Laryngeal Paraganglioma: A Rare Clinical Entity Managed by Supraselective Embolization and Lateral Pharygotomy

Abstract

Laryngeal paragangliomas are benign slow growing tumors with symptoms resembling squamous cell carcinoma. Hoarseness or dysphasia are the commonest presenting symptoms and usually it presents as an submucosal mass on laryngoscopy. Ninety percentage of these tumors occur in the supraglottic larynx and the rest in the glottis and the subglottic region. Functional activity is seen in a few (2.9 %), none are associated with paraneoplastic syndromes. A 35-year-old male presented to us with hoarseness of voice since 4 months duration. Contrast arteriography demonstrated that the left superior thyroid artery supplied [80 % of the blood supply to the laryngeal mass. Supraselective embolization was done from the right femorals under local anaesthesia and sedation which was uneventfull. The tumor was excised from lateral pharyngotomy approach with an partial laryngectomy procedure. Microscopy and immune-histochemistry confirmed it to be paraganglioma. Complete surgical resection or partial laryngectomy with meticulous dissection of surrounding tissues and preservation of neurovascular structures gives an excellent prognosis as far as oncological clearance is concerned. Malignant paragangliomas of the larynx are rare and an major meta-analysis is necessary to provide a true biological behaviour of this tumor.

Paragangliomas Arising From the Laryngeal Paraganglia: Thyroid and Laryngeal Paragangliomas With Radiology-Pathology Correlation

“…Although definitive data is lacking, it is estimated that 90% of laryngeal paragangliomas are located in the supraglottic area, with 12% in the subglottic region, and 3% in the glottis [1]. Given their origin from the neural crest cells linked to the parasympathetic nervous system, they often associate with either the superior or recurrent laryngeal nerves [9]. Thyroid paragangliomas are also extremely rare, constituting fewer than 0.1% of all thyroid neoplasms and under 1% of all extra-adrenal paragangliomas [10,11].…”

“…T1 MRI with contrast is a preferred MRI sequence for laryngeal paragangliomas because the tumor typically presents with avid contrast enhancement. MRA or catheter angiogram will show the arterial supply of the paragangliomas, excluding a low-flow venous malformation [9]. Nuclear imaging with gallium or copper DOTATATE has great sensitivity for head and neck paragangliomas and may be used for preoperative evaluation, surveillance imaging, and screening for additional paragangliomas [16].…”

Operative technique in laryngeal paraganglioma: A case series and literature review

“…Preoperative angioembolization of the feeding artery is a consideration in patients with LPs and can minimize intraoperative bleeding and create a more favorable surgical field. 20 In Case 2, angiography was performed without decision to embolize. In an external cervical approach vascular control is good and we find that these vessels can be readily ligated.…”

Seltene Erkrankungen des Larynx, der Trachea und der Schilddrüse

“…Frequently, open approaches are described, e. g. via lateral pharyngotomy or thyrofissure. Naik et al report about preoperative superselective embolization of the superior thyroid artery with subsequent partial laryngeal resection via lateral pharyngotomy including tracheostomy 136 . In addition, transoral laser surgical procedures are performed 137 .…”

“…über eine laterale Pharyngotomie oder eine Thyrofissur. Naik et al berichten über eine präoperative superselektive Embolisation der Arteria thyreoidea superior mit anschließender Larynxteilresektion über eine laterale Pharyngotomie inklusive Tracheotomie 136 . Auch transorale laserchirurgische Verfahren werden durchgeführt 137 .…”