Benign tumors of oropharynx and larynx: causes, symptoms, diagnosis, treatment

In the area of the oropharynx and laryngopharynx, tumors can sometimes develop that originate from the tissues that form the morphological basis of the organs of these anatomical formations: from the epithelium and connective tissue, for example, papillomas, epitheliomas, adenomas, fibromas, lipomas, chondromas, and less often vascular tumors - angiomas, lymphomas.

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Papillomas of the oropharynx and laryngopharynx

Papillomas develop most often at the level of the soft palate, on the palatine tonsils, less often on the epiglottis or one of the arytenoid cartilages. They can be combined with laryngeal papillomatosis. Pharyngeal papillomas look like a blackberry, grayish-pink in color, and are often located on a stalk that comes from the top of the uvula. Tumors do not cause any discomfort, with the exception of tumors of significant size or, being discovered by the patient himself, cause him to fear the presence of a tumor disease. They are removed in the usual way (with scissors, a cutting loop).

Adenomas of the oropharynx and laryngopharynx

Adenomas arise from the glandular apparatus and are classified as "solid" homogeneous or cystic tumors. Gliomas and myxomas are less common. In the laryngeal part of the pharynx, these tumors most often arise on the lingual surface of the epiglottis and in the pyriform sinuses. Glandular tumors of the root of the tongue are cystic formations the size of a pea. Tumors from dystopic salivary glands can reach the size of a walnut or a small apple. Such tumors cause significant difficulties in swallowing and are subject to removal.

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Vascular tumors of the oropharynx and laryngopharynx

Vascular tumors, which include angiomas and lymphomas, are most often associated with similar tumors of the oral cavity and are located on the root of the tongue or on the soft palate. They can be arterial, venous, mixed, or have a cavernous structure. Angiomas of blood vessels vary in color from bright red (for example, polypoid telangiectasia of the palatine tonsils) to bluish-purple (cavernous angioma). Tumors from lymphatic vessels (lymphomas) usually have a dull yellowish color and are denser than tumors consisting of blood vessels. Unlike angiomas, they are not subject to erosion, while tumors from blood vessels often cause bleeding, which is an indication for their removal.

Treatment consists of preliminary introduction of sclerosing substances into these tumors, followed by their diathermocoagulation. Usually, such tumors are within the competence of surgical dentistry specialists.

Connective tissue tumors of the oropharynx and laryngopharynx

Connective tissue tumors are very diverse. Fibromas and lipomas are located along the mucous membrane; the former are grayish-blue, the latter are yellowish and may resemble lymphomas. Fibromas in the palatine tonsils originate from the connective tissue layer. Osteomas, chondromas, and neuromas occur in the posterior pharyngeal wall.

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Tumors of thyroid tissue

Thyroid gland tissue tumors originate from the unclosed embryonic thyroglossal canal and develop in the root of the tongue (the so-called lingual goiter) directly in front of the epiglottis, reaching the size of a walnut or a chicken egg. These tumors are spherical in shape, located along the midline in a dense connective tissue capsule and covered with normal mucous membrane, mobile relative to the underlying layer, in which dilated veins sometimes pass. At first, the tumor causes only a sensation of a foreign body in the lower part of the pharynx, but when it reaches a more significant size, breathing problems occur, up to asphyxia, requiring emergency tracheotomy. The tumor is detected by indirect laryngoscopy and palpation, which determines either a fluctuating formation (cystic form) or a dense tumor (parenchymatous or colloid form).

If the tumor is small, it is removed transorally. If the tumor is large, especially when it is richly vascularized and causes respiratory distress, a preliminary tracheotomy is performed and the tumor is removed tranechially under intubation anesthesia. The tumor is removed partially, since it may be singular and its total removal may lead to the development of postoperative myxedema. Before the operation, it is advisable to conduct a study with radioactive iodine fixation to determine the topography of the thyroid tissue.

Tumors of the thyroepiglottic space

Tumors of the thyrohyoid space, limited posteriorly by the lingual surface of the epiglottis, anteriorly by the thyrohyoid membrane and the hyoid-epiglottic ligament, are most often cystic in nature. In other cases, they may consist of fibrous tissue or even be of a mixed nature. At the beginning of their development, these tumors cause mild respiratory distress, especially during physical exertion, but as they grow, respiratory distress becomes increasingly significant, especially during sleep (snoring, apnea). Indirect laryngoscopy in this area reveals a smooth-walled, rounded tumor covered with normal mucous membrane, which displaces the epiglottis toward the entrance to the larynx, deforms the aryepiglottic fold, widening it and smoothing the laryngopharyngeal groove.

The tumor is removed by means of subchnoid pharyngotomy and dissection of the thyrohyoid membrane, after which the tumor becomes accessible and can be easily enucleated in its entirety.