硬化療法と経口的切除手術を併用した喉頭血管奇形例

抄録

It is difficult to treat laryngeal vascular malformations because of airway problems, bleeding, etc. A variety of treatments have also been described, including direct laryngoscopic excision, excision through an external incision, laser surgery, and sclerotherapy. As important goals of treatment, preservation of the laryngeal functions, such as voice and swallowing functions is important, as this condition is a benign one.

We report a case of laryngeal capillary malformation in which transoral surgery was performed after sclerotherapy, and a good outcome was obtained.

The patient was a man in his 30s, who presented to his neighborhood otorhinolaryngologist with a history of pharyngeal discomfort; he was found to have a laryngeal mass and referred to our hospital, and we diagnosed him as having a laryngeal vascular malformation. After tracheotomy under local anesthesia, we performed sclerotherapy twice by injecting monoethanolamine, and resected the lesion by transoral surgery. One year seven months after the surgery, the patient’s voice and swallowing functions remain good, and there has been no evidence of lesion recurrence.

Sclerotherapy is a relatively easy procedure and effective in the treatment of vascular malformations. Although sclerotherapy alone does not result in sufficient tumor regression in cases with large lesions, it should be the treatment modality of first choice, as it can reduce intraoperative bleeding and facilitate surgery by shrinking the lesion. For relatively large lesions, as in the present case, we consider it effective to first administer sclerotherapy, and then perform transoral resection surgery.