Diverticula of the larynx and pharynx (喉部及咽部憩室)

Pharyngeal pouch (咽囊)

A pharyngeal pouch develops from a herniation of pharyngeal mucosa through Killian’s dehiscence.

Clinical features:
Dysphagia and regurgitation of food occur. Large pouches may cause aspiration pneumonia. Pooling of saliva in the hypopharynx may be noted on indirect laryngoscopy. Barium swallow confirms the diagnosis.

Following an endoscopy to exclude an associated carcinoma, the pouch may be excised via an external approach or the wall between the pouch and oesophagus divided endoscopically using a stapling gun.

Laryngocele (喉膨出)

Distension of the laryngeal saccule can produce an internal or external laryngocele.

Clinical features:
Hoarseness or dysphagia may occur. External laryngoceles may produce a swelling in the neck accentuated by performing Valsalva’s manoeuvre. Laryngeal tomograms taken during this manoeuvre will demonstrate the laryngocele.

Following endoscopy to exclude an associated carcinoma, an internal laryngocele can be ‘uncapped’ whilst an external laryngocele is excised through the neck.


食物的營養成分及保健功效 - 海帶







Tracheostomy (氣管造口術)

A tracheostomy is an artificial opening made into the trachea. It may be created after the larynx has been removed, when it is permanent, or when the larynx is still in place, when it is usually temporary.

  • Total laryngectomy
  • Airway protection, e.g. after major head and neck surgery, neurological disease involving the larynx
  • Airway obstruction, e.g. epiglottitis, bilateral recurrent laryngeal nerve palsy, tumour
  • Respiratory insufficiency (when endotracheal intubation required for longer than 72h) e.g. severe chest wall injury, Guillain-Barre syndrome

Surgical technique:
  • Incision, horizontal, midway between the cricoid cartilage and suprasternal notch.
  • Vertical incision and separation of strap muscles.
  • Transfixion and separation of thyroid isthmus.
  • Creation of an opening into the trachea. In adults a window is cut out. A vertical slit incision is used in children. A trap-door flap should not be used.
  • Insertion of tracheostomy tube. A correctly sized cuffed synthetic tube is used for the first 24h. this can be replaced later on by an uncuffed tube.

  • Immediate. Pneumothorax, haemorrhage, surgical emphysema and tube displacement can all occur.
  • Early. Wound infection, dysphagia and tube obstruction are all common. Tracheal erosion with innominate artery rupture, perichondritis and apnoea in hypercapnoeic bronchitics are rare.
  • Late. Tracheal stenosis may result from prolonged or overinflation of the cuffed tube. Decannulation may be difficult in children. Surgical closure of a persistent tracheocutaneous fistula is rarely required after decannulation. 

Stomal stenosis (造瘻口狹窄)
Aetiology:Following laryngectomy the lower end of the trachea is brought out through the neck skin. Local wound infection, radiotherapy and keloid formation all predispose to the later development of a stomal stenosis. The other cause of stomal stenosis is recurrence of tumour.

Management of benign stomal stenosis is either by the permanent wearing of a stoma button or laryngectomy tube or by surgical revision of the stoma.


食物的營養成分及保健功效 - 蔥






Congenital neck masses (先天性頸部腫塊)

Throglossal cyst (甲狀舌管囊腫)
Most common midline neck cyst usually presenting in childhood.

Clinical features:
Painless, unless infected, and moves on protrusion of tongue. Sinus formation may follow previous infection or incomplete excision.

If a thyroid scan shows functioning tissue elsewhere, then excise with central portion of hyoid bone and tract up to foramen caecum (Sistrunk’s operation).

Branchial cyst and fistula (鰓裂囊腫及瘻管)
Represent branchial apparatus remnants. The fistula results from persistence of the second pouch and cervical sinus.

Clinical features:
Cysts usually lie deep to the anterior border of sternomastoid, presenting with a painless neck swelling or mimicking a parapharyngeal abscess if infection occurs. A complete branchial fistula has its internal opening in the region of the tonsil and an external opening anterior to sternomastoid. Diagnosis can be confirmed by needle aspiration of cyst contents.

Excision, with any fistulous tract.

Cystic hygroma (水囊狀淋巴管瘤)
A variety of lymphangioma.

Clinical features:
A soft transilluminable mass usually presenting in the parotid region in the first year of life.

Excision, which may have to be incomplete because of the diffuse infiltration of soft tissues by the tumour.


食物的營養成分及保健功效 - 紹菜







Upper aerodigestive tract foreign bodies (上呼吸消化道異物)

Oropharynx (口咽)
Fish bones may lodge in the tonsil or tongue base.

Clinical features:
The patient complains of pain on swallowing and points to the suprahyoid region. The bone may only be obvious on palpation: X-rays are unhelpful.

Removal under direct vision.

Hypopharynx/oesophagus (下咽/食管)
A bone or food bolus usually gets lodged at one of four sites:
  • One piriform fossa
  • The postcricoid region (15cm from the upper incisor)
  • The level of the aortic arch (at 25cm)
  • At the oesophago-gastric junction (40cm)
Clinical features:
Dysphagia may be total, the patient spitting out saliva and pointing to the suprasternal or retrosternal region. A soft tissue lateral X-ray of the neck may delineate a bone.

Endoscopic removal should be undertaken as soon as possible, to avoid airway oedema, soft tissue infection or oesophageal perforation.

Bronchus (支氣管)
Often a peanut in a young child.

Clinical features:
After an initial coughing fit there is often a latent period before respiratory distress becomes obvious. The chest X-ray may show collapse of the lung distally, if the obstruction is complete, or emphysema of the involved side if the obstruction acts as a one-way valve.

Bronchoscopic removal is mandatory.


食物的營養成分及保健功效 - 白菜







Laryngeal Tumours (喉腫瘤)

Papilloma (乳頭狀瘤)
Localized infection with human papillomavirus (HPV).

Clinical features:
  • In the child (juvenile form): multiple lesions that may spread to the trachea and bronchi. Cases may regress at puberty.
  • In the adult: less common and usually a single lesion.
Both forms present with hoarseness or airway obstruction.

Endoscopic removal using either suction diathermy or a CO2 laser. Surgical seeding of lesions within the larynx or trachea is common, and removal may be necessary for frequent recurrence.

Carcinoma (癌)
Associated with cigarette smoking and high alcohol intake, although the latter is more important in causing piriform fossa carcinoma.

Clinical features:
Usually presents as persistent hoarseness. Dysphagia, chronic cough, stridor and referred otalgia may also occur. Occasionally a supraglottic tumour may present with metastatic neck nodes. The tumour may be evident on indirect laryngoscopy but endoscopic assessment and biopsy are mandatory before deciding on the appropriate treatment. A second primary (1%) in the upper aerodigestive tract should be searched for at this time.

Fine-needle aspiration cytology of any suspicious neck mass should also be undertaken. A CT scan will show any spread outside the larynx, or involvement of laryngeal cartilages.

Small (T1 and T2) carcinomas are best treated with primary radiotherapy, laryngectomy being reserved for post-radiation recurrences, larger (T3 and T4) lesions and primary tumours associated with neck nodes greater than 2cm in diameter. Primary endoscopic excision of laryngeal carcinomas with a carbon dioxide laser is now being undertaken by some surgeons.

Voice rehabilitation:
Following total laryngectomy the patient may be able to speak again by:
  • Learning oesophageal speech (swallowed air is voluntarily regurgitated through the pharynx)
  • Using an artificial larynx, which transmits vibrations into the pharynx and oral cavity while the patient articulates
  • Surgical provision of a tracheo-oesophageal fistula, which is fitted with a button or valve. The button has a one-way flutter valve, which allows airflow from the trachea into the pharynx when the tracheostome is occluded. In selected patients this enables the development of good voice.

Patients require close follow-up. Recurrences can develop in the larynx, pharynx, stoma or neck. Further surgery or radiotherapy may be indicated. The expected 5-year survival for a T1 laryngeal cancer is about 95%. This falls to about 50% for T4 disease.


風癩「抓狂」 呷醋止痕傷胃灼食道【明報專訊】2019-7-22

風癩「抓狂」 呷醋止痕傷胃灼食道【明報專訊】2019-7-22



歎冷氣吃生冷食物誘發 驟起驟退

  • 風寒束表:風團偏淡色,患者多為常吹冷氣或進食生冷食物,致風邪進入身體,氣血不能正常運作,繼而發為風團
  • 風熱犯表:風團顏色偏紅,痕癢較劇烈,發作時皮膚會感到灼熱,患者多為進食發物,如牛肉、羊肉、海鮮等,引致皮膚過敏,誘發風癩


蒜醋久放招菌 外敷易過敏





Chronic laryngitis (慢性喉炎)

Chronic non-specific laryngitis (慢性非特異性喉炎)
Common. Usually associated with vocal abuse, smoking or sepsis elsewhere in the respiratory tract, e.g. chronic sinusitis.

Clinical features:
Hoarseness may be accompanied by sore throat. Indirect laryngoscopy may distinguish localized forms, e.g. singer’s nodules, Reinke’s oedema or laryngeal polyps, from the generalized forms, e.g. chronic hypertrophic laryngitis.

Treatment involves the removal of any precipitating factors and speech therapy is important. Localized polyps or nodules may merit endoscopic removal.

Chronic specific laryngitis (慢性特異性喉炎)
Rare. Most of the granulomatous diseases can involve the larynx, e.g. tuberculosis, syphilis, sarcoidosis, scleroma or Wegener’s granulomatosis.

The lesions may mimic a carcinoma and a direct laryngoscopy and biopsy is mandatory. Treatment is that of the underlying systemic condition.

Leukoplakia (聲帶白斑)
Usually affects the true cords. The aetiology is as for chronic non-specific laryngitis. Microscopically, the findings of hyperkeratosis and dysplasia are common, although in situ or invasive carcinoma can only be excluded by an adequate biopsy.

Endoscopy should be undertaken in all cases. Leukoplakia should be regarded as having the potential to undergo malignant change.


食物的營養成分及保健功效 - 芫荽







Clinical examination of the larynx (喉部臨床檢查)

If symptoms of hoarseness, dysphagia, chronic sore throat or a lump in the neck continue for longer than 6 weeks, careful examination of the upper airway is mandatory.

Listen to the patient’s voice: is it intermittently or permanently dysphonic? 

The former might suggest a functional problem, the latter an organic one. A breathy voice is a typical of a vocal cord palsy. Also, listen for evidence of stridor. A “hot potato” voice is indicative of supraglottic or oropharyngeal pathology.

When assessing the oral cavity and oropharynx, particular attention should be paid to mucosal ulceration or swelling. If the patient has a particularly brisk gag reflex, the palate and oropharynx should be sprayed with Lidocaine prior to attempting indirect laryngoscopy. 

A warmed laryngeal mirror is used to visualize the larynx while the doctor gently holds the patient’s protruded tongue. The patient should mouth breathe. Vocal cord movement is assessed by asking the patient to say “Hey!” or “eeee…”. If the technique is not tolerated, then the patient’s better nasal airway is locally anaesthetized and a fibre-optic scope is used to examine the larynx and pharynx.

Both the nose and neck should be routinely examined as part of the assessment of the upper airway.


食物的營養成分及保健功效 - 通菜







Tumours of the tonsil (扁桃體腫瘤)

Benign cysts (良性囊腫)
Clinical features:
Mucous retention cysts, tonsilloliths or cysts of inspissated epithelial debris may occur. They are smooth and localized to one portion of the tonsil.

Symptomatic cysts may be helped by tonsillectomy.

Lymphoma (淋巴瘤)
Clinical features:
Unilateral tonsillar swelling with an intact overlying mucosa may cause dysphagia and is suspicious of a lymphoma. The tonsil feels rubbery. Excision biopsy confirms the diagnosis.

After staging the disease, treatment involves radiotherapy for localized disease, with chemotherapy being added in more advanced cases.

Carcinoma (癌)
Clinical features:
Squamous carcinoma of the tonsil presents as otalgia, sore throat or dysphagia in heavy drinkers and smokers. More than 50%of cases have involved neck nodes ipsilaterally: this may be the mode of presentation. The tonsil is hard and ulcerated.

After full endoscopy and biopsy small primaries without nodes are best treated by radiotherapy. Surgery (which involves a block dissection of neck, partial mandibulectomy and excision of the primary) is reserved for radiation failures and large primaries. 


食物的營養成分及保健功效 - 南瓜







Leukoplakia and tongue carcinoma (舌白斑和舌癌)

Leukoplakia (舌白斑)
A white patch which cannot be wiped away and for which no other diagnosis is apparent. Risk factors in the development of oral cavity or tongue leukoplakia include alcohol, smoking, spice and betel nut chewing, syphilis and dental trauma. About 5% of cases become malignant. Exclusion of an associated carcinoma is essential.

Tongue carcinoma (舌癌)
Almost all tongue carcinomas are squamous in origin. There need not be any pre-existing leukoplakia.

Clinical features:
May present as an exophytic or infiltrative lump on the tongue. Pain and dysphagia are common. Referred otalgia (via lingual and glossopharyngeal nerves) may also occur. At presentation most tumours are greater than 2cm diameter and 50% have palpably involved lymph nodes.

Small lesions  Radiotherapy, using external beam or interstitial implant techniques, or surgery, in the form of a partial or hemiglossectomy are equally effective.

Large lesions – Treatment is with radiotherapy or surgery alone or a planned combination of the two. Both modalities produce quite severe functional disability in the oral cavity, especially regarding speech and swallowing.


食物的營養成分及保健功效 - 青瓜







Nasal airway obstruction in children (兒童鼻氣道阻塞)

Nasal obstruction in children is usually noted by parents,, particularly when accompanied by rhinorrhea and snoring. Adenoid hypertrophy is the common cause of pediatric nasal obstruction. However, the following conditions should also be borne in mind.

Posterior choanal atresia (後鼻孔閉鎖)
A congenital condition caused by persistence of the embryonic bucconasal membrane. The obstruction is at the posterior end of the nose near the edge of the hard palate.

Clinical features:
In bilateral cases there is respiratory difficulty at birth aggravated by feeding and necessitating the use of an oral airway. Unilateral cases present later with unilateral nasal obstruction and rhinorrhea. Diagnosis is made by the inability to pass a rubber catheter through the nose into the pharynx and is confirmed by CT scanning.

Surgical division of the atretic plate by the transnasal or transpalatal route is required.

Nasal foreign body (鼻腔異物)
A common occurrence in children, e.g. with beads, pieces of sponge or paper.

Clinical features:
Typically presents with unilateral foul blood-stained rhinorrhea, nasal vestibulitis and fetor.

A general anesthetic is occasionally required for removal in an uncooperative child.


食物的營養成分及保健功效 - 菠菜







Otitis externa (外耳道炎)

Inflammation of the skin of the external auditory meatus.

Caused by either primary infection or contact sensitivity to topically applied substances such as cosmetics or antibiotics. Gram-negative organisms (e.g. Proteus, Pseudomonas) and fungi (e.g. Aspergillus) are often found. 
Precipitating factors include impacted cerumen, local trauma, middle ear discharge through a tympanic membrane perforation, swimming and skin conditions such as psoriasis and seborrheic dermatitis.

Clinical features:
Presents as otalgia, otorrhoea and deafness. The skin of the external auditory meatus is oedematous and inflamed. The meatus may be occluded with discharge and in fungal infections hypae may be seen. Traction on the pinna increases the otalgia, a sign not found in inflammatory conditions of the middle ear.

Debris must be removed from the meatus, either by dry mopping or by suction aided by the use of an operating microscope. A swab of the meatus is taken for bacteriology prior to the instillation of drops containing an antibiotic and steroid mixture. If the meatus is total occluded, an impregnated gauze wick may be inserted. In severe cases with cellulitis spreading onto the pinna systemic antibiotics are also needed.

Furunculosis of the external auditory meatus (外耳道癤)
Staphylococcal infection of hair follicles found in the lateral part of the meatus.

Clinical features:
Presents as severe otalgia exacerbated by traction on the pinna, with deafness if the meatus becomes occluded. The furuncle is often visible.

Most furuncles rupture spontaneously. Ribbon gauze impregnated with glycerin/ichthammol may be inserted daily into the meatus. Systemic flucloxacillin and analgesics are also needed.

Necrotizing (malignant) otitis externa (壞死性/惡性外耳炎)
A potentially fatal Pseudomonas infection of the external auditory meatus, with spread to the skull base. It occurs in elderly diabetics and also in patients with HIV/AIDS.

Clinical features:
Presents as severe otalgia, otorrhoea and deafness with progression to cranial nerve palsies (VII, IX, X, XI, XII) in advanced cases.

Treatment is by local surgery, usually mastoidectomy, combined with a prolonged course of specific antipseudomonal antibiotics. Skull base involvement and its response to treatment may be assessed by radioisotope scanning.


食物的營養成分及保健功效 - 茄子







Diseases of the external nose (外鼻疾病)

Rhinophyma (肥大性酒渣鼻)
Clinical features:
Red nodular masses centred around the nasal tip in association with acne rosacea, usually seen in elderly men.

If unsightly, treat by dermabrasion or surgical shaving.

Lupus vulgaris (尋常狼瘡)
Inoculation of the bacterium Mycobacterium tuberculosis, possibly through nose picking.

Clinical features:
Red/brown patches or nodules on the nasal or facial skin. Perforation of the cartilaginous nasal septum can occur, with scarring in long-standing cases.

Treatment is by antituberculous chemotherapy.

Lupus pernio (凍瘡樣狼瘡)
Clinical features:
Skin lesions other than erythema nodosum occur in 20% of patients with sarcoidosis. Lupus pernio is common and is frequently associated with bone cysts and chest disease.

Treat the underlying disease.

Malignant tumours (惡性腫瘤)
Clinical features:
Basal or squamous cell carcinomas present as warty or ulcerating lesions, rarely with lymphadenopathy. Melanomas are more rare.

Excision biopsy when possible; radiotherapy for larger tumours not involving bone. 


食物的營養成分及保健功效 - 大蒜







Neck space infections (頸部間隙感染)

Acute retropharyngeal abscess (急性咽後膿腫)
Lymphadenitis of the retropharyngeal nodes following an upper respiratory tract infection in children.

Clinical features:
Presents with sore throat, pyrexia and swelling of the posterior pharyngeal wall. Lateral X-ray shows retropharyngeal swelling.

The abscess should be drained via the mouth with precautions taken to avoid inhalation of pus.

Chronic retropharyngeal abscess (慢性咽後膿腫)
Occurs in adults in association with tuberculous cervical spine disease.

Clinical features:
Swelling is seen in the midline of the pharynx and X-rays show vertebral disease.

Treatment is with antituberculous chemotherapy.

Parapharyngeal abscess (咽旁膿腫)
The tissue space lateral to the pharynx may become infected by spread of organisms from the tonsils or lower third molar teeth.

Clinical features:
Presents with sore throat and trismus. The tonsil is pushed medically and there is neck swelling.

Treatment is by incision and drainage via the neck followed by appropriate antibiotic therapy.

Ludwig’s angina (Ludwig咽峽炎)
Clinical features:
Cellulitis of the submandibular space secondary to dental disease or tonsillitis presents with swelling of the submental region and floor of the mouth.

Treat with high-dose antibiotics. 


食物的營養成分及保健功效 - 生姜







Acute tonsillitis (急性扁桃體炎)

A very common disease particularly affecting children between the ages of 4 and 10 years.

Over 50% of the cases are due to a B haemolytic streptococcus, the majority of the others being of viral, staphylococcal or pneumococcal origin.

Clinical features:
Sore throat, dysphagia, pain on swallowing and otalgia are associated with pyrexia and general malaise. The pharyngeal mucosa appears red and the tonsils are often enlarged and covered by discrete microabscesses or a confluent exudate. 
The tonsils often remain chronically enlarged and inflamed. Lymphadenopathy is frequent, the jugulo-digastric nodes being most commonly involved. A full blood count reveals a leukocytosis but a bacteriology swab does not always grow the pathogen concerned.

Differerntial diagnosis:
  • Infectious mononucleosis – it may be impossible to distinguish between the two without a Paul-Bunnell test and a differential white cell count (the latter shows atypical monocytes and a lymphocytosis).
  • Blood dyscrasias – any white cell abnormality giving an impaired immune status may present as a severe pharyngitis, e.g. acute leukaemia.
  • Diphtheria – rarely seen but should always be borne in mind when there is a membranous exudate over the tonsils or when severe airways obstruction is evident.

Bed rest, antibiotics and adequate hydration. Penicillin is given (orally or intravenously) unless organism sensitivities or allergy dictate otherwise. In severe cases with grossly enlarged tonsils a tracheostomy may be necessary for airway obstruction.
Recurrent episodes over a prolonged period of time are best managed by tonsillectomy. Following surgery the tonsillar fossae heal over a period of 7-10 days during which time they are covered by a slough, which may mimic an ulcerative pharyngitis. Infection and secondary haemorrhage from the fossae can occur during this period.


Chronic tonsillitis
  • Peritonsillar abscess (quinsy): hospitalization, antibiotics and intraoral incision and drainage are required
  • Parapharyngeal abscess: requires surgical drainage through an external neck incision

Acute otitis media
Post-streptococcal rheumatic fever/glomerulonephritis: now rare. 


Laryngeal obstruction in children (兒童喉阻塞)

Clinical features:
The hallmark of laryngeal obstruction is stridor. Inspiratory stridor indicates glottic or supraglottic obstruction, expiratory stridor bronchial obstruction and two-way stridor subglottic obstruction. If stridor is accompanied by cyanosis, tachycardia and intercostal and sternal recession, urgent measures are needed to save life. In less severe cases a hoarse voice, feeding problems and recurrent chest infections may occur.

Congenital laryngeal obstruction (先天性喉阻塞)

Congenital anomalies include laryngeal cysts, webs, stenosis, vascular rings and vocal cord paralysis. Laryngomalacia is a condition caused by abnormal flaccidity of the larynx allowing the supraglottic structures to be drawn into the airway on inspiration; the condition resolves with age.

All cases of congenital stridor should undergo direct laryngoscopy.

Acquired laryngeal obstruction (後天性喉阻塞)

  • Acute epiglottitis – due to Haemophilus influenzae. It causes rapidly progressive airway obstruction.
  • Acute laryngotracheobronchitis (croup) – due to para-influenzae virus or respiratory syncytial virus. It produces oedema, exudates and crusting of the larynx, trachea and bronchi.
  • Subglottic stenosis – may follow infant tracheostomy or prolonged endotracheal intubation.

  • Acute epiglottitis – treatment is with intravenous chloramphenicol. Endotracheal intubation or an emergency tracheostomy may be necessary.
  • Acute laryngotracheobronchitis – endotracheal intubation is rarely required.


食物的營養成分及保健功效 - 紅蘿蔔




營養成分:含豐富類胡蘿蔔素,蛋白質,脂肪,碳水化合物,維他命B 雜,維他命C等。



Paranasal sinus tumours (鼻竇腫瘤)

  • Benign tumours – include papillomas, adenomas, osteomas and angiomas. The inverting papilloma may undergo malignant change.
  • Malignant tumours – 50% of malignant tumours are found in the maxillary sinus. Squamous cell carcinoma is the most common type. Others include adenocarcinoma, adenoid cystic carcinoma, melanoma and sarcoma.

Clinical features:
Benign tumours frequently present as a unilateral nasal polyp. Malignant tumours spread medically to produce nasal obstruction or epistaxis, posteriorly to give Eustachian tube obstruction and cranial nerve palsies, inferiorly to disrupt the teeth to give proptosis or epiphora. Lateral spread produces swelling of the cheek.

Prior to treatment planning, histological diagnosis and radiological assessment of the extent of the tumour using CT scanning and sinus tomography are necessary. Benign tumours are treated by local extension, either endoscopically or by an external lateral rhinotomy approach. 
Malignant tumours have a poor prognosis due to their late presentation and extensive spread. When curative treatment is possible a combination of radical surgery (maxillectomy) and radiotherapy is usually used. The resulting defect is filled with a dental plate and obturator.