What is the primary treatment for leiomyoma of the larynx?

Leiomyoma of the Larynx: Primary Treatment

Complete surgical excision is the definitive treatment for laryngeal leiomyoma, with endoscopic resection being the preferred approach for small, well-circumscribed tumors. 1, 2, 3

Surgical Approach Selection

The choice of surgical technique depends on tumor characteristics:

• Endoscopic resection (transoral laser or direct laryngoscopy) is now considered the gold-standard for small, well-defined laryngeal leiomyomas 1, 3
• CO2 laser technology offers superior hemostasis, reduced bleeding, less tissue damage, and better functional outcomes compared to traditional cold instruments 1
• External surgical approach may be necessary for larger tumors or those not amenable to transoral access, and effectively prevents intraoperative hemorrhage and postoperative recurrence 3

Critical Surgical Principles

Margin Management

• Achieve complete excision with dissection along the tumor capsule to ensure total removal 1
• The tumor is typically well-encapsulated beneath normal mucosa, facilitating clean dissection 2
• Tumor-free margins are essential, as incomplete excision may lead to recurrence (though recurrence is rare with complete removal) 2

Hemorrhage Prevention

• Preoperative embolization can be considered for vascular leiomyomas to reduce bleeding risk during transoral resection 3
• Meticulous technique is required given the abundant vascularity characteristic of these tumors 2, 3
• External approaches provide better hemorrhage control for highly vascular lesions 3

Tumor Characteristics Guiding Treatment

Laryngeal leiomyomas present with specific features that inform surgical planning:

• Most commonly located in the supraglottic region (58% of cases), followed by glottic (29%) and subglottic (13%) regions 3
• Appear as submucosal masses with dilated surface vessels covered by normal mucosa 2, 3
• Histologically composed of well-differentiated smooth muscle bundles with numerous blood vessels, lacking mitotic activity 3
• Peak incidence between ages 40-60 years, with male predominance (4:1 ratio) 3

Common Pitfalls to Avoid

• Do not perform biopsy alone—definitive complete excision is required, not just tissue sampling 1, 2, 3
• Avoid piecemeal resection—remove the tumor intact with its capsule to prevent bleeding and ensure complete removal 1
• Do not underestimate bleeding risk—these are vascular tumors requiring careful hemostatic technique 2, 3

Postoperative Considerations

• Recurrence is rare following complete surgical excision 2
• No adjuvant therapy (radiation or chemotherapy) is indicated for benign leiomyomas 1, 2, 3
• Functional outcomes are excellent with appropriate surgical technique, particularly with laser resection 1