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Benign tumours of larynx

Benign tumours of larynx



Benign tumours of larynx

Benign tumours of larynx



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    Benign tumours of larynx Benign tumours of larynx Presentation Transcript

    • BENIGN TUMOURS OF LARYNX Department of Otorhinolaryngology J.J.M. Medical College
    • BENIGN TUMOURS OF LARYNX• These are uncommon• Divided intoI. Non neoplasticII. neoplastic
    • NON-NEOPLASTIC• These are not true neoplasms• These are formed as a result of infection, trauma or degeneration
    • NON-NEOPLASTIC- SOLID LESIONS• Vocal nodules (singer’s nodules/screamers nodules) Appear symmetrically In the free edge of the vocal cord at the junction of anterior 1/3 rd and posterior 2/3rd, as this is the area of maximum vibration and thus subjected to maximum trauma Usually they measure less than 3mm They are results of vocal trauma Mostly seen in teachers, actors, singers, vendors
    • Vocal nodules- pathology• Trauma to the vocal cords in the form of vocal abuse or misuse causes oedema and hemorrhage in the Submucosal space• This undergoes hyalinization and fibrosis• Underlying epithelium also undergoes hyperplasia forming a nodule
    • Vocal nodules- clinical features• Patient complains of hoarseness, vocal fatigue and pain in neck on prolonged phonation• On examination the nodule appears soft, reddish and oedematous swelling, later becomes grayish or whitish in colour
    • Vocal nodules- Treatment• Voice rest• Surgery for larger nodules and long standing nodules in adults• Excised by Microlaryngeal surgery• Speech therapy and re-education in voice production is necessary to prevent recurrence
    • Vocal polyp• Result of vocal abuse or misuse• Allergy and smoking are other contributing factors• Mostly affects men in age group of 30-50• Typically its unilateral and arising from same position as vocal nodule• Its soft smooth and often pedunculated• It may flop up and down during phonation or respiration• Its caused by sudden shouting resulting in haemorrhage in the vocal cord and subsequent submucosal oedema
    • Vocal polyp- clinical features• Hoarseness is a common symptom• Large polyp may cause dyspnoea, stridor or intermittent choking• Some patients may complain of diplophonia due to different vibratory frequencies of two vocal cords• Treatment: surgical excision under operating microscope and speech therapy
    • Reinke’s oedema• This is due to collection of the oedema fluid in the subepithelial space of reinke• Usual cause is vocal abuse and smoking• Both vocal cords show diffuse symmetrical swellings• Treatment is vocal cord stripping preserving enough mucosa for epithelisation• Only one cord is operated at a time• Cessation of smoking is important to prevent recurrence
    • Contact ulcer• This is again due to faulty voice production• Vocal process of arytenoid hammer against each other resulting in ulceration and granuloma formation• Some cases are due to laryngopharyngeal reflux• Complaints are hoarseness, constant desire to clear the throat and pain in the throat which worsens on phonation• Examination reveals unilateral or bilateral ulcers with congestion of arytenoid cartilages• There may be granuloma formation
    • Intubation Granuloma• It results from injury to vocal processes of arytenoids due to rough intubation• Use of large tube or prolonged intubation are the common causes• Mucosal ulceration followed by granuloma formation over the exposed cartilage• Usually these are bilateral involving posterior third of true cords• They present with hoarseness, if large dyspnoea• Treatment is voice rest and endoscopic removal of granuloma
    • Leukoplakia (keratosis) larynx• This is localized form of epithelial hyperplasia involving upper surface of one or both vocal cords• It appears as white plaque or warty growth on cord without affecting its mobility• Its regarded as pre cancerous condition because carcinoma in situ frequently supervenes• Hoarseness is common presenting symptom• Treatment is stripping of the vocal cords and histopathological examination to rule out malignancy
    • Amyloidosis of larynx• Mostly affects men aged between 50- 70 years• Tumour presents as smooth plaque or a pedunculated mass• Diagnosis is only on histology• Treatment is endoscopic surgical excision
    • Cystic lesions of larynx• There are 3 types of cysts in larynx Ductal cyst: they are retention cysts due to cyst blockage of ducts of the seromucinous glands of laryngeal mucosa. They are seen in vallecula, aryepiglottic folds, false cords, ventricles and pyriform fossa. They remain asymptomatic if small, or cause hoarseness, cough, throat pain and dyspnoea if large. Sometimes a intracordal cyst may occur on true cords. It is similar to epidermoid inclusion cyst
    • Epidermoid inclusion cyst
    • Cystic lesions of larynx Saccular cyst: obstruction to the orifice of cyst the saccule causes retention of secretions and distention of the saccule which presents as cyst in the laryngeal ventricle. Anterior saccular cysts present in the anterior part of the ventricle and obscure part of the vocal cord. Lateral saccular cysts which are larger extend into the false cord, AE folds and may even appear in the neck
    • Cystic lesions of larynx• Laryngocoele: it is an air filled cystic swelling Laryngocoele due to the dilatation of the saccule• It may be internal, external or combined (mixed)• Internal laryngocoele: it is confined within the larynx and present as distension of the false cord and AE fold• External laryngocoele: here distended saccule herniates through the thyrohyoid membrane and present in the neck• Mixed laryngocoele: here both internal and external laryngocoeles are seen
    • Laryngocoele• Laryngocoele is supposed to arise from raised transglottic air pressure as in trumpet players, glass blowers and weight lifters• Clinical features: presents with hoarseness, cough and if large obstruction to the airway• External laryngocoele presents as reducible swelling in neck, which increases in size on coughing and on performing valsalva• Diagnosis can be made by indirect laryngoscopy and x-ray soft tissue AP and lateral views of the neck with valsalva• CT scan helps to find the extent of the lesion• Surgical excision through external neck incision• Marsupialisation of internal laryngocoele can be done by laryngoscopy, but chances of recurrence are high• Laryngocoele in an adult may be associated with carcinoma
    • Neoplastic laryngeal lesions• Squamous Papillomas: can be juvenile or adult onset type• Juvenile laryngeal Papilloma: They are viral in origin and multiple, often involving infants and young children who present with hoarseness and stridor• They are mostly seen on the true, false vocal cords and epiglottis, but they may involve other sites in larynx and trachea• Clinically appear as glistening white irregular growths, pedunculated or sessile, friable and bleeding easily
    • Juvenile laryngeal Papilloma• They are known for recurrence after removal, therefore multiple laryngoscopies may be required• Tend to disappear spontaneously after puberty• Treatment: endoscopic removal with cup forceps, Cryotherapy, microelectrocautery• CO2 laser is preferred these days• Interferon therapy to prevent recurrence
    • Juvenile laryngeal Papilloma
    • Adult onset Papilloma• Usually single, smaller in size, less aggressive and does not recur after surgical removal• It is common in males in age group of 30-50 years• Usually arises from anterior half of the vocal cord or anterior commissure• Treatment is same as for juvenile type
    • Chondroma• Arise from cricoid cartilage and present in subglottic area causing dyspnoea• May grow outward posterior plate of cricoid and cause sense of lump in the throat and dysphagia• Mostly affect men in age group 40-60 years
    • Haemangioma• Infantile haemangioma involves subglottic area and presents with stridor in first six months of life, about 50% of such children have haemangioma elsewhere in the body, particularly in the head and neck• Tend to involute spontaneously but tracheostomy may be needed to relieve respiratory obstruction if airway is compromised• Most of them are of capillary type and can be vaporized with CO2 laser• Adult haemangiomas involve vocal cord or Supraglottic larynx, they are cavernous type and can not be treated by laser, they are left alone if asymptomatic• Larger ones causing symptoms steroid or radiation therapy may be employed
    • Granular cell tumour• It arises from the Schwann cells and is often submucosal• Overlying epithelium shows pseudoepitheliomatous hyperplasia, which may on histopathology resemble well differentiated carcinoma
    • Glandular Tumour• Pleomorphic adenoma or oncocytoma are rare tumours• Other rare tumours include rhabdomyoma, neurofibroma, neurilemmomas, Lipoma or fibroma