Vallecular CYST in Neonates: A Case Report

Abstract

Introduction: Congenital valvular cysts are rare and can present with acute airway obstruction with wheezing as a chief complaint in neonates and young children. In absent of early detection and appropriate treatment, airway obstruction can cause severe morbidity and mortality. Symptoms appear in most affected infants within the first week of life. Even with case reports in the literature, symptoms must be identified and recognized for early detection of congenital trough cysts. Case report: A 12-days-old term male baby was referred from pediatric department to ENT department with chief complaint of shortness of breath. The patient always coughs when suckling milk, and vomits. The patient had marked inspiratory stridor with suprasternal and epigastrium retraction. At the oropharynx there was a rounded and translucent mass (cyst) found at oropharynx region with size 2x2x2 cm. Neck soft tissue X-ray examination revealed compressed air column, caused by opaque soft tissue density on the posterior part of the tongue, suggestive of a vallecular cyst. Chest x-ray examination on this patient shown bronchopneumonia bilateral. The patient diagnosed with upper airway obstruction grade 2 due to cyst at region vallecula with suspected aspiration pneumonia was made. The next examination for this patient was tracheotomy with local anaesthesia for securing airway and planning to do flexible layrngoscope. On flexible laryngoscope examination, it was revealed that cystic mass was found attached to the left side of the vallecula and epiglottis measuring 2x2x1 cm and the arytenoid cartilage was edema. We plan to do cyst extirpation approach microlaryngoscopy but it was delayed because of the restrictions on elective surgery, caused by pandemic Covid-19 situation, at Hasan Sadikin Hospital. After given maximum medicamentosa such as infusion of D5 NS 21 ml/hour, Cefotaxime 4 x 150 mg IV, Metronidazole 3 x 30 mg IV, Methylprednisolone 3 x 6 mg IV, Paracetamol 3 x 50 mg IV drip, the cyst was found reduced in size. The follow up treatment planning was cyst marsupialization but it was postponed due to good response during therapy. Conclusion: Vallecular cysts are rare upper aerodigestive tract congenital diseases. A complete medical history, ENT examination, imaging, flexible laryngoscope, and clinical investigations are all recommended for diagnosis. Management therapy for vallecular cyst usually with aspiration and marsupialization. Antibiotics can be used for therapy but do not guarantee recurrence.