Fatal asphyxia due to large laryngeal granuloma

Abstract

Laryngeal granuloma, vocal process granuloma, or post-intubation granuloma are benign, inflammatory lesions of the arytenoid cartilage vocal process. The etiology of laryngeal granulomas is multifactorial, such as chronic irritation due to endotracheal intubation, vocal cord injury or trauma, and gastroesophageal reflux disease. They can arise postoperatively after mucosal injury due to orotracheal intubation. Clinical manifestations include voice change and dyspnea, which may start one to four months after extubation and may rarely lead to asphyxia. We presented a case of death due to glottic granuloma occurring after a surgical procedure to remove a laryngeal polyp attributed to previous laryngeal injuries by multiple intubations.

Keywords: Asphyxia; Fibrin; Granulation Tissue; Granuloma laryngeal; Polyp.

Figure 1. Gross view of a nodular mass measuring 3 cm x 2 cm occluding the laryngeal lumen (scale bar = 4 cm).

Figure 2. Photomicrographs of: A – section from polypoid mass shows mushroom-shaped fibrin clot (H&E, 40x); B  – An adjacent area near the base shows papillary proliferation with squamous metaplasia over the granulation tissue (H&E 40x); C – The base of the mass shows inflammatory granulation tissue with edema, proliferating capillaries, fibroblastic cells proliferation, lymphocytes, and plasma cells infiltrate (H&E 200x); D – Section from the brain shows red neurons with shrunken cytoplasm, angulated nuclei and uniform eosinophilia of cytoplasm and nuclei (H&E 400x).