Epiglottic Cyst Research Articles

Treatment of wide-based epiglottic cyst by microdebrider

Epiglottic cyst is not an unusual disease in the larynx. Although it is usually a benign lesion, airway problems may occur due to a large cyst. Surgical excision is usually the treatment of choice, with low recurrence. Because of the limited view and mobility of laryngoscopes, there is sometimes difficulty in the procedure of excision or marsupialization, especially in wide-based epiglottic cysts. The microdebrider has been widely used in treatment of otolaryngological diseases, and specialized blades were designed for laryngeal lesions. We report the use of a microdebrider for treatment of wide-based epiglottic cysts in six patients. The follow-up period ranged from five months to 62 months without recurrence. One hand-powered instrument provided a clear surgical field for precise removal of the cyst and synchronized suction, and increased mobility of the laryngoscope held in the other hand. In comparison to traditional microinstrumentation and carbon dioxide laser, the microdebrider offered a rapid and effective alternative in treatment of wide-based epiglottic cyst.

Endoscopic carbon dioxide laser procedure for an endogenous thyroglossal duct cyst

From 1940 to September 2008, 21 cases with TDCs extending into respiratory tract have been reported, often with misdiagnosis. There were only 10 cases by the end of 2006, but the number increased rapidly recently. To evaluate endoscopic carbon dioxide (CO 2) laser procedure for thyroglossal duct cyst (TDC) extending into respiratory tract, we reported an unusual case and performed a retrospective correlate review. A 3-year-old female patient with a TDC extending into respiratory tract, without any neck lumps, was previously misdiagnosed as an epiglottic cyst. An asymptomatic follow-up visit had been for 10 months after she had received endoscopic CO 2 laser procedure. To our best knowledge, endoscopic CO 2 laser procedure was administered for the first time for TDCs, though it had been a valid management of other benign lesions in respiratory tract. The endoscopic CO 2 laser procedure might be for TDC extending into respiratory tract. In order to increase awareness of this situation, we recommend that the novel concept of endogenous type should be considered to unify these TDCs extending into respiratory tract without projecting neck masses.

Laryngocele and epiglottic cyst as rare causes of obstructive sleep apnea

Upper airway pathologies have been reported to cause obstructive sleep apnea (OSA). We present two rare cases of OSA, one with laryngocele secondary to partial laryngectomy and the other with epiglottic cyst. In the management of cases with OSA symptoms, a detailed evaluation of upper airways, including endoscopic and radiological examinations as well as polysomnography, should be done.

入院加療を行った急性喉頭蓋炎１２２例

In a retrospective study of clinical acute epiglottitis findings, we reviewed cases of 122 subjects-85 men and 37 wemen from 17 to 90 years old (mean: 49.1)-hospitalized and treated between January 2003 and December 2008. Chief symptoms (individual cases had multiple symptoms) were sore throat in 121 (99.2%), dysphagia in 32 (26.2%), elevated fever in 30 (24.6%), and dyspnea in 17 (13.9%). Prior to hospitalization, 70.5% of patients had been to otorhinolaryngological clinics and 27.0% to internal medicine clinics. Laryngeal inspection using a flexible fiberscope was important for diagnosis. Based on epiglottis swelling, arytenoid and aryepiglottic fold, and the dyspnea grade, we divided patients into stage I, slight, stage II, moderate, and stage III, severe. Stage I epiglottitis cases number 61 (50.0%), stage II 43 (35.2%), and stage III 18 (14.8%). Time from symptom onset to hospital visit averaged 3.7 days in stages I and II and 2.6 days in stage III. Local complications were peritonsillitis or peritonsilar abscess in 9 (7.4%), whitish wound of the epiglottis in 9 (7.4%), and epiglottic cyst in 8 (6.6%). We administered antibiotics in 121 cases (99.2%), mainly flomoxef sodium (FMOX) and clindamycin (CLDM) and steroid in 110 cases (90.2%). Six stage III cases (4.9%) required emergency airway management, 5 tracheostomy, and 1 endotracheal intubation. Hospitalization was from 3 to 33 days, or an average of 6.9 days, specifically 6.0 days for stage I, 6.3 days for stage II, and 11.6 days for stage III. Recurrence was seen in 5 (4.1%) and prognosis was good with no deaths. Clinicians should keep each other mutually informed about clinical features of acute epiglottitis, especially those involving severe sore throat and/or dysphagia without severe local pharyngeal findings.

Difficult endotracheal intubation due to an undiagnosed epiglottic cyst :A case report.

An epiglottic cyst is a common form of laryngeal cysts which are rare causes of upper airway obstruction. A congenital laryngeal cyst always causes neonatal respiratory distress, but an acquired cyst shows very wide spectrum of symptoms such as no specific complaints, dysphagia, respiratory difficulty, or even death according to its size, location, or age. From anesthesiologists' point of view, an asymptomatic undiagnosed laryngeal cyst is a major concern. Unexpectedly, it can cause difficult airway such as 'cannnot intubate' or 'cannot intubate and cannot ventilate' situation during anesthesia. Recently we discovered an undiagnosed epiglottic cyst obscuring laryngeal inlet, leading to difficult intubation during general anesthesia for decompression and fusion of lumbar vertebrae. Fortunately, mask ventilation was possible, and after failed attempts of direct laryngoscopy, we could perform oral fiberoptic bronchoscope-aided intubation. He was discharged 10 days later with no harmful events.

咽喉頭・頸部病変に対する高周波スネアの利用

The electrocautery snare has been widely used in gastroenterology and to remove bronchial and urinary bladder lesions, but rarely in head and lesion electrocautery. Since October 2006, we have used this instrument to treat 17 head and neck granuloma, papilloma, cyst, and cancer lesions under local or general anesthesia. Lesions were localized in the larynx, oropharynx, hypopharynx, or tracheostoma. The snare was used through a rhinolaryngovideoscope in most cases with a current of 15-30 watts produced by an electrosurgical generator. All procedures were easy, quick and successful, with minimal bleeding. No severe adverse effects were seen in any of our cases. The electrocautery snare was extremely useful in treating pedunculated lesions and in removing epiglottic cysts with a clear margin after excision of the mass without bleeding. Our results indicate the electrocautery snare to be useful and safe in treating selected head and neck lesion cases.

Description of original endoscopic findings and respiratory functional assessment using barometric whole-body plethysmography in dogs suffering from brachycephalic airway obstruction syndrome

The clinical features of brachycephalic airway obstructive disease in 11 brachycephalic dogs are described in this study. The respiratory strategy was assessed before (n=11) and after (n=6) surgery using barometric whole-body plethysmography (BWBP), with the relationship between BWBP variables and the severity of the clinical signs assessed by the use of a respiratory score based on clinical, radiographic and endoscopic findings. Partial collapse of the left main bronchus was a common finding not previously described as part of the brachycephalic airway obstructive disease syndrome. Epiglottic cysts, laryngeal granulomas and nasopharyngeal turbinates in English Bulldogs were other previously unreported findings. No significant correlation between the respiratory score and any of the BWBP variables was detected. Compared to healthy dogs, brachycephalic dogs had a significantly lower Te/Ti ratio (expiratory time over inspiratory time), peak inspiratory flow (PIF) per kg bodyweight (BW), significantly higher peak expiratory flow (PEF) per kgBW, PEF/PIF, and enhanced pause. These variations are compatible with upper airway obstructions primarily in the extrathoracic airways. Following surgery, a significant decrease in PEF/PIF was detected. The study showed that BWBP could be used to characterise the respiratory strategy in brachycephalic dogs before and after surgery.

Epiglottic cyst in an infant

Epiglottic cyst is a rare cause of stridor and respiratory distress in newborns and infants. A 2-year-old girl was referred to our department for the treatment of an epiglottic cyst causing inspiratory stridor. Flexible fiberoptic laryngoscopy and a computed tomography (CT) scan revealed a cystic lesion on the lingual surface of the epiglottis. Frequent episodes of sleep apnea accompanied by desaturation had been observed during her sleep. Endoscopic deroofing was performed under general anesthesia. After the operation, stridor and sleep apnea disappeared.

B-042 Three case of epiglottic cyst(Oral Presentation Thoracic surgery,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

B-042 Three case of epiglottic cyst(Oral Presentation Thoracic surgery,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

Safe, complete resection of epiglottic cysts with phono-ultra-microsurgical technique

Generally, epiglottic cysts have been treated by the puncture technique or surgical resection. However, these techniques can result in accidental injury to the cyst wall. As a result, the contents of the cyst may spread throughout the larynx, trachea and pharyngeal cavity. The ideal treatment would involve complete resection without cyst perforation. We use a completely different approach for the resection of epiglottic cysts, with successful results, which we term the advanced phono-ultra-microsurgical technique. One difference between this method and previous techniques of surgical epiglottic cyst resection is that the cyst is sealed off before resection in order to prevent rupture and spread of its contents. To enable this, we have developed a special device to facilitate suturing of the vocal fold epithelium, utilising a knot-pusher. This suturing technique allows complete removal of epiglottic cysts. Our technique allows optimal prevention of cyst rupture and spread of contents.

Transoral Laser Marsupialization of Epiglottic Cysts

The objective of this study is to investigate the safety and effectiveness of laser marsupialization of epiglottic cysts via a transoral route. A prospective clinical series. Twenty-eight consecutive patients with epiglottic cyst underwent laser marsupialization of an epiglottic cyst via a transoral approach. Pre- and postoperative laryngoscopic examinations were carried out. A total of 28 patients were enrolled, including 19 males and 9 females, ranging in age from 38 to 69 years, with a mean age of 54 years. Among these patients, 23 had a lumpy throat, and the remaining 5 had a voice alternation. The diameters of the cysts ranged from 1 to 3 cm. No perioperative bleeding or airway swelling was noted in any patient. The postoperative follow-up period ranged from 4 to 41 (mean, 16) months. No recurrence was found during the follow-up examinations. Transoral laser marsupialization is a simple, safe, and effective method for treatment of epiglottic cysts. This procedure has the potential to serve as the treatment of choice in the management of this condition.

Anesthesia management in children of epiglottic cyst combined with dyspnea

Anesthesia management in children of epiglottic cyst combined with dyspnea

Congenital epiglottic cyst presenting with severe airway obstruction at birth

We report severe airway obstruction and distress at birth, in aterm newborn, caused by a congenital epiglottic cyst.Case reportA 3751 g female infant was born at 41 weeks to a 22-year-oldmother following an uneventful pregnancy. Antenatal ultrasoundscans at 18 and 22 weeks were reported normal. There wasevidence of respiratory distress and severe upper airway obstructionimmediately upon delivery. Direct laryngoscopy for intubationrevealed a white cystic mass in the oropharynx, obstructing thevisualization of the pharynx and, therefore, the glottis as well. Thepediatrician managed to move the mass out of the way, intubateorally and stabilize the airway. The infant was transferred to atertiary center for further management. Examination of the oralcavity revealed a white cystic mass filling the oropharynx.Transnasal fibro-optic laryngoscopy revealed the same but theexact site of origin could not be well delineated. Computedtomography (CT) was performed to rule out an intracranialconnection. The infant underwent surgery at 7 h of life.Examination of the oral cavity was undertaken in the operatingroom to try and establish exactly where the cyst attached andwhether it was broad based or on a stalk. This was difficult due tothe size of the cyst (Figure 1). The cyst was decompressed tofacilitate exposure and a revealed a viscous yellowish fluid. It wasestablished that the cyst was attached in a broad-based fashion tothe left lateral aspect of the epiglottis, into the vallecula, along thefree margin and lateral surface of the aryepiglottic fold and ontothe pharyngo-epiglottic fold.The covering of the cyst was then injected with 1% xylocainewith 1 in 200 000 epinephrine and deroofed. The sidewalls andbase of the cyst were dissected off of their respective underlyingstructures with microlaryngeal instruments utilizing high powermagnification of the microscope.The infant received broad-spectrum antibiotic coverage anddexamethasone in the perioperative period. Postoperative periodwas uneventful and the infant was successfully extubated after48 h. There was no evidence of upper airway obstruction or distresspostextubation and the infant was discharged home on day 4 oflife. At follow-up examination, 1 month postexcision, no evidenceof a recurrence was noted.Histological examination showed soft tissue lined by squamousepithelium, consistent with an epiglottic cyst.DiscussionCongenital laryngeal cysts are rare but may be fatal.

剖検例からの考察

This article presents the post-mortem findings of acute epiglottitis in adults. Acute epiglottitis is a serious disease because of its potential for sudden fatal obstruction in a previously healthy individual. We reported on a case of adult epiglottitis who could not be resuscitated. The patient had complained dyspnea. An upper airway obstruction occurred within an hour after an intravenous steroid injection. The patient underwent emergent tracheotomy. The patient died after 17days after the tracheotomy. The autopsy revealed that inflamed cells had infiltrated around an epiglottic cyst. This evidence indicated that an epiglottic cyst is one of the risk factors which can cause or make worse acute epiglottitis.

Postextubation Airway Obstruction and Negative-pressure Pulmonary Edema Due to a Laryngeal Cyst: A case report

Laryngeal cysts, including epiglottic cysts, are rare lesions which are clinically asymptomatic in many cases. Rarely laryngeal cysts cause unexpected airway management difficultties perioperatively. We report up on a case of laryngeal cyst that caused postextubation airway obstruction and negative-pressure pulmonary edema. A 25-year-old man was admitted for brain surgery with neurofibromatosis. He did not have any specific airway problem preoperatively, and anesthesia was done uneventfully. But when he was extubated after surgery, he revealed symptoms of upper airway obstruction in the recovery room. We reintubated him easily, and then we found a laryngeal cyst. Though negative-pressure pulmonary edema occurred after reintubation, he responded to conservative treatment and was discharged without specific problems. We present a review of postextubation airway obstruction and negative-pressure pulmonary edema due to a laryngeal cyst.

Second Branchial Cleft Anomaly Presenting as a Rudimentary Pinna in the Nasopharynx of a Newborn

We describe the case of a 4-day-old girl who presented with an epiglottic cyst that was later identified as a rudimentary pinna attached to the soft palate.

Airway Problems Related to Laryngeal Mask Airway Use Associated with an Undiagnosed Epiglottic Cyst

This report describes airway management difficulties in a patient with an asymptomatic and undiagnosed epiglottic cyst. Mask ventilation after induction of general anesthesia was uneventful. Insertion of an LMA resulted in inadequate ventilation. Fiberoptic intubation through an intubating LMA was impossible because the LMA pushed the cyst into the laryngeal inlet. Fibreoptic intubation, assisted by the use of a direct laryngoscope without the LMA was uneventful. Preoperative craniocervical scans performed for assessment of other conditions may reveal asymptomatic pathology in the airway.

喉頭蓋嚢胞と術前診断された血管腫例

We describe a rare case of epiglottic hemangioma in 71-year-old female with dyspnea and abnormal sensation of the larynx. There was no associated history of hemoptysis. The lingual surface of the epiglottis was occupied by a whitish pink mass with a smooth surface. The preoperative diagnosis was an epiglottic cyst. Intraoperative direct laryngoscopy demonstrated that the mass arose from the right edge of the epiglottis. The tumor was resected by YAG laser with a blood loss of 350ml, mainly originating from the feeding artery of the mass. However, bleeding was well controlled with electrocoagulation. The pathological diagnosis was venous hemangioma

Difficult Endotracheal Intubation Due to an Asymptomatic Epiglottic Cyst

Airway problems are easiest to manage when they are anticipated. Difficult intubation might, however, occur in patients with no obvious signs or symptoms suggesting airway obstruction. We describe a case of difficult intubation where the laryngeal inlet was obscured by a large epiglottic cyst that was discovered during rapid-sequence induction of general anesthesia. A 3-year-old male weighing 15㎏ was admitted for an emergency appendectomy. After preoxygenation, a rapid-sequence induction was carried out. Direct laryngoscopy (Macintosh # 1 blade) revealed a large 2-㎝ cyst arising from the lingual surface of the epiglottis. The cyst completely obstructed the view of the epiglottis and larynx, and several attempts at endotracheal intubation were unsuccessful. Fortunately, the patient was mask ventilated without difficulty and oxygen saturation was 98 - 99%. After a second 10㎎ dose of succinylcholine, intubation was attempted using the same laryngoscope blade and a styletted 4.5㎜ endotracheal tube by another anesthesiologist as cricoid pressure was maintained. By using the tube to push the cyst upward, intubation of the trachea was performed after a brief view of the arytenoid cartilages. Anesthesia and the operation then proceeded uneventfully. Following an appendectomy, an ENT surgeon removed the cyst. (Korean J Anesthesiol 2002; 42: 685-689)

Unanticipated Difficult Intubation in a Patient with an Asymptomatic Epiglottic Cyst

Unanticipated Difficult Intubation in a Patient with an Asymptomatic Epiglottic Cyst