Schwannoma of the larynx.

Of the 25 to 45% of benign schwannomas that occur in the head and neck region, few arise in the larynx. (1,2) We evaluated a 26-year-old Chinese man who presented with a 1-year history of hoarseness. He reported no swallowing problem or subjective shortness of breath. No lymph nodes were palpable.

Direct laryngoscopy detected a submucosal bulge in the left aryepiglottic fold that extended into the laryngeal ventricle (figure 1). The left vocal fold was immobile. Computed tomography (CT) identified a dumbbell-shaped soft-tissue mass in the left supraglottis; the mass extended from the aryepiglottic fold superiorly to the vocal fold inferiorly (figure 2). The surrounding fat planes were preserved, and no erosion of cartilage was evident. Aperiphery enhancement pattern was found, and it was suggestive of a neurogenic tumor.

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Magnetic resonance imaging (MRI) showed that the lesion was isointense on T1-weighted imaging and heterogenous with hyperintensity on T2-weighted imaging. Heterogenous enhancement of the lesion was also found with gadolinium injection (figure 3).

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The patient underwent a lateral thyrotomy. Intraoperatively, a well-encapsulated 2.5-cm tumor was found (figure 4). Microscopic sections showed characteristic Antoni A and B patterns and reactivity for S-100 protein. The overall features were consistent with a schwannoma. At the 6-week follow-up, the patient's vocal fold mobility had been restored and his voice had improved significantly.

In general, a conservative surgical approach should be employed for laryngeal schwannomas.

References

(1.) Jamal MN. Schwannoma of the larynx: Case report and review of the literature. J Laryngol Otol 1994;108:788-90.

(2.) Zbaren P, Markwalder R. Schwannoma of the true vocal cord. Otolaryngol Head Neck Surg 1999;121:837-9.

Wai-kuen Ho, FACS, FRCS; Stephen D.C. Lo, MBBS, DLO; Raymond W.M. Ng, FRCS

From the Division of Otorhinolaryngology--Head and Neck Surgery (Dr. Ho) and the Division of Plastic Surgery (Dr. Ng), Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, and the Department of Otorhinolaryngology--Head and Neck Surgery, St. George's Hospital Medical School, University of London (Dr. Lo).