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An undulating vallecular cyst.

A vallecular cyst is an uncommon and generally benign lesion in the larynx. In adults, it is usually asymptomatic, but it can cause airway distress. Although most lesions are indolent, physicians should maintain full awareness of the potential occurrence of unanticipated catastrophic consequences in those rare cases in which such a cyst might enlarge and produce airway obstruction.

A 47-year-old man presented to our Otolaryngology Department complaining of a decade-long lump-in-the-throat sensation. His medical history was not remarkable. Diagnostic indirect laryngoscopy revealed a well-delineated cystic mass lying on the right vallecular fossa (figure, A). When we asked the patient to phonate, the mass shifted to the left side (figure, B). The tumor oscillated from side to side along the axis of the median glossoepiglottic fold.

The patient underwent an endoscopic total excision. Histopathology revealed a cystic structure composed of stratified squamous and columnar epithelium, with no lymphatic elements or oncocytic changes, compatible with a diagnosis of a ductal cyst. After surgical excision, the patient's symptom vanished. He had no recurrence over the next 27 months.

Vallecular cysts (VCs) account for approximately 10.5% of all laryngeal cysts. (1-3) VC has a higher occurrence in the fifth and sixth decades of life, with no sex predilection.13 There is no consensus on the genesis and development of VCs; a commonly accepted hypothesis is that the cyst is either an embryologic remnant or a consequence of ductal obstruction. (1-3)

In contrast to infantile VC--which is recognized as a distinct entity and often occurs with laryngomalacia, leading to choking during feeding, cyanotic spells, failure to thrive, and a feeling of airway obstruction--adult VC is usually asymptomatic. (4) Patients sometimes present with relapsing acute epiglottitis or an episode of epiglottic abscess. (5) The differential diagnosis includes hemangioma, lymphangioma, teratoma, thyroid ectopia and, thyroglossal duct cyst. Endoscopic excision and transoral laser marsupialization are effective treatments. (6) Repeated aspiration of the lesion represents a more conservative strategy, but it is often associated with a higher recurrence rate. (4,6)

Yu-Hsuan Lin, MD; Ming-Yee Lin, MD, PhD

From the Department of Otolaryngology, Head and Neck Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainen, Taiwan (Dr. Y.H. Lin); and the Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Dr. M.Y. Lin).

References

(1.) DeSanto LW, Devine KD, Weiland LH. Cysts of the larynx-classification. Laryngoscope 1970;80(1):145-76.

(2.) Forte V, Fuoco G, James A. A new classification system for congenital laryngeal cysts. Laryngoscope 2004;114(6): 1123-7.

(3.) Arens C, Glanz H, Kleinsasser O. Clinical and morphological aspects of laryngeal cysts. Eur Arch Otorhinolaryngol 1997; 254(9-10):430-6.

(4.) Tsai YT, Lee LA, Fang TJ, Li HY. Treatment of vallecular cysts in infants with and without coexisting laryngomalacia using endoscopic laser marsupialization: Fifteen-year experience at a single center. Int I Pediatr Otorhinolaryngol 2013;77(3):424-8.

(5.) Berger G, Averbuch E, Zilka K, et al. Adult vallecular cyst: Thirteen-year experience. Otolaryngol Head Neck Surg 2008; 138(3):321-7.

(6.) Su CY, Hsu JL. Transoral laser marsupialization of epiglottic cysts. Laryngoscope 2007;117(7):1153-4.

Caption: Figure. The laryngoscopic exam reveais a vallecular cyst attached to the median glossoepiglottic fold. The cyst flickers from side to side when the patient is asked to phonate and sniff repeatedly (A and B).
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Title Annotation:LARYNGOSCOPY CLINIC
Author:Lin, Yu-Hsuan; Lin, Ming-Yee
Publication:Ear, Nose and Throat Journal
Article Type:Case study
Date:Apr 1, 2018
Words:555
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