Laryngocele: causes, symptoms, diagnosis, treatment

Laryngotsele is a racemous, air-containing tumor that develops at the level of the ventricles of the larynx with a certain predisposition to this defect. This formation is rare, mainly in men in middle age. The first observations of this disease medicine owes to the surgeon of the Napoleonic army Larey, who observed it from the inhabitants of Egypt during the Egyptian expedition of Bonaparte from 1798 to 1801. VL Gruber in 1857 proved that phylogenetically laryngocele is an analog of the so-called air sacs of anthropoid monkeys - orangutans and gorillas. The term "laryngocele" was first introduced by R.Virkhov in 1867.

The reason is laryngocele. Laryngocele by origin are divided into true (congenital), due to the abnormality of embryonic development of the larynx, and symptomatic, ie, acquired as a result of the appearance in the larynx of any obstacles exhaled air stream (tumor, granuloma, cicatricial stenosis, etc.). Normally, the ventricles of the larynx do not contain air, and their walls are in tight contact with each other. Under certain conditions, especially with forced exhalation, insufficient opening of the respiratory gap and approaching the folds of the vestibule, exhaled air penetrates the ventricles of the larynx and opens them under pressure, stretching and thinning the mucous membrane and the submucosal layer. Multiple repetition of this phenomenon leads to the formation of a laryngocele. Usually such a mechanism for the formation of acquired laryngoceles is observed in glassblowers, trumpeters, and sometimes in singers.

Very interesting are the data given by N. Costines (1964), according to which the diverticula of the larynx, from which the laryngocele may form under appropriate conditions, is not a rare phenomenon. Thus, in almost all children who died for various reasons, spreading kverkho diverticula are found on autopsy, and according to Kordoleva, 25% of adults have laryngeal diverticula reaching the area of the sublingual-epiglottis membrane, while none of them during their lifetime there were no signs of laryngocele.

Pathological anatomy. By localization laryngoceles are divided into internal, external and mixed. Originating initially in the region of the ventricles of the larynx, the laryngoceles spreads in the direction of the anterior larynx and into the anterolateral region of the neck. The saccate tumor is formed due to the hernial protrusion of the mucous membrane of the ventricle of the larynx, which penetrates into the thickness of the tissues either through a gap in the lining of the thyroid membrane, or by stratifying it in the places of its least strength.

The diagnosis of laryngoceles is established with laryngoscopy and examination of the anterior surface of the neck.

Internal laryngocele is a swelling, covered with a normal mucosa, located at the level of the ventricle and cherpalodnagortannogo folds. This swelling can occupy most of the vestibule of the larynx, covering the vocal folds and causing disturbances in breathing and voice formation. External laryngoceles develop slowly - for many months and even years; located on the anterolateral surface of the neck, on the larynx or in front of the sternocleidomastoid muscle. It has the form of oval swelling, covered with normal skin. When palpation of the tumor, the symptom of crepitus, as with subcutaneous emphysema, is not detected; the swelling is painless, it is not soldered to surrounding tissues, when it is pressed on the tumor, it decreases, when the pressure stops, it quickly acquires the former form, when straining increases, the filling of the laryngocle with air is noiseless. If the tumor is palpated above the upper edge of the thyroid cartilage, you can identify a cavity that leads to the place where the foot of the laryngocere perforates the thyroid membrane. When percussion of the tumor reveals a tympanic sound. During phonation or swallowing, the internal laryngocele is emptied noiselessly, while the air outlet from the outer laryngocele is accompanied by a characteristic noise produced by the air stream. This noise can be heard from a distance or be listened to with a phonendoscope.

In the X-ray study, the laryngocel is visualized as a round-oval enlightenment of different density from one or both sides near the larynx with clearly delineated boundaries, either only in the projection of the ventricles of the larynx, or spreading outward from the large horn of the thyroid cartilage and lateral of the latter; with lateral projection, this enlightenment can spread to the hyoid bone, pushing back the scooped-epiglottis fold, but in all cases the laryngocel retains its connection with the ventricle of the larynx.

The accidental detection of laryngocele should always alert the doctor to the secondary origin of this anomaly due to the presence of a tumor in the area of the ventricle of the larynx or some other laryngeal location. The combination of laryngecele and laryngeal cancer is a rare phenomenon, described by many authors (Lebogren - 15%, Meda - 1%, Leroux - 8%, Rogeon - 7%).

Differential diagnosis is performed with the cysts of the larynx, benign and malignant tumors, infectious granulomas and various other malformations of the larynx.

Treatment laringocele is to excise from the external access air bag, which is easily separated from the surrounding tissues, without being soldered. Some authors suggest removing Laringocele with the endolaryngeal method, which is largely facilitated by the introduction of microlaringosurgical techniques into the wide practice. However, with the endolaryngeal method, recurrences of laryngocele are not excluded. Preventive maintenance of infectious complications is carried out by appointment in the postoperative period of antibiotics and antihistamines.

[1], [2], [3]