(A723) Laryngeal Neurofibroma: A Case Report and Review of the Literature

Introduction: Laryngeal neurofibromas account for less than 1% of all benign laryngeal tumors and are caused by proliferations of Schwann cells, fibroblasts, and perineural cells. Most cases of laryngeal neurofibroma occur in patients diagnosed with neurofibromatosis type 1 (NF-1) or neurofibromatosis type 2 (NF-2), making an isolated presentation without other lesions particularly rare. Neurofibromas most commonly present as sessile or pedunculated mucosal or sub-mucosal masses of the aryepiglottic fold, arytenoid, or false vocal cords, typically arising from the terminal plexus of the superior laryngeal nerve or branches of the recurrent laryngeal nerve.

Methods: We report on a case of a solitary laryngeal neurofibroma in a 75-year-old male with a previously known laryngeal mass lost to follow up without known NF-1 or NF-2 who re-presented with worsening dyspnea requiring intubation for airway protection.

Results: CT imaging was notable for a hypoattenuating cystic mass centered between the hyoid and cricoid cartilage superior to the true vocal cords measuring 3.3 x 4.5 cm in size. Direct laryngoscopy revealed a large sub-mucosal laryngeal mass involving the endolarynx, extending to the left false vocal fold, ventricle, arytenoid, and aryepiglottic fold, which necessitated tracheostomy for airway protection. Subsequent pathological analysis revealed neurofibroma. Surgical debulking utilizing carbon dioxide laser and microdebrider restored airway patency, allowing for decannulation prior to discharge.

Conclusions: Given the broad differential of benign sub-mucosal laryngeal lesions, including neurofibromas, paragangliomas, chondromas, lipomas, rhabdomyomas, and leiomyomas, biopsy and subsequent surgical resection to restore function are paramount.