Laryngeal Schwannoma, Alarming Mass of Airway: A Case Report

Laryngeal schwannomas are rare tumors of neural sheath origin. They normally present as a slow-growing, encapsulated, submucosal mass commonly in the supraglottic region. We describe a 13-year-old boy presenting with a 4-month history of progressive worsening dysphagia. Fiber optic laryngoscopy and computed tomography revealed a polypoidal mass in the laryngeal surface of epiglottis abutting left the aryepiglottic fold, base of the tongue and hypopharyngeal wall. Direct laryngoscopic evaluation and microdebrider assisted debulking was performed with tracheostomy. Schwannoma was confirmed by histopathological study. In a regular follow-up after two months, 70 degree endoscopic evaluation revealed similar mass in the left aryepiglottic fold obscuring the vocal cord. Definite complete excision of the tumor was planned and endoscopic excision of the masswas performed with removal of ipsilateral aryepiglottic fold, arytenoid and false vocal cord with retracheotomy. Rapid occurrence of mass after debulking and biopsy was demonstrated in this case. Though rare, neurogenic tumors of the larynx are life-threatening and need complete removal.

Schwannoma of False Vocal Cord - A Rare Entity

Laryngeal Schwannoma is rare comprising 0.1 – 1.5% of all benign laryngeal tumors. The most common site in larynx is aryepiglottic fold followed by arytenoids, ventricular folds, and vocal cord. Patients present with the symptoms of hoarseness, dysphagia or globus sensation. We present a 33-year-old male with supraglottic schwannoma who experienced hoarseness of voice for three months. The patient underwent micro laryngeal surgery and submucosal solid tumor of false vocal cord was removed. Postoperative recovery was uneventful and after one month of follow up the patient was improving with no hoarseness of voice.

Laryngeal Adductor Reflex Movement Latency Following Tactile Stimulation

Objective To measure the latency of laryngeal adductor reflex (LAR) motion onset at 2 laryngopharyngeal subsites using calibrated aesthesiometers. Study Design Cross-sectional. Setting Academic institution. Methods Twenty-one asymptomatic, healthy subjects (11 male, 10 female) underwent laryngopharyngeal sensory testing with tactile stimuli delivered to the aryepiglottic fold and medial pyriform sinus using 30-mm Cheung-Bearelly monofilaments (4-0 and 5-0 nylon sutures) via channeled flexible laryngoscope. The LAR onset latency, defined as the first visual detection of ipsilateral vocal fold adduction following tactile stimulation, was measured with frame-by-frame analysis of video recordings. Results The overall mean LAR latency across both subsites and stimulation forces was 176.6 (95% CI, 170.3-183.0) ms, without significant difference between subsites or forces. The critical value for LAR response latency prolongation at the .01 significance level was 244 ms. At 30 frames/s video capture resolution, LAR response latency ≥8 frame intervals would indicate abnormal prolongation. Conclusion Aesthesiometer-triggered LAR latency appears to be invariant over an 8.7-dB force range and between the aryepiglottic fold and medial pyriform sinus subsites in controls. Laryngeal adductor reflex latency incongruences between stimulation forces or laryngopharyngeal subsites may serve as pathophysiological features to dissect mechanisms of upper aerodigestive tract disorders. Level of Evidence Level 3B.

Three Synchronous Head and Neck Cancers: A Multidisciplinary and Surgical Challenge

Second primary cancer (SPC) is a term used to describe a new primary cancer occurring in patients who had formerly been diagnosed with tumor. Even though SPCs appear to be related to primary cancers, they are actually entities that have arisen independently and not as a result of recurrence. This report is of the first case in literature of a patient hospitalized for the surgical treatment of 3 synchronous Head and Neck Cancers. A 66-year-old male was admitted to our hospital (Ospedale Degli Infermi—Biella, Italy) complaining about pharyngodynia. Three different lesions were identified through endoscopic examination and narrow band imaging: the first one on left tonsil, the second one on epiglottis, and the third one on right aryepiglottic fold. The case was subject to a multidisciplinary team analysis due to its complexity, then the surgery consisted in (1) CO2 laser left tonsillectomy, associated with (2) CO2 laser excision of the lesion on epiglottis free edge, and (3) CO2 laser excision of right aryepiglottic fold lesion. Synchronous tumors are among the most defiant challenges for surgeons since no international guideline specifies differentiated strategies to be adopted in patients affected by synchronous Head and Neck Cancers, therefore surgical planning must be tailored differently from patient to patient, and many unsolved questions still concern clinical treatments to be adopted.

Neonatal Lateral Epiglottic Defects

Introduction: Multiple congenital abnormalities of the epiglottis have been reported and iatrogenic injuries to the larynx and subglottis are well known. We present a new pattern of defect not previously reported in the literature. Methods: Epiglottic abnormalities at two institutions are reviewed. Cases of defects involving the lateral aspect of the epiglottis and aryepiglottic fold are identified. A literature review of known epiglottic defects is performed. Results: Two children possessing lateral notch injuries at the aryepiglottic attachment to the epiglottis are described. Both children have a history of multiple laryngeal instrumentation attempts and prolonged intubation. Both have swallowing difficulties and are gastrostomy dependent. Congenital epiglottic defects include aplasia and midline bifidity, however, no lateral congenital epiglottic defects have been reported. Conclusion: Epiglottic defects, while rare, should be part of the differential for children with aspiration and feeding difficulties. A new pattern of defect is described and iatrogenic etiology proposed.

Intraductal Papilloma Arising From the Minor Salivary Glands of the Larynx: A Case Report

It is rare for intraductal papilloma, a benign papillary tumor, to occur in the salivary glands. To our knowledge, intraductal papilloma occurring in the minor salivary glands of the larynx has not been reported. In this report, we describe a case of intraductal papilloma that occurred in the minor salivary glands of the larynx. A woman in her 30s presented with hoarseness and dyspnea since a year. Fiber-optic laryngoscopy revealed a submucosal tumor involving the left aryepiglottic fold and the left false vocal fold. Computed tomography and magnetic resonance imaging revealed a 17 × 15 × 10 mm3 mass with homogenous isodensity, with regular, well-defined margins located on the left aryepiglottic fold and the left false vocal fold. Surgical resection was performed, and subsequently a diagnosis of intraductal papilloma was made by pathologic evaluation. During the follow-up period of over 3 years, the lesion has not recurred. In conclusion, intraductal papilloma of the minor salivary glands should be considered in the differential diagnosis of laryngeal submucosal tumors.

Descending Necrotizing Mediastinitis Resulting from Pharyngitis with Perforation of the Aryepiglottic Fold

Descending necrotizing mediastinitis and pharyngeal perforation are uncommon complications of pharyngitis that are associated with high morbidity and mortality. This case report describes a previously healthy 18-year-old male who presented to the emergency room with 5 days of severe sore throat, intermittent fevers, and vomiting and was found to have extensive posterior pharyngeal and mediastinal air along with extravasation of contrast on computed tomography, consistent with perforation of the left aryepiglottic fold as well as descending necrotizing mediastinitis. The patient had a complicated hospital course including multiple operative interventions, abscess formation, and development of pericardial and pleural effusions. Successful treatment required swift resuscitation including broad-spectrum antibiotics and significant coordination of emergent operative intervention between otolaryngology and cardiothoracic surgery. It is important to recognize descending necrotizing mediastinitis as a clinical entity that may result from oropharyngeal infections as early intervention significantly decreases subsequent complications and mortality. Furthermore, pharyngeal perforation is an extremely rare complication which requires either CT with oral contrast or esophagram for diagnosis.