Diagnosis and Treatment of Laryngeal Schwannoma: A Systematic Review

Abstract

Objective This review summarizes the clinical features, diagnostic workup, and surgical treatment of laryngeal schwannoma with the aim of providing guidance for the management of this rare disease. The collated data allowed the statistical testing of several hypotheses, including the efficacy of endoscopic vs open surgical intervention and the usefulness of preoperative biopsy. Data Sources PubMed, Google Scholar, Cochrane, and SCOPUS. Review Methods Basic epidemiological and clinical presentation data were collated together with details of diagnostic image modality, lesion attributes, and the use of preoperative biopsy. Surgical approach to intervention and outcome was also collated and simple statistical analyses applied. Results The 60 original articles selected provided a combined cohort of 74 patients for review. The combined data revealed that schwannoma with pedunculated morphology were always safely removed by endoscopic resection regardless of size and should be treated as a separate entity. Of the nonpedunculated schwannoma, larger tumors were more likely to undergo an open approach, which in turn was associated with higher rates of tracheotomy and postoperative vocal fold paralysis. The small cohort did not reveal a significant association between surgery type and persistent disease. Interestingly, the data revealed a significant association between the use of incisional biopsy and persistent disease. Cases exhibiting extralaryngeal extension of the lesion were shown to exclusively belong to patients with neurofibromatosis/schwannomatosis syndromes. Conclusions Taken together, these findings suggest that incisional biopsy should be avoided, and given the benign nature of the pathology, the least invasive radical approach should be employed.

Laryngeal Schwannoma: Emphasis on Treatment with Surgical Instrument Excision

“…Various surgical approaches can be performed depending on the size of the mass. These approaches include transoral approach with the use of laser or steel instruments for smaller tumors, or open approaches including lateral or median thyrotomy or lateral pharyngtomy for larger tumors [12,13]. Prognosis is good but recurrence can occur rapidly with incomplete surgical excision.…”

“…Around 45% of neurogenic tumors present in the parapharyngeal space [1]. However, schwannomas presenting in the larynx are extremely rare, and account for less than 1.5% of all benign laryngeal tumors [2]. Laryngeal schwannomas are indolent growths that primarily appear in the supraglottic area.…”

Transoral‐transpharyngeal CO2 laser en bloc excision of voluminous left recurrent laryngeal nerve schwannoma: Case report and review of the literature

“…Supraglottic localization of laryngeal schwannomas is the most frequently reported in literature, 5,14 and it is generally managed by an endoscopic approach.…”

“…Open approach can be done by median thyrotomy, lateral thyrotomy, and lateral pharyngotomy. 14 Five authors [6][7][8][9]13 choose this approach because it allows a wide exposure of the lesion for a complete en bloc removal. The morbidity of the open approach varies noticeably.…”

“…Transoral endoscopic microsurgery, with or without the use of laser, is traditionally reserved to small glottic and supraglottic schwannomas, in patients with good pharyngo-laryngeal exposure. 4,5,14 The advantages of the technique are less morbidity, the absence of scar in the neck, and shorter hospitalization time. However, some authors believe that the endoscopic approach could be associated with an increased risk of residual disease because of nonoptimal exposure of the mass.…”