29 - A Rare Case of Laryngeal Schwannoma in Young Female - An Interventional Aid
Purpose: A 24 year young female patient presented with noisy breathing for seven years and change in voice for three years. On local examination there was a growth in right aryepiglottic fold, right arytenoid cartilage. Right vocal cord was not seen. Pooling of saliva was seen in right pyriform fossa.
Material and Methods: MRI Images were done using Siemens Skyra 3 Tesla MRI Scanner. The interventional procedure was done in cathlab using GE Innova 41001Q machine.
Results: MRI neck showed well defined, intensely enhancing lesion involving hypopharynx, right aryepiglottic fold and extending upto right vocal cord. The patient is planned for preoperative embolization, to minimize intraoperative blood loss. Using 4F head hunter catheter right external carotid artery was accessed and angiogram showed an area of contrast blush in subglottic region. The right ascending pharyngeal artery was super selectively catheterized with 2.4F microcatheter and angiogram showed area of contrast blush which was subsequently embolized with 150 to 250 micron size polyvinyl alcohol particles. Post embolization angiogram showed significant reduction in the flow to the lesion. Next day patient underwent Transoral Robotic Excision of the lesion without any complications. Histopathological diagnosis of the excised lesion came as laryngeal schwannoma.
Conclusions: Laryngeal Schwannomas are rare, benign neurogenic tumors. They are slow growing, encapsulated, submucosal lesions in the larynx. Aryepiglottic fold is the most common anatomical site. Preoperative embolization is a valuable adjunct to surgical resection.