(711) Function-Preserving Endoscopic Management of Laryngeal Schwannoma: A Two-Case Experience

Introduction: Laryngeal schwannomas are rare benign nerve sheath tumors that may present with dysphonia, dyspnea, or airway obstruction. Surgical excision is the definitive treatment; however, complete endoscopic resection can be technically challenging, particularly for larger tumors, due to limitations in visualization, hemostasis, and preservation of laryngeal function. We present a two-case series describing endoscopic resection strategies using different laser modalities, with microdebrider use in the management of a larger tumor.

Methods: Two patients with symptomatic nonpedunculated laryngeal schwannomas underwent transoral endoscopic resection. One patient had a 2-cm midline supraglottic lesion treated with CO2 laser-assisted resection and mucosal flap reconstruction. The second patient had a 3.5-cm right supraglottic lesion treated with Vylo laser-assisted resection and microdebrider debulking. Clinical presentation, operative technique, pathologic findings, and postoperative outcomes were reviewed.

Results: Complete endoscopic resection was achieved in both cases without perioperative complications. Laser-assisted techniques enabled precise mucosal incision and tumor dissection, while microdebrider use facilitated debulking of the larger lesion with preservation of surrounding laryngeal structures. Histopathology confirmed schwannoma in both cases. Both patients demonstrated postoperative voice improvement, with no evidence of early recurrence.

Conclusions: Transoral endoscopic resection of laryngeal schwannomas can be safely and effectively performed using laser-assisted techniques. CO2 and Vylo lasers provide precise tissue dissection with effective hemostasis and limited thermal injury, facilitating preservation of critical laryngeal structures. Adjunctive microdebrider debulking may enhance endoscopic management of larger tumors and reduce the need for open approaches. Technique selection based on tumor size may optimize complete resection while preserving laryngeal function.