Therapeutic efficacy of intralesional bleomycin injection for laryngopharyngeal haemangioma in adults

Epiglottic capillary hemangioma in an adult female: A rare case report

INTRODUCTION AND IMPORTANCE

Capillary hemangioma of larynx can occur in both pediatric and adult population. However, epiglottic capillary hemangioma in adults is a very rare presentation. Its pathophysiological basis involves self limiting and self expanding vascularization and it is a characteristically well delineated benign mass.

CASE PRESENTATION

Here we present a case of a 40-year-old female who presented with complaint of per oral bleed in spitting which was about a teaspoon in quantity since 1 month. There was no associated hoarseness, dysphagia, respiratory distress, hemoptysis or neck swelling. There were no other systemic manifestations i.e. weight loss, fatigue or anemia. There was no familial history.

CLINICAL DISCUSSION

On examination, Indirect Laryngoscopy (IDL) revealed a mass on the posterior surface of epiglottis. 70° view endoscope confirmed the findings of IDL. All other neighboring structures i.e. vocal cords, anterior and posterior commissures and pyriform fossa were normal and no mass or pathology was seen. Imaging studies contrast enhanced CT scan of neck soft tissue window showed isodense opacity in supraglottic region. Surgical excision and hemostasis were carried out using Colorado bipolar cauterization. The histopathological investigation of the mass revealed a benign lesion compatible with capillary hemangioma.

CONCLUSION

As until now, no case of capillary hemangioma of epiglottis has been reported, head and neck surgeons are not well aware of this case. This case report will add valuable insight to the relative surgeons/clinicians.

Management of Adult Laryngeal Hemangioma With Low-Temperature Plasma Radiofrequency Coblation

Objective: This study investigated the therapeutic effects of low-temperature plasma radiofrequency (LPRF) coblation on adult laryngeal hemangiomas (ALHs) using suspension laryngoscopy. Material and Methods: The clinical data of 23 patients with ALH treated by LPRF coblation were analyzed retrospectively. All patients underwent edge coagulation before ablation resection. Postoperative voice and swallowing were assessed. Results: The 23 ALHs were diagnosed clinically as 6 cavernous hemangiomas and 17 capillary fibroangiomas. All 23 cases achieved success after a single LPRF coblation, and there was no postoperative bleeding, dyspnea, dysphagia, dysphonia, or other complications. None required postoperative tracheotomy. The patients were followed for 1 year without recurrence. Before surgical intervention, only 2 (8.7%) of the 23 patients had mild (n = 1) or moderate (n = 1) dysphagia. Postoperative dysphagia was assessed at the 1- and 3-month follow-ups. At 1 month, 5 (21.7%) of 23 patients had mild dysphagia, including 3 (13.0%) reporting new mild dysphagia. However, at 3 months postoperatively, none of patients had any dysphagia. The mean Voice Handicap Index was 11.2 ± 3.7 preoperatively, 7.1 ± 2.8 at 1 month postoperatively, and 4.8 ± 3.1 at 3 months postoperatively; the mean maximum phonation time was 10.8 ± 3.7 seconds preoperatively and 12.6 ± 1.8 and 14.1 ± 3.9 seconds at 1 and 3 months postoperatively, respectively. Conclusions: LPRF coblation is an effective minimally invasive method for treating ALHs with better voice and swallowing recovery. Edge coagulation before ablation resection may reduce intraoperative bleeding.

Clinical Characteristics, Classification, and Management of Adult Nasopharyngolaryngeal Hemangioma

OBJECTIVES/HYPOTHESIS

To analyze the clinical features, classification, and treatment of adult nasopharyngolaryngeal hemangioma (ANPLH).

STUDY DESIGN

Retrospective study.

METHODS

From February 2009 to May 2020, 101 patients with ANPLH were reviewed and analyzed.

RESULTS

Symptoms of ANPLH were frequently displayed as abnormal pharyngeal sensation and functional defection. According to lesion location, ANPLH was divided into five categories including nasopharyngeal, oropharyngeal, hypopharyngeal, laryngeal, and mixed types. The mixed type constitutes the highest portion, and the nasopharyngeal type is the least in our cohort. Most lesions could resect through natural cavity under endoscopy. Patients with mixed lesions had a higher rate of postoperative recurrence and planned multiple surgeries. Acceptable but not severe intraoperative and postoperative complications occurred in our patient cohort.

CONCLUSIONS

Patients with ANPLH are always symptomatic and even functional defective, which can be classified into five categories based on lesion location. For these patients, endoscopic surgery through natural cavity is recommended to remove lesions with fewer complications and favorable clinical outcomes.

LEVEL OF EVIDENCE

4 Laryngoscope, 2021.

Clinical Effects of Radiofrequency Coblation for Adult Laryngopharyngeal Vascular Lesions

OBJECTIVE

To explore the feasibility and efficacy of transoral radiofrequency coblation surgery (TRS) in the treatment of adult laryngopharyngeal vascular lesion (LVL).

METHODS

A total of 15 patients with LVL were retrospectively studied, including 11 capillary lesions and five cavernous lesions (there was one case with two separate lesions). All of the lesions were treated with TRS alone (capillary lesion) or with a combination of TRS and sclerotherapy (cavernous lesion). The treatment efficacy was evaluated according to the modified Achauer criteria: grade 1, no change in size; grade 2, a decrease of < 50% in size; grade 3, a decrease of ≥ 50% but < 100%; and grade 4, the disappearance of the lesion with no recurrence for at least 6 months.

RESULTS

The surgical procedures were successfully completed in all patients. According to the modified Achauer criteria, the treatment outcomes were grade 4 for 10 capillary lesions and one cavernous lesion; grade 3 for one capillary lesion and one cavernous lesion; grade 2 for one cavernous lesion; and grade 1 for two cavernous lesions, respectively. No complications related to the surgery, including bleeding, dysphagia, and infections, occurred after treatment.

CONCLUSION

The TRS is an effective treatment option for LVL, especially for patients with laryngopharyngeal capillary lesions.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:566-570, 2021.