Transoral Robotic Resection of a Massive Laryngeal Lipoma

Abstract

Poster PresentationsP213 a nylon brush through the tracheostoma. Tacrolimus (0.2 or 1.0 mg/kg i.m.) was systemically administered for 5 days. The pathological changes at the airway mucosa and the tracheal lumen were assessed at 7 days after the scraping. The percentage of stenosis was calculated by image analysis software.Results: Both hyperplasia of airway epithelium and thickened submucosal layer with extensive fibrosis, angiogenesis, and collagen deposition provoked lumen stenosis. There was significant preventive effect on airway stenosis in the lower dose of Tacrolimus (0.2mg/kg) compared to brushing only group (P < 0.05). The high dose of Tacrolimus group (1.0mg/kg) also showed a trend to potential protection of airway stenosis.Conclusions: This study suggests that the systemic immunosuppressive agent, Tacrolimus, has a preventive effect on LTS from mucosal injury of the airway.Objectives: Describe the clinical and radiographic features of a massive laryngeal lipoma and discuss the management through a transoral robotic approach.Methods: Retrospective case report. An otherwise healthy 66 year old male presented with 6 months of progressive dysphagia, dyspnea, and muffled voice. On flexible endoscopy a massive, smooth mass was seen filling the oropharynx and obstructing visualization of the vocal folds and hypopharynx. Computed tomography imaging revealed an 8.5x4.9 cm lowattenuation mass extending from the right paraglottic space posteriorly into the hypopharynx and oropharynx. On magnetic resonance imaging, the mass was T1 hyperintense with slight rim enhancement and complete suppression on T2 weighted fat saturation. The patient underwent tracheotomy under local anesthesia and excision of the mass through a transoral robotic approach.Results: Final pathology was consistent with lipoma. The patient began tolerating oral intake on postoperative day 1 and was decannulated on postoperative day 8. At 2 months followup, he had right vocal cord paresis but had significant improvement in both his vocal quality and dysphagia and no recurrent mass in the oropharynx or hypopharynx.Conclusions: Lipomas of the larynx are rare, accounting for 0.6% of benign laryngeal lesions. Despite their benign nature, removal is indicated to manage airway obstruction and dysphagia. To our knowledge, this is the first report of transoral robotic resection of a laryngeal lipoma. We propose the use of transoral robotic surgery for large benign lesions of the larynx in order to avoid the morbidity of an open cervical approach.