Vocal fold granulomas: a case series

Background: Vocal fold granulomasare still largely unidentified by otolaryngologist. This entity could be one of the most prevalent cause of extubation failure, aside from subglottic stenosis. Postintubation granuloma is one of post-endotracheal intubation complications. Prolonged intubation or history of multiple intubation increases the risk of granuloma formation. Thus we need to be aware of the existence possibility of this pathologic condition.

Methods: Case series

Results: During Januari 2014 to Januari 2017 at Sardjito General Hospital, it has been reported four cases of post-intubation vocal fold granuloma. Three cases with prolonged intubation, one case with long hours operation. All patients were female. One patient had bilateral vocal cord granulomas, while three others are unilateral. Three cases of vocal cord granulomas were removed by microlaringoscopic surgery, two cases were operated due to risk of upper airway obstruction, one for biopsy, and the fourth was managed conservatively. The first case was a 28 years old woman with bilateral vocal fold granuloma, had history of multiple operations with general anesthesia using endotracheal tube intubation, and also history of prolonged intubation in the ICU. Endoscopic examination revealed bilateral large vocal fold masses. After removal of granulomas, we administered intraoral steroid and PPI therapy and the patient was relief completelywithno tightness or hoarseness post-operative. The second case, a 59 years old woman with unilateral laryngeal granuloma withhistory of craniectomy. Endoscopic examination showed large size unilateral granuloma which moved along with inspiration and expiration. The patient was then managed by microlarynx surgery and showed no recurrence atevaluation. The third case was a 25 years old woman with unilateral granuloma which has been managed with antiinflammatory drugs for 2 weeks without any changes in the size of mass. This patient also had history of prolonged intubation in the ICU due to pneumonia. The granuloma was removed with microlarynx surgery. The fourth case, a 24 years old female with history of prolonged intubation and tracheal stenosis post repair, endoscopic examination showed a unilateral mass in the left posterior commissure, patient was managed conservatively, and has not yet come for follow up.

Conclusion: Four cases of bilateral and unilateral post-intubation laryngeal granulomas associated with history of intubation were reported.