ENT (Otorhinolaryngology) · MU Sofia

39. Benign tumors of the larynx and vocal cords. Papillomatosis of the larynx. Phonosurgery.

Covers benign laryngeal and vocal cord tumours, starting with definition, causes such as HPV, smoking and vocal abuse, and a classification into epithelial, mesenchymal and pseudotumour groups. It then describes clinical features, diagnostic steps including videostroboscopy and biopsy, treatment options such as CO2 laser excision, possible complications and differential diagnoses. Further sections address recurrent respiratory papillomatosis, including juvenile and adult forms with the Derkay-Coltrera staging scale, and phonosurgery, its indications and operative stages with complications.

Inside: 3 sections · 16 flashcards · 9 min

Topic 39 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 3 sections, about 1,284 words (9 min of reading), with 16 flashcards.

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  1. Benign tumors of the larynx and vocal cords. Papillomatosis of the larynx. Phonosurgery.
  2. Benign tumours of the larynx and vocal cords.
  3. Papillomatosis of the larynx – (RECURRENT RESPIRATORY PAPILLOMATOSIS)

Benign tumours of the larynx and vocal cords.

1. Definition: Benign tumours of the larynx are non-malignant, slow-growing neoplasms that arise from various tissues within the larynx (epithelial, mesenchymal, or minor salivary glands). Unlike malignant tumours, they do not metastasize, but they can cause significant morbidity through airway obstruction or voice destruction.

2. Etiopathogenesis

  • Viral Infection: Human Papillomavirus (HPV types 6 and 11) is the primary cause of laryngeal papillomatosis.
  • Chronic Irritation: Long-term exposure to tobacco smoke, pollutants, or gastroesophageal reflux (GERD).
  • Vocal Abuse: Mechanical trauma from screaming or improper singing (primarily leads to "tumor-like" lesions like nodules).
  • Congenital Factors: Hemangiomas are often present at birth or appear shortly after.
  • Genetic Predisposition: Seen in rare cases like neurofibromas (NF1).

3. Classification

  • Epithelial tumours: Squamous Papilloma (most common), Adenoma
  • Mesenchymal tumours: Hemangioma, Chondroma, Neurofibroma, Schwannoma, Fibroma.
  • Pseudotumors: Vocal Nodules, Vocal Polyps, Cysts, Contact Granulomas

4. Clinical Picture

  • Dysphonia (Hoarseness): The most common symptom, especially for glottic tumours (on the vocal cords). The voice may be breathy, harsh, or "muffled."
  • Dyspnea and Stridor: Large tumours can obstruct the airway. Inspiratory stridor suggests a supraglottic or glottic lesion.
  • Cough: Often a dry, "brassy" cough or a sensation of a foreign body in the throat.
  • Dysphagia: Difficulty swallowing, more common in large supraglottic tumours.
  • Pain: Rare in benign lesions unless secondary infection occurs.

5. Paraclinical and Radiological Examinations

  • Indirect/Direct Laryngoscopy: Visualization of the lesion’s size, site, and appearance.
  • Smooth or pedunculated lesion
  • Normal cord mobility (usually)
  • No ulceration or infiltration
  • Videostroboscopy: The "Gold Standard" for phonosurgery. It assesses the mucosal wave and vocal fold vibration.
  • Biopsy: Essential for definitive diagnosis to rule out malignancy.
  • Computed Tomography (CT): Primarily for larger mesenchymal tumours to see cartilage involvement.

6. Treatment Options

  • Microlaryngeal Surgery (MLS): Using an operating microscope and "cold steel" instruments for precise excision.
  • CO2 Laser Excision: Currently the preferred method for many benign tumors (especially papillomas) due to minimal bleeding and precision.
  • Medical Therapy:
  • Cidofovir (intralesional injection) for recurrent respiratory papillomatosis.
  • Propranolol for infantile hemangiomas.
  • Reflux medication (PPIs) if the lesion is an intubation granuloma.
  • Tracheostomy: Only in emergency cases of severe airway obstruction where immediate excision isn't possible

7. Possible Complications

  • Recurrence: Common in HPV-related papillomas.
  • Vocal Cord Scarring: Can lead to permanent hoarseness or "web" formation.
  • Airway Obstruction: If the tumor grows rapidly or causes glottic edema.
  • Malignant Transformation: While rare, some long-standing papillomas (especially with HPV 16/18) or chondromas can undergo malignant change.

8. Differential Diagnosis

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