Hutnik Robert, Chen Philip G, Mortensen Melissa M
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, New York.
Department of Otolaryngology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
J Clin Sleep Med. 2020 Apr 15;16(4):635-638. doi: 10.5664/jcsm.8290.
Obstructive sleep apnea (OSA) is commonly encountered in the pediatric population and has a large differential diagnosis. As clinicians, we must determine who needs to undergo flexible laryngoscopy to rule out potential obstructing lesions causing OSA. This report presents a 16-year-old female who presented with snoring, "asthma," dysphagia, and OSA. Flexible laryngoscopy and computed tomography revealed a neurofibroma of the aryepiglottic fold without associated neurofibromatosis type 1. The patient underwent microlaryngoscopy and the lesion was excised using cold steel and a carbon dioxide laser. At 6 months' follow-up, the patient was breathing without difficulty and had no evidence of recurrence. Solitary laryngeal neurofibromas are extremely rare, and this is the first case of an adolescent with OSA caused by a solitary supraglottic neurofibroma. A supraglottic mass needs to be considered in the differential diagnosis of patients with OSA who fail conservative treatment, even a diagnosis as rare as a solitary laryngeal neurofibroma.
阻塞性睡眠呼吸暂停(OSA)在儿科人群中很常见,且鉴别诊断范围广泛。作为临床医生,我们必须确定哪些患者需要接受纤维喉镜检查,以排除导致OSA的潜在阻塞性病变。本报告介绍了一名16岁女性,她出现打鼾、“哮喘”、吞咽困难和OSA症状。纤维喉镜检查和计算机断层扫描显示会厌襞神经纤维瘤,无相关的1型神经纤维瘤病。患者接受了显微喉镜检查,并使用冷钢和二氧化碳激光切除了病变。在6个月的随访中,患者呼吸顺畅,无复发迹象。孤立性喉神经纤维瘤极为罕见,这是首例由孤立性声门上神经纤维瘤导致OSA的青少年病例。对于保守治疗无效的OSA患者,即使诊断为像孤立性喉神经纤维瘤这样罕见的疾病,在鉴别诊断中也需要考虑声门上肿物。