Adenocarcinoma of the cardias and simultaneous carcinoma epidermoid of the larynx.
Four months previously, the patient presented with hoarseness.
The etiology of oral epidermoide carcinoma is connected to the abusive use of tobacco and alcohol, having been in various studies demonstrated the effect synergetic of these agents, the gastroesophageal reflux disease play role in pathogenesis of the Squamous cell carcinoma of the larynx.
For further endoscopic information, download the video clip by clicking on the endoscopic image. Wait to be downloaded complete then Press Alt and Enter for full screen ( Windows Media), Real Player: Ctrl and 3. All endoscopic images shown in this Atlas contain video clips.We recommend seeing the video clips in full screen mode. Medline.
VideoEndoscopic Sequence 2 of 3.
Squamous cell carcinoma of the larynx.
Laryngeal cancer is the most common cancer of the upper aerodigestive tract. The incidence of laryngeal tumors is closely correlated with smoking, as head and neck tumors occur 6 times more often among cigarette smokers than among nonsmokers. The age-standardized risk of mortality from laryngeal cancer appears to have a linear relationship with increasing cigarette consumption. Death from laryngeal cancer is 20 times more likely for the heaviest smokers than for nonsmokers.
VideoEndoscopic Sequence 3 of 3.
Squamous cell carcinoma of the larynx.
We used a regular endoscopy forceps biopsy device to get the biopsies of the larynx cancer.
Extensive carcinoma that invades larynx, epiglottis and base of the tongue.
The history of supraglottic laryngectomies starts off in 1883 with Bill Roth, pictured here, who performed the first laryngectomy. This was a very morbid procedure at the time, and many of his patients died on the operating room table. Since then, Trotter was one of the first to excise an epiglottic cancer via lateral pharyngotomy. It was Alonso from South America in the 1950s who was the first to describe the first supraglottic laryngectomy, but it wasn’t until the 60s that Dr. Ogura standardized the technique and showed its efficacy in treating this disease. In the 1970s, Bocca was the first to report a large series of supraglottic laryngectomies in his results.
Video Endoscopic Sequence 2 of 2.
The image and the video clip display a carcinoma that invades several extructures in the oropharingeal area.
Extensive Larynx Carcinoma.
Squamous Cell Carcinoma of the Larynx.
Patient was referred to our unit for placement of PEG. tube.
Narrow Band Imaging (NBI).
NBI is an optical imaging technology. It works by altering the white light source to consist of specific wavelength bands, which take advantage of the scattering and absorption properties of human tissues.
Because the gastrointestinal tract is mainly composed of blood vessels and mucosa, narrow band illumination, which is strongly absorbed by hemoglobin and penetrates only the surface of tissues, is ideal for enhancing the contrast between the two. As a result, under narrow band illumination, capillaries on the mucosal surface are displayed in brown and veins in the submucosa are displayed in cyan on the monitor.
Larynx Carcinoma.
Laryngeal carcinoma is one of the most common head and neck tumours with an annual incidence of approximately 1 per 100,000. It should be suspected in any patient with hoarseness of the voice for three weeks or longer until proven otherwise.
Men are affected more often than women but during the last decade, the number of cases in women has increased such that they now account for about 20% of cases. Most patients are elderly and almost always, are smokers.
Sixty percent of tumours occur in the glottis and present early with dysphonia. If detected early, the prognosis is excellent with a 90% 5 year cure rate.
Video Endoscopic Sequence 1 of 8.
Case of Severe Epistaxis.
A 76 year-old female that one month previously was hospitalized due to severe epistaxis in a hospital of the Social Insurance of El Salvador, had been treated with repeated anteroposterior nasal packing, presented significant secondary anemia. Patient does not accept sanguineous transfusions due to religious rules. Three years earlier, we had practiced an upper endoscopy and a colonoscopy, both were negative. Due to generalized weakness, edema and anemia (with Hb. 6.2 mg/dl) she was hospitalized. 2 days later she initiates with multiple melenas, the clinical picture was of severe bleeding of the upper digestive tract, nevertheless gastric lavage with nasogastric tube was negative to bled, the next day the hemoglobin falls to 3.2 mg/dl, an upper endoscopydid not find any pathological site that bled.
Due to the antecedent of epistaxis we decided to inspect the nose with the endoscope that we use for the upper gastrointestinal track, finding the images and videos displayed here.
Video Endoscopic Sequence 2 of 8.
Injectionof absolute alcohol was injected into the lesion.
Video Endoscopic Sequence 3 of 8.
Epistaxis
In rare cases, this condition may lead to massive bleeding and even death. Although epistaxis can have an anterior or posterior source, it most often originates in the anterior nasal cavity.
Video Endoscopic Sequence 4 of 8.
The image and the video clips display the second injection of absolute alcohol
Epistaxis is one of the most frequent emergencies in Otorhinolaryngology and occurs in other disciplines.
Epistaxis is classified on the basis of the primary bleeding site as anterior or posterior. Hemorrhage is most commonly anterior, originating from the nasal septum. A common source of anterior epistaxis is the Kiesselbach plexus, an anastomotic network of vessels on the anterior portion of the nasal septum. Anterior bleeding may also originate anterior to the inferior turbinate. Posterior hemorrhage originates from branches of the sphenopalatine artery in the posterior nasal cavity or nasopharynx.
Video Endoscopic Sequence 5 of 8.
Approximately 90% of nosebleeds can be visualized in the anterior portion of the nasal cavity.
Massive epistaxis may be confused with hemoptysis or hematemesis. Blood dripping from the posterior nasopharynx confirms a nasal source.
Bimodal incidence exists, with peaks in those aged 2-10 years and 50-80 years.
Video Endoscopic Sequence 6 of 8.
Those images and video clips are final status of absolute alcohol ablation.
Video Endoscopic Sequence 7 of 8.
Video Endoscopic Sequence 8 of 8.
Status after alcohol ablation
Carcinoma of the base of the tongue.
Etiology: Risk factors for the development of base of tongue carcinoma include chronic alcohol and tobacco use, older age, geographic location, and family history of upper aerodigestive tract cancers. Environmental exposure to polycyclic aromatic hydrocarbons, asbestos, and welding fumes may increase the risk of pharyngeal cancer. Nutritional deficiencies and infectious agents (especially papillomavirus and fungi) also may play a significant role.
The most common symptoms associated with malignant neoplasms of the tongue base are dysphagia, odynophagia, sensation of a mass in the throat, or the presence of a mass in the neck. Patients also may complain of referred ear pain or hemoptysis. Delay in diagnosis is not uncommon because of the common and sometimes vague nature of symptoms and the relative inaccessibility of the base of the tongue to examination. Upon physical examination, a mass is usually palpable in this area. Extensive submucosal disease or a strong gag reflex may make palpation more difficult. Patients may have bilateral palpable adenopathy because of the midline location and the high propensity for regional lymph node metastases. Indirect or flexible fiberoptic laryngoscopy in the office is a useful adjunct to the physical examination.
Larynx with ictericia (yellowish color).
A 76 year-old woman with obstructed ictericia.
Small papilomas of the larynx.
Video Endoscopic Sequence 1 of 2.
Enlarged Tonsils
Video Endoscopic Sequence 2 of 2.
Chronic Tonsillitis - These people have a chronic low grade infection of the tonsils. Often they have large crypts which are difficult to sterilize with antibiotics. The lymph nodes in_ the neck are usually swollen from constant stimulation. Sometimes the crypts retain food and debris leading to chronic halitosis (bad breath) and this in and of itself may be an indication for tonsillectomy. The typical history from these patients is that their sore throat gets better on antibiotics, but then comes back as soon as they stop.
Video Endoscopic Sequence 1 of 2.
Oropharinx of a professional singer.
A 45 year-old male. Curiously one of the arathinoids is a little hypertrophic.
Video Endoscopic Sequence 2 of 2.
Tonsils.
Small crypts are observed.
Bilobulated Uvula.
Normal anatomical variation.
The uvula plays an important role in the articulation of the sound of the human voice to form the sounds of speech. It functions in tandem with the back of the throat, the palate, and air coming up from the lungs to create a number of guttural and other sounds. Consonants pronounced with the uvula are not found in English; however, languages such as Arabic, French, German, Hebrew, Ubykh, and Hmong use uvular consonants to varying degrees. Certain African languages use the uvula to produce click consonants as well. In English (as well as many other languages), it closes to prevent air escaping through the nose when making some sounds.
Larynx with ictericia.
A 59 year-old female with ictericia due to hepatic cirrhosis.
Oropharingeal lipoma.
The left arathinoids shows a small yellowish nodule.
Video Endoscopic Sequence 10 of 32.
Nasopharynx.
Observed through trans-fistula-gastrostomy retrograde endoscopy. We passed it from the mouth right to the back of the nose. After observing the nasopharynx, the endoscope was passed through the mouth.
This image and video clip is not usually observed in normal endoscopic conditions.
With this possibility give us, an unlimited therapeutical approach alone or together with the otorhinolaryngologist.
GRANULOMA - The vocal fold on the right side of the picture has a granuloma attached to the vocal process which is causing a small reactive lesion on the opposite vocal process.
Laryngopharyngeal reflux (LPR) is the most common cause of formation of a granuloma. Another common cause is irritation from an endotracheal tube (the tube placed in the throat for breathing during a surgery under general anesthesia), which can rub against the back of the larynx.
Treatment for granuloma depends upon the size of the lesion and the length of time it has been present, but most likely will require control of reflux, and may also include relative voice rest, and/or surgery and voice therapy. Surgery by itself, without other measures, will often result in the regrowth of the lesion in a short period of time.
Video Endoscopic Sequence 2 of 2.
This picture shows the diminution of the size after one month of treatment with PPI.
This 35 year old male with long standing reflux disease. The upper endoscopy displayed reflux esophagitis.
Findings suggestive of laryngopharyngeal reflux include the following: erythema of the arytenoid, interarytenoid area or laryngeal surface of the epiglottis; a cobblestone appearance of the interarytenoid area; edema of the true vocal cords; inflammatory lesions of the true vocal cords, such as granuloma and contact ulcer; and pooling of secretions in the hypopharynx. Edema of the true vocal cords can range from mild to severe; severe edema has the appearance of polypoid masses. Vocal cord edema of this degree can result in severe dysphonia, stridor or airway compromise. The edema develops in the superficial layer of the lamina propria of the true vocal cords, also called Reinke's space. Thus, it is often referred to as Reinke's edema. The presence of edema of the true vocal cords is highly suggestive of laryngopharyngeal reflux, even in the absence of laryngeal erythema.
The diagnosis of hemangioma is established by clinical findings and history in most cases although ultrasound, computer tomography, and particularly magnetic resonance imaging may be helpful in certain situations. MRI can accurately determine the extent of the lesion and the finding of serpentine high-volume flow voids surrounded by nonvascular soft tissue is characteristic of hemangiomas Biopsy is rarely indicated and may be dangerous.
Candidiasis is a frequent complication for HIV-positive individuals. Candida can infect the lining of the mucous membranes in the esophagus, intestines.
Video Endoscopic Sequence 2 of 5.
Candidiasis. White plaques are present on the buccal mucosa and the undersurface of the tongue and represent thrush. When wiped off, the plaques leave red erosive areas.
Video Endoscopic Sequence 3 of 5.
The usual clinical presentation of Candida esophagitis is dysphagia and/or odynophagia in a patient with 1 or more predisposing factors for the condition. Symptoms are variable in severity, ranging from mild difficulty in swallowing to such intense odynophagia that the patient is unable to eat or swallow saliva. Other patients may present with chest pain or gastrointestinal tract bleeding, and occasionally, they may be asymptomatic.
Video Endoscopic Sequence 4 of 5.
Oropharyngeal candidiasis is commonly associated with esophageal candidiasis; therefore, the presence of oral thrush may be helpful in suggesting the diagnosis of Candida esophagitis in the appropriate clinical setting. Nevertheless, only 50-75% of patients with Candida esophagitis have oropharyngeal disease, and some patients with oropharyngeal candidiasis and dysphagia are found to have other types of esophagitis; therefore, the correct diagnosis cannot always be suggested on the basis of clinical presentation.
Video Endoscopic Sequence 5 of 5.
This image and the video clip display esophageal candidiasis.
Uvula with Herpes.
Endotracheal Tube
Proper management of the endotracheal tube is a critical and often overlooked aspect of care for patients receiving mechanical ventilation. Clinicians must take measures to prevent complications related to the tube, and must recognize and treat these complications if they do occur.
An endotracheal tube should be placed and maintained so that the end of the tube is two to six cm above the carina. In an average adult with an orally placed endotracheal tube, the distal tip of the tube is usually appropriately positioned midway between the vocal cords and the carina when the tube is between the 18- and 24-cm mark measured at the incisors.
