From the Guidelines
The treatment for a laryngeal mass causing airway narrowing should prioritize securing the airway first, followed by definitive management of the mass, with a focus on preserving laryngeal function and quality of life, as recommended by the American Society of Clinical Oncology clinical practice guideline update 1.
Initial Management
Initial management may include:
- Supplemental oxygen
- Heliox therapy (a helium-oxygen mixture) to reduce airflow resistance
- Emergency airway intervention such as endotracheal intubation or tracheostomy if severe obstruction is present
- Corticosteroids like dexamethasone (10mg IV initially, followed by 4mg every 6 hours) to reduce inflammation and edema surrounding the mass
Definitive Treatment
Definitive treatment depends on the underlying cause:
- Benign or malignant tumors typically require surgical excision, which may be performed using microlaryngeal surgery, laser resection, or open surgical approaches depending on the size and location
- For malignant lesions, treatment may include radiation therapy (typically 60-70 Gy over 6-7 weeks) and/or chemotherapy (regimens often include cisplatin or carboplatin)
- Infectious causes may require appropriate antimicrobial therapy
Considerations
Throughout treatment, voice preservation and swallowing function should be prioritized when possible. The approach must be individualized based on the specific diagnosis, size and location of the mass, degree of airway compromise, and patient factors, with management typically coordinated by a multidisciplinary team including otolaryngologists, oncologists, and speech pathologists. As stated in the guideline update, "All patients with T1, T2 laryngeal cancer should be treated, at least initially, with intent to preserve the larynx" 1. Additionally, "T1, T2 laryngeal cancer can be treated with radiation or larynx-preserving surgery with similar survival outcomes" 1. The guideline also emphasizes the importance of considering patient factors, local expertise, and the availability of appropriate support and rehabilitative services when selecting a treatment approach 1. The use of larynx-preservation strategies has been shown to improve quality of life and functional outcomes for patients with laryngeal cancer, while also reducing the risk of complications and mortality 1.
From the Research
Treatment Options for Laryngeal Mass with Airway Narrowing
- The treatment for a laryngeal mass causing airway narrowing depends on the severity of the obstruction and the underlying cause of the mass 2, 3.
- Tracheostomy is a common procedure used to secure the airway in patients with laryngeal tumors, especially in cases of severe airway obstruction 2, 4.
- Other treatment options include:
- Tumor debulking using cold-steel or CO2 laser to stabilize the emergency situation and convert the definitive treatment to an elective procedure without the need for tracheostomy 3.
- Emergency laryngectomy in some cases, although this is less common 3.
- Controlled tracheal intubation with or without tumor debulking 3.
- Temporary tracheostomy to avoid postoperative intubation laryngeal edema in patients with laryngeal edema after radiotherapy 5.
- Diagnosis and evaluation of the airway obstruction are critical in determining the best course of treatment, and may involve:
- Preoperative examination, including history, physical examination, computed axial tomography and/or magnetic resonance imaging, and ear, nose, and throat surgeons' evaluation via indirect laryngoscopy or fiberoptic bronchoscopy 2.
- Pulmonary function tests, including flow-volume loops and blood gas analysis, to evaluate the degree of obstruction and gas exchange 2.
- Computed tomography scan to determine the nature and site of the lesion 4.
- The treatment of laryngopyocele, a rare cause of acute airway obstruction, typically involves immediate endoscopic drainage, followed by surgical excision 4.