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Clinical Challenge
November 2015

A Submucosal True Vocal Fold Mass

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
  • 2Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
JAMA Otolaryngol Head Neck Surg. 2015;141(11):1025-1026. doi:10.1001/jamaoto.2015.2168

A man in his 60s presented to the clinic with a 5-month history of sudden-onset, progressively worsening dysphonia, dry cough, and the sensation of a lump in his throat. He described a progressively worsening voice with use to the point where he was nearly aphonic by the end of his workday. He denied any heartburn, hemoptysis, pain, neck masses, or smoking history. Prior treatment with 2 rounds of oral antibiotics and 1 round of oral steroids from his primary care physician did not improve his symptoms. Objectively, the patient’s voice was rough, diplophonic, and very strained. Videostroboscopic examination in the clinic revealed a broad-based submucosal mass in the anterior two-thirds of the right true vocal fold (Figure, A) that disrupted vibration of both vocal folds owing to its size and anterior location (Figure, B and Video). Findings from the remainder of his head and neck examination were unremarkable. The patient was taken to the operating room for microdirect laryngoscopy under general anesthesia (Figure, C). A microflap incision along the lateral aspect of the right true vocal fold mass was performed, and a firm, submucosal, tan-colored, seemingly encapsulated, multilobulated mass was removed en bloc with narrow margins and sent for permanent section analysis (Figure, D). The mass was deep to the epithelium of the true vocal fold and superficial to the vocal ligament.

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