Vallecular Cyst Synchronous with Laryngomalacia: Presentation of Two Cases

Abstract

Laryngeal cysts are uncommon in infants, who usually have stridor, dyspnea, and feeding difficulties. Supraglottic cyst at tongue base and vallecular cyst are the most common laryngeal cysts in children, l Although these cysts are benign, they may cause serious airway obstruction and even death if not treated appropriately. A mortality rate of about 40% in children with laryngeal cysts was reported. 2-5 However, most of the tongue base cysts improve symptomatically after surgical removal. 5~' In this article we report two young infants with valiecular cysts associated with laryngomalacia presenting symptoms of feeding difficulties and stridor. After excision of the vallecular cyst, stridor persisted despite improvement of feeding difficulties. Because vallecular cyst in combination with laryngomalacia is an extremely rare clinical finding, we herein report two such cases diagnosed by flexible bronchoscopy. CASE REPORTSCase t. A 1-month-old male infant was referred by a pediatrician with a 2-week history of decreased appetite, choking episodes during milk feeding, and noisy respiration. Physical examination showed a stridulous child with suprasternal retraction. Chest x-ray film was normal, and soft-tissue x-ray film of the neck showed a globular lesion at the tongue base (Fig. 1). Flexible bronchoscopy revealed a 2.5-cm cystic mass at the vallecular space and an epiglottis that was flaccid and sucked into the laryngeal introitus during inspiration. The trachea and bilateral mainstem bronchi were normal. A thyroid scan was normal with no ectopic uptake. Excision of the cyst was done after needle aspiration. After surgery stridor persisted, and poor feeding and respiratory distress improved. One From Division of Pediatric Pulmonology (Dr. Wong), Chang Gung Children's Hospital; and the Department of Otolaryngology (Drs. Li and Huang), Chang Gung Memorial Hospital.

Vallecular cyst: an uncommon cause of stridor in newborn infants

“…Simple aspiration of the cyst is not advocated because of its high recurrence rate [11]. De-roo®ng of the cyst with a laser could vapourize the lining epithelium after excision of the wall and minimize airway morbidity [17]. Most of our patients tolerated these procedures well and there was no recurrence during follow-up.…”

“…In most of our cases, the cysts were readily seen as a projecting mass from the tongue base into the vallecular space on lateral neck radiography. There are, however, diagnostic pitfalls; a small cyst may be missed, crying may induce prevertebral thickening, and glossoptosis in Pierre-Robin sequence may simulate tongue base swelling [17]. Other entities such as lingual thyroid [7], thyroglossal duct cyst [15], foregut cyst [4], or neoplasms [17] may present as a mass lesion at the tongue base.…”

“…There are, however, diagnostic pitfalls; a small cyst may be missed, crying may induce prevertebral thickening, and glossoptosis in Pierre-Robin sequence may simulate tongue base swelling [17]. Other entities such as lingual thyroid [7], thyroglossal duct cyst [15], foregut cyst [4], or neoplasms [17] may present as a mass lesion at the tongue base. CT is helpful in demonstrating the location and nature of VC [12,16,17].…”

“…Other entities such as lingual thyroid [7], thyroglossal duct cyst [15], foregut cyst [4], or neoplasms [17] may present as a mass lesion at the tongue base. CT is helpful in demonstrating the location and nature of VC [12,16,17]. Thyroid scans and thyroid function tests may be necessary to con®rm a normally located and functioning thyroid.…”

Failure to thrive caused by the coexistence of vallecular cyst, laryngomalacia and gastroesophageal reflux in an infant

“…According to its location, the most common laryngeal cyst in infants is the aryepiglottic cyst, followed by the vallecular cyst [9]. There have very few reports of congenital vallecular cysts in the literature [1,[9][10][11][12][13][14][15][16]. Vallecular cysts were described as containing clear, nonpurulent fluid, and malignant transformation has not been reported [2].…”