Vascular Polyp of the Vocal Cord

Abstract

Vascular polyp is the most common of growths occurring on the vocal cords. It is known variously as hemangioma (Kramer and Yankauer1), varix (Faunce2; Imperatori3), inflammatory tumor (Tucker4), cavernous papilloma (Hooper5), angioma (Chiari6), hemangiectatic fibroma and papilloma (Eppinger7), capillary angioma (Schwartz8) and pseudoangioma (New9). I prefer the name vascular polyp. Vascular polyp is not a true growth but is inflammatory in nature. It is the result of trauma in the form of strain or abuse in the presence of chronic inflammation of the mucous membrane and the immediate subjacent tissue. Because vascular polyp is so distinctive, it is difficult to confuse with other benign growths of the larynx. It frequently is called papilloma or fibroma; this is evidence of the perpetuation of erroneous nomenclature.It is likely that vascular polyp has been occurring ever since man first found his voice. From a perusal of the literature of the prelaryngoscopic era one gets the impression that all conditions which might cause suffocation were included under the general heading of polyp of the larynx. In the writings of Ehrmann10 (1844) and Green11 (1852) there is mentioned a series of cases, all of which were considered as cases of laryngeal polyp. All the patients were threatened with asphyxia; 3 were saved by op¬ eration.After the invention of the laryngeal mirror by Garcia (1855) there was a better understanding and therefore a finer differentiation of the neo¬ plasms and other lesions found in the larynx. Yet it was not until fairly recently that a clear understanding and a fairly accurate diagnosis became the rule.The removal of a tumor of a vocal cord through the natural passages was recorded as early as 1750 by Kaderik.12 Fauvel13 is credited with having been the first to recognize what was probably a vascular polyp by mirror examination of the larynx. He found a polyp "in the for¬ ward part of the vocal cord of a man" ; the cavernous structure of the polyp was demon¬ strated microscopically. For the removal of laryngeal growths Desault14 recommended laryngotomy in 1813. Twenty years later Brauers15 attempted the removal of a polyp by this means. Three years after that, in 1836, Regnoli1G re¬ moved a neoplasm through the mouth after first performing tracheotomy. In 1844 Ehrmann10 also removed a polyp in this manner. By 1871 Mackenzie 1T was able to collect 28 cases in which thyrotomy had been performed for a growth in the larynx. In prelaryngoscopic days and for some time afterward, laryngeal growths were re¬ moved by means of thyrotomy. This operation was used until the establishment of indirect pro¬ cedures for the same purpose by the pioneers in laryngology. On rare occasions a laryngeal polyp has been encountered in the dissection room. It was only after Turck and Czermak had popularized the use of the mirror that reports