Laryngeal amyloidosis

Excerpt

A 43-yr-old woman who provided written consent for publication of this report was diagnosed with laryngeal amyloidosis and presented for resection of the mass. Fibreoptic laryngoscopy showed a local laryngeal mass that appeared to originate from the right vocal cord and extend to the subglottic area, occupying most of the glottic opening (Figure, panel A). Further bronchoscopic examination indicated that an elliptic neoplasm was blocking almost 85% of the glottis (Figure, panel B). We used videolaryngoscopy to visualize the mass under topical anesthesia to determine the most appropriate intubation technique. Based on the laryngoscopic view, we planned to use a 5.5-mm internal diameter endotracheal tube (ETT). Nevertheless, the patient refused awake fibreoptic intubation. Instead, the patient was induced via sevoflurane inhalation. Upon exposure of the glottis with the videolaryngoscope, we found that, unlike during the prior examination, the laryngeal mass had almost completely blocked the glottic opening. A first attempt at intubation was unsuccessful. In a second attempt, while simultaneously preparing to wake the patient up and for front-of-neck access, we navigated a negative suction catheter to the mass in an attempt to move it peripherally. Fortunately, the glottis became visible by suction, which left sufficient room for the ETT to pass. The 5.5-mm ETT was inserted safely during expiration. The surgeon removed the laryngeal amyloidosis. There was no recurrence at the two-month follow-up visit (Figure, panel C).

…