176 THE LARYNX, BRONCHI AND OESOPHAGUS
SALIVARY GLAND TUMOURS
Pleomorphic adenoma and less commonly oxyphil-cell adenoma (oncocytoma)
may occur in any salivary tissue in the supraglottis. The most usual site is the
false cord and wide local removal is sufficient to cure the condition.
This vascular tumour is most commonly diagnosed in the first 2 years of life,
and may present on the cord or in the subglottis. Since spontaneous resolution
often occurs no treatment need be undertaken in early childhood unless there
is respiratory obstruction. If the growth is confined to the cord it may be
removed at direct laryngoscopy.
It is not only as a concomitant feature of a debilitating illness that amyloid
disease of the larynx occurs. Although uncommon it has to be borne in mind
in the differential diagnosis of the solitary laryngeal mass. It is removed
locally, but it may require more radical surgery if it recurs.
Lower animals have air sacs and in some humans remnants of these remain
and are situated in the laryngeal ventricle. If one expands to form a laryngo-
cele it either grows outwards through the thyrohyoid membrane and appears
in the neck (external laryngocele) or it extends upwards and presents as a
swelling in the vallecula (internal laryngocele). The presentation is often an
intermittent neck swelling with or without hoarseness. On other occasions if
the neck of the sac is blocked the sac becomes infected and it presents as a
pyocele. Laryngocele is often said to occur most commonly in trumpet
players and glass blowers but a review of the literature shows this to be false.
The relationship is that if a person has a residual air sac that is liable to form a
laryngocele this will occur when pressure is put upon it by blowing. The
blowing per se does not cause the laryngocele, it only brings it to the patient's
attention. It may be diagnosed by the characteristic radiographic appearance
(Fig. 80) when the large translucent sac is seen and is made larger by the
Valsalva manoeuvre. Treatment is to approach the sac from the neck, dissect it
free, remove the upper half of the thyroid lamina, locate the neck of the sac,
ligate it and remove &e laryngocele. The repair line is reinforced by the strap
muscles of the neck.
An internal laryngocele may resemble a supraglottic cyst but it is diagnosed
and differentiated by the typical radiographic appearances. A cyst occurs
mainly in the supraglottis where there are a large number of mucous glands
and the mouth of one of these may become blocked to cause a mucous reten-
tion cyst. Treatment is to uncap the cyst at direct laryngoscopy hoping that
marstipialization will be permanent.