SMF/Lab Ilmu Kesehatan Telinga Hidung dan Tenggorok Fakultas Kedokteran Universitas Mulawarman
Referat
KARSINOMA LARING
Oleh: Nur Hayati Amaliaturrahmah
Pembimbing: dr. Selvianti, Sp. THT-KL
Dibawakan Dalam Rangka Tugas Kepaniteraan Klinik SMF/Laboratorium Ilmu Kesehatan Telinga Hidung dan Tenggorok Fakultas Kedokteran Universitas Mulawarman Samarinda 2012
0
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
BAB I PENDAHULUAN
1.1. Latar Belakang
Karsinoma laring merupakan keganasan yang sering terjadi pada saluran nafas dan masih merupakan masalah karena penanggulannnya mencakup berbagai segi. Angka kejadian karsinoma laring di RS Cipto Mangunkusuma Jakarta menduduki urutan ketiga setelah karsinoma nasofaring dan karsinoma hidung dan sinus paranasal.
1
Penyebab karsinoma laring belum diketahui dengan pasti. Meningkatnya insiden karsinoma laring sangat berkaitan dengan merokok dimana seorang perokok memiliki risiko 6 kali lipat untuk menderita tumor kepala dan leher dibandingkan dengan bukan perokok dan lebih banyak terjadi pada laki-laki. Namun, akhir-akhir ini jumlah penderita perempuan semakin meningkat karena adanya kecenderungan makin banyaknya wanita yang merokok. Mortalitas penderita karsinoma laring lebih banyak terjadi pada perokok berat dibandingkan dengan bukan perokok yaitu sekitar 20 kali lipat.
2
Pasien karsinoma laring biasanya datang dalam stadium lanjut sehingga hasil pengobatan yang diberikan kurang memuaskan, oleh karena itu perlu diagnosis dini untuk penanggulangannya. penanggulangannya.
3
Secara umum penatalaksanaan karsinoma laring meliputi pembedahan, radiasi, sitostatika ataupun terapi kombinasi, tergantung stadium penyakit dan keadaan umum penderita. Tujuan utama penatalaksanaan karsinoma laring adalah mengeluarkan bagian laring yang terkena tumor dengan memperhatikan fungsi 2,3
respirasi, fonasi serta fungsi sfingter laring .
1.2 Tujuan
Tujuan penulisan referat ini yaitu untuk menambah wawasan pengetahuan penulis dan pembaca tentang karsinoma laring agar bermanfaat dalam menegakkan diagnosis lebih dini, sehingga dapat ditangani lebih awal dan
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
BAB II TINJAUAN PUSTAKA
2.1
Anatomi dan fisiologi laring
2.1.1 Anatomi laring
Faring, laring, trakea dan paru merupakan derivat foregut embrional yang terbentuk sekitar 18 hari setelah terjadi konsepsi. Sesudahnya terbentuk alur faring median yang berisi petunjuk-petunjuk pertama sistem pernafasan dan benih laring. Sulkus atau alur laringotrakeal mulai nyata sekitar hari ke 21 kehidupan embrio. Perluasan alur ke kaudal merupakan primaordial paru. Alur menjadi lebih dalam dan berbentuk kantung dan kemudian menjadi dua lobus pada hari ke 27 atau 28. Bagian yang paling proksimal dari tuba akan menjadi laring. Pembesaran aritenoid dan lamina epitelial dapat dikenali pada hari ke 33. Sedangkan kartilago, otot, dan sebagian besar pita suara terbentuk dalam 3-4 minggu berikutnya. Hanya kartilago epiglotis yang tidak terbentuk hingga masa midfetal. Banyak struktur merupakan derivat apartus brankialis.
4
Laring merupakan bagian yang terbawah dari saluran napas bagian atas bentuknya menyerupai limas segitiga terpancung, dengan bagian atas lebih besar daripada bagian bawah. Laring terletak setinggi vertebra servicalis IV – VI, dimana pada anak-anak dan wanita letaknya relatif lebih tinggi.
1,5
Batas-batas laring yaitu sebelah kranial terdapat aditus laringeus yang berhubungan dengan hipofaring, di sebelah kaudal dibentuk oleh sisi inferior kartilago krikoid dan berhubungan dengan trakea, di sebelah lateral ditutupi oleh otot-otot sternokleidomastoideus, infrahyoid dan lobus kelenjar tiroid. Sedangkan di sebelah posterior dipisahkan dari vertebra servikalis oleh otot-otot prevertebral, dinding dan cavum laringofaring serta disebelah anterior ditutupi oleh fascia, jaringan lemak, dan kulit. Secara keseluruhan laring dibentuk oleh sejumlah kartilago, ligamentum dan otot-otot.
5
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
a. Tulang dan kartilago Laring dibentuk oleh sebuah tulang di bagian atas dan beberapa tulang rawan yang saling berhubungan satu sama lain dan diikat oleh otot intrinsik dan ekstrinsik serta dilapisi oleh mukosa. Tulang dan tulang rawan l aring yaitu : 1. Os hyoid Os hyoid terletak paling atas, berbentuk huruf “U”, mudah diraba pada leher bagian depan. Pada kedua sisi tulang ini terdapat prosesus longus dibagian belakang dan prosesus brevis bagian depan. Permukaan bagian atas tulang ini dihubungkan dengan lidah, mandibula dan tengkorak oleh tendo dan otot-otot.
1,5
2. Kartilago epiglottis Bentuk kartilago epiglotis seperti bet pingpong dan membentuk dinding anterior aditus laringeus. Tangkainya disebut petiolus dan dihubungkan oleh ligamentum tiroepiglotika ke kartilago tiroidea di sebelah atas pita suara. Sedangkan bagian atas menjulur di belakang korpus hyoid ke dalam lumen faring sehingga membatasi basis lidah dan laring.
5
3. Kartilago tiroid Kartilago tiroid merupakan tulang rawan laring yang terbesar, terdiri dari dua lamina yang bersatu di bagian depan dan mengembang ke arah belakang. apple, Pada kartilago tiroid terdapat penonjolan yang disebut Adam’s apple, penonjolan ini dapat diraba pada garis tengah leher.
4,5
4. Kartilago krikoid Kartilago krikoid terletak di belakang kartilago tiroid dan merupakan tulang rawan paling bawah dari laring. Di setiap sisi tulang rawan krikoid melekat ligamentum krikoaritenoid, otot krikoaritenoid lateral dan di bagian belakang melekat otot krikoaritenoid posterior. Kartilago krikoidea pada dewasa terletak setinggi vertebra servikalis VI – VII dan pada anak-anak 5
setinggi vertebra servikalis III – III – IV. IV. 5. Kartilago aritenoid
Terdapat 2 buah kartilago ariteoid yang terletak dekat permukaan belakang
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
6. Kartilago kornikulata Kartilago kornikulata merupakan kartilago fibroelastis yang terletak di atas 5
aritenoid serta di dalam plika ariepiglotika. 7. Kartilago kuneiformis
5
Kartilago kuneiformis terletak di dalam lipatan l ipatan ariepiglotik. 8. Kartilago tritisea
Kartilago tritisea terletak di dalam ligamentum hiotiroid lateral.
4
Gambar 1. Struktur laring
b. Ligamentum dan membrana 5
Ligamentum dan membran laring terbagi menjadi : 1. Ligamentum ekstrinsik yang terdiri dari : - Membran tirohioid - Ligamentum tirohioid - Ligamentum tiroepiglotis - Ligamentum hioepiglotis - Ligamentum krikotrakeal
5
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Gambar 2. Ligamentum ekstrinsik laring
5
5
2. Ligamentum intrinsik yang terdiri dari : - Membran quadrangularis - Ligamentum vestibular - Konus elastikus - Ligamentum krikotiroid media - Ligamentum vokalis
5
Gambar 3. Ligamentum intrinsik laring
c. Otot-otot Otot-otot laring terbagi menjadi otot ekstrinsik dan otot intrinsik. 1. Otot-otot ekstrinsik 5
a. Otot-otot suprahioid / otot-otot elevator laring, yaitu :
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
- m. geniohioideus - m. digastrikus - m. genioglosus - m. hioglosus 5
b. Otot-otot infrahioid / otot-otot depresor laring, yaitu : - m. omohioideus - m. sternokleidomastoideus sternokleidomastoideus - m. tirohioideus
Gambar 4. Otot-otot ekstrinsik laring
5
2. Otot-otot intrinsik Otot-otot ini menghubungkan kartilago satu dengan yang lainnya dan berfungsi menggerakkan struktur yang ada di dalam laring terutama untuk membentuk suara dan bernafas. Otot-otot pada kelompok ini berpasangan berpasangan kecuali m. interaritenoideus yang serabutnya berjalan transversal dan oblik. Fungsi otot ini dalam proses pembentukkan suara, proses menelan dan bernafas. Bila m.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Otot-otot ini berfungsi untuk merapatkan/menggerakkan pita suara ke 5
medial.
2. Otot-otot abduktor M. krikoaritenoideus posterior (m. posticus) yang berfungsi untuk menggerakan menggerakan pita suara ke lateral.
5
3. Otot-otot tensor - Tensor internus : m. tiroaritenoideus dan m. vokalis - Tensor eksternus : m. krikotiroideus Otot-otot ini mempunyai fungsi untuk menegangkan pita suara. Pada orang tua, m. tensor internus kehilangan sebagian tonusnya sehingga pita suara melengkung ke lateral mengakibatkan suara menjadi lemah dan serak.
Gambar 5. Otot-otot instrinsik laring laring
5
5
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
d. Persarafan Laring dipersarafi oleh cabang n. vagus yaitu n. laringeus superior dan n. laringeus inferior kiri dan kanan. 1. Nervus laringeus superior Nervus laringeus superior meninggalkan n. vagus tepat di bawah ganglion nodosum, melengkung ke depan dan medial di bawah a. karotis interna dan eksterna yang kemudian akan bercabang menjadi: -
Ramus internus yang bersifat sensoris, mempersarafi valekula, epiglotis, sinus piriformis dan mukosa bagian dalam laring di atas pita suara sejati.
-
Ramus eksternus yang bersifat motoris, mempersarafi m. krikotiroid dan 5
m. konstriktor inferior. 2. Nervus laringeus inferior
Nervus laringeus inferior merupakan lanjutan dari n. laringeus rekuren, nervus ini berjalan dalam lekukan diantara trakea dan esofagus, mencapai laring tepat di belakang artikulasio krikotiroidea.
5
Nervus ini merupakan cabang n. vagus setinggi bagian proksimal a. subklavia dan berjalan membelok ke atas sepanjang lekukan antara trakea dan esofagus, selanjutnya akan mencapai laring tepat di belakang artikulasio krikotiroidea dan memberikan persarafan : -
Sensoris pada daerah sub glotis dan bagian atas trakea
-
Motoris pada semua otot laring kecuali m. krikotiroid
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
e. Vaskularisasi Laring mendapat perdarahan dari cabang a. tiroidea superior dan inferior yaitu a. laringeus superior dan inferior.
5
1. Arteri laringeus superior Arteri ini berjalan bersama ramus interna n. laringeus superior menembus membrana tirohioid menuju ke bawah diantara dinding lateral dan dasar sinus 5
pyriformis.
2. Arteri laringeus inferior Arteri ini berjalan bersama n. laringeus inferior masuk ke dalam laring melalui area Killian Jamieson yaitu celah yang berada di bawah M. konstriktor faringeus inferior, di dalam laring beranastomose dengan a. laringeus superior dan memperdarahi otot-otot dan mukosa laring.
5
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
f. Sistem Limfatik Laring mempunyai 3 (tiga) sistem penyaluran limfe, yaitu : 1. Daerah bagian atas pita suara sejati, pembuluh limfe berkumpul membentuk saluran yang menembus membrana tiroidea menuju kelenjar limfe servikal superior profunda. Limfe ini juga menuju ke superior jugular node dan middle jugular node.
5
2. Daerah bagian bawah pita suara sejati bergabung dengan sistem limfe trakea, middle jugular node, dan inferior jugular node.
3. Bagian anterior laring berhubungan dengan kedua sistem tersebut dan sistem limfe esofagus. Sistem limfe ini penting sehubungan dengan metastase karsinoma laring dan menentukan terapinya.
5
5
Gambar 9. Aliran Aliran Limfatik Laring
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
seperti rongga mulut, udara dalam paru-paru, trakea, faring, dan hidung. Nada dasar yang dihasilkan dapat dimodifikasi dengan berbagai cara. Otot intrinsik laring berperan penting dalam penyesuaian tinggi nada dengan mengubah bentuk dan massa ujung-ujung bebas dan tegangan pita suara sejati.
4,5
2. Proteksi Benda asing tidak dapat masuk ke dalam laring dengan adanya reflek otot otot yang bersifat aduksi, sehingga rima glotis tertutup. Pada waktu menelan, pernafasan berhenti sejenak akibat adanya rangsangan terhadap reseptor yang ada pada epiglotis, plika ariepiglotika, plika ventrikularis dan daerah interaritenoid melalui serabut aferen n. laringeus superior sehingga sfingter dan epiglotis menutup. Gerakan laring ke atas dan ke depan menyebabkan celah proksimal laring tertutup oleh dasar lidah. Struktur ini mengalihkan makanan ke lateral menjauhi aditus dan masuk ke sinus piriformis lalu ke introitus esofagus.
4,5
3. Respirasi Pada waktu inspirasi diafragma bergerak ke bawah untuk memperbesar rongga dada dan m. krikoaritenoideus posterior terangsang sehingga kontraksinya menyebabkan menyebabkan rima glotis terbuka. Proses ini dipengaruhi oleh tekanan parsial CO 2 dan O2 arteri serta pH darah. Bila pO2 tinggi akan menghambat pembukaan rima
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
5. Fiksasi Berhubungan dengan mempertahankan tekanan intratorakal agar tetap tinggi, misalnya batuk, bersin dan mengedan.
4,5
6. Menelan Terdapat 3 (tiga) kejadian yang berhubungan dengan laring pada saat berlangsungnya proses menelan, yaitu : - Pada waktu menelan faring bagian bawah (m. konstriktor faringeus superior, m. palatofaringeus dan m. stilofaringeus) mengalami kontraksi sepanjang kartilago krikoidea dan kartilago tiroidea, serta menarik laring ke atas menuju basis lidah, kemudian makanan terdorong ke bawah dan terjadi t erjadi pembukaan faringoesofageal. - Laring menutup untuk mencegah makanan atau minuman masuk ke saluran pernafasan dengan jalan menkontraksikan orifisium dan penutupan laring oleh epiglotis. - Epiglotis menjadi lebih datar membentuk semacam papan penutup aditus laringeus, sehingga makanan atau minuman terdorong ke lateral menjauhi aditus laring dan maduk ke sinus piriformis piri formis lalu ke hiatus esofagus.
4
7. Batuk Bentuk plika vokalis palsu memungkinkan laring berfungsi sebagai katup,
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
laring per 100.000 penduduk laki-laki dan 1.3 kasus karsinoma laring per 100.000 penduduk perempuan. Pada akhir-akhir ini tercatat insiden tumor ganas laring pada wanita meningkat. Ini dihubungkan dengan meningkatnya jumlah wanita yang merokok.
1,6,7
Di RSUP H. Adam Malik Medan, Februari 1995 – Juni – Juni 2003 dijumpai 97 kasus karsinoma laring dengan perbandingan laki dan perempuan 8 : 1. Usia – Februari 2000, penderita berkisar antara 30 sampai 79 tahun. Dari Februari 1995 – Februari 28 orang diantaranya telah dilakukan operasi laringektomi total.
8
2.2.2 Etiologi
Penyebab pasti sampai saat ini belum diketahui. Dikatakan oleh para ahli bahwa perokok dan peminum alkohol merupakan kelompok orang-orang dengan resiko tinggi terhadap karsinoma laring. Merokok merupakan faktor risiko utama pada karsinoma laring dimana pada rokok terdapat 43 bahan karsinogen antara lain polisiklik hirokarbon, nitrosamin, radioaktif polonium-210.
9,10
Alkohol (etanol) jika dikombinasi dengan penggunaan rokok maka akan berpotensi untuk memberikan efek karsinogenik yang akan memudahkan penetrasi zat karsinogenik dalam jaringan tubuh. Etanol juga mengganggu sintesis
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
ini mengakibatkan proliferasi terus-menerus dari sel anaplastik yang akan mengambil suply oksigen, darah dan nutrien dari sel normal sehingga penderita akan mengalami penurunan berat badan. Sealin itu akan terjadi penurunan serta serta destruksi komponen darah, penurunan trombosit menyebabkan gangguan perdarahan, penurunan jumlah eritrosit menyebabkan anemia dan penurunan leukosit menyebabkan menyebabkan gangguan gangguan status imunologi pasien. pasien. Proliferasi sel kanker yang terus berlanjut hingga membentuk suatu masa mengakibatkan mengakibatkan kompresi pada pembuluh darah sekitar dan saraf sehingga terjadilah odinofagi, disfagi, dan nyeri pada kartilago tiroid. Massa tersebut juga mengakibatkan hambatan pada jalan nafas. Iritasi pada nervus laringeus menyebabkan suara menjadi serak. Jika mutasi yang terjadi sangat progresif, kanker dapat bermetastasis ke jaringan sekitar dan kelenjar getah bening.
9
2.2.4 Histopatologi
Karsinoma sel skuamosa meliputi 95 – 98% dari semua tumor ganas laring, dengan derajat differensiasi yang berbeda-beda. Karsinoma sel skuamosa dibagi 3 tingkat diferensiasi, yaitu:
1,7,11
a. Berdiferensiasi baik (Grade I)
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Yang termasuk supraglotis adalah : permukaan posterior epiglotis yang terletak di sekitar os hioid, lipatan ariepiglotik, aritenoid, epiglotis yang terletak di bawah os hioid, pita suara palsu, ventrikel.
1, 12
Yang termasuk glottis adalah : pita suara asli, komisura anterior dan komisura posterior.
1,12
Yang termasuk subglotis adalah : dinding subglotis. Klasifikasi dan stadium tumor berdasarkan UICC
1,12
1,12
:
1. Tumor Primer (T) Supraglotis Tis
Karsinoma insitu
T0
tidak jelas adanya tumor primer l
T1
Tumor terdapat pada satu sisi suara/pita suara palsu (gerakan masih baik). T1a: tumor terbatas pada permukaan laring epiglotis, plika ariepiglotika, ventrikel atau pita suara palsu satu sisi. T1b: tumor telah mengenai epiglotis dan meluas ke rongga ventrikel atau pita suara palsu
T2
Tumor sudah menjalar ke 1 dan 2 sisi daaerah supra glotis dan
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
T2
Tumor meluas ke daerah supraglotis atau subglotis, pita suara masih dapat bergerak atau sudah terfiksir (impaired mobility).
T3
Tumor meliputi laring dan pita suara sudah terfiksir.
T4
Tumor sangat luas dengan kerusakan tulang rawan tiroid atau sudah keluar dari laring.
Subglotis Tis
karsinoma insitu
T0
Tak jelas adanya tumor primer
T1
Tumor terbatas pada daerah subglotis. T1a : tumor terbatas pada satu sisi T1b : tumor telah mengenai kedua sisi
T2
Tumor sudah meluas ke pita, pita suara masih dapat bergerak atau
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
M1
Terdapat metastasis jauh.
4. Stadium STADIUM
TUMOR
KEL.LIMFA
METASTASIS
PRIMER Stadium 1
T1
N0
N0
Stadium 2
T2
N0
N0
Stadium 3
T3
N0
M0
T1/T2/T3
N1
M0
T4
N0/N1
M0
T1/T2/T3/T4
N2/N3
T1/T2//T3/T4
N1/N2/N3
Stadium 4
M1
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
2.
Sesak nafas dan stridor Terjadi karena adanya sumbatan jalan nafas oleh massa tumor, penumpukan kotoran atau sekret, maupun fiksasi pita suara. Adanya stridor dan dispnea adalah tanda prognosis kurang baik.
3.
1,8
Rasa nyeri di tenggorok Keluhan bervariasi dari rasa goresan sampai rasa nyeri yang tajam.
4.
1,8
Disfagia dan odinofagia Merupakan ciri khas tumor pangkal lidah, supraglotik, hipofaring, hipofaring, dan sinus piriformis. Keluhan ini merupakan keluhan yang paling sering pada tumor ganas postkrikoid. Adanya odinofagi menandakan adanya tumor ganas lanjut yang mengenai struktur ekstra laring.
5.
Batuk dan hemoptisis
1,8
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
tersamar bersamaan dengan adanya TBC paru, sebab banyak penderita menjelang tua dan dari sosial-ekonomi yang lemah.
1,8
B. Pemeriksaan fisik Untuk melihat ke dalam laring dapat dilakukan dengan cara tak langsung maupun langsung dengan menggunakan laringoskop untuk menilai lokasi tumor, penyebaran tumor yang terlihat ( field cancerisation).
Selain
itu
dapat
laryngoscope dan flexible endoscope.
1,8
juga
menggunakan
of
fiber-optic
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Gambar 11. Hipertrofi dari plika vokalis
Diagnosis
pasti
ditegakkan
dengan
9
pemeriksaan
patologik
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Sering bermetastase ke paru-paru dan hepar. Two years survival ratenya sangat rendah. Terapi yang dianjurkan adalah reseksi radikal dengan diseksi kelenjar limfe regional dan radiasi pasca operasi. d)
8
Kondrosarkoma Tumor ganas yang berasal dari tulang rawan krikoid 70%, tiroid
20% dan aritenoid 10%. Sering pada laki-laki 40 – 60 tahun. Terapi
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
dan proliferasi sehingga tampak hiperemis. Pada keadaan kronis terbentuk 12
jaringan fibrotik yang disebut dengan laringitis kronik hiperplastik.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
2.2.9 Pengobatan
Secara umum ada 3 jenis penanggulangan karsinoma laring yaitu pembedahan, pembedahan, radiasi dan sitostatika, ataupun kombinasi.
1, 7, 15
I. Radioterapi Radioterapi merupakan modalitas untuk mengobati tumor glotis dan
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
perlu dilakukan tindakan diseksi leher. Pembedahan ini tidak disarankan bila telah terdapat metastase jauh.
1,8
Komplikasi dari pembedahan antara lain infeksi, perdarahan, fistel faring kutaneus, pneumonia aspirasi, stenosis stoma, faring dan esofagus serta dapat juga terjadi stenosis glotis dan supraglotis.
10
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Banyak faktor yang mempengaruhi suksesnya proses rehabilitasi suara ini. Tetapi faktor fisik dan psiko-sosial merupakan 2 faktor utama. Mungkin dengan adanya wadah perkumpulan guna menghimpun pasien-pasien tuna laring guna menyokokng aspek psikis dalam lingkup yang luas dari pasien, baik sebelum maupun sesudah operasi.
1,8
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Titles you can't find anywhere else
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.