Benign Lesions of Larynx and Its Micro-Laryngeal Surgery - A Clinical Evaluation

BACKGROUND The larynx is a unique organ in the spectrum of functions it performs. Its role in normal respiration, maintenance and protection of the airway. Simple laryngeal lesions are not uncommon. The great majority of the cordal benign lesions are non-neoplastic, usually in a ratio of about 6:1. They are the product of some form of irritation and do not have the histological characteristics of true neoplasms. Therapy is directed at restoring as much normal function of the larynx as possible. Microlaryngeal surgery and postoperative voice rest offer a cost-effective, useful and safe approach to the management of benign laryngeal lesions. Objectives The study was undertaken to identify the common types of benign lesions of the larynx and the age, sex distribution, symptomatology, sites of involvement and  histopathology of the lesions following micro-laryngeal surgery. Microlaryngeal surgery and postoperative voice rest offer a cost-effective, useful and safe approach to the management of benign laryngeal lesions. METHODS A prospective study was conducted from February 2017 to September 2019 at NRM ENT Hospital, Raichur, Karnataka and a secondary referral hospital. 30 patients with benign laryngeal lesions were included based on the patient’s clinical symptoms and findings on indirect laryngoscopy in the age group of 13–65 years. All non-operative cases and malignant cases were excluded. Routine preoperative surgical work-up and therapeutic micro-larnygoscopic procedures were employed. RESULTS A male preponderance with a male-to-female ratio of 1.3:1 was observed. The majority of the patients were in the age group of 31–40 years. Non-neoplastic lesions are much more common than neoplastic lesions. Vocal nodules, polyps, and angiofibromas with the same pathogenesis were common lesions. Abuse of voice, exposure to a known agent, and trauma were causative factors. Most of the lesions are solitary and unilateral, arising from the vocal cord. The right side is the common side, and sessile lesions are more numerous than pedunculated. Only 10% of cases are true neoplastic; vocal polyps, nodules, and angiofibromas with the same pathophysiology account for 70% of cases. CONCLUSIONS Benign lesions of the larynx are common in males, but in this series, amusingly, housewives are at the top of the list. Voice abuse, exposure to a known agent and trauma are the etiological factors. A common symptom is hoarseness of voice. On the basis of this study, it has been emphasized that the removal of the tumor should be flushed from the surface of the vocal cords to aviod any injury to the epithelium, which can be done either under microscopic or endoscopic view.