James R. Tate, MD; Peter C. Belafsky, MD, PhD; Kristen Vandewalker, MD
A 68-year-old diabetic woman presented to the Center for Voice and Swallowing with progressive dyspnea and dysphonia of 5 years’ duration. She was a lifelong non.smoker. Her medical history was notable for a right subtotal thyroidectomy for benign disease 50 years earlier. That surgery had been complicated by right vocal told paralysis, and 31 years later, she underwent an injection niediulization with Teflon at another institution.
At our center, fiberoptic nasopharyngeal laryngoscopy revealed the presence of a right submucosal mass that extended from the right true vocal fold to the subglottic region. The diameter of the airway was 3 to 4 mm. No granulation tissue was appreciated. Findings on the remainder of the head and neck examination were normal.
Contrast-enhanced computed tomography (CT) of the neck demonstrated a large heterogeneous mass at the level of the right true vocai fold (tigure 1). No cervical lymphadenopathy was identified.
The patient underwent excision of the well-circumscribed mass via a right laryngotomy approach (figure 2). The vocal fold was medialized with an inferiorly based tigure 2. flic Teflon granuloma is seen intraoperatively. thyrohyoid muscle flap, and an arytenoid adduction was performed through tbe laryngotomy window. Tbe patient underwent a tracheotomy during the procedure to secure a severely compromised airway. Pathology revealed a Teflon granuloma (figure 3).
The patient did well postoperatively. and sbe was decannulated on postoperative day 9 witbout complication. Transnasal fiberoptic laryngoscopy and tracheobroncboscopy revealed a well-medialized right vocal fold witb complete glottal closure. The airway was widely patent.
Teflon (polytetrafiuoroethylene) has been supplanted by other materials because it is associated with a risk of granuloma formation after superficial injection, as well as ariskof migration. Also. Tefion has been known to stiffen tbe mucosal wave, and it can be difficult to remove. Tbe reported incidence of Teflon granuloma is 2 to 3%.’ but its true incidence may be higher.
Patients with Teflon granuloma likely fall into one of two groups: (1) those with an immediate reaction to overinjection or improper injection and (2) those with delayed symptoms secondary to an exuberant granulo- matous response.- The duration between Teflon injection and granuloma removal has been reported to range from 4 months to 18 years (mean: 55 mo), which suggests that the inflammatory reaction to Teflon is highly variable.’
Teflon granulomas can be surgically managed via an endoscopic, open, or combined approach.”‘ Many consider granuloma removal through a large laryngotomy window with strap muscle reconstruction and arytenoid adduction to be the surgical treatment of choice.
ENT-Ear, Nose & Throat Journal • March 2007