[Adult laryngeal hemangioma].

Case Description: A patient aged 31 was admitted to the Ward because of hoarseness and difficulties in breathing. Family case history was negative. Personal case history shows pneumonia and jaundice. Hoarseness occurred suddenly, four months earlier, and did not change until hospitalization. The patient occasionally woke up for air loss. He first came for otolaryngological examination on November 23, 1995, and was admitted for examination and treatment. By frontal rhinoscopy, oropharingoscopic and otoscopic findings are regular. Indirect laryngoscopy shows regular findings in the hypopharynx. The epiglottis has regular configuration and appropriate insertion, but lay extremely low, covering the passage to larynx and thus making its examination impossible. As it was impossible to examine the patient by indirect laryngoscopy, we decided for directoscopy of larynx in neurolept analgesia, finding that the mucous membrane of epiglottis and larynx was pink, smooth, and glossy. The passage to larynx was free. Plicae aryepiglotticae and false vocal chords were regular. Morgagni's ventricles were free. The left vocal chord was yellowish, with smooth surface, sharp edge, slightly edematous. The front third of the upper surface of the right vocal chord showed a wide grip of a large globular formation of livid colour, the size of a cherry, taking two thirds of larynx's lumen, and a hematoma on the same vocal chord, spreading into Morgagni's chamber. Due to the local findings the patient was intubated and given general endotracheal anesthesia. In direct laryngomicroscopy, ablation of the polypous formation was performed. Bleeding was minimal. The removed material was sent for histopathological analysis. The post-operative course passed regularly. The patient was released from hospital on the third postoperative day without subjective discomforts and with appropriate local post-operative findings. Histopathological finding: hemangioma cavernosum. At control examinations the patient shows no subjective discomforts and has regular local findings, with no signs of local recurrence.

Discussion: The first larynx hemangioma was described by Mackenzie in 1871 (1). In 1921 Sweeter (1) classified hemangiomas as infantile and adult. Infantile hemangiomas are in 40-50% cases followed by multiple skin and gastrointestinal localizations (2). They are more frequent with girls. Dyspenia and inspiratory stridor with obstruction signs and cough are the main symptoms with neonates (3,4,5,6,7). These discomforts are not permanent, there are periods of improvement and deterioration. In most cases a spontaneous involution of hemangioma occurs during the second year of life. Adult hemangiomas are bluish red, clearly defined, appearing most often in the region of glottis and supraglottis. They are more frequent with males. The principal symptom is hoarseness, occasional hemoptysis, and in advanced cases dysphagia and difficult breathing (1,8,9). They do not show tendency of spontaneous regression. The sources give varied opinions on therapeutic procedure with laryngeal hemangioma (3,5,7,10,11,12,13,14). The factors influencing the choice of therapy are age, type, size and localisation of the tumor, and the patient's discomforts. With infantile hemangiomas which do not cause significant discomforts, we can expect spontaneous regression (15,16,17). The greatest discomforts are caused by hemangiomas during the first years of life, when followed by difficult breathing and choking. In these cases tracheotomy is inevitable. Radiotherapy used to play the principal role in therapy of hemangiomas (15,10,12). Nowadays the treatment of laryngeal hemangiomas with neonates is done with steroids (3,5,7), embolisation (5,14), laser (3,713) and cryotherapy (12). Adult hemangiomas are mostly treated surgically, applying various methods, from tumor ablation to laryngectomy, depending on the size of tumor (1,8,18,19,20). (ABSTRACT TRUNCATED)