Laryngology

An unusual presentation of anterior subglottic stenosis

June 8, 2014     Harry V. Wright, MD; Kenneth C. Fletcher, MD
article

Acquired subglottic stenosis should be suspected in any patient with unexplained dyspnea weeks to months following decannulation.

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.

Retropharyngeal pseudoabscess manifesting in nephrotic syndrome

May 7, 2014     Shirish Johari, DLO, MRCSEd, DOHNS(Edin); Pankaj Handa, MD, MRCP(Ire), FAMS; Jin Keat Siow, MD, MBBS, FRCSEd
article

Abstract

We describe a case of nephrotic syndrome that manifested as a retropharyngeal pseudoabscess. The patient was a 32-year-old man who presented with a short history of throat discomfort and a choking sensation. Laryngoscopy identified bulging of the posterior pharyngeal wall that partially occluded the laryngeal inlet. A lateral neck x-ray revealed that the prevertebral space was widened, and computed tomography detected fluid in the retropharyngeal and parapharyngeal spaces. Neck exploration revealed that the edema had been caused by nonsuppurative fluid. Biochemical analyses revealed marked hypoalbuminemia and heavy proteinuria suggestive of nephrotic syndrome. Following surgery, the patient's symptoms resolved. Aseptic effusion into the retropharyngeal space is rare; reported etiologies include internal jugular vein thrombosis, neoplasia, radiation therapy, trauma, acute calcific tendinitis, hereditary angioedema, and myxedema of hypothyroidism. To the best of our knowledge, this is the first case of nephrotic syndrome initially manifesting as retropharyngeal pseudoabscess to be reported in the literature. Thrombotic occlusion of the pharyngeal venous plexus secondary to hypercoagulability is a plausible explanation for such isolated retropharyngeal effusion.

Complex posterior arytenoid dislocation

May 7, 2014     Rima A. DeFatta, MD; Jenna Briddell, MD; Robert T. Sataloff, MD, DMA, FACS
article

Arytenoid cartilage dislocation is an uncommon entity that is frequently misdiagnosed as vocal fold paresis or paralysis. The most common cause of dislocation is endotracheal intubation injury.

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.

Laryngeal schwannoma presenting as a pedunculated mass in the glottis

March 18, 2014     Hideki Nakagawa, MD; Naoyuki Kohno, MD; Toshiyuki Kusuyama, MD; Hiroyuki Fukuda, MD
article

This is the first case of laryngeal schwannoma that presented as a pedunculated tumor arising from the true vocal fold.

Two cases of granular cell tumors of the head and neck at different sites

March 18, 2014     Mustafa Paksoy, MD; Mehmet Eken, MD; Emin Ayduran, MD; Gokhan Altin, MD
article

Abstract

Granular cell tumor (GCT) is an uncommon, primarily benign lesion. We describe 2 cases of GCT. Patient 1 was a 38-year-old man who presented with a reddish, vegetative lesion that involved the posterior third of the left true vocal fold. Patient 2 was an 18-year-old girl who presented with a firm, slightly extruded submucosal mass in the posterior lateral third of the tongue. Both lesions were identified as GCTs on biopsy. Both tumors were removed surgically, and both patients exhibited no signs of recurrence during follow-up. It is important that otolaryngologists be familiar with GCT and its management. Although the length of follow-up has varied substantially in the literature, we recommend long-term surveillance, including regular clinical examinations and periodic imaging with contrast-enhanced magnetic resonance imaging, at least until additional studies have clarified the natural history and recurrence patterns of GCT with greater certainty.

Multiple plasma cell granulomas of the larynx in a young man

March 18, 2014     Courtney Shires, MD; Sandeep Samant, MD, FACS
article

Abstract

Plasma cell granuloma of the larynx is a rare benign lesion of unknown etiology, with only 21 cases reported previously. We report an additional case of plasma cell granuloma in which a 26-year-old man experienced a 1.5 x 3.4-cm, completely obstructing subglottic lesion. Because of the patient's young age, history of hemoptysis, bleeding from his tracheostomy, and the rarity of plasma cell granulomas, the patient was assumed to have hemangioma until proven otherwise. He presented with a partially obstructing glottic lesion 4 months later. Both the subglottic and glottic lesions were excised endoscopically. Multiple modalities have been used to treat plasma cell granulomas, including radiation, endoscopic CO2 laser ablation, high-dose prednisone, and open excision. In our case, steroids were given in the interim between the 2 excisions. This is the first report of a patient with two laryngeal plasma cell granulomas and the 22nd reported case of laryngeal plasma cell granuloma.

Descending necrotizing mediastinitis: A conservative approach

March 18, 2014     Sriram Iyer, MRCP; Joseph Collum, MRCP; Marta Babores, FRCP
article

Abstract

Descending necrotizing mediastinitis (DNM) is a now-rare complication of dental and pharyngeal infections. Reports in the literature have emphasized the need for early, aggressive surgical intervention. We present a case of DNM with bilateral empyemas that arose secondary to a perforated pharyngeal abscess. The patient was successfully managed conservatively with intravenous antibiotics and intercostal drainage. We conclude that conservative management with antibiotics and image-guided percutaneous pleural drainage may be initially appropriate for the stable patient.

Conservative cricoid surgery for chondrosarcoma: A case report

February 12, 2014     Elena Gaio, MD; Giandomenico Maggiore, MD; Alessandra Canesso, MD; and Riccardo Artico, MD
article

Abstract

We present the case of a 39-year-old man who presented with hoarseness and progressively worsening dyspnea. Findings on laryngoscopy and computed tomography strongly suggested the presence of a chondrosarcoma. The patient underwent open surgery for removal of the lesion with wide margins. Reconstruction was carried out with two segments of costal cartilage. Laryngeal chondrosarcomas are rare, malignant, usually well-differentiated neoplasms that should be treated with conservative surgery. Recurrences should be treated more aggressively.

Laryngeal tuberculosis: Use of videostroboscopy in diagnosis

February 12, 2014     Michelle Levian, DO; Amy Chapman, MA-SLP; and Reena Gupta, MD
article

The diagnosis of laryngeal tuberculosis is often suspected clinically, but in patients with less specific symptoms, flexible laryngoscopy may reveal only an inflammatory picture.

Recurrent pyogenic granuloma in a noncompliant patient

January 21, 2014     David Galos, MD; Farhad R. Chowdhury, DO; Reena Gupta, MD; Yolanda D. Heman-Ackah, MD; and Robert T. Sataloff, MD, DMA, FACS
article

Patients occasionally develop multiple recurrent granulomas even after excellent reflux control (including fundoplication), voice therapy, surgical removal (including steroid injection into the base of the granuloma), angiolytic laser therapy, and other treatments.

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