Tumors of the laryngopharynx
Last reviewed: 23.04.2024
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Of benign tumors of the laryngopharynx, papilloma is most often met, somewhat less often - hemangioma, rarely - neoplasms, developing from muscle tissue (leiomyoma, rhabdomyoma), neurin, fibroma, etc.
The larynx is much less common than the larynx, it is the primary localization of the tumor process. For malignant tumors of the laryngopharynx, the most characteristic is the exophytic form of growth. Infiltrative growing tumors are prone to rapid ulceration, although the exophytic tumor often disintegrates and ulcerates.
Most often, the initial location of the tumor of the larynx is the medial wall (lateral surface of the scaly palate fold) of the pear-shaped sinus. Neoplasms of this localization penetrate rather quickly into the larynx. More rarely, the tumor originates from the anterior wall (the anterior angle of the pear-shaped sinus is the place of the medial wall's lateral passage) of the pear-shaped sinus. Along the anterior wall, the tumor extends upwards towards the epiglottis-pharyngeal fold and downwards to the cervical region of the esophagus. As with localization on the medial wall of this sinus, the tumor can penetrate the larynx and the front surface of the neck. Even less often the neoplasm of the military on the lateral wall of the sinus.
Less common are tumors of the posterior wall of the laryngopharynx and the posterolumperous region. Neoplasms arising on the posterior wall of the laryngopharynx often grow exophytally, slowly spreading up and down, reaching the top of the oropharynx, below - the mouth and cervical esophagus. The process does not go to the spine for a long time, the tumor spreads along the pre-invertebrate fascia. This fact should be taken into account when deciding on the possibility of surgical treatment. From the posterolumperous region, the tumor descends fairly quickly into the cervical region of the esophagus, and through the esophagus - anterior to the trachea.
Symptoms of the tumors of the larynx
The most frequent symptoms of benign tumors of the laryngopharynx of this localization are signs of dysphagia - the sensation of a foreign body, the difficulty of swallowing. Pain sensations for these tumors are not characteristic. Pain can disturb the patient only with certain types of neurinoma. With hemangiomas, bleeding from the pharynx is possible. Reaching a large size, the neoplasm can squeeze and cover the entrance to the esophagus, narrow the laryngeal lumen (with the location of the tumor at the entrance to the larynx). Narrowing the entrance to the larynx leads to difficulty breathing.
Symptoms of malignant tumors of the larynx
Most patients associate the onset of the disease with the appearance of a foreign body sensation in the pharynx, less often the first sign is pain. Initially, this is a mildly painful sensation that worries the patients mainly in the morning when they swallow saliva. Gradually the pains increase and arise not only when swallowing saliva, but also when eating. Since the laryngopharynx neoplasms attack the larynx rather quickly, symptoms of dysphagia are joined by the symptoms of the larynx: hoarseness, buriness, coughing, difficulty breathing. With the disintegration of the tumor, there is an unpleasant smell from the mouth and an admixture of blood in the sputum.
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Diagnostics of the tumors of the larynx
The diagnosis of benign tumors of the laryngopharynx is established based on the history of the disease (the sequence of the onset of symptoms, the duration of the disease), the results of hypopharyngoscopy (direct and indirect), fibroscopy, radiography and other radiation methods of examination (CT, MRI). The decisive role in determining the type of tumor (its histological structure) is biopsy with subsequent histological examination.
Diagnosis of tumors of the larynx is more difficult than that of the oropharynx. The age and gender of the patient, the presence of bad habits, occupational or industrial hazards, the duration of the disease, the presence of precancerous conditions are important. All this information can be obtained by studying the anamnesis.
It is difficult to establish the correct diagnosis with a limited tumor process on the anterior and outer walls of the pear-shaped sinus, as well as in the posterolumpered region. The first symptoms are often regarded as an exacerbation of chronic pharyngitis or tonsillitis. Patients sometimes persistently complain about the sensation of a foreign body in the throat. This symptom is not always given due importance, as it often occurs with pharyngitis, diseases of internal organs, certain disorders of the nervous system. The tumor infiltrates the walls of the pear-shaped sinus, and even if it is still impossible to determine, in some patients it is already possible to detect the indirect signs of the lesion: the asymmetry of the pear-shaped sinuses, the accumulation of saliva on the affected side.
Disruption of food passage is observed only in far-reaching processes, when the tumor occupies both pear-shaped sinuses or spreads down to the "mouth" and cervical region of the esophagus.
Instrumental research
Auxiliary diagnostic methods - radiography. CT and MRI of the laryngopharynx and cervical esophagus, as well as contrast fluoroscopy. Using these research methods, it is possible to determine the spread of the process to the esophagus, trachea, cervical spine. Great importance in the diagnosis of tumors of the larynx is hypopharyngoscopy with the use of optics and fibroscope.
The final diagnosis is established based on the results of a histological examination of the material obtained by biopsy. In some cases, when performing a biopsy, you have to perform direct hypopharyngoscopy or fibroscopy.
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Treatment of the tumors of the larynx
Treatment of benign tumors of the laryngopharynx is surgical. Small lesions on a thin base (stalk) can be removed endofaringuially with direct or indirect pharyngoscopy using a microscope. The large tumors located deep in the tissues (neurinomas, leiomyomas, rhabdomyomas, etc.) are removed through external access, which is used by various methods of pharyngotomy. With diffuse hemangiomas, cryoviation can be successfully used.
Treatment of patients with malignant tumors of the larynx. Despite certain successes of surgical and radiation treatment, does not give good results. Radiation treatment for tumors of the laryngopharynx is ineffective.
Often when spreading tumors of the pharyngeal pharynx to the larynx, large laryngectomy with a circular throat resection is performed on large volumes of the removed tissues. The operation can be expanded by resection of the root of the tongue, cervical esophagus, trachea. Intervention is completed by the formation of pharyngostomy, orostomy, esophagostomy and tracheostomy. In the subsequent it is necessary to perform plasty of the alimentary canal. FG Sarkisova (1986) considers it possible to leave half of the larynx in unresolved pear-shaped sine tumors.