Nerwiakowłókniak krtani jako przyczyna duszności – opis przypadku i przegląd literatury

Abstract

Neurofibromas of the larynx occur extremely rarely and present in 0.5% of laryngeal benign tumors. Schwannomas occur more frequently (1,5% of laryngeal benign tumors)and its extracranial prevalence in head and neck is between 25–45%.Laryngeal neurofibroma usually develops in places rich in terminal nerve plexuses. The nerve of origin is usually an internal branch of the superior laryngeal nerve. Hence, aryepiglottic folds and arytenoids are most commonly affected.Symptoms of neurofibroma are determined by the location. Hoarseness, dysarthria, dyspnea, globus sensation are most commonly associated with neurofibroma. The other symptoms include: cough, obstructive sleep apnea, dyspnea on exertion. Because of its benign character, neurofibroma can remain asymptomatic for years.In computed tomography scans neurofibroma shows as a hypodense heterogenic tumor, well-delineated, with smooth edges. Heterogenic and medium enhancement is observed after contrast administration. A “target” appearance is typical for the plexus subtype of neurofibroma, this consists of low signal intensity centrally, high signal peripherally and lobulated pattern.The choice of treatment for laryngeal neurofibroma depends on its location, size and associated symptoms. Currently there are no specific guidelines with regard to the management of laryngeal neurofibromas. Tumor resection is possible by both endoscopic or external approach. Endoscopic CO2 laser excision is recommended for patients who present small localized lesions, well visible in direct laryngoscopy.