Subglottic nerve sheath tumor in a pediatric patient: case report and literature review.

Background: Although nerve sheath tumors (neurilemmoma and neurofibroma) can occur on any nerve with Schwann cells, laryngeal involvement is very uncommon. The vast majority of reported laryngeal nerve sheath tumors have been located in the supraglottic area. Our case report involves the diagnosis and management of a subglottic nerve sheath tumor in a pediatric patient. Only two previous reports of such a lesion appear in the world literature.

Methods: A 12-year-old girl was initially seen by her allergist for evaluation of a 2-month history of wheezing and nocturnal dyspnea. Therapy with bronchodilators and steroids had limited success. Flow-volume loop studies suggested a fixed upper airway obstruction, and an office laryngoscopy identified a cherry red, submucosal subglottic lesion. Magnetic resonance imaging (MRI) scan verified the presence of a smooth, homogeneous subglottic mass.

Results: An endoscopic CO2 laser excision of the lesion was performed using jet ventilation technique. Histopathology determined the lesion to be a nerve sheath tumor (neurilemmoma versus neurofibroma). Postoperatively, the patient has been asymptomatic without evidence of recurrence.

Conclusions: A subglottic nerve sheath tumor in a pediatric patient is very rare. Although endoscopic and open approaches have been advocated, CO2 laser with jet ventilation provided an excellent modality for resecting this lesion.