Sistemik Hastalıklarda Larenks
Özet
Sistemik hastalıklar, özellikle otoimmün, romatolojik ve granülomatöz süreçler, larenks tutulumu göstererek disfoni, disfaji, ses kısıklığı ve solunum sıkıntısı gibi önemli KBB semptomlarına yol açabilir. Romatoid artritte krikoaritenoid eklem ankilozu ve vokal kord nodülleri görülürken; SLE’de mukozal ülserler ve vokal kord paralizileri, Sjörgen Sendromu’nda ise bambu nodülleri ve kuruluk dikkat çeker. Skleroderma sınırlı hareket ve disfajiye neden olur, idiyopatik enflamatuvar miyopatiler ve nöromüsküler hastalıklar ise kas zayıflığına bağlı işlev bozuklukları yaratır. Tekrarlayan Polikondrit ve Wegener granülomatozu gibi hastalıklar kıkırdak yıkımı ve subglottik stenoz ile hayati hava yolu daralmalarına yol açabilir. Pemfigus supraglottik stenoza, Sarkoidoz ise soluk ödemli kabarıklıklara neden olur. Larenks tüberkülozu, sifilis ve lepra gibi enfeksiyonlar nekroz ve granülomlarla maligniteleri taklit edebilir. Sistemik mikozlar immün yetmezliği olanlarda görülürken, Amiloidoz vokal kordlarda lokalize veya yaygın protein birikimiyle seyreder. Bu hastalıkların tanısında klinik muayene, spesifik otoantikor panelleri ve histopatolojik biyopsi kritik öneme sahiptir. Tedavi süreçleri, hava yolu güvenliğini sağlamaya yönelik cerrahi müdahaleler ile romatoloji başta olmak üzere multidisipliner medikal stratejileri içerir.
Systemic diseases, particularly autoimmune, rheumatologic, and granulomatous disorders, frequently involve the larynx, presenting with critical symptoms such as dysphonia, dysphagia, hoarseness, and airway obstruction. Rheumatoid arthritis manifests through cricoarytenoid joint ankylosis and rheumatoid nodules, whereas SLE causes mucosal ulcers and vocal cord paralysis, and Sjögren's syndrome presents with bamboo nodules and severe mucosal dryness. Scleroderma leads to tissue fibrosis and dysphagia, while idiopathic inflammatory myopathies and neuromuscular disorders result in laryngeal muscle weakness. Conditions like relapsing polychondritis and granulomatosis with polyangiitis (Wegener's) induce cartilage destruction and subglottic stenosis, causing life-threatening airway collapse. Pemphigus triggers supraglottic stenosis, and sarcoidosis causes pale supraglottic edema. Infectious granulomatous diseases including laryngeal tuberculosis, syphilis, and leprosy mimic malignancies through necrosis and structural destruction. Systemic mycoses affect immunocompromised individuals, whereas amyloidosis causes extracellular protein deposition in the vocal cords. Diagnosis relies heavily on comprehensive clinical examination, specific autoantibody screenings, and histopathological biopsies. Management requires a multidisciplinary medical approach, primarily collaborating with rheumatology, combined with surgical interventions like tracheostomy or lesion excision when airway patency is compromised.
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