Larynx

Potentially lethal pharyngolaryngeal edema with dyspnea in adult patients with mumps: A series of 5 cases

April 27, 2015     Masafumi Ohki, MD; Yuka Baba, MD; Shigeru Kikuchi, PhD; Atsushi Ohata, PhD; Takeshi Tsutsumi, PhD; Sunao Tanaka, MD; Atsushi Tahara, MD; Shinji Urata, MD; Junichi Ishikawa, MD
article

Abstract

In this article we describe 5 rare cases of mumps-associated pharyngolaryngeal edema. To the best of our knowledge, this report includes the first case of mumps-associated pharyngolaryngeal edema in a patient who had previously received mumps vaccination, and these cases represent the sixth report of mumps-associated pharyngolaryngeal edema in the English literature. All 5 of our patients with mumps infection were adults and manifested airway stenosis due to pharyngolaryngeal edema. This edema responded favorably to steroid treatment without tracheotomy. We conclude that a pharyngolaryngeal examination is recommended for patients with mumps infection. Steroid treatment is usually effective against pharyngolaryngeal edema; however, in certain cases tracheotomy may be inevitable.

Mixed verrucous and squamous cell carcinoma of the larynx

February 2, 2015     Giuseppe V. Staltari, BS; John W. Ingle, MD; Clark A. Rosen, MD
article

The lesion was removed en bloc, including the involved thyroarytenoid muscle.

Primary calcitonin-secreting neuroendocrine carcinoma of the supraglottic larynx

January 19, 2015     Arsheed H. Hakeem, MBBS, MS; Sultan Pradhan, MS, FRCS; Sanica Bhele, MD; Jagadish Tubachi, MS
article

The most troubling differential diagnosis for calcitonin-secreting neuroendocrine carcinoma of the larynx is medullary carcinoma of the thyroid, as these two tumors can be morphologically indistinguishable.

Laryngeal inflammatory myofibroblastic tumor

December 19, 2014     Fábio M. Girardi, MD, MSc; Ciro W. Fontana, MD; Ricardo G. Kroef, MD; Marinez B. Barra, MD; Felipe O. Detanico, MD; Nilton T. Herter, MD
article

Inflammatory myofibroblastic tumor seldom involves the larynx, as only about 50 to 60 cases have been described in the literature. Even though these tumors are often not aggressive, they have the potential for invasion and local recurrence. We describe the case of a 27-year-old man who was admitted to an emergency department with signs of upper airway obstruction secondary to an obstructive mass. Histology identified the mass as an inflammatory myofibroblastic tumor of the subglottis. The patient underwent an emergency tracheotomy followed by a partial laryngectomy. During 14 months of follow-up, he remained free of active disease.

Fish bone impaction in the supraglottis

October 17, 2014     Willis S.S. Tsang, FRCSEd(ORL); John K.S. Woo, FRCS(ORL); C. Andrew van Hasselt, M Med (Otol)
article

The most common sites of fish bone impaction are the tonsils, tonsillar pillars, tongue base, valleculae, and piriform fossa. Impaction in the supraglottic area is extremely uncommon.

Primary laryngeal tuberculosis: An unusual cause of hoarseness

October 17, 2014     Peter Fsadni, MD, MRCP(UK); Claudia Fsadni, MD, MRCP(UK), MSc(Lond); Brendan Caruana Montaldo, MD, FACP
article

Abstract

Tuberculosis (TB) of the larynx is usually associated with concomitant pulmonary TB, but approximately 20% of cases represent primary disease. We report the case of an 85-year-old woman with asthma who presented with a 6-month history of persistent hoarseness. Bronchoscopy confirmed the presence of a lesion in the hemilarynx, and histology identified tuberculoid granulomas that were suggestive of TB. Treatment with a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol led to a complete resolution of symptoms. A high index of suspicion for laryngeal TB is required in patients who present with hoarseness.

Saccular cyst as a complication of medialization laryngoplasty: A case report

August 27, 2014     Brent J. Benscoter, MD; Lee M. Akst, MD
article

Abstract

We report the case of a 54-year-old woman who presented for evaluation of deterioration in her voice and swallowing function, which had begun after she had undergone a medialization laryngoplasty for unilateral vocal fold paralysis. Findings on examination and imaging revealed that a mass had developed adjacent to the Silastic implant that had been placed during the laryngoplasty. The superior extent of the implant reached above the laryngeal ventricle. Endolaryngeal surgical resection of the mass was accomplished without the need to remove the implant. Pathologic analysis identified the mass as a laryngeal saccular cyst. Although laryngeal saccular cysts are uncommon, medialization laryngoplasties are not. This case represents a rare complication of medialization laryngoplasty in which an implant compressed the laryngeal saccule and led to formation of the cyst.

Postoperative management in laryngeal cancer with subglottic extension and histologically negative nodes: Which patients need adjuvant radiotherapy?

August 27, 2014     Federico Ampil, MD; Cherie-Ann O. Nathan, MD; Timothy Lian, MD; Roxana Baluna, MD, PhD; Edward Milligan, MD; Gloria Caldito, PhD
article

Abstract

We conducted a study of 19 patients who had laryngeal cancer with subglottic extension (LCSE) and pathologically negative lymph nodes (pN0) following total laryngectomy and neck dissection (TLND). These patients had undergone surgery during a 17-year period from 1986 through 2002. Of this group, 9 did not receive postoperative radiotherapy (non-RT group) and 10 did (RT group). Adjuvant irradiation had been administered to those with additional histopathologic risk factors for recurrence. We found that recurrence rates in the neck were 44% in the non-RT group and 11% in the RT group (1 of 9 evaluable patients), and the corresponding 5-year disease-free survival rates were 51 and 89%. While both of these differences were clinically significant, neither was statistically significant (p = 0.29 and p = 0.14, respectively). The presence of LCSE was not known prior to or during TLND in 4 non-RT patients and in 7 RT patients; their corresponding neck recurrence rates were 50 and 0%. Two of 8 patients (25%) whose ipsilateral lobe of the thyroid gland was not removed experienced a stomal recurrence. We conclude that three factors can be used to identify patients with pN0 LCSE who may be candidates for adjuvant postoperative radiotherapy: (1) a failure to remove the ipsilateral thyroid gland lobe during TLND, (2) a failure to examine the level VI lymph node for metastatic disease status, and (3) unfavorable histopathologic findings.

Invasive primary aspergillosis of the larynx presenting as hoarseness and a chronic nonhealing laryngeal ulcer in an immunocompetent host: A rare entity

July 13, 2014     Mimi Gangopadhyay, MD; Kaushik Majumdar, MD; Arghya Bandyopadhyay, MD; and Anup Ghosh, MS(ENT)
article

Abstract

Primary aspergillosis usually affects the paranasal sinuses, orbit, ear, and lower respiratory tract. Laryngeal aspergillosis usually occurs as a result of secondary invasion from the tracheobronchial tree, more commonly in immunocompromised hosts. Primary laryngeal localization of Aspergillus infection is seldom encountered. We report the case of an immunocompetent 42-year-old man who presented with hoarseness and a laryngeal ulcer of fairly long duration. A malignancy was initially suspected clinically, but a laryngoscopic biopsy led to a diagnosis of invasive primary laryngeal aspergillosis. No other focus of aspergillosis was found on x-ray and computed tomography. After identification of Aspergillus niger on culture, inquiries revealed no exposure to steroids, cytotoxic drugs, or irradiation, and workups for malignancy, human immunodeficiency virus infection, tuberculosis, and diabetes were negative. Although isolated laryngeal involvement is rare, aspergillosis may be considered in the differential diagnosis of a chronic nonhealing laryngeal ulcer that is clinically suggestive of a malignancy, even in an immunocompetent host.

The role of contact endoscopy in screening for premalignant laryngeal lesions: A study of 141 patients

May 7, 2014     Marisa Klancnik, MD; Ivo Gluncic, MD, PhD; Drasko Cikojevic, MD, PhD
article

Abstract

At their earliest stage, pathologic lesions of the laryngeal epithelium are macroscopically invisible. Ideally, these lesions should be detected before their clinical manifestations appear so that prompt management can be initiated. However, most diagnostic modalities are unable to detect early premalignant lesions. We conducted a retrospective study of the use of contact endoscopy in analyzing the vocal fold mucosal epithelium in adults who had been operated on at our hospital under general anesthesia for various nonlaryngeal diseases. After we identified 71 such patients who were smokers, we chose an almost equal number of nonsmokers (n = 70) for comparison purposes. In all, our study population was made up of 141 patients-51 men and 90 women, aged 21 to 78 years (mean: 52). All patients had normal findings on preoperative laryngeal endoscopy. Our goal was to determine if the routine use of this diagnostic modality is justified in selected cases. Contact endoscopy identified dysplastic vocal fold lesions in 4 patients and chronic laryngitis in 3; all 7 of these patients were smokers. Since early laryngeal lesions are not macroscopically evident, early detection of these changes by other means is associated with a better prognosis and easier management. Our study demonstrates that the use of contact endoscopy during general anesthesia as a standard diagnostic method in long-time cigarette smokers is fully justified.

A "nail-biting" case of an airway foreign body

May 7, 2014     Parker A. Velargo, MD; Jennifer D. McLevy, MD
article

While cases of large, completely obstructing foreign bodies in the subglottis would lead to sudden respiratory distress, the initial presentation of smaller foreign bodies in the subglottis can be quite similar to croup, presenting with biphasic stridor, cough, and/or the steeple sign.

Resolution of laryngeal granuloma with high-dose prednisone

May 7, 2014     Matthew L. Mesick, MD; Philip A. Weissbrod, MD
article

Laryngeal manifestation of pemphigus vulgaris is extremely rare and typically associated with ulcerations, bullae, and crusting.

Page
of 13Next