Bilateral ventricular webs - Laryngoscopic Clinic - Brief Article

Ear, Nose & Throat Journal, Nov, 2003 by Stacey L. Halum, Albert L. Merati

Acquired bilateral ventricular webs have not been previously described in the literature. Two years ago, a non-smoking 72-year-old woman came to us with a 3-month history of hoarseness. Examination revealed that she had bilateral leukoplakia. Initial microlaryngoscopy with medial microflap excisional biopsies (1,2) revealed pathology consistent with mild dysplasia. Despite aggressive anti-reflux therapy and a trial of the antifungal fluconazole, the leukoplakia recurred. She underwent two subsequent microlaryngoscopic examinations with medial microflap excisions, but she again developed recurrent leukoplakia within months (figure, A and B).

[FIGURES A-B OMITTED]

The patient sought further care at an outside institution, where biopsy demonstrated carcinoma in situ at the lateral true vocal folds bilaterally. She was treated with carbon dioxide laser excision. Approximately 6 weeks postoperatively, the patient returned with complaints of progressive hoarseness. Videostroboscopic examination demonstrated scattered areas of leukoplakia with decreased mucosal waveforms bilaterally. Microlaryngoscopy demonstrated bilateral ventricular webs (figure, C and D). The webs were carefully excised with a carbon dioxide laser, and mitomycin was applied topically. One month later, videostroboscopy demonstrated scattered leukoplakia but no evidence of recurrent web formation.

[FIGURES C-D OMITTED]

From the Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee.

References

(1.) Schweinfurth JM, Powitzky E, Ossoff RH. Regression of laryngeal dysplasia after serial microflap excision. Ann Otol Rhinol Laryngol 2001;110:811-14.

(2.) Courey MS, Garrett CG, Ossoff RH. Medial microflap for excision of benign vocal fold lesions. Laryngoscope 1997; 107:340-4.