January 1, 2010 Megan L. Durr, MD, Nishant Agrawal, MD, John R. Saunders, MD, and Patrick K. Ha, MD
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Abstract
Lipomas are benign mesenchymal tumors that are often found in the head and neck. Intrinsic lipomas of the larynx and supraglottic area are rare, as fewer than 115 cases have been reported in the literature; almost all of these occurred in isolation. We report a case of a laryngeal lipoma that was associated with diffuse systemic lipomatosis. The tumor was successfully removed via an endoscopic laser resection. To the best of our knowledge, this is only the second case of laryngeal lipoma associated with lipomatosis to be reported in the English-language literature. We also review the literature on head and neck lipomas.
January 1, 2010 Sohit P. Kanotra, MS, Sonika Kanotra, MS, J. Paul, MS, and Padam S. Jamwal, MS
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Abstract
Chondrosarcoma is the most frequently encountered nonepithelial tumor of the larynx. Still, laryngeal chondrosarcoma is a rare disease, accounting for less than 1% of all laryngeal neoplasms; only about 600 cases have been reported in the world literature. The two most common sites of origin are the cricoid cartilage (69% of cases) and the thyroid cartilage (9%); arytenoid cartilage origin has been seen in less than 3% of cases. The diagnosis of laryngeal chondrosarcoma is easy to miss because of its infrequent occurrence, its indolent pattern of growth, and the difficulty in differentiating it histopathologically from chondroma. However, suspicion of arytenoid chondrosarcoma may be raised by a finding of its characteristic appearance as a smooth, hard, mucosa-covered supraglottic mass that is fairly recognizable on indirect laryngoscopy. We report a new case of chondrosarcoma of the arytenoid cartilage in a 47-year-old man, and we discuss the clinical features, diagnosis, and management of this uncommon tumor.
December 1, 2009 Heitham Gheriani, FRCSI, FRCSC, Mohammad Habibulla Khan, MRCSI, and John D. Russell, MCh, FRCSI
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Abstract
Vocal fold granuloma induced by polytef (Teflon) injection is rare. This condition requires surgical intervention in order to restore the voice. In this report, we discuss the use of an endoscopic laryngeal microdebrider blade in successfully treating this condition. To the best of our knowledge, this procedure has not been previously described in the literature.
October 31, 2009 Mete Iseri, MD, Murat Ozturk, MD, and S. Arif Ulubil, MD
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Abstract
Simultaneous extramedullary plasmacytoma of the nasopharynx and larynx is exceedingly rare; to the best of our knowledge, only 1 other case has been previously reported. We report a new case, which occurred in a 46-year-old woman. She was treated with a combination of surgery, radiotherapy, and chemotherapy. At 2 years of follow-up, no evidence of recurrence or progression to multiple myeloma was noted. We discuss the clinical features and treatment of plasma cell neoplasms in general and their three variants in particular.
September 30, 2009 Juliana Godoy Portas, SLP, Débora dos Santos Queija, SLP, Leonora Pereira Arine, SLP, Alessandra Sampaio Ferreira, SLP, Rogério A. Dedivitis, MD, PhD, Carlos Neutzling Lehn, MD, PhD, and Ana Paula Brandão Barros, SLP, PhD
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Abstract
We conducted a prospective study of 11 patients with laryngeal cancer who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. Our goal was to evaluate their postoperative voice and swallowing function and to ascertain the impact that surgery had on patient-perceived quality of life. Postoperative assessments were made by auditory perception analyses, objective voice analyses, the Voice Handicap Index questionnaire, the Quality of Life in Swallowing Disorders questionnaire, and videofluoroscopy. Following surgery, 8 patients experienced severe dysphonia and 3 experienced moderate dysphonia. Also, 5 patients experienced mild to severe dysphagia whereas 6 patients experienced normal or near-normal swallowing function. Postoperative acoustic measurements were higher than expected, and spectrographic evaluation revealed the presence of high-grade noise without predominant concentration over the spectrum. Some association with the grade of dysphonia and self-perception of voice handicap was observed. With regard to swallowing, 5 patients (45.5%) showed a decrease in laryngeal remnant elevation and a slight or moderate degree of stasis in the oropharynx. Overall, patients reported good quality of life regarding both voice and swallowing. No relationship between the functional swallowing and the number of preserved arytenoid cartilages was observed.
September 30, 2009 Robert T. Sataloff, MD, DMA, FACS, Editor-in-Chief
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Medicine is replete with assumptions and myths based on faulty reasoning. It is important for all of us to be aware of this problem and diligent about assessing evidence to draw the best possible conclusions.
September 30, 2009 Scott Rickert, MD, Robert Buckmire, MD, and Lucian Sulica, MD
July 31, 2009 Núria Gonzàlez, MD, Blanca Xicoy, MD, Alejandro Olivé, MD, Josep Jové, MD, Josep-Maria Ribera, MD, and Evarist Feliu, MD
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Abstract
Primary lymphomas of the larynx are extremely rare. Even more unusual is their association with rheumatologic diseases. Some cases of lymphoma have developed after chemotherapy for rheumatologic diseases, suggesting that the treatment may contribute to the development of lymphoma. The converse can also occur-the development of rheumatologic disease after a primary laryngeal lymphoma-but that is even rarer. We report a case of primary extranodal marginal zone B-cell MALT (mucosa-associated lymphoid tissue)lymphoma of the larynx in a 42-year-old woman treated with involved-field radiotherapy who developed systemic lupus erythematosus (SLE) 1 year after the lymphoma diagnosis. Currently, the patient remains in remission 8 years after her diagnosis. The SLE, for which she is receiving maintenance therapy, is stable.
July 31, 2009 Scott L. Lee, MD, David Neskey, MD, and Jason Mouzakes, MD
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Abstract
Methotrexate is a dihydrofolate reductase inhibitor with application both as a chemotherapeutic agent and as a disease-modifying antirheumatic drug. Although its ability to inhibit cellular proliferation is a desired effect in its role as an antineoplastic agent, this property may also hinder normal physiologic regeneration of the nasal epithelium. This effect may predispose patients to septal cartilage ischemia, necrosis and, eventually, perforation. We report 2 cases of septal perforations in the setting of prolonged methotrexate use and present a literature review. Patient 1 is an 8-year-old boy with juvenile rheumatoid arthritis managed with weekly methotrexate who developed a 4-mm septal perforation with an unremarkable biopsy. This was closed with a mucosal advancement flap without incident. Patient 2 is an 11-year-old boy with non-Hodgkin lymphoma treated with methotrexate. His examination was significant for a large perforation of the dorsocaudal septum. A biopsy was negative for malignancy in this patient. Repair has been deferred-initially for chemotherapy and currently for treatment relapse. We hypothesize that prolonged use of methotrexate alters the balance between physiologic desquamation and epithelial regeneration. This imbalance may promote septal ischemia and predispose patients to the development of septal perforations.
July 31, 2009 Swapna K. Chandran, MD, Karen M. Lyons, MD, Venu Divi, MD, Matthew Geyer, NRCMA, and Robert T. Sataloff, MD, DMA
July 31, 2009 Dary J. Costa, MD, Mark A. Varvares, MD, and B. Kirke Bieneman, MD
June 30, 2009 Farzad Izadi, MD, Mohammad Reza Azizi, MD, Hadi Ghanbari, MD, Maryam Kadivar, MD, and Behzad Pousti, MD
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Abstract
Laryngeal spindle cell neoplasms are uncommon tumors, frequently misdiagnosed as reactive lesions or mesenchymal malignancies. One of the rare mesenchymal tumors of the larynx is myxoid spindle cell tumor (angiomyxoma), a benign proliferative lesion. It is considered the laryngeal counterpart of the aggressive angiomyxoma of the pelvis and perineum. Although benign, angiomyxomas have a propensity for local recurrence due to their tendency to infiltrate surrounding tissues. They commonly appear encapsulated, but simple enucleation does not provide adequate treatment; excision should include a margin of normal tissue around the tumor. We describe a case of laryngeal angiomyxoma in a 40-year-old man that, to the best of our knowledge, is only the second such case reported in the literature. The tumor in our case showed no histologic evidence of aggressive behavior, but because of the potential for local recurrence, close follow-up was warranted.
