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Clinical Challenge
November 2016

A Highly Vascularized Supraglottic Neoplasm

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Regina Elena National Cancer Institute, Rome, Italy
  • 2Department of Organs of Sense, Ear, Nose, and Throat Section, University of Rome “La Sapienza,” Roma, Italy
JAMA Otolaryngol Head Neck Surg. 2016;142(11):1127-1128. doi:10.1001/jamaoto.2016.0033

A man in his 50s presented with intermittent dysphagia to solid foods, dry cough, foreign-body sensation in the throat, and dyspnea on effort for 4 months. His medical history included hypertension and chronic rhinosinusitis. On oral endoscopic examination, mild bilateral hyperemia of the tonsillar area and posterior pharyngeal wall were noted. The base of tongue was normal. Fiber-optic laryngoscopy revealed a reddish, 2-cm supraglottic lesion involving medially the free margin of the suprahyoid epiglottis (Figure, A). The neoplasm appeared highly vascularized on narrowband imaging (Figure, B). For this reason, before attempting an incisional biopsy, contrast magnetic resonance imaging (MRI) was performed. The MRI scan revealed an oval, 2.2-cm hypervascular mass arising from the free border of the suprahyoid epiglottis, which extended along the right aryepiglottic fold. The mass appeared to be capsulated, with regular margins, and did not show laryngeal deep tissues invasion. We proposed to the patient a surgical excision that could have been transoral or open according to the quality of exposure (which would be evaluated in general anesthesia). After evaluating the optimal exposure using a Crowe-Davis retractor, a transoral excision using the da Vinci robotic system was performed. The postoperative course was uneventful, and patient did not develop complications. On the second postoperative day, pain was fully controlled with oral medications, and the patient tolerated oral intake. He was discharged on the second postoperative day.

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