Benign Larengeal Lezyonlar
Özet
Benign vokal fold lezyonları, larenkste en sık görülen ve ses kısıklığı ile yaşam kalitesinde düşüşe yol açan iyi huylu oluşumlardır. Bu dokümanda vokal fold nodülleri, polipleri, Reinke ödemi, kistleri, granülomları, sulkus vokalis ve larengeal papillomatozis gibi temel lezyonlar ele alınmıştır. Nodüller genellikle sesin yoğun kullanımıyla ilişkili çift taraflı lezyonlarken, polipler tek taraflı olup sigara ve kronik travmayla tetiklenir. Neredeyse tamamen kronik sigara içicilerinde görülen Reinke ödemi ise yüzeyel lamina propriada sıvı birikmesiyle karakterizedir. Kistler subepitelyal yerleşimliyken, granülomlar entübasyon veya reflü kaynaklı mekanik/kimyasal travmalarla posterior glottiste ortaya çıkar. Sulkus vokalis fold boyunca uzanan bir olukken, larengeal papillomatozis HPV kaynaklı, tekrarlama eğilimi yüksek epitelyal bir hastalıktır. Teşhiste larengostroboskopi kritik bir rol oynar. Tedavi yaklaşımlarında öncelikle ses terapisi, sigaranın bırakılması, reflü kontrolü ve botulinum toksini gibi konservatif medikal yöntemler tercih edilir. İyileşme sağlanamayan veya hava yolu tıkanıklığı gibi riskli durumlarda ise vokal fold dokusunu korumayı amaçlayan fonomikrocerrahi, mikroflep teknikleri ve anjiyolitik lazer uygulamaları gibi hassas cerrahi müdahalelere başvurulmaktadır.
Benign vocal fold lesions are the most common laryngeal pathologies that cause dysphonia and decrease patients' quality of life. This document reviews primary benign lesions, including vocal fold nodules, polyps, Reinke's edema, cysts, granulomas, sulcus vocalis, and recurrent respiratory papillomatosis (RRP). Nodules are typically bilateral lesions associated with intensive voice use, whereas polyps are mostly unilateral, triggered by chronic trauma and smoking. Reinke's edema, observed almost exclusively in chronic smokers, is characterized by gelatinous fluid accumulation in the superficial lamina propria. Cysts are located subepithelially, while granulomas develop in the posterior glottis due to mechanical or chemical trauma from intubation, chronic coughing, or acid reflux. Sulcus vocalis presents as a linear groove along the fold, and laryngeal papillomatosis is an HPV-induced epithelial disease with a high recurrence rate. Laryngostroboscopy is essential for definitive diagnosis. Treatment approaches primarily emphasize conservative methods, including voice therapy, smoking cessation, reflux management, and botulinum toxin injections. Surgical interventions, such as phonomicrosurgery, microflap techniques, and angiolytic lasers, are reserved for refractory cases or airway obstruction, focusing strictly on preserving vocal fold tissue and mucosal waves.
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