Varied Clinical Presentation and Management of Paediatric Vallecular Cyst

Abstract

The aim of this article is to highlight the varied presentation and management of vallecular cysts. Three children with diagnosis of vallecular cyst presented in our department were reviewed retrospectively for clinical presentation, diagnostic tools and treatment options. All three cases presented with respiratory and feeding difficulty. Diagnosis in all the three cases was made with laryngoscopy (flexible/direct) and imaging. All three patients were treated by transoral approach aimed for excision of cyst using cold instruments. Postoperative period was uneventful and no recurrences were observed on the long-term follow up. Vallecular cysts should be considered as one of the differentials in children with respiratory distress and dysphagia in spite of being a rare anomaly. Direct transoral approach for excision of the vallecular cyst is recommended as a safe and reliable method with no recurrences till date. 
 Keywords: Vallecular Cyst; Respiratory Distress; Dysphagia; Laryngoscopy

Successful excision of a large congenital vallecular cyst in a female newborn: A case report

“…There are many anomalies and disorders which can worsen the condition, such as laryngomalacia and gastroesophageal reflux disease (GERD). Laryngeal cysts can coexist in approximately 12–45% of laryngomalacia cases; however, none were observed in our case [ 4 , 5 ].…”

“…The most serious clinical feature of this condition is supraglottic respiratory tract obstructions, which can cause several symptoms such as inspiratory stridor, poor feeding, choking while eating or drinking, respiratory distress, and failure to thrive [ [2] , [3] , [4] , [5] , 9 ]. Larger cysts can increase the risk of life-threatening airway obstruction, particularly in infants due to the small size of their respiratory tract [ [2] , [3] , [4] , [5] ]. Infants typically present within the first weeks after birth with congenital stridor and poor feeding [ 5 , 8 , 9 ].…”

“…In the case of congenital stridor, several differential diagnoses should be considered, such as thyroglossal duct cyst, lingual thyroid, lymphatic malformation, and teratoma [ 3 , 8 ]. Clinical history of congenital stridor and dyspnea with poor feeding, in addition to laryngoscopy findings are crucial in confirming the final diagnosis of vallecular cyst [ 4 ]. Computed tomography (CT) and magnetic resonance imaging (MRI) can be used to identify the location, extension, size, and shape of the cyst and whether other lesions existed [ 4 , 8 ].…”

“…vallecular cysts are uncommon in infants, representing 10.5–20.1% of all congenital laryngeal cysts [ 2 , 3 ]. The vallecular cyst is a unilocular cystic mass and its content is clear and non-infected fluid [ 4 ]. The first case was reported in 1881 [ 3 ].…”

“…Nasopharyngolaryngoscopy is needed to confirm the diagnosis and determine the extension of the cyst. Treatment options may include cyst aspiration, marsupialization, deroofing of the cyst wall, and complete excision [ 4 ]. In this case, we report a congenital laryngeal cyst on the lingual surface of the epiglottis in a female newborn that was successfully excised without any complications with an improvement in the patient's condition.…”