Lateral Thyrotomy Approach in the Era of Transoral Laser Surgeries

Ab s t r Ac t Background: Laryngeal lipomas are rare benign lesions and are usually asymptomatic till they grow in size to become obstructive. Excision of a laryngeal submucosal lesion presents with the dilemma of an external or an endoscopic approach. The transoral endoscopic approach is preferred for smaller lesions and external approach for large tumors. This report introduces the external lateral thyrotomy approach for excision of a paraglottic space lipoma. Case description: A 33-year-old female patient, teacher by profession, presented with complaints of voice change and choking sensation for 3 months. Flexible laryngoscopy revealed a smooth submucosal swelling of the right false cord and aryepiglottic (AE) fold with fullness in the right pyriform fossa and bilateral mobile vocal cords. Contrast-enhanced computed tomography (CECT) scan of neck was suggestive of a right paraglottic 5 × 3 cm dumbbell-shaped lipoma that was excised by the lateral thyrotomy approach. Conclusion: The lateral thyrotomy approach provided adequate exposure of the tumor and excellent visibility of the entire paraglottic space under direct vision. A complete excision could be performed without any breach of the laryngeal mucosa or tracheostomy and with preservation of voice and laryngeal framework. Clinical significance: An individualized approach is needed for rare tumors and sometimes a simple procedure may outweigh the benefits of an advanced technique.