Angioma of the larynx: causes, symptoms, diagnosis, treatment

Angioma of the larynx is divided into hemangiomas and lymphangiomas.

True laryngeal hemangiomas are very rare in otolaryngology and, according to different authors, account for about 1% of all benign laryngeal tumors. According to VA Borodulina (1948), before 1948, only 119 cases of laryngeal hemangiomas were published in all available world literature, and the Romanian author N. Kostinescu (1964) from 1937 to 1964 observed only four cases of this disease.

[1], [2], [3], [4], [5], [6]

Pathological anatomy of the angiomy of the larynx

Structurally, the laryngeal hemangiomas are telangiectasias, but more often cavernous angiomas. In early childhood, capillary hemangiomas of the larynx prevail, in adults - cavernous.

Lymphangiomas of the larynx are much less common than hemangiomas and are usually located on the epiglottis, cherpalodnagortane folds, vocal folds, in the ventricles of the larynx and in the lining space. Hemangiomas of the larynx often spread into pear-shaped sinuses, on the pits of the epiglottis, tonsils and soft palate, can be combined with hemangiomas of the face and upper parts of the neck. Hemangioma of the larynx of the telangiectatic structure looks like a red spot slightly elevating above the surface of the mucous membrane; Lymphangioma is more pale and has a yellowish-pinkish color, contains a milky fluid. Teleangiectasias with bleeding are usually bleeding, as opposed to cavernous hemangiomas, which are prone to spontaneous bleeding or are abundant enough to damage them.

Symptoms of angiomy of the larynx

Minor angiomas of the larynx clinically are asymptomatic, especially small-sized telangiectasias, and are found by chance during endoscopic examination of the larynx. This form of the laryngeal hemangioma does not increase for a long time, then for no apparent reason begins to increase rapidly, acquiring the structure of the cavernous hemangioma. In women, intensive growth of the laryngeal hemangiomas is observed during menstruation and pregnancy. Frequently repeated hemorrhages often lead to severe anemia.

Diagnosis of angiomy of the larynx

The diagnosis of "angiomy of the larynx" is established easily by a typical type of tumor; As for the definition of its prevalence, in some cases the methods of contrast-based vasography, MRI, fibrolaringoscopy are used. Biopsy is contraindicated in any form of hemangioma because of the danger of profuse bleeding with an unpredictable outcome.

Differential diagnosis of angiomy of the larynx is performed with fibroangiomatous polyps of the larynx, myxoma, sarcoma.

[7], [8], [9], [10], [11], [12], [13], [14]

Treatment of angiomy of the larynx

In view of the slow development of the laryngeal hemangiomas and when the tumor does not cause any subjective disorders, it should be limited to dynamic observation. Minor angiomas of the larynx causing fissure disturbances can be removed with subsequent cauterization of the surface on which they were located. With significant cavernous hemangiomas, some authors recommend that the external carotid artery be ligated on the appropriate side to reduce the likelihood of an aneurysmal development of the process, reduce the risk of bleeding and as preoperative preparation. In some cases, as a preoperative preparation, a provisional tracheotomy is also used, which is also performed in attempts to obliterate the hemangioma by introducing sclerosing substances (quinine, urethane, alcohol, etc.) into it. Large laryngeal hemangiomas are removed from the external approach, for example by laryngophyssura.

The development of laser surgery allowed to significantly expand the indications for extirpation of the laryngeal hemangiomas and to produce it even in newborns.

For surgical interventions of this kind, a low-energy surgical carbon dioxide laser is used that has the property of coagulating blood vessels and drastically minimizing bleeding. The operation is performed under endotracheal anesthesia, with mechanical ventilation and muscle relaxation. If the endotracheal tube interferes with the operation, W. Steiner and J. Werner (2000) are allowed to extract it for a short, biologically acceptable time and conduct operative manipulations in the state of apnea of the patient. As an alternative, injectable (reactive) ventilation can be used.