Abstract
Laryngeal cysts are relatively rare benign lesions of the larynx. Congenital cysts can cause neonatal respiratory distress and death, but airway obstruction due to acquired cysts in adults is rare. We present a case report of 51-year-old male with dysphagia who was found to have a mobile pedunculated epiglottic cyst that intermittently caused partial obstruction of the laryngeal inlet. Patient was taken to operating room and following transoral fiberoptic intubation, endoscopic excision of this cyst was accomplished. Patient’s postoperative course was uneventful.
1
Introduction
Laryngeal cysts are relatively rare lesions that represent approximately 5% of benign laryngeal lesions . Many of the epiglottic or vallecular cysts are asymptomatic, but common symptoms include globus sensation, voice changes and dysphagia . While congenital cysts in neonates often cause respiratory distress, airway obstruction is rare in adults, with only a few reported cases . This report described a case of a patient with dysphagia and a pedunculated epiglottic cyst, which was capable of partially obstructing the laryngeal inlet and could have led to impending airway obstruction.
2
Case report
A 51-year-old male was referred with a chief complaint of dysphagia and globus sensation for seven months. A local provider had evaluated him with a barium swallow, which was unremarkable. Further evaluation included diagnostic esophagogastroduodenoscopy, where he was found to have a large mass located in the vallecula. He was referred to our Otolaryngology practice for further management. On presentation, he denied odynophagia, otalgia, difficulty breathing and weight loss. More recently, patient stated that he also had a feeling of something in his throat that he could occasionally catch with the “back of his tongue.” Flexible fiberoptic laryngoscopy in the office revealed a large pedunculated cyst at the superior surface of the epiglottis that rested in the vallecular and was partially obstructed from view by the epiglottis ( Fig. 1 ). During the examination, the pedunculated cyst was observed to be mobile and capable of intermittently prolapsing into laryngeal introitus ( Fig. 2 ). Patient was scheduled for endoscopic excision of this cyst. A transoral fiberoptic intubation was performed and the mass was noted to be suspended from the epiglottis. The mass was examined with direct laryngoscopy and the stalk was once again seen to be emanating from the tip of the epiglottis. Suction cautery was used to remove the cysts at its base. The mass, including the stalk, measured 2.5 cm × 1.2 cm. Histologic evaluation revealed a cyst lined with squamous and respiratory epithelium. Given the clinical history this was felt to represent an epiglottic retention or inclusion cyst. The patient’s post-operative course was uneventful.
