Clinical, histological and electron microscopic aspects of vocal fold granulomas.
Granulomas are bilateral and pediculated lesions of the vocal apophysis. Etiologies: intubation, reflux, trauma, vocal abuse, idiopathic origin.


OBJECTIVE
To analyze the clinical and morphological aspects of post intubation granulomas.


METHODS
retrospective study of patients submitted to microsurgery for post intubation laryngeal granulomas seen at our Medical School starting in 2002. We analyzed: age, gender, indication and time of intubation, symptoms, videolaryngoscopic diagnosis and biopsy findings. Light microscopy was performed on all specimens, and electron microscopy on three of them.


RESULTS
ten patients (7 females and 3 males), between the ages of 2 and 72 years, intubation time between 4h and 21 days. Hoarseness was a frequent symptom, starting in the first week following extubation. Histology shows mild epithelial hyperplasia, severe inflammation and vessel proliferation in the corion. Under SEM, the epithelium presented mild superficial desquamation. Under TEM, intracellular junctions showed widening with structural changes in the desmosomes. In the corion there were vessel proliferations, inflammation and fibroblasts with structural alterations.


CONCLUSIONS
post intubation granulomas appear in any age and hoarseness is a frequent symptom. Morphological alterations occur in the corion as vessel proliferations, inflammation, and intracytoplasmatic alterations in fibroblasts suggesting cellular dysfunction and damage.
Martins
Regina Helena Garcia
RH
Faculdade de Medicina de Botucatu, Unesp.
Dias
Norimar Hernandes
NH
Santos
Daniela Carvalho Dos
DC
Fabro
Alexandre Todorovic
AT
Braz
José Reinaldo Cerqueira
JR
D000293:Adolescent; D000328:Adult; D000368:Aged; D002675:Child, Preschool; D005260:Female; D006102:Granuloma, Laryngeal / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D012189:Retrospective Studies; D014827:Vocal Cords / Q000601:surgery / Q000648:ultrastructure*; D055815:Young Adult