A Case Report of Transoral Laryngeal Surgery for Pediatric Neurofibroma

Abstract

A neurofibroma of the larynx is a rare disease that usually involves the arytenoids and the aryepiglottic fold. Treatment options for laryngeal neurofibroma are either the transoral or pharyngotomy approaches. The transoral approach had been indicated only for small tumor due to its limited operative field and difficulty in managing massive hemorrhaging. New device, such as the laser, distending laryngoscopy, videoendoscopy and special forceps enable us to resect larger tumors of the larynx.
Since laryngeal neurofibromas are benign tumor, transoral surgery could be the treatment of choice in order to reduce surgical invasion. We reported on a case of a huge laryngeal neurofibroma resected by a novel transoral approach. A five-year-old girl complaining of stridor and dyspnea and suffering from type 1 neurofibromatosis (von Recklinghausen's disease) was referred to our clinic. A tracheostomy and biopsy had already been performed at another institution. A flexible laryngoscopic examination revealed a 35 by 25 mm smooth pinkish mass covered by mucosa on the left arytenoid which was obstructing the airway. The left vocal cord was fixed and the right one was restricted by mass effect. The tumor was completely resected by the transoral approach. No intraoperaive and postoperative complications were noted. Oral intake commenced two days after the operation without swallowing disturbance. There was no recurrence of the tumor during a one year follow up and her tracheostoma was closed successfully.