Laryngeal lipoma with spread to the anterior surface of the neck. Clinical observation

Relevance. Lipomas are the most common benign tumors of mesenchymal origin, very rarely found in the upper respiratory tract. Laryngeal lipomas are so rare that, to date, just over 100 cases have been described in the literature. This tumor has a slow growth and can manifest various symptoms due to the mass effect with compression of neighboring structures, causing dysphagia, hoarseness and life threatening symptoms due to airway obstruction. For preoperative diagnosis, indirect laryngoscopy using flexible and rigid endoscopes, computer and magnetic resonance imaging can be used. These methods provide a volume of useful information sufficient for adequate treatment planning. Surgery is the method of choice and includes endoscopic and/or external surgical access. It is very important to completely remove the lipoma to avoid local recurrence. A clinical case. A 45 year old patient came to our clinic with complaints of hoarseness of voice, a feeling of lack of air, which increases with physical exertion, the presence of a “swelling” on the front surface of the neck. For the first time, I noticed a change in voice about 22 years ago, the presence of a “swelling” on the neck – about 10 years ago. I did not seek medical help. Four years ago, he was examined by an ENT doctor, diagnosed with a neoplasm of the larynx, refused surgical treatment. Due to the increasing difficulty of breathing, in 2022 he entered our clinic for examination and surgical treatment. After the examination, a neoplasm of the larynx was revealed with its spread through the cricothyroid ligament to the anterior surface of the neck. The formation was removed using a combined approach: external and endoscopic (transoral laser microsurgery using CO2 laser). Histological examination revealed mature adipocytes without cellular atypia, which corresponded to a lipoma. It can be assumed that the tumor originated primarily in the larynx (as indicated by the anamnesis data, the presence of feeding vessels in the laryngeal component of the tumor) for a long time, and, having reached a certain size and experiencing pressure from surrounding tissues in the larynx, it began to spread along the inner surface of the thyroid cartilage plate downwards, pushing the thyroarytenoid muscle medially, and having reached the cricothyroid ligament and gradually stratified it, it continued to grow outward, into the area of the anterior surface of the neck. This access was necessary for the complete removal of a large lipoma, preventing the possibility of relapse and rapid rehabilitation of the patient. Conclusion. Patient R. underwent successful surgical treatment – removal of laryngeal lipoma spreading through a defect in the cricothyroid ligament to the anterior surface of the neck. In our opinion, the choice of combined access made it possible to radically remove the formation and preserve the anatomical structures of the larynx as much as possible, which made it possible to quickly restore vocal and respiratory functions.
Key words: lipoma, larynx, laryngeal lipoma, neck, CO2 laser
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study