Life-threatening vallecular cyst in a 3-month-old infant: case report and literature review

Aspiration Avoiding Tracheostomy in Neonatal Cystic Oral Lesion

Oral cyst is uncommon in the neonatal period. Depending on the size and site of occurrence, its symptoms may vary. If not diagnosed and managed expeditiously, these oral cysts may cause significant and potentially fatal morbidity and mortality. We report a successfully managed case of oral cyst in neonate that presented with huge tongue at birth and complaints of impending airway obstruction. She was referred for tracheostomy as intubation was impossible. We attempted needle aspiration and the airway successfully relieved without the need for tracheostomy.

Vallecular cyst in neonates: case series-a clinicosurgical insight

The objective of the case series is to understand the clinical and surgical aspects of new minimally invasive technique of coblation in cases of vallecular cysts in neonates. Method of Study. Four neonates underwent surgery for vallecular cyst by using Arthrocare ENT coblator system. Results Obtained. All the four cases presented in stridor and difficult intubation was also a concern which necessitated a swift, high precision instrument with almost immediate results. Coblation excision includes direct contact with vallecular cyst, improved targeting of the cyst, and preservation of normal tissue. All the four cases had an uneventful postoperative period and smooth recovery and had an early discharge from the hospital. Conclusions. Early diagnosis and intervention hold the key for an early recovery and for minimizing nutritional disturbances secondary to poor feeding in cases of neonatal vallecular cysts.

Clinical effect analysis of microscopic surgery for epiglottis cysts with coblation

This study aims to explore the effects and advantages of coblation combined with microscopy to treat epiglottis cysts. Ninety patients with epiglottis cysts were randomly assigned to three groups: the first group: marsupialisation + electric coagulation group, n = 30; the second group: marsupialisation + coblation, n = 30; and the third group: marsupialisation + coblation + microsurgery, n = 30. To compare the cure rate, intraoperative bleeding volume, postoperative pain, operation time and postoperative complications were investigated among these three groups. The comparison among three procedures showed a significant difference for intraoperative bleeding volume, operation time and postoperative pain (P < 0.05), whereas no significant difference was observed for cure rate (P > 0.05). These three procedures are effective in treating epiglottis cysts. Microscopic surgery with coblation has the advantages of less bleeding, short procedure duration, less pain and few complications. Thus, microscopic surgery is worthy of clinical application.

An Unusual Presentation of Vallecular Cyst with near Fatal Respiratory Distress and Management Using Conventional Laparoscopic Instruments

Vallecular cyst is a rare cause of upper airway obstruction in infants and children and presentation like acute stridor with near fatal respiratory distress is extremely rare. It is one of the rare causes of difficult intubation, during which cyst aspiration can improve the access. Vallecular cyst is commonly managed using microlaryngoscope and specialized instruments. We hereby report a method of endoscopic management of these cysts using conventional laparoscopic instruments.

Congenital tongue base cyst presenting with laryngeal stridor in youth: a case report

Introduction. Tongue base cyst is an uncommon but potentially dangerous cause of stridor in neonates and infants. Case Presentation. We report a case of a 2-month-old Arabic male infant with a congenital tongue base cyst revealed by inspiratory stridor and recurrent respiratory distress. Diagnosis of cyst was suspected at endoscopy and confirmed by MRI imaging. The cyst was marsupialized with CO₂ laser. One year later, the child remains asymptomatic without recurrence of the mass. Conclusion. Tongue base cysts should be considered in differential diagnosis in new borns with stridor, respiratory difficulties, or swallowing problems. Definitive therapy requires large marsupialization under general anesthesia.

[Congenital laryngeal cyst: an uncommon cause of stridor in neonates]

Laryngeal cyst is a rare but generally benign lesion in the larynx. It may cause stridor and life-threatening airway obstruction in early infancy. We report the case of a neonate who developed respiratory distress 24h after birth in relation with materno-fetal infection. Airway obstruction was then suspected because of stridor. A laryngeal mass was discovered at the time of intubation. The infant experienced a nosocomial infection and died on day 14 of life before any surgical treatment. Autopsy concluded in an epiglottic congenital laryngeal cyst.

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

OBJECTIVES

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.

CASE REPORT

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.

CONCLUSION

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.

Update on endoscopic management of lingual thyroglossal duct cysts

OBJECTIVES/HYPOTHESIS

Thyroglossal duct cysts (TGDC) are uncommon congenital midline neck masses arising from tubal remnants of embryologic thyroid descent. A rare variant of TGDC can present in the central tongue base and is named lingual TGDC (LTGDC). Left untreated, LTGDC may present with life-threatening airway obstruction. TGDC require surgery for cure; however, the surgical approach to LTGDC has not been discussed fully. This study was designed to examine the incidence, clinical features, and surgical management of LTGDC.

STUDY DESIGN

Retrospective chart review.

METHODS

Retrospective chart review of patients from a pediatric tertiary care institution diagnosed with lingual TGDC from 1997 to 2008.

RESULTS

One hundred eighty-nine patients underwent surgical excision of TGDC, of which 16 (8.5%; mean age, 3 years) presented with lingual TGDC alone. Most lingual TGDC were discovered incidentally, although seven patients (44%) presented with moderate to severe upper airway obstruction. Endoscopic transoral excision was performed in each case. This included suspension laryngoscopy with electrocautery, electrocautery, and cold dissection, or a combination of microdebridement and electrocautery. Most patients were intubated electively overnight for airway protection. All patients recovered without complication and have shown no evidence of recurrence (median follow-up, 3.7 years). Two LTGDC cases were revisions of prior surgeries (marsupialization and an open procedure) performed at outside hospitals.

CONCLUSIONS

Although rare, LTGDC frequently present as a prominent tongue base mass with the potential of life-threatening airway obstruction. Herein we described the typical presentation, workup, and ideal surgical approach of these lesions. Complete surgical extirpation can be performed successfully with endoscopic techniques and minimal risk of complication or recurrence.