Larynx

Primary laryngeal actinomycosis in an immunosuppressed woman: A case report

July 21, 2013     Tarik Abed, MBBS; Jay Ahmed, MBBS; Niamh O'Shea, MBBS; Simon Payne, FRCPath; Gavin W. Watters, FRCS
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Abstract

We report a rare case of primary laryngeal actinomycosis, which occurred in a 35-year-old woman with end-stage renal failure secondary to systemic lupus erythematosus with membranous glomerulonephritis. The patient, who had been on long-term immunosuppression therapy, presented with hoarseness. Flexible laryngoscopy detected the presence of a granular glottic mass at the anterior commissure of the larynx. Histology revealed actinomycotic organisms associated with an abscess. The patient was treated with a prolonged course of oral penicillin V and speech therapy, and her dysphonia resolved almost completely. Although actinomycotic infection of the larynx is rare, it should be considered in the differential diagnosis of hoarseness in an immunocompromised patient.

Laryngotracheal rhinosporidiosis

July 21, 2013     J. Madana, MS; Deeke Yolmo, MS; S. Gopalakrishnan, MS; Sunil K. Saxena, MS
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Abstract

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It usually affects mucous membranes of the nose, nasopharynx, and ocular conjunctiva. Cutaneous, laryngeal, tracheal, genital, and bony dissemination is rare. Laryngotracheal involvement poses many diagnostic and therapeutic challenges. A 45-year-old South Indian man presented with complaints of a mass in both nostrils for 2 years, associated with progressive hoarseness of voice and difficulty in breathing for 6 months. Rhinosporidial lesions were seen bilaterally in the nasal cavity. Telescopic and fiberoptic laryngoscopic examinations showed reddish, strawberry-like masses with whitish spots on their surface involving the larynx and trachea. Computed tomography of the head and neck revealed soft-tissue mass lesions involving the bilateral nasal cavities and nasopharynx, extending to the oropharynx and involving the larynx and trachea. A preliminary tracheostomy was performed, followed by direct laryngoscopic excision of the laryngeal lesions and rigid-bronchoscopy-guided excision of the tracheal lesions. The patient was prescribed dapsone and advised to take it for 2 years. At 2 years of follow-up, there was no recurrence.

Spindle cell lipoma of the larynx

June 11, 2013     Antonio D'Antonio, MD, PhD; Giampiero Mottola, MD; Alessia Caleo, MD; Maria Addesso, MD; and Amedeo Boscaino, MD
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Abstract

Among the primary mesenchymal tumors of the hypopharynx and larynx, lipomas are rare. Macroscopically, they often resemble a retention cyst or laryngeal nodule. Spindle cell lipomas (SCLs) are an uncommon variant of lipoma. SCLs are extremely rare in the larynx; as far as we know, only 4 cases have been previously described in the literature. We present a new case of laryngeal SCL in a 65-year-old man who presented with a 1-year history of hoarseness, choking spells, stridor, and dyspnea. Examination revealed the presence of a large polyp on the left true vocal fold that had caused stenosis of the posterior glottis. The polyp was removed endoscopically, and the patient's stridor and dyspnea resolved. Histologically, the tumor was composed of bland, CD34-positive spindle cells with an abundant fibrous and myxoid stroma interspersed with mature fatty tissue. The patient was free of local recurrence at 2 years of follow-up.

Letters to the Editor

June 11, 2013    
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Laryngeal plexiform neurofibroma in a child

June 11, 2013     Fikret Kasapoglu, MD; Talip Ozdemircan, MD; and Levent Erisen, MD
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Abstract

Neurofibromatosis (NF) is a genetically inherited, autosomal dominant disease, characterized by multiple cafe au lait spots, cutaneous neurofibromas and “Lisch nodules.” Neurofibromatosis can develop from a neural source at any age. However, neurofibroma of the larynx is extremely rare and is usually manifested by obstructive airway symptoms. We encountered a 5-year-old child presenting with stridor and dyspnea, who had a diagnosis of laryngeal plexiform neurofibroma. The purpose of our report is the consideration of laryngeal NF in the differential diagnosis of dyspnea in infants and children.

Giant cell tumor of the larynx: A case of malignant sarcomatous transformation

June 11, 2013     Richard J. Vivero, MD; Sandeep P. Dave, MD; Carmen R. Gomez, MD; and Donald T. Weed, MD
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Abstract

We report what is to the best of our knowledge the first case of malignant transformation of a giant cell tumor of the larynx. The patient, a 34-year-old man, presented to our tertiary care university teaching hospital where he underwent hemilaryngopharyngectomy with radial forearm free flap reconstruction and 11 of 15 cycles of chemotherapy. He remained disease-free at approximately 6 years and 4 months of follow-up. The patient is decannulated and continues to have a good voice with excellent quality of life to this day. We discuss the patient's clinical course and subsequent treatment within the context of a review of the current literature regarding this disease entity. Our experience demonstrates that giant cell tumor of the larynx may present as a malignant neoplasm without adversely affecting the patient's prognosis when treated aggressively with surgical resection and adjunct chemotherapy.

Previous presentation: The information in this article has been updated from its original presentation as a poster at The Triologic Society's Combined Southern and Middle Sections Meeting; January 8-11, 2009; Bonita Springs, Fla.

Bilateral Gore-Tex implant extrusion following type I thyroplasty

March 24, 2013     Farhad R. Chowdhury, DO; Adam L. Baker, MD; Robert T. Sataloff, MD, DMA, FACS
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Gore-Tex thyroplasty permits easy revision, and minor adjustments can be made, often without removing and replacing the entire prosthesis.

Malignant melanoma metastatic to the larynx: A case report

January 24, 2013     Aliasghar Arabi Mianroodi, MD; Tourajreza Mirshekari, MD; Aliakbar Taheri, MD
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Abstract

Malignant melanoma of the larynx is a rare cancer that can appear as a primary tumor or as a metastasis from a cutaneous head and neck primary. To the best of our knowledge, only 60 cases of primary laryngeal melanoma have been reported in the world literature. Melanomas metastatic to the larynx are even more rare, as only 24 cases have been previously reported. Survival is poor, and recurrence is uncommon. We describe a new case of a malignant melanoma metastatic to the larynx, which represents the first such case in Iran.

Thyroid cartilage fracture following percutaneous tracheotomy tube placement

December 31, 2012     Jaime Eaglin Moore, MD and Andrew Heller, MD
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Patients whose body mass index (BMI) is 30 or greater have a higher likelihood of a distorted anatomy, which can make tracheotomy tube placement difficult.

Mucoepidermoid carcinoma of the larynx with transglottic involvement in a child: A case report

December 31, 2012     Sanjeev Bhagat, MS; Saurabh Varshney, MS; Rakesh K. Singh, MS; Sampan Bist, MS
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Abstract

Mucoepidermoid carcinoma (MEC) of the larynx is one of the rarest tumors in the pediatric age group. Our review of the English-language literature found only 1 previously reported case of a laryngeal MEC in a child. We present what to the best of our knowledge is the first case of a pediatric MEC of the larynx with transglottic involvement. Our patient was a 12-year-old girl who presented with long-standing hoarseness and recent dysphagia, breathing difficulty, and pain radiating to the left ear. Investigation revealed the presence of an endophytic mass in the larynx. Histopathologic examination of biopsy tissue identified the mass as a low-grade MEC. The patient was scheduled to undergo a total laryngectomy 1 week later, but she did not report for surgery. Three weeks later, she presented to the emergency department in a semiconscious state and in respiratory distress. Despite all resuscitative measures, she died.

Obstructive sleep apnea syndrome induced by laryngeal lesions: Two cases

October 31, 2012     Taha Tahir Bekci, MD; Mesut Tezer, MD; Nurdogan Ata, MD; Levent Emre, MD
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Abstract

We describe 2 cases of obstructive sleep apnea syndrome (OSAS) that were found to be caused by the presence of laryngeal masses. Both patients presented with a long-standing history of snoring, gasping for air while sleeping, excessive daytime sleepiness, and morning headaches. In both patients, the lesions were discovered by fiberoptic nasopharyngoscopy. Patient 1, a 46-year-old man, declined surgery, and his lesions (and OSAS) resolved spontaneously in 4 months. Patient 2, a 39-year-old man, did undergo excision of his mass, and he also experienced an alleviation of OSAS.

Radiation-induced osteosarcoma of the larynx: Case report and literature review

October 8, 2012     Murat Ulusan, MD; Rasim Yilmazer, MD; Yasemin Ozluk, MD; Murat Enoz, MD; Yusufhan Suoglu, MD
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Abstract

Laryngeal osteosarcoma is an extremely rare disease. Only 23 cases have been published in the literature. Radiation-induced laryngeal osteosarcoma is even rarer; this is only the third such case to be reported. A 59-year-old man underwent radiotherapy for an in situ laryngeal squamous cell carcinoma at another institution. Five years later he developed a laryngeal osteosarcoma, and a total laryngectomy was performed. Although previous reports showed a poor prognosis, our patient was without disease at the 8-year follow-up. To the best of our knowledge, this is the longest disease-free follow-up to be reported in the literature. We also present a review of the world’s literature.

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