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Congenital Vallecular Cyst in an Infant
Acta Otorrinolaringol Esp. 2015;66(1):59---60
www.elsevier.es/otorrino
IMAGES IN OTORHINOLARYNGOLOGY
Congenital Vallecular Cyst in an Infant夽 Quiste de vallécula congénito en un lactante Hugo Rodríguez, Giselle Cuestas,∗ Verónica Solernou Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
Two-month-old female patient brought to Endoscopy Service for consultation due to inspiratory stridor present since birth, swallowing disorder and increasingly difficult respiration. Cervical X-ray in profile revealed a mass at the base of the tongue (Fig. 1A); fibreoptic laryngoscopy showed a round mass that caused posterior prolapse of the epiglottis. A cervical sonogram was performed and thyroid function was assessed, ruling out the possibility of lingual thyroid. Direct laryngoscopy was performed under general anaesthesia (Fig. 1B), as well as diagnostic transoral puncture, after orotracheal intubation to ensure the airway; a
Figure 1
gelatinous fluid was seen from the puncture. The cyst was completely resected using a CO2 laser under microscopic control (Fig. 2A). The patient was extubated in the operating theatre, fed orally within 24 h and given postoperative treatment with antibiotics and corticoids. Pathology reported that the wall of the cyst was lined with stratified pavement epithelium, without cellular atypia, confirming the diagnosis of epithelial-type laryngeal cyst (Fig. 2B). There were no complications. The patient remained asymptomatic at the 6-month follow-up.
(A) Profile cervical X-ray showing cystic image (arrow). (B) Endoscopic image of the vallecular cyst.
夽 Please cite this article as: Rodríguez H, Cuestas G, Solernou V. Quiste de vallécula congénito en un lactante. Acta Otorrinolaringol Esp. 2015;66:59---60. ∗ Corresponding author. E-mail address: giselle [email protected] (G. Cuestas).
2173-5735/$ – see front matter © 2013 Elsevier Espa˜ na, S.L.U. and Sociedad Espa˜ nola de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.
60
H. Rodríguez et al.
Figure 2
(A) Endoscopic image after removal of the cyst. (B) Histopathology. Stratified epithelium lining the cyst lumen.
Duct cysts represent 75% of congenital laryngeal cysts. They arise from the obstruction of the submucosal gland ducts and are mainly found in the vallecula. Although congenital vallecular cysts are rare, they should be
included in differential diagnosis of stridor and progressive obstruction of the airway in newborns and infants. Marsupialization is rarely sufficient; complete removal of the cyst wall is necessary to prevent relapse.
www.elsevier.es/otorrino
IMAGES IN OTORHINOLARYNGOLOGY
Congenital Vallecular Cyst in an Infant夽 Quiste de vallécula congénito en un lactante Hugo Rodríguez, Giselle Cuestas,∗ Verónica Solernou Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
Two-month-old female patient brought to Endoscopy Service for consultation due to inspiratory stridor present since birth, swallowing disorder and increasingly difficult respiration. Cervical X-ray in profile revealed a mass at the base of the tongue (Fig. 1A); fibreoptic laryngoscopy showed a round mass that caused posterior prolapse of the epiglottis. A cervical sonogram was performed and thyroid function was assessed, ruling out the possibility of lingual thyroid. Direct laryngoscopy was performed under general anaesthesia (Fig. 1B), as well as diagnostic transoral puncture, after orotracheal intubation to ensure the airway; a
Figure 1
gelatinous fluid was seen from the puncture. The cyst was completely resected using a CO2 laser under microscopic control (Fig. 2A). The patient was extubated in the operating theatre, fed orally within 24 h and given postoperative treatment with antibiotics and corticoids. Pathology reported that the wall of the cyst was lined with stratified pavement epithelium, without cellular atypia, confirming the diagnosis of epithelial-type laryngeal cyst (Fig. 2B). There were no complications. The patient remained asymptomatic at the 6-month follow-up.
(A) Profile cervical X-ray showing cystic image (arrow). (B) Endoscopic image of the vallecular cyst.
夽 Please cite this article as: Rodríguez H, Cuestas G, Solernou V. Quiste de vallécula congénito en un lactante. Acta Otorrinolaringol Esp. 2015;66:59---60. ∗ Corresponding author. E-mail address: giselle [email protected] (G. Cuestas).
2173-5735/$ – see front matter © 2013 Elsevier Espa˜ na, S.L.U. and Sociedad Espa˜ nola de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.
60
H. Rodríguez et al.
Figure 2
(A) Endoscopic image after removal of the cyst. (B) Histopathology. Stratified epithelium lining the cyst lumen.
Duct cysts represent 75% of congenital laryngeal cysts. They arise from the obstruction of the submucosal gland ducts and are mainly found in the vallecula. Although congenital vallecular cysts are rare, they should be
included in differential diagnosis of stridor and progressive obstruction of the airway in newborns and infants. Marsupialization is rarely sufficient; complete removal of the cyst wall is necessary to prevent relapse.