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Clinical Challenge
October 2016

Right-Sided Laryngeal Mass With Hoarseness

Author Affiliations
  • 1Case Western Reserve University, School of Medicine, Cleveland, Ohio
  • 2Department of Otolaryngology–Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio

Copyright 2016 American Medical Association. All Rights Reserved.

JAMA Otolaryngol Head Neck Surg. 2016;142(10):1021-1022. doi:10.1001/jamaoto.2016.0534

A man in his 20s presented with a 5-week history of hoarseness and foreign body sensation in his throat. His voice was breathy and raspy, and he projected his voice poorly. He denied dyspnea, dysphagia, odynophagia, weight loss, and lymphadenopathy. He had no clinically significant medical, surgical, or social history. Flexible Lindholm laryngoscopy revealed a large, right-sided, supraglottic, submucosal mass expanding the aryepiglottic fold and false vocal fold with hypomobility of the right vocal fold (Figure, A). The lesion extended posterolaterally to the aryepiglottic fold and obscured visualization of the glottis. The right laryngeal ventricle was effaced, but the mucosal surface of both true vocal cords appeared normal. A computed tomographic (CT) scan to determine the extent of the lesion revealed a cystic mass with no protrusion out of the thyrohyoid space or into the subglottic airway (Figure, B and C). Intraoperatively, the lesion was fully visualized with a Lindholm laryngoscope (Figure, A). The mass was completely removed using a pulsed potassium titanyl phosphate laser to make mucosal incisions just lateral to the aryepiglottic fold and cold instrumentation to manipulate and remove the mass. Strategic needle decompression and angled endoscopes facilitated complete visualization and removal of the mass. The paraglottic space was closed via endoscopic suturing. The patient tolerated oral intake and was discharged home within 24 hours. Pathologic findings were benign. Considerable voice improvement and vocal fold mobility was noted at 6 weeks, with normal vocal fold movement, normal mucosal pliability, and complete glottic closure achieved at 1 year (Figure, D).

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