Diagnosis and Treatment of Laryngeal Schwannoma: A Systematic Review

Michele Tulli, Stefano Bondi, CE Smart, L Giordano, M Trimarchi, A Galli, D Di Santo, M Biafora, M Bussi

Research output: Contribution to journalArticle

Abstract

Objective This review summarizes the clinical features, diagnostic workup, and surgical treatment of laryngeal schwannoma with the aim of providing guidance for the management of this rare disease. The collated data allowed the statistical testing of several hypotheses, including the efficacy of endoscopic vs open surgical intervention and the usefulness of preoperative biopsy. Data Sources PubMed, Google Scholar, Cochrane, and SCOPUS. Review Methods Basic epidemiological and clinical presentation data were collated together with details of diagnostic image modality, lesion attributes, and the use of preoperative biopsy. Surgical approach to intervention and outcome was also collated and simple statistical analyses applied. Results The 60 original articles selected provided a combined cohort of 74 patients for review. The combined data revealed that schwannoma with pedunculated morphology were always safely removed by endoscopic resection regardless of size and should be treated as a separate entity. Of the nonpedunculated schwannoma, larger tumors were more likely to undergo an open approach, which in turn was associated with higher rates of tracheotomy and postoperative vocal fold paralysis. The small cohort did not reveal a significant association between surgery type and persistent disease. Interestingly, the data revealed a significant association between the use of incisional biopsy and persistent disease. Cases exhibiting extralaryngeal extension of the lesion were shown to exclusively belong to patients with neurofibromatosis/schwannomatosis syndromes. Conclusions Taken together, these findings suggest that incisional biopsy should be avoided, and given the benign nature of the pathology, the least invasive radical approach should be employed.
Original languageEnglish
Pages (from-to)222-231
Number of pages10
JournalOtolaryngology - Head and Neck Surgery
Volume158
Issue number2
DOIs
Publication statusPublished - 2018

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Neurilemmoma
Biopsy
Epidemiologic Methods
Tracheotomy
Neurofibromatoses
Vocal Cords
Information Storage and Retrieval
Therapeutics
Rare Diseases
PubMed
Paralysis
Pathology
Neoplasms

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Diagnosis and Treatment of Laryngeal Schwannoma: A Systematic Review. / Tulli, Michele; Bondi, Stefano; Smart, CE; Giordano, L; Trimarchi, M; Galli, A; Di Santo, D; Biafora, M; Bussi, M.

In: Otolaryngology - Head and Neck Surgery, Vol. 158, No. 2, 2018, p. 222-231.

Research output: Contribution to journalArticle

Tulli, M, Bondi, S, Smart, CE, Giordano, L, Trimarchi, M, Galli, A, Di Santo, D, Biafora, M & Bussi, M 2018, 'Diagnosis and Treatment of Laryngeal Schwannoma: A Systematic Review', Otolaryngology - Head and Neck Surgery, vol. 158, no. 2, pp. 222-231. https://doi.org/10.1177/0194599817735508
Tulli, Michele ; Bondi, Stefano ; Smart, CE ; Giordano, L ; Trimarchi, M ; Galli, A ; Di Santo, D ; Biafora, M ; Bussi, M. / Diagnosis and Treatment of Laryngeal Schwannoma: A Systematic Review. In: Otolaryngology - Head and Neck Surgery. 2018 ; Vol. 158, No. 2. pp. 222-231.
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N2 - Objective This review summarizes the clinical features, diagnostic workup, and surgical treatment of laryngeal schwannoma with the aim of providing guidance for the management of this rare disease. The collated data allowed the statistical testing of several hypotheses, including the efficacy of endoscopic vs open surgical intervention and the usefulness of preoperative biopsy. Data Sources PubMed, Google Scholar, Cochrane, and SCOPUS. Review Methods Basic epidemiological and clinical presentation data were collated together with details of diagnostic image modality, lesion attributes, and the use of preoperative biopsy. Surgical approach to intervention and outcome was also collated and simple statistical analyses applied. Results The 60 original articles selected provided a combined cohort of 74 patients for review. The combined data revealed that schwannoma with pedunculated morphology were always safely removed by endoscopic resection regardless of size and should be treated as a separate entity. Of the nonpedunculated schwannoma, larger tumors were more likely to undergo an open approach, which in turn was associated with higher rates of tracheotomy and postoperative vocal fold paralysis. The small cohort did not reveal a significant association between surgery type and persistent disease. Interestingly, the data revealed a significant association between the use of incisional biopsy and persistent disease. Cases exhibiting extralaryngeal extension of the lesion were shown to exclusively belong to patients with neurofibromatosis/schwannomatosis syndromes. Conclusions Taken together, these findings suggest that incisional biopsy should be avoided, and given the benign nature of the pathology, the least invasive radical approach should be employed.

AB - Objective This review summarizes the clinical features, diagnostic workup, and surgical treatment of laryngeal schwannoma with the aim of providing guidance for the management of this rare disease. The collated data allowed the statistical testing of several hypotheses, including the efficacy of endoscopic vs open surgical intervention and the usefulness of preoperative biopsy. Data Sources PubMed, Google Scholar, Cochrane, and SCOPUS. Review Methods Basic epidemiological and clinical presentation data were collated together with details of diagnostic image modality, lesion attributes, and the use of preoperative biopsy. Surgical approach to intervention and outcome was also collated and simple statistical analyses applied. Results The 60 original articles selected provided a combined cohort of 74 patients for review. The combined data revealed that schwannoma with pedunculated morphology were always safely removed by endoscopic resection regardless of size and should be treated as a separate entity. Of the nonpedunculated schwannoma, larger tumors were more likely to undergo an open approach, which in turn was associated with higher rates of tracheotomy and postoperative vocal fold paralysis. The small cohort did not reveal a significant association between surgery type and persistent disease. Interestingly, the data revealed a significant association between the use of incisional biopsy and persistent disease. Cases exhibiting extralaryngeal extension of the lesion were shown to exclusively belong to patients with neurofibromatosis/schwannomatosis syndromes. Conclusions Taken together, these findings suggest that incisional biopsy should be avoided, and given the benign nature of the pathology, the least invasive radical approach should be employed.

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