Strategies and Controversies in the Treatment With Carbon Dioxide Laser of Laryngeal Hemangioma: A Case Series and Review of the Literature

Abstract

Introduction: The hemangioma is the most common vascular tumor, involving the head and neck in 60% of cases. It is rare in the larynx. In children, hemangiomas are more frequent on the subglottis, whereas in adults the most common site is the supraglottis. Laryngeal hemangioma with cavernous features isolated to the free edge of the vocal fold is a very rare clinical finding. We present 2 cases of glottic hemangioma. Both patients reported severe hoarseness. Cases: In the first patient, an extensive blue-purple mass was seen on the right vocal cord. The patient was posted for microlaryngeal surgery with carbon dioxide (CO2) laser. Second patient had a large, smooth, flesh-colored polypoid mass emanating from the left vocal cord. The patient was posted for microlaryngeal surgery. After 2 months, both patients showed a considerable voice improvement. Discussion: Vocal cord hemangiomas are very rare, and they usually cause problem in the voice of the patient. A vascular lesion that may mimic a hemangioma may sometimes result from an organizing hematoma following a hemorrhage on the vocal cords due to voice abuse. Laryngeal hemangiomas also need to be distinguished pathologically from polypoidal vascular granulation tissue that may be produced by laryngeal biopsy, intubation, or trauma. Indirect endoscopy is enough to diagnosis. No active treatment is advised for adult laryngeal hemangiomas unless the lesions are symptomatic or show a tendency to involve other parts. There is no uniformly accepted treatment of head and neck hemangiomas. Surgical excision with laser CO2 microlaryngoscopic techniques gives satisfactory results.

Congenital Laryngeal Hemangioma: A Case Report of a Rare Presentation

“…Laryngeal hemangiomas are mostly found in the subglottic region in infants with the adult type being found attached to supraglottic structures such as epiglottis, aryepiglottic folds, arytenoids, and false and true vocal cords [5,8]. In our case, unlike the mostly reported location, the lesion was attached by a stalk to the left arytenoid in a baby.…”

“…Laryngeal hemangiomas occur in different forms, i.e., cavernous, capillary, or mixed types. The capillary type tends to have larger vascular channels with deeper infiltration into the submucosa while the cavernous types are well-circumscribed and less infiltrative [8]. Our case was a cavernous type.…”

“…It has been argued that radical surgical excision of hemangioma is necessary when the lesion is circumscribed and attached only to the submucosal layer. This is believed to prevent recurrence and possible later complications as the structures of phonation are mostly spared [8]. The lesion in our case was excised without injuring the underlying tissues.…”

The clinical value of DCE-MRI for differentiating secondary laryngeal cartilage lesions

“…The higher K trans values may be caused by a large irregularly sized vascular channel which is arranged haphazardly through the tissue in the laryngopharynx hemangiomas. [ 1 ]…”

“…These tumors are benign, but sometimes they cause locally destructive lesions. [ 1 ] Granulomatous hemangiomas grow rapidly, often ulcerate, and they are easily misdiagnosed as malignant tumors. [ 2 ] Squamous cell carcinoma, a common malignant tumor of the head and neck, is the most common pathological type of laryngopharyngeal malignant tumors.…”