Indirect laryngeal surgery of vocal fold polyps: a dying or evolving art?

Objective: Vocal fold polyps (VFPs) are the most common benign laryngeal lesions that require surgery and are routinely managed by microlaryngoscopy (MLS) under general anaesthesia. Prior to introduction of MLS, VFPs were removed using indirect laryngoscopic surgery (ILS) in local anaesthesia, a procedure that required substantial surgical skill to operate with an unmagnified mirror view of the larynx. With the adoption of wireless endoscopy equipment and personal computers, we tried to simplify this technique so that it can be easily performed in the office. This study aimed to assess the effectiveness of ILS by comparing voice outcomes with MLS. Materials and methods: ILS and MLS were performed in six patients each. Treatment outcomes were measured using a voice self-assessment and objective acoustic analysis. The total cost of both procedures was calculated. Results: Both techniques allowed successful removal of VFPs in all patients, without significant intergroup differences in voice outcomes. The cost of ILS was significantly lower. Conclusions: Despite the pilot nature of the study and the small sample size, our data indicate the potential value of this technique which, considering its simplicity and economic value could be used as an alternative to MLS in carefully selected patients.

Giant Lipoma of the Anterior Neck Causing Dyspnea.

Lipomas are the most common benign mesenchymal tumors, composed of mature adipocytes, and may occur anywhere in the body where fatty tissue is present. Neck lipomas are rare and usually appear as solitary, small (<5 cm), and asymptomatic lesions located in the subcutis of posterior neck. Giant anterior neck lipomas are exceptionally rare and, other than cosmetic concerns, seldom present with respiratory symptoms. A 37-year-old female patient was referred for a long-standing anterior and right-sided neck swelling, which had markedly increased in size causing cosmetic disfigurement, neck discomfort, and transient episodes of dyspnea when lying on the side opposite the neck mass. Under general anesthesia, the lesion was completely dissected and removed through the elliptical cervical incision over the right supraclavicular fossa, while carefully preserving the surrounding neck structures. The postoperative recovery was uneventful and the patient was satisfied with the cosmetic outcome and relief of her respiratory symptoms.

A case of hypoharyngeal lipoma with extrapharyngeal extension

Hypopharyngeal lipoma is a rare entity and is usually asymptomatic until it reaches a large size. The lipoma described in this case was unusual because of its deep extension from the hypopharynx to the visceral space of the neck. On endoscopic and MRI examination the tumour appeared as an encapsulated, well-defined lesion covered by yellowish intact mucosa. The lipoma was completely removed through the transcervical approach. The surgery produced excellent cosmetic results and no functional impairment. The approach used also provided a rapid and uneventful postoperative recovery and optimal locoregional control of the disease during the follow-up period.

Vagus Nerve Schwannoma Mimicking a Lateral Neck Cyst.

Schwannomas are benign tumors originating from Schwann cells of the myelin sheath. The cystic appearance of a cervical vagal schwannoma is an extremely rare finding, with few patients reported in the literature. A 60-year-old female patient was seen at our service for a slow-growing, 9 × 6 cm left-sided cystic neck mass. Preoperative clinical and computed tomography evaluation suggested a diagnosis of a lateral neck cyst. The surgical exploration through the lateral cervicotomy revealed a large cystic mass and clearly identified that the tumor was originating from the left vagal nerve. The histopathologic analysis confirmed the diagnosis of schwannoma. Although uncommon, vagal schwannoma with pronounced cystic component should be included in the differential diagnosis of the cystic neck swellings.