BENIGN TUMOURS OF LARYNX

Benign tumours of the larynx are not as common as the malignant ones.
Divided into
I. Neoplastic
II. Non-neoplastic
NEOPLASTIC
Laryngeal fibroma and papilloma are the most
frequent.
FIBROMA
Occurs with equal frequency in men
and women aged 20-50 years ,
children are extremely rare.
Usually grow on the free edge on the
upper surface of the vocal fold , have a
dark cherry (sometimes lighter ) color,
usually solitary, mobile.
Its size ranges from a grain of lentil to
a pea.
Complaints of the patient hoarse and
whispered voice.
Treatment - surgery. Removed under
local or general anesthesia , with
special forceps (Moritz -Schmidt or
Cordes).
SQUAMOUS PAPILLOMAS

They are viral in origin (HPV types 6 and 11)

1. Juvenile
2. Adult onset type


JUVENILE LARYNGEAL PAPILLOMA
Often involving infants and young children who present with
hoarseness and stridor
They are mostly seen on the true, false vocal cords and epiglottis, but
they may involve other sites in larynx and trachea
Clinically appear as glistening white irregular growths, pedunculated
or sessile, friable and bleeding easily

JUVENILE LARYNGEAL PAPILLOMA
They are known for recurrence after removal, therefore multiple
laryngoscopies may be required
The other way to diagnose laryngeal papilloma is for a biopsy to be
conducted and for the lesion to be tested for HPV.
Tend to disappear spontaneously after puberty
Treatment: endoscopic removal with cup forceps, cryotherapy,
microelectrocautery
CO2 laser is preferred these days
Interferon therapy to prevent recurrence
ADULT ONSET PAPILLOMA
Usually single, smaller in size, less aggressive
and does not recur after surgical removal
It is common in males in age group of 30-50
years
Usually arises from anterior half of the vocal
cord or anterior commissure
Treatment is same as for juvenile type
CHONDROMA
Arise from cricoid cartilage and
present in subglottic area
causing dyspnoea
May grow outward posterior
plate of cricoid and cause
sense of lump in the throat and
dysphagia
Mostly affect men in age group
40-60 years
HAEMANGIOMA
Infantile haemangioma
involves subglottic area
and presents with stridor
in first six months of life,
about 50% of such
children have
haemangioma
elsewhere in the body,
particularly in the head
and neck

Direct laryngoscopy , X-ray
Tend to involute spontaneously but tracheostomy may be needed to
relieve respiratory obstruction if airway is compromised
Most of them are of capillary type and can be vaporized with CO2 laser
Adult haemangiomas involve vocal cord or supraglottic larynx, they
are cavernous type and can not be treated by laser, they are left
alone if asymptomatic
Larger ones causing symptoms steroid or radiation therapy may be
employed

GRANULAR CELL TUMOUR
It arises from the
Schwann cells and is
often submucosal
Overlying epithelium
shows
pseudoepitheliomatous
hyperplasia, which may
on histopathology
resemble well
differentiated carcinoma
Treated by surgical
resection under a fine
dissection
laryngomicroscope

OTHER RARE TUMORS
Pleomorphic adenoma or oncocytoma are rare tumours
Other rare tumours include rhabdomyoma, neurofibroma,
neurilemmomas,
NON-NEOPLASTIC
These are not true neoplasms
These are formed as a result of infection, trauma or degeneration
Divide into:
Solid
Cystic



NON-NEOPLASTIC
SOLID LESIONS
VOCAL NODULES (SINGERS
NODULES/SCREAMERS NODULES)
Appear symmetrically in the
free edge of the vocal cord at
the junction of anterior 1/3
rd

and posterior 2/3
rd
, as this is
the area of maximum
vibration and thus subjected
to maximum trauma
Usually they measure less
than 3mm
They are results of vocal
trauma
Mostly seen in teachers,
actors, singers, vendors

VOCAL NODULES- PATHOLOGY
Trauma to the vocal cords in the form of vocal abuse or misuse causes
oedema and hemorrhage in the submucosal space
This undergoes hyalinization and fibrosis
Underlying epithelium also undergoes hyperplasia forming a nodule
VOCAL NODULES- CLINICAL FEATURES
Patient complains of hoarseness, vocal fatigue and pain in neck on
prolonged phonation
On examination the nodule appears soft, reddish and edematous
swelling, later becomes grayish or whitish in colour.

VOCAL NODULES- TREATMENT
Early cases of vocal nodules can be
treated conservatively by educating
the patient in proper use of voice.
With this treatment, many nodules in
children disappear completely.
Surgery for larger nodules and long
standing nodules in adults - excised
by microlaryngeal surgery
Speech therapy and re-education
in voice production is necessary to
prevent recurrence
VOCAL POLYP
Result of vocal abuse or misuse
Allergy and smoking are other
contributing factors
Mostly affects men in age group of
30-50
Typically its unilateral and arising
from same position as vocal
nodule
Its soft smooth and often
pedunculated
It may flop up and down during
phonation or respiration
Its caused by sudden shouting
resulting in haemorrhage in the vocal
cord and subsequent submucosal
oedema

VOCAL POLYP- CLINICAL FEATURES
Hoarseness is a common symptom
Large polyp may cause dyspnoea, stridor or intermittent choking
Some patients may complain of diplophonia due to different vibratory
frequencies of two vocal cords


TREATMENT: surgical excision under operating microscope and
speech therapy
REINKES EDEMA (BILATERAL DIFFUSE
POLYPOSIS)
This is due to collection of the eedema
fluid in the subepithelial space of reinke
Usual cause is vocal abuse and
smoking
Both vocal cords show diffuse
symmetrical swellings
Individuals with Reinke's edema typically
have low-pitched, husky voices, as
they use false vocal folds for voice
production.
Treatment is vocal cord stripping
preserving enough mucosa for
epithelization
Only one cord is operated at a time
Cessation of smoking is important to
prevent recurrence
CONTACT ULCER
This is again due to faulty voice production
Vocal process of arytenoid hammer against each other resulting in ulceration
and granuloma formation.
The most common cause of the condition is sustained periods of increased
pressure on the vocal folds, and is commonly seen in people who use their
voice excessively such as singers.
Some cases are due gastroesophageal reflux
Complaints are hoarseness, constant desire to clear the throat and pain
in the throat which worsens on phonation
Examination reveals unilateral or bilateral ulcers with congestion of arytenoid
cartilages (endoscopy).
There may be granuloma formation
TREATMENT: Resting the vocal cords for as long as six weeks, normally
followed by vocal therapy.
INTUBATION GRANULOMA
It results from injury to vocal processes of arytenoids due to rough intubation
Use of large tube or prolonged intubation are the common causes
Mucosal ulceration followed by granuloma formation over the exposed cartilage
Usually these are bilateral involving posterior third of true cords
They present with hoarseness, if large dyspnoea
Treatment is voice rest and endoscopic removal of granuloma

LEUKOPLAKIA (KERATOSIS) LARYNX
This is localized form of epithelial
hyperplasia involving upper surface
of one or both vocal cords
It appears as white plaque or warty
growth on cord without affecting its
mobility
Its regarded as pre cancerous
condition because carcinoma in situ
frequently supervenes
Hoarseness is common presenting
symptom
Treatment is stripping of the vocal
cords and histopathological
examination to rule out
malignancy

AMYLOIDOSIS OF LARYNX
Mostly affects men
aged between 50-70
years
Patient usually
complains of
hoarseness of voice.
Presents as smooth
plaque or a
pedunculated mass
Diagnosis is only on
histology
Treatment is
endoscopic surgical
excision
NON-NEOPLASTIC
CYSTIC LESIONS
CYSTIC LESIONS OF LARYNX
There are 3 types of cysts in larynx
Ductal cyst
Saccular cyst
Laryngocele

DUCTAL CYST
They are retention cysts due to blockage of ducts of the seromucinous
glands of laryngeal mucosa.
They are seen in vallecula, aryepiglottic folds, false cords, ventricles and
pyriform fossa.
They remain asymptomatic if small, or cause hoarseness, cough, throat
pain and dyspnoea if large.
Sometimes a intracordal cyst may occur on true cords. It is similar to
epidermoid inclusion cyst

EPIDERMOID INCLUSION CYST

SACCULAR CYST
Obstruction to the orifice of the saccule
causes retention of secretions and
distention of the saccule which
presents as cyst in the laryngeal
ventricle.
Anterior saccular cysts present in the
anterior part of the ventricle and
obscure part of the vocal cord.
Lateral saccular cysts which are
larger extend into the false cord,
aryepiglottic folds and may even
appear in the neck.
Removed endoscopically
LARYNGOCELE
It is an air filled cystic swelling due to the dilatation of the saccule
It may be internal, external or combined (mixed)
Internal laryngocoele: it is confined within the larynx and present as
distension of the false cord and AE fold
External laryngocoele: here distended saccule herniates through the
thyrohyoid membrane and present in the neck
Mixed laryngocoele: here both internal and external laryngocoeles are
seen
LARYNGOCOELE
Laryngocoele is supposed to arise from raised transglottic air pressure as
in trumpet players, glass blowers and weight lifters
Clinical features: presents with hoarseness, cough and if large may
cause obstruction to the airway
External laryngocoele presents as reducible swelling in neck, which
increases in size on coughing and on performing valsalva
Diagnosis can be made by indirect laryngoscopy and x-ray of soft tissue
AP and lateral views of the neck with valsalva
CT scan helps to find the extent of the lesion
Surgical excision through external neck incision (laryngotomy)
Marsupialisation of internal laryngocoele can be done by laryngoscopy, but
chances of recurrence are high
Laryngocoele in an adult may be associated with carcinoma
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