Benign Laryngeal Lesions

Benign laryngeal lesions represent a diverse set of pathologies whose clinical presentation may range from no symptoms to dyspnea and/or dysphonia. Flexible fiberoptic laryngoscopy and videolaryngostroboscopy are important in distinguishingdifferent types of lesions, and management and treatment are dependent on the identification of these lesions, as they have different etiologies. Some lesions such as vocal fold nodules and polyps are primarily phonotraumatic and may benefit fromspeech therapy and vocal hygiene as initial approaches. Vocal fold cysts and benign tumors may benefit from microlaryngeal approaches, while capillary ectasias, polypoid corditis, laryngoceles, saccular cysts, and papilloma may benefit from laser therapy. Vocal fold granulomas may arise from various etiologies such as intubation, traumatic behaviors, or reflux. Polypoid corditis arises from smoking. This review is intended to provide an overview of the variety of lesions that encompass non-malignant laryngeal lesions that is both suitable for junior and senior residents. This review contains 12 figures, 5 tables, and 64 references Keywords: Benign laryngeal lesions, Laryngocele, Polyp, Cyst, Polypoid Corditis, Papilloma

Nodular Fasciitis and Myxolipoma of the Larynx

Nodular fasciitis (NF) is a peculiar, rapid-growing soft tissue lesion, typically appearing in subcutaneous tissue. 20% of NF occur in the head and neck region, where they can involve any anatomic site. Laryngeal involvement, however, is quite rare. On the contrary, Lipoma is recognized as a slow growing, benign mesenchymal tumour. Myxolipoma is a rare variant which has a prominent myxoid background. Laryngeal lipoma is infrequent, accounting for only 0.6% of all benign laryngeal lesions. Here, we report a unique case of adult laryngeal nodular fasciitis coexisting with myxolipoma in a 61-year-old male patient, describing their clinical and histopathological features, the strategies used to treat such conditions along with a brief review of the literature. The purpose is to broaden the differential diagnosis of rapid-growing laryngeal masses that cause airway obstruction and to stress the significance of integrative interdisciplinary collaboration on reaching an accurate diagnosis, thereby allowing proper management for benign pathologies and avoiding any futile aggressive treatment. Keywords: Nodular fasciitis, Larynx, Stridor, Myxolipoma.

A clinicopathological study of non-malignant lesions of the larynx

<p class="abstract">The study was undertaken to identify the type of laryngeal lesions, the age, sex distribution, symptomatology, sites of involvement, conservative and surgical management, histopathological analysis and outcome of the same. This is a prospective study conducted at a tertiary care centre for one and a half years. A total of 20 patients were included based on symptomatology such as hoarseness of voice, foreign body sensation, throat pain, and respiratory distress. All malignant cases were excluded. Hematological and radiological investigations, along with microlaryngoscopic procedures followed by histopathology, were employed. A male preponderance with an M: F ratio of 3:2 was observed. The majority of the patients were in the age group of 30 to 45 years. Vocal cord polyps were observed to be the commonest type of the lesion. A case of a bilobed concomitant tonsillar cyst of the larynx was the rarest encountered. In this study, hoarseness of voice, cough, foreign body sensation, and throat pain proved to be the commonest symptoms. Early diagnosis with routine clinical examination aided by radiological investigation such as contrast enhanced computed tomography (CECT) has proven to be useful in suspicious lesions of the larynx. Micro laryngeal surgery, voice rest, and postoperative speech therapy together offer a cost-effective and safe method for the management of benign laryngeal lesions.</p>

COMPARISON OF PATIENTS WITH MALIGNANT OR BENIGN LARYNGEAL LESIONS AND HEALTHY INDIVDUALS IN TERMS OF HEMATOLOGICAL INFLAMMATORY PARAMETERS

Purpose: Recent studies have shown a relationship between cancer and inflammatory response. The aim of this study is to compare NLR and PLR values, which are inflammatory parameters, in precancerous and cancerous lesions and to determine whether there is a parameter that can be used in the early diagnosis of laryngeal squamous cell carcinoma. Methods:174 patients who were benign as a result of pathology, 122 patients who were malignant, 39 patients who were premalignant (335 patients in total) and 117 normal individuals were included in the study. Data groups were divided into 4 groups as Benign Laryngeal Lesion(BLL), Precancerous Laryngeal Lesion(PLL), Malignant Laryngeal Lesion(MLL) and Control Group(CG). In addition, the PLL group was subdivided into Mild Dysplasia(MiD), Moderate Dysplasia(MoD) and Severe dysplasia-carcinoma in situ (SeD/CIS). NLR, PLR and other parameters were calculated. Results: NLR and PLR values were significantly different between the groups. (p = 0.000, p = 0.002) The mean NLR was higher in the MLL and PLL groups, and was lower in the BLL and control groups. The mean PLR was also higher in the MLL and PLL groups. When the groups were compared in pairs, there was a significant difference between BLL and MLL (p = 0.001) and MLL and CG.(p = 0.006) The PLL group was subdivided into MiD, MoD and SeD / CIS. There was a significant difference in NLR when CG and other subgroups were compared.(p = 0.027) Significant differences were found between CG and SeD when the groups were compared in pairs.(p = 0.007) There was no significant difference between the groups in terms of PLR and dysplasia.(P = 0.516) Conclusion: As revealed in this study, these rates were low in the CG and BLL groups and high in the MLL group, so they could be used as markers to differentiate malignant lesions.

Smoking effect in patients following benign laryngeal lesions excision

Background. Patients with benign laryngeal lesions usually complain on hoarseness, increased vocal effort, fatigue, stain, and if the lesion is large enough, a feeling of dyspnea with phonation. These symptoms considerably deteriorate the quality of life of the patients especially voice professionals. Aim. To optimize the treatment of patients with benign laryngeal lesions. Materials and methods. In the ENT Department of Sechenov First Moscow State Medical University (Sechenov University) a total of 90 patients presented with BLL were studied. All patients underwent microlaryngoscopy under general anesthesia and were divided into 3 groups depending on the surgical method that has been used: ʺcold-steelʺ instruments (n=30), radiofrequency ablation (n=30) and semiconductor laser (n=30) with wavelength of 1.94 mkm. Patients of each group were divided into smokers and non-smoking persons. We assessed preoperative and postoperative fibrolaryngoscopy during 6 month follow up period. Results. Earlier involution of postoperative reactive inflammation of vocal cord tissue (in 7 days after surgery) was observed in group 3, comparing with 14 days and longer period in group 1 and group 2 (p<0.0001). Reactive tissue inflammation was significantly higher in all smokers comparing to non-smoking patients (p<0.0001). Conclusion. The data we have obtained provide the basis for choosing semiconductor laser as a better surgical instrument while performing phonosurgical procedures. The proposed surgical technique makes it possible to reduce the recovery period in patients with benign laryngeal lesions. At the same time, it is important to recommend to quit smoking for the patients undergoing phonosurgery.

Analysis of Surgical Recurrence after Larynx Microsurgery for Benign Lesions

Introduction The study of larynx lesions is of great importance. More than 50% of people with vocal complaints have benign vocal fold alterations and some require surgery. Objective To determine which factors are related to surgical recurrence of benign laryngeal lesions and to determine which videolaryngoscopic diagnoses are related to the risk or protection of surgical relapses over time. Methods Observational, analytical, cross-sectional study with retrospective data collection of 1,383 surgeries in 1,301 patients. Results The mean age at the first surgery was 39.2 years old. The predominant gender was female (65.6%).There were 396 cases of polyps (25.34%), 349 cases of cysts (22.33%), 261 cases of Reinke edema (16.7%), 175 cases of nodules (11.2%), 153 cases of minor structural alterations (MSAs) (9.79%), 94 cases of leukoplakia (6.01%), 77 cases of granulomas (4.93%) and 58 cases of pseudocysts (3.71%). The age presented statistical significance with the risk of surgical relapses (p = 0.016). Male gender was associated with the greatest chance of relapse.Diagnosis of granuloma (p < 0.001) and of leukoplakia (p < 0.001) were associated with a higher risk of surgical recurrence. Cyst diagnosis was associated with protection (p = 0.015) in relation to the chance of further surgeries. Patients with associated lesions, bilaterals or voice professionals did not present a statistically significant association with surgical recurrence. Conclusion Age and gender are statistically related to the increase of surgical relapses. Leukoplakia and granuloma are associated with increased surgical relapses. Patients submitted to cyst microsurgery appear to be protected against surgical recurrence.