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Full text of "Diseases Of The Nose Throat And Ear"

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.