Perineurioma originating from the recurrent laryngeal nerve, and the phonochirurgical treatment of the developed vocal fold palsy.

Perineurioma is a rare, benign tumour of the perineurium, which develops mostly on the nerves of the extremities. The neoplasm related to a genetic mutation on the 22nd chromosome, is a rarity on the vagal nerve branches. Authors report the case of a 15-year-old female with an immunhistochemically verified (focal EMA positive, vimentin, CD56 positive) perineurioma originating from the left recurrent laryngeal nerve. After the removal of the tumour together with the involved 2-cm-long part of the nerve, vocal fold palsy developed with aphonia (left vocal fold was in intermedian position). The treatment had to be chosen carefully as the larynx was still in growth. In our case there was no possibility of spontaneous regeneration, thus we chose lipoaugmentation of the left vocal fold, which does not affect the laryngeal framework, so causes the least harm to the larynx. Following surgery the patient's voice reached the normal range (before lipoaugmentation perception (0-100): G40 B80 R40 Acoustics: Ji 1.1%, Shi 10.8% Harmonicity: 13.9 dB maximum phonation time (MPT) 5 s after augmentation, Perception: G10 B10 R20, Acoustics: Ji 0.3 %, Shi 2.6%, Harmonicity: 21.2 dB MPT 22 s). This result was permanent, as the regularly performed objective voice evaluations confirmed during the 2-year follow-up.