A Case of Laryngeal Granulomas After Oral and Maxillofacial Surgery With Prolonged Intubation

Abstract

Laryngeal granuloma development can be a postoperative complication of laryngeal trauma or irritation resulting from general anesthesia and endotracheal intubation. These rare benign lesions are located primarily over the cartilaginous portions of the larynx, particularly the vocal processes of the arytenoids. Airway manipulation during the intubation process and prolonged intubation periods can be contributing factors to intubation-related laryngeal granulomas, which may manifest 1 to 4 months after intubation. The patient in this case was a female who returned with complaints of throat pain without hoarseness or sensations of a “lump in her throat” 3 months following surgery, during which she was intubated with a 7.0-mm nasotracheal tube for 30 hours, likely contributing to her bilateral laryngeal granulomas. The patient underwent successful conservative medical management consisting of a proton pump inhibitor and an inhaled corticosteroid.

Fatal asphyxia due to large laryngeal granuloma

“…Laryngeal granuloma, first described by Chevalier Jackson in 1928 as a contact laryngeal ulcer, is commonly termed a laryngeal contact ulcer, contact granuloma, vocal process granuloma, vocal fold granuloma or post-intubation granuloma. 1 - 4 Vocal process granulomas are benign, inflammatory lesions located over the vocal process of the arytenoid cartilage. 2 They may be uni or bilateral ulcerative, pedunculated, sessile, erythematous, or white lesions.…”

“…They often arise postoperatively following an injury of the arytenoid cartilage mucosa overlying. 1 Clinical manifestations include voice change and dyspnea, which may not manifest until one to four months after extubation, 1 and may lead to potentially fatal complications such as asphyxia. Vocal granulomas affect both genders 5 and can be caused by acid laryngitis secondary to laryngopharyngeal reflux disease, vocal overuse, and traumatic or prolonged intubation.…”