Oropharyngeal rhabdomyoma: the cause of severe sleep apnoea?

Abstract

This case report presents an elderly male patient who on diagnosis with a large oropharyngeal tumour had no specific symptomatology apart from severe obstructive sleep apnoea. Histopathology revealed the tumour to be an adult rhabdomyoma, a rare but benign tumour arising from striated muscle cells. The tumour obstructed most of the oropharyngeal space and almost occluded the patient's airway when lying in a supine position. The patient was deemed operable, and the tumour was excised in toto using a transoral robotic surgery system. On follow-up, the patient had a severe reduction of apnoeas/hypopnoeas and felt subjectively 'reborn'. This is to our knowledge the first case where an adult rhabdomyoma is removed using a robot-assisted approach, thus presenting a new and viable option when considering removal of benign tumours of the pharynx leading to a very minor degree of morbidity for the patients.

Keywords: ear, nose and throat; head and neck surgery; otolaryngology / ENT; sleep disorders (respiratory medicine).

Figure 1

Photo of the tumour from the primary clinical examination.

Figure 2

MRI from primary diagnosis. Coronal view. Tumour marked and measured.

Figure 3

Histopathology with H&E colouring showing striated muscle cells. No dysplasia of malignant infiltration.

Figure 4

Peroperative photo from TORS resection. Tumour partially resected. TORS, transoral robotic surgery.