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Clinical Challenge
December 2016

Laryngeal Mass in an Infant

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill
  • 2Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill
JAMA Otolaryngol Head Neck Surg. 2016;142(12):1239-1240. doi:10.1001/jamaoto.2016.2967

An infant girl presented to the outpatient clinic with a history of recent-onset hoarseness in her cry. Her parents also reported loud snoring and some retractions during sleep. There was no clinically significant medical or family history. Her birth had been uncomplicated after a term pregnancy. Physical examination revealed mild inspiratory stridor and several light-brown macules approximately 1 cm in size on the patient’s skin. On flexible fiberoptic laryngoscopy (Figure), a supraglottic mass could be seen, but visualization of the full extent of the larynx or the mass was difficult owing to lack of cooperation by this very young patient. The decision was made to obtain a better view under direct laryngoscopy in the operating room. A submucosal lesion of the left aryepiglottic fold extending inferiorly to the level of the arytenoid, and displacing the epiglottis medially, was found. An incision was made through the mucosa, where a firm, whitish mass that bled minimally was noted, and a biopsy specimen was sent for permanent pathologic analysis. A magnetic resonance image was then obtained to assess the full extent of the mass and whether surrounding tissues were involved.

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