Congenital Vallecular Cyst Research Articles

Surgical approach to congenital vallecular cyst with concomitant laryngomalacia

Surgical approach to congenital vallecular cyst with concomitant laryngomalacia

Two Cases of Laryngomalacia With Congenital Vallecular Cyst Treated by Supraglottoplasty

Vallecular cyst consisted of a unilocular cystic mass of variable size arising from the lingual surface of the epiglottis and containing clear fluid is a rare occurrence in children. Although a cyst is benign, it may cause serious airway obstruction and even death if not treated appropriately. Also, laryngomalacia is the most common congenital anomaly that causes inspiratory stridor and airway obstruction in the newborn. Symptoms typically begin to appear at around 2 to 3 weeks of age and become worse between 4 and 8 months. With a review of literature, we report two cases of vallecular cyst with symptomatic laryngomalacia in a 1-month-old female and a 2-month-old male. Both patients experienced symptom relief after undergoing endoscopic supraglottoplasty.

Diagnosis and management of congenital vallecular cyst: An institutional experience

Objectives: This study aims to evaluate the clinical presentation, diagnosis, and management of infants with a congenital vallecular cyst (VC). Patients and Methods: Four infants (2 males, 2 females; mean age: 45±17 days; range, 28 to 63 days) who were operated or followed for a congenital VC were retrospectively analyzed between January 2016 and March 2020. Data including patient demographics, major symptoms (cyanosis, inspiratory stridor, suprasternal retraction, difficulty feeding), diagnostic methods, type of coexisting anomalies, surgical procedures, and length of follow-up and recurrence were recorded. Results: All patients presented with varying degrees of respiratory symptoms including inspiratory stridor and suprasternal retraction. The diagnosis was made based on awake flexible fiberoptic laryngoscopy (FFL) in all four infants. Two patients were treated with endoscopic cyst excision. One case underwent endoscopic cyst excision and supraglottoplasty, while the other was followed without surgery. All surgeries were successful, as none of the patients experienced recurrence. Conclusion: Although congenital VCs are extremely rare, they should be considered among the differential diagnosis of congenital stridor. A detailed examination with FFL should be performed for diagnosis. Based on our findings, transoral endoscopic excision of VCs is a safe, effective, and feasible procedure as a surgical treatment to prevent recurrence. 

Vallecular cyst in the pediatric population: Evaluation and management

ObjectiveTo review the presentation of pediatric vallecular cysts and outline an approach for evaluation and management. MethodsMedical records of patients diagnosed with vallecular cyst between 2005 and 2017 were reviewed. Data on demographics, clinical characteristics, diagnostic methods, surgical procedures, and outcomes were collected and analyzed. A comprehensive literature search for pediatric cases of vallecular cyst was conducted for comparative analysis. ResultsTwenty patients underwent surgery for congenital vallecular cysts during the study period. Age at diagnosis ranged from birth to 8 years (median age = 1.1 years). The most common preoperative symptom was inspiratory stridor (45%) followed by feeding difficulties (40%). Eight patients (40%) initially presented with laryngomalacia and 7 (35%) with feeding difficulties. Imaging was obtained in 16 patients and consisted of plain films, ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). Marsupialization of the cyst was performed in all 20 patients. Three patients (15%) presented with recurrence. ConclusionVallecular cysts can cause feeding difficulties due to upper airway obstruction and pressure at the laryngeal inlet. Diagnostic work-up for vallecular cysts should include a detailed medical history, complete head and neck examination including endoscopic examination, and appropriate imaging, as each of these components complements the histopathologic findings. Our findings indicate that performing marsupialization is associated with low rate of recurrence or complication.

Endoscopic Assisted Coblation of Congenital Vallecular Cyst – A Novel Technique

To the Editor: Congenital laryngeal cysts are a rare entity and are potentially dangerous because of inspiratory stridor in newborns. They comprise about 5 % of benign laryngeal lesions [1, 2]. We present a technique utilizing Coblation technology, which results in bloodless dissection and no risk of airway fire. We use a 0° 4 mm nasal endoscope, Mckintosh and Coblator (Smith & Nephew, USA) for this procedure. A 4 mm nasal endoscope is inserted into the oral cavity visualizing the vallecular cyst (Fig. 1a). The surgeon introduces the Procise max Coblat ion (Fig. 1b) wand into the oral cavity. Coblation of the cyst is undertaken and excision is carried onto the base making sure to remove the lining completely (Fig. 1c and d). We did not use any postoperative steroids since there is no edema due to the low temperatures of this method. We have done two cases utilizing this technique. The first patient was an 8-wk-old child who had presented to the Pediatric emergency with noisy breathing since birth and difficulty in breathing since last 2 wk. Child also had difficulty in feeding since 2 wk. CT Scan of the child showed a cyst like structure in the valleculae, which was confirmed on laryngoscopy. The second child was 10-wk-old who presented with stridor and difficulty in feeding since 10 d. Direct laryngoscopic examination showed it to be a vallecular cyst, which was confirmed on imaging. None of the children have shown any recurrence 3 mo post operatively and are on regular follow up. The annual incidence of vallecular cysts shows a variation among many studies; from 5.3 cases per 100,000 live births to 1.87 and 3.49 cases per 1 0 0 , 0 0 0 l i v e b i r t h s [ 3 , 4 ] . A f i b e r o p t i c nasopharyngoscope is a great tool for diagnosis in children. Vallecular cysts develop either as an embryological malformation or as a consequence of ductal obstruction of mucus glands. Coblation means COntrolled aBLATION. It creates a controlled, plasma field to precisely remove tissue at a low temperature, resulting in minimal thermal damage to surrounding soft tissues and structures. Temperatures are between 40 °C and 70 °C with thermal penetration of less than 1100 μm. Endoscopic assisted coblation of congenital vallecular cyst is a safe procedure. It is quick, precise and bloodless. There is no edema or charring post operatively. * Ramandeep Singh Virk virkdoc@hotmail.com

Upper Airway Obstruction in a Newborn with Vallecular Cyst

Vallecular cyst is a rare cause of stridor in neonates, which may present as a life threatening airway obstruction. Here, we report a preterm infant with a congenital vallecular cyst who presented with stridor and respiratory distress that developed immediately after birth. She was successfully treated with endoscopic marsupialization.

Congenital Vallecular Cyst Causing Airway Compromise in a 2-Month-Old Girl.

Congenital vallecular cyst is a rare entity and may present with acute airway obstruction. This is a case of congenital vallecular cyst presenting with airway compromise requiring immediate management. The epidemiology, pathogenesis, and clinical presentation of vallecular cysts are discussed as well as the diagnosis and management.

Congenital Vallecular Cyst in an Infant

Congenital Vallecular Cyst in an Infant

Application of electric coagulation treatment via bronchoscopy in the management of congenital vallecular cyst in children

To discuss the effect of electric coagulation through bronchoscopy in diagnosis and treatment of congenital vallecular cyst in children. Ten cases of congenital vallecular cyst in the study with age ranged from 21 days to 4 years and 10 months were treated with electric coagulation through bronchoscopy. The therapeutic effect was evaluated by endoscopic and clinical manifestation. And all the patients were followed-up for 6-12 months. All the patients obtained 3-5 times electric coagulation. After the operation, the cyst decreased in size, epiglottis softening was subsided, uplift uncompression, dyspnea and laryngeal stridor were improved obviously. After follow-up periods of 6-12 months, no capsule wall were left, and the activity of the epiglottis resumed.No severe complication was found in any patient. Electric coagulation through bronchoscopy is a simple, effective and safe method to treat congenital vallecular cyst in children.

Treatment of vallecular cysts in infants with and without coexisting laryngomalacia using endoscopic laser marsupialization: Fifteen-year experience at a single-center

ObjectiveTo share our experience in treating a large cohort of infants with congenital vallecular cysts using endoscopic laser marsupialization. We describe the clinical characteristics of infants with pediatric vallecular cysts and compare these characteristics between infants with and without concurrent laryngomalacia and those who did or did not require preoperative airway support. MethodsMedical records of infants treated for vallecular cyst at Chang Gung Memorial Hospital between March 1994 and July 2008 were reviewed. Demographic and clinical characteristics and outcomes were recorded and compared. ResultsTwenty-eight infants were included in our study: 11 (39.3%) males and 17 (60.7%) females. The incidence of vallecular cyst was 5.3 cases/100,000 live births. Median ages at symptom onset and diagnosis were 3.0 and 40.0 days, respectively. Mean symptom onset to diagnosis interval was 42.4 days. Eighteen (64.3%) infants had coexisting laryngomalacia and 11 (39.3%) required ventilatory support. The number of symptoms decreased in all patients after surgery (median no. symptoms before=4.5, after=0.5) and most symptoms were completely resolved within 3 months of surgery. Compared with infants who did not have laryngomalacia, infants with laryngomalacia: were younger at symptom onset (2 vs 10 days); had more symptoms before (5.0 vs 3.5) and after treatment (1.0 vs 0.0); had a longer length of hospital (14.6 vs 9.4 days) stay; and more commonly required airway intervention compared with infants without laryngomalacia (55.6% vs 10.0%: all P<0.05). Compared with infants who did not require ventilatory support, those that did: had a shorter interval between symptom onset and diagnosis (31.8 vs 49.3 days); were younger at the age of diagnosis (38.0 vs 49.0 days); had more symptoms before surgery (5.0 vs 4.0); had a higher prevalence of laryngomalacia (90.9% vs 47.1%); had a longer length of hospital (16.4 vs 10.4 days) stay (all P<0.05). ConclusionsOur study included a large number of infants with vallecular cyst who were treated with endoscopic laser marsupialization. Of note, we found that a large proportion of infants had coexisting laryngomalacia, which appears to complicate the clinical presentation and management of vallecular cyst.

Radiofrequency ablation of pediatric vallecular cysts

ObjectivePediatric congenital vallecular cysts are an infrequent cause of infantile airway obstruction that can cause difficulty breathing or feeding, and lead to failure to thrive or death. There have been many different techniques proposed for effective treatment. We present three cases of congenital vallecular cyst, all excised utilizing a bipolar radiofrequency plasma ablation (RFA) device. The bipolar RFA device provides excellent hemostasis without the risk of airway fire. We offer a review of literature and a discussion of the potential advantages of this modality in treating neonatal/infantile vallecular cysts. MethodsRetrospective case series of three infants all between 2 and 3 months old who presented with failure to thrive due to partially obstructive vallecular cysts. The cysts were removed surgically utilizing a bipolar RFA device. Patients were followed by complications and signs of recurrence for periods ranging from 9 to 20months. ResultsAll cysts were excised completely in a single operation. All children are feeding well and without stridor or evidence of recurrence between 9 and 20 months postoperatively. ConclusionsRFA appears to be an effective and safe modality for removing vallecular cysts. We were able to demonstrate complete removal of lesions in our patients. This provides an alternative to other ablative modalities in treating cystic lesions of the vallecula and larynx.

Congenital vallecular cyst in an infant: case report and review of 52 recent cases

Vallecular cyst is uncommon in infants. We treated a female infant with vallecular cyst, and curious magnetic resonance imaging findings. We also review 51 other cases of vallecular cyst in infants reported over the past 23 years. A three-month-old female infant presented with congenital inspiratory stridor and failure to thrive. Flexible laryngoscopy and ultrasonography revealed a cystic mass in the vallecula. Magnetic resonance imaging findings were initially curious because of artefacts from breathing and swallowing. Marsupialisation of the cyst was performed. Post-operatively, the patient was immediately free of symptoms. Magnetic resonance imaging presents various difficulties in infants, but has the best diagnostic effectiveness. We recommend the use of magnetic resonance imaging, flexible fibroscopy and ultrasonography to enable extensive examination of suspected vallecular cysts in infants. Marsupialisation has a recurrence rate of only one in 39 cases, and its safety and effectiveness are well balanced. Thus, prompt marsupialisation of vallecular cyst is the recommended surgical procedure.

Congenital vallecular cyst with laryngomalacia: A report of two cases

Vallecular cyst in an infant is uncommon, and it finds infrequent mention in the literature as well. However when present, it accounts for severe inspiratory stridor, causing airway compromise, and sometimes even death. Laryngomalacia is the commonest congenital anomaly of the larynx, which is present after birth giving rise to inspiratory stridor. Laryngomalacia results as a collapse of supraglottic structures of the larynx. Clinical co-presentation of vallecular cyst and laryngomalacia is very rare. This is a report of two cases of 2-month-old infants who presented with the history of noisy breathing and refusal to feeds since 10-15 days. CT scan of the neck revealed a huge cyst in the vallecula compromising the airway. Microlaryngoscopic-guided aspiration and marsupilization of the cyst was done using CO 2 laser and the release of aryepiglottic fold was done using microlaryngeal scissors. Respiratory and feeding problems dramatically improved in these patients by immediate surgical intervention.

Two Cases of Congenital Vallecular Cyst with Respiratory Distress and Feeding Problems in Young Infant

Congenital vallecular cyst (VC) is a rare cause of stridor and respiratory distress in neonates and infants. Due to the anatomical location of the cyst, an infant with a VC is at risk of lifethreatening upper airway obstruction and eventual death. The cyst sits in the vallecular space and can cause significant retroflexion of the epiglottis. It may also present with feeding prob lems resulting in failure to grow. Endoscopic laryngoscopy is necessary to visualize it and marsupialization of the cyst is the preferred treatment. We present 2 successfully treated cases of congenital VC in young infants with symptoms of upper respiratory obstruction and feeding problems.� Korean J Otorhinolaryngol-Head Neck Surg 2011;54:646-9

Endoscopic treatment of vallecular cyst in newborn

Summary Congenital vallecular cyst is a rare disease in neonates and infants. Even though benign in nature, it owns a high potential morbidity and mortality. Stridor, dyspnea, feeding difficulties, coughing, voice changes, failure to thrive are the most common symptoms. The authors report a case of a 4-month-old infant who presented with a failure to thrive and respiratory distress due to a congenital vallecular cyst. Marsupialization was performed with total symptoms resolution.

A case of congenital vallecular cyst associated with gastroesophageal reflux presenting with stridor, feeding cyanosis, and failure to thrive

= Abstract = Vallecular cyst is an uncommon but potentially dangerous condition causing stridor and has been associated with sudden airway obstruction resulting in death due to its anatomical location in neonates. It may also present with various degrees of feeding problems resulting in failure to thrive. When a vallecular cyst is suspected clinically, endoscopic laryngoscopy is necessary to visualize it. Other conditions leading to neonatal stridor such as laryngomalacia and other laryngotracheal abnor- malities should be ruled out. Marsupialization with a CO 2 laser is the most effective and safest treatment to pre vent recurrence. We report a case of a 1-month-old male infant with a vallecular cyst synchronous with gastroesophageal reflux, and failure to thrive. He was referred to our hospital because of hoarseness, inspiratory stridor, feeding-cyanosis, chest retraction and failure to thrive. Diagnostic workup revealed a cyst at the tongue base, suggesting a vallecular cyst. The cyst was removed by laryngomicrosurgery with CO 2 laser. After the surgery, the symptoms improved and the body weight increased steadily. We report a successfully treated case of neonatal vallecular cyst with symptoms of upper respiratory obstruction, gastroesophageal reflux, and failure to thrive. (Korean J Pediatr 2008;51:775-779)

Vallecular cyst: a cause of failure to thrive in an infant

Congenital vallecular cyst is fairly uncommon in neonates and infants. Although benign in nature, it may cause stridor and even life-threatening airway obstruction in early infancy. A 3-month-old male baby presented with failure to thrive and respiratory distress was found to have a vallecular cyst. Marsupialization with CO 2 laser was performed.

CONGENITAL VALLECULAR CYST: A CAUSE OF FAILURE TO THRIVE

SUMMARY Congenital vallecular cysts are fairly uncommon, but can lead to death. They may present as failure to thrive. This case emphasises the value of plain radiographs of the neck. Direct laryngoscopy is mandatory to confirm diagnosis and ablate the lesion satisfactorily. Laryngomalacia should be a diagnosis of exclusion. Adequate marsupialisation is necessary to prevent recurrence.