CHAPTER 36 BENIGN LARYNGEAL TUMOURS Benign laryngeal tumours are not common and are usually diagnosed by the pathologist because most of them appear as solitary masses on the vocal cords causing hoarseness. FIBROMA This connective tissue tumour can arise from any laryngeal structure hut mainly occurs on the dorsum of the vocal cords. It presents as a sessile reddish-grey smooth mass (Plate VII, 4) which can move downwards between the cords on inspiration. The mass is removed at direct laryngoscopy as an excision biopsy. Recurrence is rare. Neurofibroma may also occur and is dealt with similarly. PAPILLOMA 1. Single. This usually arises from the free edge of a vocal cord in adults (Plate VII9 5). Histologically it is often a squamous-cell papilloma. It is liable to recurrence and may undergo malignant change. The papilloma should be removed at direct laryngoscopy, and the patient should be followed up for 5 years because of the danger of recurrence and malignant degeneration. 2. Multiple. These are described more fully in Chapter 40. They occur at any age from birth to 5 or 6 years and although they are said to disappear at puberty this is the exception rather than the rule. They may present as scattered single papillomata all over the larynx or as a huge exuberant mass causing respiratory obstruction. They are not pre-malignant, but the larynx may be severely damaged from repeated removals. The papillomata can become implanted into the trachea "and bronchi. Patients with this condition should be followed up at monthly intervals and the papillomata removed whenever they appear. In most instances this prevents the papillomata building up to cause respiratory obstruction which would require emergency laryngoscopy and tracheostomy. GRANULOMA 1. Intubation Granuloma. This is occasionally seen after a traumatic blind intubation but it most commonly occurs after a long operation on a lightly anaesthetized patient where the arytenoids and posterior ends of the vocal cords vibrate against the tube. This causes abrasion and subsequent granula- tion tissue formation. The granuloma should be removed locally and it should not recur.