Laryngeal Amyloidosis in 10 Patients

Abstract

Review the location, symptoms, treatment, and outcomes in 10 consecutive laryngeal amyloid (LA) patients. Pre and retrospective evaluation after treatment. Analysis of visual and phonatory pathology and detailed description of surgery. Amyloid on the undersurface of both true vocal cords (TVCs) was found in two cases, uni- or bilaterally submucosally in the false vocal cords (FVCs) in eight cases, extending down into the lateral TVC in four cases, or on the undersurface of the TVCs as well in one case. The chief complaint was hoarseness and not shortness of breath. The amyloid was resected with a CO2 laser by way of microdirect laryngoscopy (MDL) on one side at a time to try to prevent anterior commissure scarring. Removal of most of the FVC improved the voice, but removal of the whole FVC to the inner thyroid perichondrium was found to be necessary to avoid recurrence from supraglottic deposits. Removal of at least 2 mm of the upper edge of a 3 to 4 mm thick submucosal deposit to the thyroarytenoid (TA) muscle along with the overlying mucosa on at least one side was necessary to improve hoarseness when amyloid was present on the undersurface of both TVCs. Partial regrowth occurred in a few months to years after partial removal. Seven patients had had one to seven prior removals. Any hard amyloid in the lateral TVC (floor of ventricle) as an inferior extension from FVC amyloid needed to be at least partially removed to avoid hoarseness from a convex vocal cord. The voice improved postoperatively in all patients. Follow-up after the first operation was 6 months to 16 years, with an average of 6.5 years. Four FVC patients required re-excision on the same side after the first operation, but none has required a third removal as of yet.