A Rare Presentation of Congenital Aryepiglottic Cyst With Concurrent Laryngomalacia

Yi Wee Lim,Suzina Sheikh Ab Hamid,Azliana Aziz,Hazama Mohamad

doi:10.51407/mjpch.v28i1.147

Yi Wee Lim, Suzina Sheikh Ab Hamid + Show 2 more

Open Access

https://doi.org/10.51407/mjpch.v28i1.147

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Abstract

Congenital laryngeal cyst remains a rare but possible cause of airway obstruction that requires urgent referral to an otorhinolaryngology centre. Vallecular cyst commonly present immediately after birth with variable degree of airway obstruction symptoms depending on its size, but presentation of aryepiglottic cyst with concurrent laryngomalacia remains a conundrum as there are very few cases reported. Unlike the more obvious manifestation of stridor or increasing respiratory effort in most supraglottic cyst or laryngomalacia, the neonate presented only with weak cry which masqueraded early suspicion and referral of an airway pathology. We provide discussion on the rare clinical presentation aryepiglottic cyst with synchronous laryngomalacia and its management.

Highlights

Laryngeal cyst is a congenital cause of stridor in the months after the initial surgery
The location of laryngeal cyst presenting at the aryepiglottic fold in our case is rare since majority of laryngeal cyst arises at the vallecula and the saccule of ventricle while only 2.2% are found at the aryepiglottic fold [2]
Synchronous presentation of aryepiglottic cyst with laryngomalacia is extremely rare with only few cases ever reported [3,4] and this coexistence causes increasing upper airway obstruction which severity was masqueraded by a soft and weak cry

Summary

Introduction

Laryngeal cyst is a congenital cause of stridor in the months after the initial surgery. The manifestation of a supraglottic cyst at the aryepiglottic fold with flexible laryngoscopy showed recurrent swelling at the previous aryepiglottic cyst site. She had a strenuous and weak cry with intermittent soft inspiratory stridor while crying without apparent hoarseness. A bedside flexible laryngoscopy was performed initially reviewing the presence of a supraglottic cyst with significant obstruction to the laryngeal inlet. 2 months after surgery, the child developed recurrent symptoms of weak cry. This time, there was no noisy breathing and no interrupted feeding. A repeated bedside flexible laryngoscopy revealed a recurrent swelling at the same site of the previous aryepiglottic cyst. Histological examination showed soft tissue lined by squamous epithelium, consistent with a cyst

Discussion

Conclusion