Benign tumors of the larynx symptoms. Benign tumors of the pharynx and larynx: symptoms and treatment

Inna Bereznikova

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A tumor of the larynx can be either benign or malignant. A malignant tumor is considered more common after a skin tumor (malignant) and occurs more in males.

In addition, a malignant tumor of the larynx is associated with the abuse of strong drinks and smoking. Benign tumors are visible to the naked eye, differ in small volumes. Tumors of the larynx: signs, diagnosis, treatment depend on whether it is cancerous or not.

Tumors of benign origin

Benign tumors of the larynx are most often diagnosed in males aged 20-40 years and are much more common than malignant tumors.

Epithelial tumors include papillomas and rare adenomas. Non-epithelial formations are:

• fibromas;
• lymphangiomas;
• angiomas;
• lipomas;
• myxomas;
• chondromas;
• neuromas;
• rhabdomyomas;
• fibroids.

Lymphangiomas and among benign neoplasms account for 1% of diseases. Hemangiomas appear mainly on the vocal folds, in rare cases on the ventricular folds. During laryngoscopy, they are often reddish in color with different shades (bluish, brown, purple). In volumes, they start from 5 mm and above, their surface is rough.

Lymphangiomas originate on the lingual surface of the epiglottis and in the area of ​​the arytenoid cartilage, usually affecting 1 half of the pharynx.

Endoscopic picture of tumors of the larynx

Angiomas and lymphangiomas are treated with surgery and radiation therapy. They are removed using an electrocoagulation loop. In rare cases, a biopsy is performed due to the possibility of pharyngeal edema and asphyxia.

Diagnosis of other non-epithelial tumors of the pharynx is established using indirect laryngoscopy with biopsy. For complete recovery, the tumor is removed endolaryngeally or through the laryngofissure.

Papillomas account for 5-5% of all cases. Papillomas tend to grow very quickly and recur. They can meet absolutely at any age. For the development of papilloma, the following reasons can serve:

• inflammatory processes;
• endocrine disorders;
• viral diseases;
• all kinds of infections.

Tumor classification

By origin, tumors are divided into congenital and acquired. They can be of different types, depending on which tissue served as the source of the formation.

The main causes of the onset of diseases of this group have not yet been established.

Scientists believe that formations of congenital origin develop under the influence of some teratogenic factors on a pregnant woman, of which the most important are:

• infectious diseases, especially up to 16 weeks;
• taking drugs that have a toxic effect on the growing embryo;
• alcoholic drinks and smoking;
• exposure to radiation.

Among the etiological reasons, the main role is played by the genetic predisposition to one or another tumor.

However, this tendency is formed only in the case of permanent damage to the mucous membrane of the larynx, which include:

• smoking, frequent drinking;
• chronic inflammation of the larynx;
• viruses, chronic infections;
• overload of the voice apparatus;
• bad ecology;
• labor activity associated with hazardous production.

In addition to these reasons, greatly reduced immunity, endocrine system disorders are of considerable importance.

Symptoms of the development of the disease

Distinguishing a benign formation is quite simple, thanks to the obvious symptoms of manifestation:

1. slow growth;
2. clearly defined boundaries;
3. the surface is smooth, even;
4. mucous membrane without ulcerative manifestations;
5. absence of metastases;
6. lymph nodes are not involved in the process.

At the initial stages, it does not manifest itself in any way. As a rule, the patient does not notice problems with his own health and is not even aware of such serious problems.

As the tumor of the larynx increases, the patient notes the following symptoms:

• feeling of discomfort;
• soreness appears in the throat;
• periodic cough;
• labored breathing.

When the tumor grows into the nasal cavity, the patient bleeds, his sense of smell worsens, nasality is noticed, and breathing through the nose becomes impossible.

With benign formations, the patient mainly complains of a change in voice timbre, hoarseness. If the tumor is located in close proximity to the vocal cords, or on them, the voice may disappear altogether.

A sign of tumors with a long stem are systematic coughing and periodic changes in the strength and timbre of the voice. Large tumors that block the lumen of the pharynx cause difficulty in breathing.

Diagnostics

Only an otolaryngologist can make a reliable diagnosis. Sometimes a tumor of benign origin is detected during the examination period due to an acute, chronic inflammatory disease of the upper respiratory tract.

A tumor can be diagnosed due to the doctor's suspicions, based on the patient's complaints, the history of the disease and the patient's lifestyle. After that, the doctor will conduct a direct examination of the pharynx - laryngoscopy, or examine it with a flexible tube with a camera - a fiber endoscope.

During endoscopy, cells of the found pathological formation can be taken. Further, the material will be studied under a microscope to determine its relationship to any disease.

To clarify the diagnosis, to understand whether the organs located near the larynx are involved in the pathological process, an ultrasound examination should be performed.

Treatment of benign tumors

Tumors of this type, causing breathing difficulties and voice disorders, significantly aggravate the patient's condition of life. Treatment must begin at the very first stages of the development of the disease. Tumors in the larynx of benign origin in 100% of cases are treated with surgical intervention.

The way in which the operation will be performed depends on what type of tumor was encountered.

1. tumor excision. It is carried out with the removal of the shell of the formation. The contents of the tumor are aspirated beforehand;
2. endoscopy. The tumor is removed with special forceps;
3. liquid nitrogen treatment. It is carried out to prevent the recurrence of the tumor.
4. surgical excision. Pathologically altered areas of the mucosa are completely removed. It is prescribed for papillomatosis in the larynx;
5. excision of the formation with further diathermocoagulation, laser irradiation, or treatment with liquid nitrogen. It is prescribed for hemangiomas;
6. occlusion of the vessels that feed the tumor;
7. sclerosis of education. It is prescribed for large hemangiomas, which are characterized by germination in the thickness of the laryngeal wall.

Preventive actions

Specific prevention of ailments of this group has not been developed. To significantly reduce the risk of developing this pathology in the prenatal period, the mother of the unborn baby must adhere to the following important rules:

• ignore actions that have a teratogenic effect on the fetus;
• it is strictly forbidden to smoke, drink alcoholic beverages;
• carry out preventive measures against infectious diseases;
• if you still managed to catch an infection, catch a cold, then carefully study the medicines before using them, do not use substances that can cause great harm to the health of the unborn child;
• go out into nature more often, walk in the fresh air, avoid places with environmentally unfavorable conditions.

To avoid the spread of acquired types of formations of the pharynx and larynx, it will be necessary to minimize all possible effects on the mucous membrane of these organs. It is also worth timely eliminating the causes that contribute to the possible development of the disease:

1. be attentive to your own health and, if necessary, start treating acute inflammatory diseases of the upper respiratory tract in time. Diseases must not be allowed to become chronic;
2. to exclude as much as possible from the usual way of life the harmful effects on the larynx. Smoking can be very detrimental to health;
3. avoid overloading the voice apparatus;
4. if possible, try not to be present in an environmentally negative environment. Avoid visits in smoky and dusty conditions. If the place of work is hazardous production, then it is imperative to use personal protective equipment;
5. pay great attention to the immune system and the state of the endocrine system.

In many cases, patients in whom the tumor was diagnosed in time and timely necessary therapy started achieve a complete recovery.

Some of the tumors, for example, papillomatosis of the larynx, have great potential for recurrence. Their course is the least favorable, since complete healing is not observed, and in some cases a second surgical operation is even required to remove the remnants of the tumor.

In the case when it was quite late to diagnose the neoplasm, the tumor may get the possibility of malignancy. That is, when a benign formation is reborn and takes a malignant form.

In this case, in addition to surgery, the patient is shown radiation therapy or chemotherapy. True, it is impossible to give guarantees of complete healing in this case. The chances of a complete recovery depend on the type of tumor, the stage of spread of the disease, the general state of health of the patient and his individual response to the treatment received.

Benign tumors of the pharynx and larynx are fortunately more than 10 times more common. They predominantly affect males aged 20–45 years. Despite the name of the tumor formations of this group - benign, some of them are precancerous conditions, that is, under the influence of certain factors, they can change their structure, degenerating into cancer. Therefore, timely diagnosis and adequate treatment of diseases of this group are extremely important, and the sooner these measures are taken, the more chances the patient has for a full recovery.

Classification of benign tumors of the pharynx and larynx

According to the time of occurrence, tumors are divided into congenital (arising in the prenatal period) and acquired (developed during a person's life).
Depending on the tissue source of the tumor, they can be:

• epidermal (papillomas);
• connective tissue (polyps, fibromas);
• vascular (hemangiomas, lymphangiomas);
• cartilage (chondromas);
• from adipose tissue (lipomas);
• from nervous tissue (neurinomas);
• mixed (from connective and vascular tissues - fibroangiomas, from nervous and connective tissues - neurofibromas).

Why do benign tumors of the throat and larynx occur?

Finally, the causes of this group of diseases, alas, are unknown.
It is believed that congenital tumors develop under the influence of certain teratogenic factors on a pregnant woman, among which the most important are:

• infectious diseases, especially in the first 16 weeks of pregnancy - measles, rubella, syphilis, HIV, viral hepatitis, mycoplasmosis, etc.;
• taking medications that have a toxic effect on the growing embryo;
• smoking and drinking alcohol;
• action of radiation.

Among the etiological factors of acquired benign tumors of the pharynx and larynx, the leading role is played by a genetic predisposition to a particular tumor. However, this predisposition does not necessarily result in a disease - it will occur only if the mucous membrane of the pharynx and larynx is regularly damaged by certain factors, the main of which are:

• smoking (including passive - inhalation of tobacco smoke of a smoker who is nearby) and drinking alcohol;
• chronic inflammatory diseases of the pharynx and larynx -,;
• acute and chronic viral infections - herpetic, adenovirus, human papillomavirus, measles, influenza, etc.;
• excessive load on the vocal apparatus (for teachers, lecturers, singers, for example);
• bad ecology - inhalation of irritating substances contained in the air and dust (particles of coal, asbestos);
• work in a smoky and polluted room.

In addition to these factors, the reduced immune status of the body and the pathology of the endocrine system organs are also important.

Signs of benign tumors of the pharynx and larynx

Benign tumors have a number of features that make it possible to distinguish them from tumors with a malignant course:

• slow growth;
• clear boundaries;
• flat, smooth surface;
• the mucous membrane covering the tumor does not tend to ulcerate;
• the structure of the tumor is similar to the structure of the tissue from which it originated;
• there is no ability to metastasize;
• lymph nodes are not involved in the pathological process;
• under certain conditions, malignancy of the tumor is possible.

In the early stages of the disease, benign tumors of the pharynx and larynx do not manifest themselves in any way - the patient feels as usual, not noticing any changes in his condition, and does not suspect how seriously he is ill.

As the swelling of the pharynx grows, the patient notices a feeling of discomfort, sore throat, occasional coughing, and some difficulty in breathing through the nose. When the tumor grows from the pharynx into the nasal cavity or the patient develops nosebleeds, the sense of smell worsens, breathing through the nose from the side of the lesion stops, nasality appears. With an exophytic variant of tumor growth (into the cavity of the organ, and in this case - the pharynx), it partially blocks the lumen of the pharynx, preventing the penetration of air into the respiratory tract - the patient notes difficulty in breathing (it is difficult for him to inhale and exhale).

With benign tumors of the larynx, the main complaint of patients is a change in the timbre of the voice - its hoarseness or hoarseness is noted, it becomes rougher. In some cases, if the tumor is located in the immediate vicinity of the vocal cords or on them, the voice may disappear completely. A symptom of tumors with a long stem is a constant cough and periodic changes in the strength and timbre of the voice. Large tumors that significantly block the lumen of the larynx cause difficulty in breathing, in addition, such patients often lose their voice.

Diagnosis of benign tumors of the pharynx and larynx

The diagnosis is made by an otorhinolaryngologist (ENT doctor). In some cases, a benign tumor is discovered by chance - during an examination for an acute or chronic inflammatory disease of the upper respiratory tract.

The diagnosis of a tumor can be suspected by a specialist on the basis of complaints, an anamnesis of the disease (how long ago the complaints appeared and how the disease has been going on since then) and life (special attention is paid to the causative factors of the tumor) of the patient. After that, the doctor will conduct a direct examination of the larynx - laryngoscopy, or examine it with a flexible tube with a camera at the end - a fiber endoscope. In the process of endoscopy, cells of a pathological formation found in the larynx (biopsy) can also be taken, which are then examined under a microscope to determine their belonging to one or another type of tissue.

• stroboscopy;
• phonetography;
• electroglottography;
• determination of the maximum phonation time.

To clarify the diagnosis and determine whether organs located near the pharynx and larynx are involved in the pathological process, ultrasound (ultrasound) may be performed, as well as imaging methods such as x-ray of the skull, computed or magnetic resonance imaging (CT or MRI).

Treatment of benign tumors of the pharynx and larynx

Since tumors of this type, causing breathing problems and voice disorders, significantly impair the patient's quality of life, they should be treated as early as possible after diagnosis. Treatment of benign tumors of the pharynx and larynx in 100% of cases is surgical. Operation methods vary depending on the type of tumor:

• endoscopic operations - removal of the tumor with special laryngeal forceps or a loop (for isolated papillomas, small single polyps and fibromas);
• excision of the tumor together with the membrane with or without preliminary suction of its contents (cysts of the pharynx and larynx);
• in order to prevent tumor recurrence, its base is treated with liquid nitrogen;
• excision of pathologically altered areas of the mucous membrane (with papillomatosis of the larynx);
• tumor excision followed by diathermocoagulation, laser irradiation or liquid nitrogen treatment (small hemangiomas growing into the lumen of the organ);
• occlusion of the vessels feeding the tumor, tumor sclerosis (large hemangiomas, characterized by growth in the thickness of the pharynx or larynx wall).

Prevention of benign tumors of the pharynx and larynx

Specific prevention of diseases of this group has not been developed. To reduce the risk of developing this pathology in the prenatal period, the expectant mother should avoid exposure to factors that have a teratogenic effect on the fetus: do not smoke, exclude alcohol, prevent infectious diseases, and in case of illness, take drugs that are safe for the fetus, if possible, be in environmentally friendly conditions.
To prevent the development of acquired types of tumors of the pharynx and larynx, it is also necessary to minimize the impact on the mucous membrane of these organs of factors that increase the likelihood of their development:

• timely treat acute inflammatory diseases of the upper respiratory tract, preventing their chronicity;
• eliminate bad habits - smoking and drinking alcohol;
• avoid regular increased loads on the vocal apparatus;
• try not to be in an environmentally unfavorable environment - in smoky and dusty rooms, and in case of such conditions at work, use personal protective equipment;
• monitor the health of the immune and endocrine systems.

Prognosis of benign tumors of the pharynx and larynx

In most cases, patients in whom the tumor was diagnosed in a timely manner and who received adequate therapy recover completely, i.e., the prognosis is completely favorable for recovery.

Certain types of tumors (for example, laryngeal papillomatosis) have a high ability to recur - their course is less favorable, since complete recovery does not occur and repeated surgical interventions are required from time to time to remove the tumor.

If the tumor is diagnosed late, it may have signs of malignancy (transition of a benign process into a malignant one). In this case, in addition to the operation, the patient will be prescribed radiation or chemotherapy according to the protocols and, unfortunately, there are no guarantees of a complete cure - the chances of recovery depend on the type of tumor, the degree of neglect of the process, the general health of the patient and his individual response to the treatment received.

In this article, you learned about the general characteristics of benign tumors of the pharynx and larynx. On the features of particular types of neoplasms of this group.

Fibroma larynx ranks first among all benign tumors of the larynx. It occurs equally often in men and women aged 20-50 years, in children it is extremely rare. Usually grow on the free edge along the upper surface of the vocal fold, have a dark cherry (sometimes lighter) color, usually single, mobile (Fig. 4.18). Its size is from a lentil grain to a pea. Complaints of the patient are reduced only to dysphonia. Treatment is only surgical. It is removed under local anesthesia, endolaryngeally with special Moritz-Schmidt forceps (Fig. 4.19) or Kordes (Fig. 4.20). If, due to the high pharyngeal reflex, removal is difficult, they resort to high-frequency endotracheal anesthesia. The technique of the operation is simple, the prognosis is favorable, relapses are extremely rare.

Papillomas of the larynx (papillomatosis) belong to conditionally benign tumors, since there is a persistent course and a tendency to relapse. As a rule, they occur in young children, starting from the age of two, with repeated operations, they spread to the pharynx, trachea, and even to the skin around the tracheostomy. In appearance, they resemble cauliflower or mulberries, the color is pale pink. Usually papillomatosis leads to persistent aphonia and cannulation. Active papillomatosis also occurs in adults. So, in the clinic we operated on a 52-year-old patient who had laryngeal papillomas removed more than 30 times in the past. Removal of papillomas is currently carried out, as a rule, under general anesthesia. With frequent recurrences, wider operations on the larynx are performed, such as a longitudinal laryngotomy (dissection of the larynx) to radically remove papillomas.

laringocele refers to rare tumors characteristic only of the larynx - swelling of the Morganian sinus with the appearance of swelling only in the larynx (internal tumors) or on the neck (external). They do not bring much damage to health, but they must be distinguished from tumors of another genesis, which is helped by radiography (Fig. 4.21).

Cancer of the larynx

Among tumors of the larynx (including benign ones), laryngeal cancer is common: from 1.5 to 6% of all tumors of the body, and among tumors of the upper respiratory tract - 69-70%. In addition, it should be noted that cancer of the larynx affects almost exclusively men and in men after 55 years of age, among all diseases of the larynx, it ranks first. Alcohol and smoking play a role. Unfortunately, patients go to the doctor, as a rule, late with severe dysphonia or sore throat when swallowing, when the development of cancer is already quite active.

Currently, there is no single point of view on the etiology and pathogenesis of tumors, there is not even an exact definition of what is a “true tumor”? The most well-known properties of a true tumor:

Proliferation of tumor cells without reverse development, with an endless continuation;

Tumor growth is not regulated, is "atypical", sharply different from the usual;

The tumor destroys neighboring tissues, occupies their living space;

Metastasis - the transfer of tumor cells to other tissues and organs, followed by their new growth;

Tumor cells have the ability to transfer their malignant properties to cells - descendants.

All taken together determines the property and essence of the concept of "true tumor".

According to A. I. Paches (1997), the number of head and neck tumors among all tumors (in Russia) ranges from 17 to 20%, that is, a fifth, while there is an increase in the absolute number of patients, including those with tumors of the pharynx and larynx.

The classification of tumors of the pharynx and larynx is also not fully unified. We prefer the classification of N. A. Karpov (1966), which is based on tissue affiliation, degree of differentiation, sensitivity to ionizing radiation.

Type I - highly differentiated tumors, practically insensitive to radiation.

Group 1 - benign (fibroma, osteoma, angioma, chondroma, etc.)

2nd group - borderline tumors, since they have some elements of malignancy - infiltrative, but slow growth, benign course of metastases (for example, skull base fibroma, cylindroma, epithelioma).

Type II - differentiated tumors. These are malignant tumors, characterized by infiltrative growth and metastases, but the degree of differentiation also makes it possible to establish tissue affiliation.

Group 1 - epithelial malignant tumors (adenocarcinoma, squamous keratinizing and non-keratinizing cancers, poorly differentiated cancer). This group of tumors is the more sensitive to radiation, the less differentiated.

Group 2 - connective tissue malignant tumors, which are more malignant, rapidly growing and metastasizing. The sensitivity to radiation is very low. These include sarcomas (osteosarcoma, fibrosarcoma, chondrosarcoma, large cell sarcoma, etc., except for tonsil sarcoma and lymphosarcoma).

3rd group - neurogenic tumors, such as melanoblastoma, esthesioneuroblastoma (olfactory nerve tumor), characterized by persistent relapses and the ability to disseminate. Not sensitive to radiation.

Type III - poorly differentiated (tonsillar) radiosensitive tumors. The degree of malignancy is the highest - rapid growth and metastasis, generalization of the tumor process, ahead of the growth of metastases compared to the main tumor. These include lymphoepithelioma (Schminke's tumor), reticulocytoma, cytoblastoma. All tumors come from the tissues of the tonsils.

According to the histological structure, laryngeal cancer is more often (97%) squamous with or without keratinization. Adenocarcinoma is less common, sarcoma is extremely rare (0.4%).

The diagnosis of laryngeal cancer is based on complaints, anamnesis of the disease, examination of the larynx using indirect laryngoscopy (Fig. 4.22, 4.23 and 4.24), external examination of the neck, palpation of the lymph nodes. If necessary, X-ray tomography of the larynx is done (Fig. 4.25 and 4.26), and at present, computed tomography. It is often necessary to resort to direct laryngoscopy to produce a biopsy under general anesthesia.

In the case of a positive diagnosis, three types of treatment are performed: radiation, surgical and combined, the latter most often when surgery is used, then irradiation with a dose of 30-40 Gray. Radiation treatment in its pure form, for example, tumors of the tonsils, involves telegammatherapy in a full therapeutic dose of 60 Gy.

According to A. N. Paches (1997), malignant tumors of the pharynx are more common in the upper part (45-55%), then in the oropharynx (30-35%) and less often in the laryngopharynx (Fig.). The same topographical features of the growth rate of tumors of the larynx (the higher, the more often) - supraglottic 56%, fold - 41% and subglottic - about 3% of all tumors of the larynx.

The volume of surgical treatment of laryngeal cancer is determined by the stage of the disease. In the early stages, relatively sparing operations are performed: chordectomy or anterolateral resection of the larynx, and in cases of a large tumor volume, laryngectomy, that is, complete removal of the larynx.

In any case, the operation begins with a tracheostomy, then endotracheal anesthesia is performed through the stoma and breathing is provided through it after the operation, and with laryngectomy - constantly.

During chordectomy, soft tissues are dissected longitudinally from the hyoid bone to the jugular notch of the sternum, and the thyroid cartilage is exposed, then it is dissected along, its plates are moved apart to access the vocal folds. The diseased fold is excised, sections of the mucous membrane of the larynx, thyroid cartilage, and soft tissues are successively sewn together.

The anterolateral resection of the larynx is similar in technique to the previous one, although its volume is wider, because part of the thyroid cartilage plate is removed along with a fold on the diseased side.

Laryngectomy also begins with the imposition of a tracheostomy, while an oblique incision is made in the trachea in the anterior-posterior direction for subsequent suturing of the lower part of the trachea to the skin. Further inhalation anesthesia is carried out through the stoma. The skin incision is T-shaped from the hyoid bone to the jugular notch, and transverse at a level just below the hyoid bone, separation of soft tissues and muscles. The thyroid gland is transected at the level of the isthmus and sutured with catgut, or it is transected with two vertical incisions, leaving the isthmus on the preparation of the trachea. Separation of a single preparation - the upper section of the trachea and larynx is preferable from the bottom up, with separation from the esophagus and pharynx, then the hyoid bone is pulled down with a tool and the muscles and mucous membrane of the piriform sinuses are crossed above it with scissors. The larynx is removed, the defect of the pharynx is sutured with two rows of sutures, then, in layers, the wound. The stoma is formed by stitching the edges of the trachea and skin. A rubber probe is inserted into the stomach to feed the patient, since self-swallowing is restored in the first week after the operation. Later, after 2-3 months, the stoma is finally formed and the patient can do without a tracheotomy tube. By far the most severe consequence of a laryngectomy is the loss of voice function. Methods and techniques have been developed for the formation of a pseudo-voice in patients with laryngeal extirpation, specially trained methodologists teach patients to master a new voice.

INFECTIOUS GRANULOMAS OF THE LARYNSE.

Tuberculosis of the larynx occurs as a complication of the pulmonary process, infection occurs sputogenno, through sputum when the patient coughs. The larynx is affected in 8-30% of patients with pulmonary tuberculosis at a flowering age (20-40 years), more often in men. Pathological forms: infiltrate, ulcer, perichondritis, essentially the stage of the disease. Usually the posterior sections of the larynx are affected: the interarytenoid space, the arytenoid cartilages and the adjacent posterior sections of the vocal folds. Infiltration is manifested by thickening of the mucosa, the presence of tubercles, similar to papillomas, their color is pale, thick sputum is visible. With further growth of the tissue, a tuberculoma is formed, followed by ulceration: flat ulcers with undermined fringed edges and a dirty bottom (granulations and sputum). With perichondritis, the arytenoid cartilages increase significantly, acquire a gelatinous appearance, and mobility is limited. The final diagnosis is made jointly with a phthisiatrician, since, as mentioned above, tuberculosis of the larynx is always combined with pulmonary tuberculosis, and therefore the treatment is carried out by phthisiatricians. Differential diagnosis with other infectious granulomas and pachydermia of the larynx. Tracheotomy is performed extremely rarely when a secondary non-specific infection joins, which increases the swelling of the tissues of the larynx.

Syphilis of the larynx. There are secondary and tertiary manifestations of syphilis. Secondary 6-7 weeks after the primary chancre, tertiary - from several months to several years. Forms of syphilis of the larynx: erythema, papule (2), gumma, diffuse gummous infiltrate, chondro-perichondritis (3). Erythema appears as a patchy red rash (roseola) on the vestibular folds, sometimes on the epiglottis and scoops. Vocal folds are rough ("cat's tongue"). Subjective symptoms are absent (sometimes dysphonia). Papules resemble singers' nodules, but larger, affect the vocal, vestibular, lingual-epiglottic folds, epiglottis. They quickly ulcerate, merging to form wide warts with three concentric rings: an ulcer, then a gray ring of sloughing epithelium, a red ring of inflamed mucosa. During this period, the patient is highly contagious. The gumma of the larynx has the appearance of a limited infiltrate or a copper-red tumor ranging in size from a pea to a nut, quickly disintegrates with the formation of an ulcer. Diffuse gummous infiltrate captures larger areas of the larynx, up to the subvocal space, can give stenosis of the larynx. At the stage of gumma ulceration, chondroperichondritis also occurs, often of the epiglottis with its complete rejection, while the regional lymph nodes almost do not react. For the correct diagnosis of syphilis of the larynx, it is necessary to take into account the symptoms of the skin, pharyngeal mucosa, and mouth. Therefore, if syphilis is suspected, it is imperative to involve a dermato-venereologist, followed by treatment with him. A frequent manifestation of late syphilis is paresis of the left vocal fold (damage to the posterior muscles of the larynx) without other pathological manifestations as a result of syphilitic periaortitis and involvement of the left recurrent nerve in the process. In the differential diagnosis of such lesions, syphilis must be ruled out.

Scleroma of the larynx. If the epidemiology of previous diseases does not raise questions (Koch's bacillus, pale spirochete), then the causative agent of scleroma has not been finally established, but the value of the Frisch-Volkovich stick, which a number of authors write about, is doubtful. Scleroma has endemic areas of distribution - the west of Belarus, Ukraine. Stages of the course of scleroma: nodular, diffuse-infiltrative and cicatricial. First, small soft infiltrates form in the subvocal space, then they merge, become extensive and dense, in the third stage they scar with a sharp narrowing of the glottis with the formation of a membrane and stenosis (Fig. 4.27). In addition to the typical localization of the scleroma, all other parts of the larynx can also be affected, up to the lingual surface of the epiglottis. Other favorite sites of scleroma lesions are the nasal cavity and pharynx with the formation of "backstage" in the region of the choanae and pharynx. Complaints of the patient are reduced to a change in voice, shortness of breath, dryness in the throat, the formation of crusts. Stenosis grows slowly over years. Treatment: streptomycin therapy 500 thousand units per day intramuscularly, radiotherapy. Surgical methods are also used, essentially palliative - scraping, biting out membranes, excision of scars.

LARYNCH DAMAGE

In peacetime, laryngeal injuries are relatively rare. Distinguish closed and open injuries, while closed are divided into internal and external.

Internal injuries occur as a result of foreign bodies, medical manipulations, for example, tracheal intubation. Such injuries do not pose a particular danger, except for the possibility of developing chondroperichondritis of the cartilage of the larynx, when the prognosis becomes serious.

Outdoor closed injuries - bruises, compression of the larynx, fractures of cartilage, hyoid bone, separation of the larynx from the trachea. This can happen as a result of a blow with the larynx on hard objects, in a fight - with the edge of the palm. The victim often loses consciousness, shock occurs, local hemorrhages, subcutaneous emphysema, which may be, and if it spreads into the laryngopharynx, there is a danger of asphyxia, in such cases a tracheotomy is required. In addition to external examination, indirect laryngoscopy, radiography is of great importance in the diagnosis of larynx injury, not only for examining cartilage, but also for the spread of emphysema through internal cellular spaces.

The prognosis for contusions of the larynx, especially with cartilage fractures, is always serious. The patient is in danger of suffocation not only because of stenosis of the larynx, but also due to possible tamponade of the trachea and bronchi with outflowing and clotted blood, and in the following days mediastinitis may develop due to the penetration of the infection there. Tracheotomy in such cases is necessary not only to restore breathing, but also to suck blood from the bronchial tree. Treatment of such patients is carried out exclusively in a hospital. If necessary, in case of significant crushing of the cartilage, a laryngofissure is performed to remove fragments, hemostasis. Patients are fed through a probe.

open injury there are three types of larynxes - cut, stab and gunshot (bullet and fragmentation), the latter are extremely rare in peacetime, during hostilities they occupy the first place among all injuries of the larynx.

The data of the analysis of neck wounds during local wars showed that injuries to the ENT organs among all wounds account for 2-3%, neck injuries 1-1.8% of the number of all wounded and up to 80% of the number of ENT wounded, while bullet wounds of the neck amounted to up to 55%, and among all neck injuries, laryngeal injuries occupy the first place - up to 43% (G.I. Burenkov).

Sliced damage to the larynx occurs when the neck is cut, as a rule, in a horizontal plane (from ear to ear), while depending on the height of the cut, the thyroid-hyoid membrane or the conical ligament is cut. In the first case, the wound gapes and the laryngopharynx is clearly visible, breathing is not disturbed, and with a low cut, breathing may be disturbed due to blood flow. The death of the wounded comes quickly only in the case of cutting the carotid arteries. If this does not happen, the prognosis depends on the severity of inflammation from the larynx and surrounding tissues.

Stab neck wounds with damage to the larynx are applied with thin, narrow, long objects and leave a narrow channel, which, when the injuring object is removed, is blocked along its length by the fascia of the neck (coulis syndrome), which contributes to the formation of emphysema and the development of mediastinitis, so such a channel has to be dissected. It must also be remembered that with neck injuries of any origin, especially with damage to blood vessels and nerves, shock develops, which also requires adequate therapy.

firearms injuries of the larynx are most often combined, since other organs of the neck are also damaged. They are usually divided into through, blind and tangent. Through wounds, when a wounding projectile (bullet) pierces both walls of the larynx and goes beyond it, with a blind person, the bullet remains in the cavity of the larynx, moving further either into the pharynx or into the trachea. With a tangential wound, the bullet only hits the wall of the trachea without tearing it.

The principles of helping such wounded do not differ from wounds of other genesis, however, they have their own characteristics. Firstly, in combat conditions it can be difficult to evacuate the wounded to provide adequate assistance in a timely manner, and he dies from shock.

Secondly, about 80% of such wounded have not an isolated wound of the trachea, but a combined one, while such vital organs as blood vessels, spine, esophagus, nerves, and thyroid gland can be damaged.

Medical measures are built in two stages - emergency care and subsequent rehabilitation. Emergency care includes providing breathing, stopping bleeding, treating a gunshot wound (if necessary, laryngofissure), removing a foreign body (a wounding projectile), inserting a food probe. Combined affected sometimes require the participation of other specialists in the provision of emergency care (for example, a neurosurgeon, maxillofacial surgeon). The rehabilitation phase can be quite long, depending on the extent of the damage.

Benign tumors of the larynx are tumor formations that are localized in the larynx. Characterized by the absence of metastasis or ulceration, slow non-invasive growth. Quite often, benign tumors of the larynx are asymptomatic. Sometimes they are manifested by hoarseness and hoarseness of voice, respiratory failure, cough. The significant size of the tumor causes asphyxia and even aphonia. An otolaryngologist is responsible for diagnosing benign tumors of the larynx, who performs endoscopic biopsy, histological examination and laryngoscopy. The most effective is the surgical method for the treatment of benign tumors of the larynx. The characteristics of the course of treatment are influenced by the nature, type and growth of the tumor.

Benign tumors of the larynx are based on various tissue structures - a vessel, cartilaginous and connective tissue, glandular components of the mucosa, nerve endings and trunks. They may appear during the life of the patient or be congenital. In otolaryngology, among all benign tumors of the larynx, angioma, fibroma, papilloma and polyps are most common. Lipoma, chondroma, cyst, neurofibroma of the larynx and neurinoma are diagnosed much less frequently. Benign tumors of the larynx are much more common in men than in women.

Types of benign tumors of the larynx

Fibromas are benign tumors of the larynx that have a connective tissue origin. In most cases, this is a single formation of a spherical shape, which is localized on the upper surface or on the free edge of the vocal fold. The size of the fibroma ranges from 0.5-1.5 cm. Laryngeal fibromas have a smooth surface, gray color and can be pedunculated. A large number of blood vessels in the fibroma structure can change its color to red (angiofibroma). These benign tumors of the larynx are clinically manifested by various changes in the voice. This type of tumor can cause breathing problems if it reaches a large size.

Laryngeal polyps are called a separate type of fibroma, the structure of which, in addition to connective tissue fibers, also consists of a large amount of fluid and cellular elements. These benign tumors of the larynx have a broad base or thick stalk and can be as large as a pea. In addition, polyps may have a less dense consistency than fibromas. These formations are localized in the anterior part of one of the vocal folds. The only manifestation of a polyp, as a rule, is hoarseness. Cough or breathing changes are usually not observed.

Angiomas are benign tumors of the larynx that are of vascular origin. Angiomas are single formations and are congenital. Tumors from blood vessels (hemangiomas) bleed heavily when injured, can grow into surrounding tissues, and are red in color. Tumors from the lymphatic vessels (lymphangiomas) do not tend to grow and have a yellowish color.

Papillomas of the larynx are a special type of benign tumors. In adults, papillomas of the larynx are single or multiple (rarely) dense outgrowths with a wide, mushroom-shaped base. They are pinkish or whitish in color, may be dark red with an intensive blood supply. Papilloma can be affected by the tracheal mucosa, but this is observed only in some cases. Juvenile papillomas are observed in children. These formations most often appear in the period from 1 to 5 years. During the period of puberty of the child, juvenile papillomas are prone to spontaneous disappearance. Multiple papillomas often develop in childhood, they occupy entire sections of the mucosa. Otherwise, this phenomenon is called papillomatosis. Such benign tumors of the larynx outwardly resemble cauliflower. Usually the lesion is localized on the vocal folds. True, in some cases, the process can extend to the subglottic region, epiglottis, trachea, scoop-epiglottic folds. Papillomatosis of the larynx is clinically manifested by hoarseness turning into aphonia. Chronic stenosis of the larynx occurs if there is a significant growth of the tumor.

Chondromas are benign tumors of the larynx of a dense structure, originate from cartilage tissue. After some time, malignant degeneration can be observed, followed by the development of chondrosarcoma.

Laryngeal cysts develop from embryonic gill slits, in turn, the occurrence of which is due to violations of embryogenesis. Retention cysts are diagnosed in children. These cysts are formed from the glands of the mucous membrane of the larynx. Laryngeal cysts rarely cause any symptoms because they are rarely large.

Lipomas are benign tumors of the larynx, ovoid in shape, yellow in color, often with a stalk. Lipomas of the larynx, like lipomas of the second localization, consist of adipose tissue.

The aforementioned benign tumors of the larynx require surgical intervention, because in the future they can be harmful to health.

Causes of benign tumors of the larynx

Congenital benign tumors of the larynx occur due to exposure to the fetus of various teratogenic factors and genetic predisposition. Teratogenic factors are infectious diseases of the mother during pregnancy (measles, rubella, chlamydia, viral hepatitis, mycoplasmosis, HIV, syphilis), the intake of embryotoxic drugs by a pregnant woman, radiation exposure, and the like.

The main causes of the appearance of benign tumors of the larynx of an acquired nature can be called some viral diseases (herpetic and adenovirus infection, measles, influenza, HPV), prolonged exposure to irritants (inhalation of tobacco smoke, fine dust, work in a smoky room), chronic inflammatory diseases (tonsillitis, adenoids, chronic pharyngitis and laryngitis), severe voice loads, changes in the endocrine system.

Symptoms of benign tumors of the larynx

In patients with benign tumors of the larynx, the voice changes markedly. He becomes hoarse or hoarse. Benign tumors of the larynx with long stalks are characterized by frequent coughing and changes in voice. The complete absence of voice (aphonia) can be observed when the tumor is localized in the region of the vocal cord and prevents it from closing. Large benign tumors of the larynx cause difficulty in breathing. Sometimes they become a prerequisite for asphyxia, especially a small child can suffer from this.

Diagnosis of benign tumors of the larynx

Small benign tumors of the larynx do not interfere with the closing of the vocal cords, are asymptomatic. In most cases, the otolaryngologist discovers them by chance when examining a patient for a disease of a different origin.

Benign tumors of the larynx clinically have fairly typical symptoms, thanks to which they can be diagnosed. However, the doctor must differentiate benign tumors from malignant processes, scleroma and foreign bodies, which may have similar symptoms.

To confirm the diagnosis of a "benign tumor of the larynx", microlaryngoscopy is performed, which allows you to examine the appearance of the tumor in more detail. The exact type of formation can be determined after its histological examination. Histology of a benign tumor of the larynx is carried out after its removal. Sometimes an endoscopic biopsy of the formation is additionally prescribed. The study of the degree of mobility and closure of the vocal cords, voice function is carried out using stroboscopy, phonetography, electroglottography and determining the time of maximum phonation. Diagnosis of the prevalence of benign tumors of the larynx is carried out using ultrasound, MRI or CT, X-ray of the skull. At this stage, it is important to determine the area of ​​\u200b\u200bdistribution of education, without which it will not be possible to start treatment.

Treatment of benign tumors of the larynx

Due to the likelihood of malignancy and due to the development of complications (respiratory and voice disorders), benign tumors of the larynx are subject to surgical removal. Endoscopic removal with laryngeal forceps or a special loop is performed with small sizes of polyps and fibromas. Small cysts of the larynx can be excised along with their membrane. Large cysts of the larynx are pierced before removal and all fluid is extracted from them. To avoid recurrence of the cyst, cryotreatment of the base is performed after the operation.

The method of removal of benign tumors of the larynx directly depends on the nature of the growth and prevalence of the tumor. Local hemangiomas, which are characterized by exophytic growth, are excised, anti-relapse treatment is carried out at the affected site by cryotherapy, laser irradiation or diathermocoagulation. Sclerosis or occlusion of the supply vessels is used for endophytic growth of benign tumors and their widespread nature.

The most difficult thing is to treat papillomatosis of the larynx, since it is necessary to remove those parts of the mucosa that have changed. It is impossible to imagine such an operation without a surgical microscope, the only way to leave healthy tissue or a certain vessel intact.

Limited areas of papillomatosis are removed using laser or cryodestruction, diathermocoagulation. Surgical intervention to prevent relapse should be accompanied by immunomodulatory and antiviral therapy. In order to increase immunity, children with papillomatosis are given autovaccination. If necessary, a second course of treatment can be carried out. Recurrence of papillomatosis and a significant increase in papilloma growths after the operation requires a special course of chemotherapy. Otherwise, a benign tumor will develop into a malignant one, which is much more difficult to fight.

Prognosis of benign tumors of the larynx

Timely treatment of benign tumors of the larynx gives a favorable prognosis for recovery. True, there is a risk of frequent recurrence of certain types of tumors. The most unfavorable in this sense of all benign tumors of the larynx is papillomatosis of the larynx, especially for young children. In adults, such relapses occur very rarely. However, after the operation, complete restoration of the voice does not always occur.

The price of early diagnosis is very high. In the article, we will cover the topic of tumors of the larynx - their types, localizations, when you can suspect the presence of a tumor in yourself and briefly about the approaches used to treat them.

The larynx is the first organ in terms of the frequency of occurrence of neoplasms in it, both benign and malignant. A tumor of the larynx manifests itself clinically in different ways depending on the localization and degree of differentiation. The key to effective treatment is timely diagnosis.

A tumor is a pathological process in which exposure to certain factors has led to a disruption in the growth and differentiation of previously normal tissues.

How do malignant tumors of the larynx differ from benign ones:

1. The nature of growth. Malignant as they grow, they are introduced into healthy tissues, growing into the blood vessels supplying them. Benign, on the contrary, do not infiltrate, but push apart normal tissues.

In the case of malignant, due to growth, a tumor can be located between the esophagus and larynx. With a tumor of the larynx, its growth affects all nearby organs - the thyroid gland, pharynx, esophagus, parathyroid glands, cartilaginous skeleton of the larynx (see).

1. Maturity of tumor cells. The less differentiated the tissue, the worse the patient's prognosis. Low- and medium-differentiated cells are characteristic of malignant tumors. They have little or no resemblance to their progenitor cells and are capable of unceasing growth and progression. More detailed information about the pathogenesis is in the video.
2. Metastasis. It is the screening of tumor cells from the area of ​​​​the primary focus to other organs or lymph nodes. This process can be carried out through the blood (hematogenous), lymph (lymphogenic) or contact. It is characteristic of a malignant process and indicates the progression of the oncological process.

Regional lymph nodes for the neck area are submandibular, anterior and posterior cervical, mental and in some cases supraclavicular.

1. Relapse. The reappearance of a tumor that has previously undergone removal is most characteristic of a malignant process, or some types of benign tumors.

Benign oncology of the larynx

The larynx is characterized by the following types of tumors with a benign course:

• papilloma;
• angioma.

In addition to the above, tumor-like formations are also characteristic of the larynx area:

• polyps of the vocal folds or diffuse polypous formations;
• nodules of the larynx fibrous or singing;
• laryngeal cysts, such as laryngocele.

Important! The determining factor in the effectiveness of treatment is early diagnosis.

Tumor-like formations

So:

1. polyps. Most often appear in middle-aged women with a tendency to smoke. Localized on the free edge of the vocal fold. They are a false formation, as they are formed due to the protrusion of the epithelium due to the underlying tissue edema. It is a type of polyposis laryngitis.

Usually they are bilateral and in some cases, signs of swelling of the larynx, in the form of cough, shortness of breath, occur due to varying degrees of airway stenosis. This is facilitated by their location.

Their diagnosis and treatment is usually not difficult. The latter is performed surgically using a fibroscopic laryngoscope.

1. Fibroma of the vocal fold. It is a fibrous formation that occurs due to prolonged repeated vocal tension, for example, in singers. Located on the vocal cords on both sides. For this reason, its second name is "singing nodules."

This formation is usually treated by people because of a sudden hoarseness of voice. Treatment is predominantly surgical.

1. Laryngeal cysts. They are usually localized on the epiglottis and are most often retentional, that is, they arise due to the accumulation of gland secretions in them.

For a long time they do not bother a person, but they begin to show symptoms of a tumor of the larynx with a significant increase in size. Patients complain of a foreign body sensation in the throat or a change in voice if the latter is located on the vocal cord.

True benign tumors

Papilloma, as one of the most common neoplasms of the larynx, not only in terms of frequency of occurrence, but also recurrence, requires special attention. Morphologically, it originates from epithelial and connective tissues and leads to voice-forming and respiratory dysfunctions of the larynx.

Important! This tumor is characterized by periods of intensive growth and its remission. Usually in the pubertal period, its growth stops somewhat. If it persists in adulthood, then the risk of its malignancy is up to 20%.

Their favorite localization is the anterior third of the vocal cords and the region of the commissure of the larynx. Outwardly, they somewhat resemble a pale pink cauliflower.

It is classified not only by stages, but also by localization:

• supraglottic space cancer;
• cancer of the middle floor of the larynx;
• lower end cancer.

The upper part of the larynx is most often affected. The good development of subcutaneous fat in this area creates the preconditions for lymphatic metastasis, primarily to the jugular and supraclavicular nodes.

The meager clinical symptoms of cancer of the supraglottic region contribute to delayed diagnosis and reduce the effectiveness of its therapy. Treatment of a malignant tumor of the larynx in this area is rarely limited to the use of only one surgical method.

Attention! In some cases, the first belated symptom of cancer is the patient's complaint that his larynx is swollen. Cancer should always be ruled out first when any disease is suspected.

Damage by a neoplasm of the middle part of the larynx is clinically manifested by a violation of the voice-forming function, namely, hoarseness, a sharp change in voice that is not characteristic of this person, sometimes aphonia.

The lower part of the larynx is affected by cancer to a lesser extent than others. The course of the oncological process in this area differs in that it is characterized by exophytic growth, due to which adjacent organs can be affected. Therefore, on CT or it may seem that the tumor is located between the larynx and esophagus and goes down.

Treatment of malignant tumors depends on their localization, metastasis and prevalence. Undoubtedly, the morphological characteristics and response of the tumor to therapy also play an important role. In severe advanced cases, when spot removal of the tumor is impossible, the larynx is removed in case of a malignant tumor and the postoperative period increases.

It is important to note in conclusion that in the absence of other clinical signs from the respiratory system and without anamnestic data, the larynx suddenly swelled up - consult a doctor. Sometimes this symptom can accompany swelling of the larynx.