Basal-cell adenoma of the subglottis: laryngotracheal resection with laryngotracheoplasty.

Benign laryngotracheal tumours of the minor salivary glands are rare,1 so experience in their treatment and evolution is limited. Indeed, we did not find any evidence of previous publication of a case of monomorphic adenoma in a subglottic location (PubMed, keys words: subglottic/laryngotracheal adenoma; larynx salivary adenoma; monomorphic/basal cell adenoma. Period covered: 1979–2012. Updated 17/11/2012). We describe the case of a 50-year-old man who attended due to a three-month history of progressive dyspnoea on moderate and heavy exertion, with mild inspiratory stridor. A history of previous intubation due to two collarbone surgeries two years previously was noted. Nasofibrolaryngoscopy showed a right anterior subglottic lesion; its extension was determined by computed axial tomography (CT) (Fig. 1A). Rigid bronchoscopy and laser resection (Neodymium-YAG) was scheduled; during surgery, biopsies were taken and partial vaporisation of the lesion was performed. The histopathological result was consistent with a pleomorphic adenoma, so subglottic resection was carried out using an open approach in a second surgical procedure: the trachea was exposed with an incision over the second ring, similar to a tracheotomy; cricothyroid membrane incision; vertical connection of the left side of both incisions (cricoid arch and tracheal ring section), lifting a flap to visualise the lesion directly (15 cm in diameter, situated along the inside of the cricoid arch up to the height of the upper border of the first tracheal ring). Tumour excision was completed with partial cricotracheal resection (cricoid arch and anterior portion of the first tracheal ring). The defect was closed by primary reconstruction with sternothyroid muscle plasty over a Montgomery silicone T-tube (8 mm) and layered wound closure. After five days, the patient was discharged with mild-moderate cervical subcutaneous emphysema, which persisted for five weeks, odynophagia, requiring a soft diet for one month, and dysphonia due to the placement of the upper rim of the stent on the vocal cords. The definitive histopathological study was a benign salivary gland tumour, consistent with basal cell adenoma (monomorphic adenoma), with clear margins. The T-stent was removed after four months. Vocal granulomas were detected, which disappeared in two weeks after treatment with oral prednisone (30 mg in tapered dosage), and the voice returned to normal. The case has been monitored by nasofibrolaryngoscopy and radiological follow-up (Fig. 1B) for the last 1.5 years, with no evidence of recurrence to date.