PROCEDURE

• Contact endoscopy can be undertaken in either in conscious patient with topical anaesthesia or under general anaesthesia.
• It is non-invasive.
• 2 endoscope are required
  7215 AA
  7215 BA
• With these endoscope the clinician has direct access tothe subsurface microvascular plexus and to the surface epithelium which can be view at magnification of X 60 and X150.
• The mucosal surface to be examined is carefully cleaned by

1. Gentle suction or with
2. A swab moistened with saline.

• The surface is then stained with 1-5% methylene blue applied on a fragment of spongostan.
• The tip of endoscope is placed gently against the surface of the mucosa allowing examination.
• Staining last around 4-5 minutes at most site before gradually disappearing (Nasal cavity-disappear quick due to mucociliary action)

CONTACT ENDOSCOPY OF LARYNX:

It is performed ↓ GA with conventional endotracheal intubation and synchronous microlaryngoscopy

Vocal cord and hypopharynx is visualized:

• Squamous cells have: Polyhedral shape and contiguous with each other.
• Nuclei are round and darkly stained cytoplasm has light blue tone.
• N:C is regular and overall morphological patterns homogeneous.
• Ciliated epithelium is present in most of the larynx
  • Nuclei are round but the limits of the cytoplasm are difficult to define.
  • Bundles of cilia appears as filamentous structures that can be displaced by the tips of contact endoscope.
  • The transition from squamous to ciliated epithelium can be observed.
  • Island of squamous cell in the middle of ciliated epithelium may be seen ad are not abnormal.
  • The duct orifices of glances can also be identified.

• With the continuous wave and pulse wave Doppler flow imaging can real-time display inside in cross-section in the direction of blood flow, flow velocity and blood flow state and other important information that can be clearly split and the origin of reflux, location and the direction and nature of disease with narrow the blood flow velocity distribution of the lesion site.
• The two dimensional colour doppler Ultrasound can quickly and timely identify abnormal blood flowing the phase duration of length.
• M type of colour doppler ultrasound can observe abnormal blood flow in the phase duration of the length.
• It can be combined with others techniques such as oesophageal ultrasonic probe for more clear image and information about blood flow.

The following are the advantages of USG

1. Ultra sound does not use ionizing radiation, making it ideal for paediatric patients as well as for patient requiring multiple examinations in oncological practice.
2. Ultrasound is readily available and relatively cheap
3. Ultrasound allows good spatial resolution and “gold standard” in determining whether a focal lesions is cystic or solid surpassing even CT and MRI.
4. Ultra sound is well tolerated by patient and is a “patient friendly” techniques.
5. Ultrasound provides diagnostic information c a high degree of accuracy allowing for more efficient use of CT and MRI when choosing how if necessary to image the patient further.
6. An increasingly important role is to guide intervention procedure such as
   • FNAC
   • Biopsies
   • Drainage and catheters insertions accurately and in real time.

• After tracheostomy, there is a disruption of the tracheal mucosa blanket which has a protective role causing the explosive increase of the papilloma.

Q. HOW MANY PERCENTAGE OF PATIENT WITH RRP DEVELOP BRONCHIAL INVOLVEMENT?

• 2 % of all affected patient will eventually develop bronchial involvement.
• RRP is usually multiple on the onset whereas single on quiescent stage.

Q. WHAT ARE THE CHANCES OF REMISSION OF RRP ACCORDANCE TO AGE?

• Chances of remission is greatest if the disease is present between the age of 6-10 years.
• Chances of remission in patent :

1. <16 years= 46%
2. >16 years = 26%

Q. WHAT ARE THE CHANCES OF REMISSION OF RRP ACCORDANCE TO SITE?

1. Larynx: 48%
2. Tracheobrinchial tree: 27 %
3. Lungs: 0-3%
4. Extralaryngeal spread: 1%

Q. WHY IS RADIOTHERAPY CONTRAINDICATED IN RRP?

• Radiotherapy is contraindicated in RRP because of the risk of malignant change of RRP into the squamous cell carcinoma.
• Surgical extirpation is the better option.

FUNCTION:

1. Induces G1 arrest until repair is complete
2. If above is not possible- direct cell to apoptotic pathway

If P53 gene supressed (mutated), they are unable to perform above function causing outgrowth of cell I.E. Malignant clones.