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CH 45
CH 45
LARYNGOSCOPY
Ellen S. Deutsch, MD
Jane Y. Yang, MD
James S. Reilly, MD
BENIGN MASSES
Vocal fold nodules, polyps, and cysts generally occur at the
junction of the anterior and middle third of the vocal fold and
involve the epithelial and superficial layers of the lamina pro-
pria. Vocal fold nodules, generally bilateral, are small, white,
firm, sessile masses containing collagenous fibers and edema.
Vocal fold cysts, usually unilateral, comprise epithelial
cysts and mucous retention cysts. Polyps, caused by vocal
trauma, are usually unilateral, pedunculated, or sessile and
may have evidence of preceding hemorrhage.
Reinke’s edema, also known as polypoid corditis or poly-
poid degeneration of the vocal folds, is most commonly
associated with tobacco use, although vocal misuse and extra-
esophageal reflux disease may contribute to this condition.
536
Laryngoscopy 537
MALIGNANCIES
The larynx is the second most common site of cancer in the
upper aerodigestive tract. Each year, 12,500 new cases are
diagnosed in the United States, with an estimated 5-year sur-
vival rate of 68% overall. Squamous cell carcinoma accounts
for over 95% of all laryngeal malignancies, with a peak inci-
dence in the sixth and seventh decades. Tobacco is the sin-
gle most significant risk factor; ethanol is believed to have a
synergistic effect with tobacco. Palliation and cure of laryn-
geal squamous cell carcinomas may be accomplished using
radiation therapy, chemotherapy, laser, or open surgical
resection, singly or in combination. Verrucous carcinoma,
an exophytic, highly differentiated variant of squamous cell
carcinoma, rarely metastasizes; surgical resection is the
treatment of choice.
Pleomorphic carcinoma may histologically resemble
other laryngeal supporting tissue neoplasms.
544 Otorhinolaryngology
RADIOLOGIC EVALUATION
OF THE LARYNX
Routine radiologic evaluation comprises anterior-posterior
and lateral neck images. The lateral view of the neck pro-
vides useful information about the base of the tongue, val-
lecula, thyroid and cricoid cartilages, posterior pharyngeal
wall, prevertebral cervical soft tissues, and intralaryngeal
structures including the epiglottis, aryepiglottic folds, ary-
tenoid cartilages, false and true vocal folds, laryngeal ventri-
cles, and subglottic space.
Fluoroscopy may be useful in assessing dynamic lesions.
Adding radiologic contrast agents such as barium, or iohexol
for tracheobronchography, may enhance visualization and
further define airflow dynamics and distal anatomy. Spiral
computed tomography and fast magnetic resonance tech-
niques allow rapid acquisition of enhanced images of laryn-
geal structures, minimizing motion artifact. Direct spiral
Laryngoscopy 545