Pharyngoceles: Photo‐Anatomic Study and Novel Management

Abstract

Objective: Pharyngoceles are outpouchings of the lateral pharyngeal wall through the thyrohyoid membrane. They are often noted as incidental findings on pharyngoesophageal imaging studies and are rarely symptomatic. Open surgical repair has been the mainstay of treatment for symptomatic pharyngoceles, save 2 reports of stapling which lack detailed anatomical description. Method: A systematic review was conducted to identify papers presenting cases of pharyngoceles. Articles were examined specifically for anatomic discussions, figures delineating the anatomy, and management strategies. To this data, we add 2 cases of bilateral symptomatic pharyngoceles with full multimedia documentation, including one treated successfully with a novel endoscopic suture-pharyngoplasty. Results: Thirty papers were identified which described 49 cases of pharyngoceles, for a total of 51 with our cases. The anatomic boundaries of the pharyngocele space are the hyoid bone, thyroid cartilage, and thyrohyoid ligament with close involvement of the superior laryngeal nerve. Both unilateral and bilateral pharyngoceles have been reported, presenting with a variety of symptoms including dysphagia, globus, and neck-swelling. One reported case of bilateral pharyngoceles was asymptomatic. Of those patients symptomatic enough to require surgery, all endorsed resolution of symptoms postoperatively. Both of our patients had complete resolution of symptoms, as determined by interview and oropharyngeal motility study. Conclusion: Relatively few true pharyngoceles have been reported in the literature. We offer the first detailed endoscopic anatomic description of pharyngoceles and a novel technique of endoscopic suture pharyngoplasty, as well as a formal evaluation of swallowing outcomes postoperatively. These lesions may be amenable to endoscopic repair with minimal morbidity.