Surgical Management of Congenital Saccular Cysts of the Larynx

Abstract

Congenital saccular cysts of the larynx are unusual lesions that commonly present with respiratory obstruction in infants and children. The saccular cyst may result from an atresia of the laryngeal saccule orifice or may represent the retention of mucus in the collecting ducts of submucosal glands located around the ventricle. Traditionally, the treatment of the lesions has been endoscopic unroofing or marsupialization. Frequently, this modality requires multiple procedures as well as concomitant tracheotomy. There also have been reports of acquired subglottic stenosis. We have found that removal of the recurrent saccular cyst can be achieved relatively safely and effectively via a lateral cervical approach to the thyrohyoid membrane. We review our experience with four patients with congenital saccular cysts and detail the evaluation and surgical management of these lesions.

Congenital cysts of the infant larynx

“…Ward et al described excision via a lateral cervical approach to the thyrohyoid membrane in four infants with lateral saccular cysts. None required tracheostomy and none exhibited signs of recurrence [3]. Malis et al reported similar success from a modification of this technique using a fold-down thryoplasty to facilitate access [4].…”

“…With regard to saccular cysts, some authors feel that complete excision is required to prevent recurrence and they advocate external approaches via either laryngofissure, midline thyroidotomy or through the thyrohyoid membrane [3,4]. A consensus opinion is elusive, partly due to the rarity of such lesions.…”

A Rare Cause of Upper Airway Obstruction in a Child

“…Excision of the cyst as a whole is the best method to prevent recurrence; [5, 12] the small cysts can be removed endoscopically, while the larger cysts require external approach [13]. Cases of laser vaporization have also been described [14].…”

Congenital laryngeal saccular cyst: a case report and literature review

“…The excision of the cyst by microlaryngoscopy and external approach are the treatments with the highest success rates according to the literature. However, some authors, such as Ward et al (12), recommend resection by means of an external approach as the only definitive and safe treatment for the non-formation of laryngeal stenosis, given the poor manipulation of the laryngeal mucosa.…”