[FIGURE 1 OMITTED]
A 25-year-old, otherwise healthy woman presented with dysphonia and mild dyspnea. A comprehensive head and neck examination was unremarkable. Flexible fiberoptic laryngoscopy revealed a 3-cm, well-circumscribed mass centered over the left aryepiglottic fold. The epiglottis was distorted, and the laryngeal vestibule was obscured (figure 1). Contrast-enhanced computed tomography (CT) of the neck revealed a large, enhancing neoplasm at the level of the hyoid bone with no cervical adenopathy (figure 2).
The patient was taken to the operating room for an awake tracheotomy and biopsy of the mass. The biopsy site had significant bleeding that was controlled with electrocautery. Pathologic examination of the specimen revealed paraganglioma (figure 3).
The patient underwent diagnostic angiography with embolization of the feeding vessels, including bilateral branches from the external carotid arteries. Endoscopic resection was attempted with the C[O.sub.2] laser and electrocautery dissection. This was aborted secondary to bleeding and difficult visualization caused by the size of the mass. A mucosa-sparing supraglottic laryngectomy was performed without difficulty. The patient was decannulated on postoperative day 7 and was tolerating a regular diet on postoperative day 10.
Paraganglioma is an uncommon, slow-growing, benign tumor that most frequently affects the carotid bifurcation and jugulotympanic area in the head and neck. Laryngeal paraganglioma is a rare tumor that has been reported in only 76 patients. (1) Paraganglia are associated with the superior laryngeal artery and nerve along the false vocal fold (superior paraganglia) and along the course of the recurrent laryngeal nerve at the lateral margin of the cricoid cartilage (inferior paraganglia). (2)
Paragangliomas are composed of two cell types: chief cells and sustentacular cells. The chief cells are characteristically packed in a Zellballen pattern, separated by a fibrovascular stroma and surrounded by the more basophilic sustentacular cells. Paragangliomas must be distinguished from carcinoid tumors, melanomas, and medullary thyroid carcinomas, which can have a similar Zellballen pattern. (3)
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Because paragangliomas are highly vascular, laryngeal paraganglioma biopsy can cause severe bleeding that requires airway protection. The superior laryngeal artery, a branch of the superior thyroid, is most commonly the feeding vessel to supraglottic tumors. Patients often undergo selective angiography with embolization prior to treatment, particularly if an endoscopic approach is attempted. Arterial ligation can be performed if a transcervical approach is utilized. Complete resection of these benign tumors is indicated while preserving speech and swallowing functions.
(1.) Myssiorek D, Rinaldo A, Barnes L, Ferlito A. Laryngeal paraganglioma: An updated critical review. Acta Otolaryngo12004;124(9) 995-9.
(2.) Lawson W, Zak FG. The glomus bodies ("paraganglia") of the human larynx. Laryngoscope 1974;84(1):98-111.
(3.) Barnes L, Ferlito A, Wenig BM. Laryngeal paragangliomas: A review and report of a single case. J Laryngol Otol 1997;111(2): 197-8.
Yoav Hahn, MD; Richard Isaacs, MD; Peter C. Belafsky, MD, PhD
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|Title Annotation:||LARYNGOSCOPIC CLINIC|
|Author:||Hahn, Yoav; Isaacs, Richard; Belafsky, Peter C.|
|Publication:||Ear, Nose and Throat Journal|
|Article Type:||Case study|
|Date:||Oct 1, 2010|
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