cause of stridor in the pediatric population?

A) Croup 

B) Foreign Body 

C) Laryngomalacia 

D) Epiglottitis

Free Response Questions:

What is the difference between stridor and stertor?

Quick Facts:
Laryngomalacia
-Stridor due to prolapse of supraglottic structures into laryngeal inlet on inspiration.
-epiglottis is omega shaped

-aryepiglottic folds are tall and thin

-arytenoids are enlarged.
-Most courses benign.
-Does not present @ birth, pt develops inspiratory stridor in first few days. Mild at first but increases over time. Peaks at 6-9 mo.
-Usually spontaneously resolves by 18-24 months.
-Stridor is intermittent; worse @ sleep/supine/feeding/exertion.
-Cry is normal
-Treat with observation for most.
-Surgery required in ~10%. Indications include:
-severe stridor
-apnea
-failure to thrive
-pulm HTN
-cor pulmonale.
Procedures for treatment include:
-division of aryepiglottic folds
-excision of a wedge of aryepiglottic fold...may trim arytenoids or lateral epiglottis
-suturing epiglottis to base of tongue.
-Can use microdissection (more bleeding) or laser (more scarring)