Surgery for Benign Tumors of the Adult Larynx

Abstract

Benign neoplasms of the larynx are uncommon, with the exception of papillomas, which comprise up to 95% of this group. Symptoms associated with these benign tumors reflect site and size; in general, dysphonia, dyspnea, and dysphagia are the most common patient complaints and a cause should be thoroughly sought. The diagnosis of a benign laryngeal neoplasm, although suspected by the duration of the history and the physical examination, must be confirmed by biopsy or at least investigation when a vascular neoplasm is suspected (e.g., hemangioma or paraganglioma). Certain tumors have a predilection for anatomical sites in the larynx. The supraglottis is the most common site (80%), followed by the glottis and subglottis. This information may hinder the accuracy of the diagnosis if one relies on the clinical examination alone. Once diagnosed, most benign neoplasms can be treated by surgical excision. The surgical approach and excision depend on the tumor size and location; but in general, preservation of laryngeal function is the primary aim of treatment in the form of complete excision with tumor-free margins. Certain neoplasms—papillomas, oncocytic tumors, pleomorphic adenoma, lymphangiomas, neurofibromas, fibromatosis, paragangliomas, rhabdomyomas—have a tendency to recur, be it months or even years, following incomplete excision. Differentiation of benign from malignant tumors is vital. Paragangliomas, neurofibromas, and chondromas, among others, have malignant variants, with certain granular cell tumors, hemangiopericytomas, and others having histological features that mimic those of malignant disease. Reliance on expert histopathologists is crucial for accurate, appropriate treatment. With improvements in imaging, histopathology, and surgical techniques—endoscopy, microscopic magnification, application of lasers—there has been marked improvement in the accuracy of diagnosis and the ability to perform precision excision surgery for benign tumors. This means more preservation and restoration of laryngeal function than was previously possible.