Sarcoidosis

This is an idiopathic chronic granulomatous disease that occasionally affects the larynx. Peak onset is from the age of 20 to 40 years. There is a higher incidence in African Americans, Puerto Ricans, and Scandinavians, and it is sometimes familial. The pathogenesis of sarcoidosis is unknown. One theory is that it results from a mycobacterial infection. It is usually systemic, most commonly including the lungs and hilar lymph nodes. Isolated local involvement is rare, so head and neck manifestations are virtually always in the context of disease in other sites. A review of 2319 patients seen at the Mayo Clinic for sarcoidosis found head and neck involvement in 9% of cases. Of these, the eyes and lacrimal system were involved in 40%, the nose in 13%, and the larynx in 6% (10). Symptoms of laryngeal involvement include hoarseness, dysphagia, stridor, and dyspnea.

On physical examination, supraglottic involvement appears as a pale and diffusely enlarged, sometimes nodular epiglottis. Vocal fold involvement appears as pale submucosal masses. Histopathologic examination of these lesions reveals characteristic granulomas. However, biopsy does not definitively establish the diagnosis, because many other conditions can produce granuloma. Laryngeal lesions require treatment only if symptomatic. Epiglottic lesions that cause dyspnea may be debulked endoscopically. Repeat surgery may be necessary. Vocal fold lesions may also impair the airway, and if so, they should be removed endoscopically; however, if the only symptom of a vocal fold lesion is hoarseness, surgery should be approached with caution. Postoperative scarring and tissue loss can further impair the voice, potentially causing severe dysphonia. Alternative management is intralesional steroid injections repeated at intervals (11). Detailed discussion of sarcoidosis can be found in Chapter 6.

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