PARTIAL AIRWAY OBSTRUCTION IN AN ASYMPTOMATIC PATIENT

• Published in: Oral surgery, oral medicine, oral pathology and oral radiology oral medicine, oral pathology and oral radiology, 2020-08, Vol.130 (2), p.e61-e61
• Main Authors: EHLERS, S., BOZANICH, J., TAHMASBI-ARASHLOW, M., LIANG, H., NAIR, M.K.
• Format: Article
• Language: English
• ISSN: 2212-4403; 2212-4411
• DOI: 10.1016/j.oooo.2020.03.016

A 66-year-old female with no complaints or symptoms presented for routine preimplantation cone beam computed tomography (CBCT). CBCT demonstrated evidence of a large, well-defined, low-attenuation/soft tissue lesion with an undulating appearance, extending from the posterior left pharyngeal wall and occluding two-thirds of the airway from the level of C2 to C4. The lesion extended laterally into the left mediopharyngeal space and inferiorly beyond the field of view. There was evidence of faint internal septations. The aim of this study was to identify, diagnose, and treat a large lesion partially obstructing the airway through multiple advanced imaging modalities and interdisciplinary collaborative treatment. The patient was referred for an otolaryngology consult after initial CBCT imaging. Laryngoscopy, magnetic resonance imaging (MRI) and contrast-enhanced computed tomography (CT) were performed to determine the extent of the lesion and to plan for potential surgical intervention. The absence of symptoms and displacement of surrounding structures without perforation suggested a benign, but fairly invasive, neoplasm with slow growth. Initial differential diagnoses included lipoma, minor salivary gland tumor, and vascular and neural tumors. Juxtaposition of T1-weighted MRI and T1 with fat suppression protocols further validated the diagnosis of benign lipoma. Resection, followed by histopathologic evaluation, confirmed a large lipoma. Periodic follow-up was recommended to monitor resolution and potential recurrence. Lipomas account for 4% to 5% of benign neoplasms, more commonly in the lower torso and extremities. Lipomas in the upper airway region account for only 0.6% of benign neoplasms, making them quite rare. Any lesion encroaching on vital structures needs prompt attention and appropriate intervention/management to avoid a life-threatening situation. The slower growth exhibited by some benign lesions may obscure symptoms because the changes are gradual and happen over an extended period. Incidental findings, such as this large and invasive benign tumor, underscore the importance of carefully evaluating the entire volume of any study and not just the region of interest.