PMC4227497_01
Findings of flexible laryngeal endoscopy. (a) The root of the tumor was unable to be visually distinguished to arise from the lingual or laryngeal surface. (b) No liquid was drained from the tumor after the anterior wall was punctured (arrow). (c) The epiglottis was not deformed (arrow), and its lingual surface was free from postoperative recurrence of the lipoma (arrow head).
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Flexible laryngeal endoscopy (Figure 1(a)) revealed a single, round tumor covered with smooth mucosa in the supraglottis. To diagnose the epiglottic tumor in the simplest manner, we used forceps to partially puncture its anterior wall under local anesthesia (Figure 1(b)) and noted that liquid contents did not drain from it. There has been no recurrence of the epiglottic lipoma (Figure 1(c)).
Contrast-enhanced (a) axial and (b) sagittal CT images showed a lipoma occurring on the lingual surface of the epiglottis (arrows).
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Subsequently, contrast-enhanced computed tomography (CT) scans (Figure 2) showed an approximately 4 cm diameter tumor with a wide base on the lingual surface of the epiglottis.
Illustrations and a photograph of transoral finger dissection. (a) After a tracheotomy and cessation of microscopic laryngeal surgery, the patient's mouth was opened with a large mouth gag (MG). Under macroscopic observation while maintaining the airway with a tracheostomy tube (TT), the epiglottic tumor (ET) was pulled into the oral cavity by grasping its frontal wall with forceps. The root of the lipoma attached to the epiglottis was slightly incised using a scalpel (arrows). (b) Traction was placed on the lipoma while simultaneously elevating the epiglottis and larynx to generate a spatial gap between ET and epiglottic cartilage. ET was blindly separated from epiglottic cartilage using the surgeon's index finger inserted into the gap. Because mucosal bundles covering ET converge to the lateral sides of the epiglottic attachment, they were cut using an electric knife (double-headed arrow). Consequently, ET was dissected en bloc. (c) ET was pulled out of the oral cavity and was manipulated using the surgeon's index finger.
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Because of the difficulty in completing the microscopic surgery, we proceeded with macroscopic surgery (Figure 3).