Abstract
We experienced a case with repeated extensive glottic granulation tissue caused by silicone tracheal tubes. The patient was a 59-year-old female who presented to a nearby otolaryngologist in April 2002 with a 6-month history of progressive hoarseness, and laryngeal fiberscopy revealed left vocal cord palsy and a left-sided subglottic tumor. Laryngeal chondrosarcoma was suspected after repeated tissue biopsy, and she was referred to our department in March 2003 for surgical treatment. She underwent tumor resection along with subtotal crycoidectomy and tracheostomy in May 2003, and was diagnosed as laryngeal chondrosarcoma. A Montgomery T-tube was placed into the tracheal stoma postoperatively. One month later, she had upper airway infection, and globus sensation dyspnea persisted thereafter. Laryngeal fiberscopy revealed granulation tissue of the left glottis. Although the lesion was first expectantly managed with adjustment of the T-tube to minimize mechanical irritation to the glottis, the lesion persisted and was finally removed by laryngomicrosurgery. Her clinical course was favorable with the adjusted T-tube for the following 2 years, until glottic granulation tissue reappeared after upper airway infection in October 2005. Since the lesion appeared suddenly with such extensive distribution throughout the glottis, surgical treatment was soon performed, and the lesion was successfully removed. In January 2007, after she had upper airway infection again, large glottic granulation tissue recurred. This time, the lesion resolved with expectant management. Her clinical course was fairly good thereafter, and the tracheal stoma was successfully closed in June 2007. There are no signs of recurrence of glottic granulation of the chondrosarcoma as of October 2009. On every occasion, granulation tissue was accompanied by upper airway infection, and mechanical irritation by silicone tracheal tubes and inflammation by infection was considered to be causative.
