Gigant Laryngocele Airway Management

Abstract

A 69 years-old male presented at the emergency room with hoarseness, fever and a right-sided cervical mass. He had a previous history significant for cigarette smoking and chronic obstructive pulmonary disease. He used to be a glass-blower. The mass was already detected 10 years ago, but the patient neglected medical care at that point in time. It was noticed to suddenly increase its size over the last 15 days. He was admitted to the ward for observation. The computed tomography scan revealed a gigantic cyst (9.5 cm lateral x 7 cm anterior-posterior diameters) of air-density in close relation to the Morgagni ventricle, placed in the anatomic cervical areas II and III. It displaced the submaxilar gland anteriorly, the sterno-cleidomastoid muscle and carotid artery posteriorly and, very significantly, displaced laterally the larynx lumen, epiglottis and hyoid bone. The diagnosis was made for a giant laryngocele. Three days later the patient complained about sudden respiratory difficulty, cervical pain and difficulty to swallow. Thirty mL of air were obtained by ultrasound-guided percutaneous needle aspiration and a drain was left in place to avoid refilling of the space. The clinical picture improved significantly. He was scheduled for surgery ten days later. Direct endotracheal intubation was achieved at its first attempt, although with moderate difficulty due to having a Cormack-Lehane grade III, but no significant lateral displacement was noticed. A tracheostomy and cyst excision under general anesthesia was completed afterwards without problems.