Congenital saccular cyst of the larynx: a rare cause of stridor in a newborn infant

Congenital saccular cyst of the larynx is a rare cause of presentation of stridor and respiratory distress in newborns. The clinical presentation of a saccular laryngeal cyst often overlaps with other common causes of stridor, such as laryngomalacia, presenting a diagnostic dilemma for clinicians. We present a case of a term newborn infant referred for evaluation of inspiratory stridor since birth. Microlaryngoscopy and bronchoscopy confirmed the presence of a large cystic mass obstructing the supraglottis. Marsupialisation of the cyst was performed with resolution of stridor, and histopathological examination confirmed the diagnosis of a saccular laryngeal cyst. Our case highlights the importance of considering congenital saccular laryngeal cysts, although rare, in the differential diagnoses of neonatal stridor. Prompt recognition, early endoscopic airway evaluation and surgical intervention are crucial to preventing potentially life-threatening airway obstruction in a newborn presenting with stridor.

A Retrospective Study of Glottic Cyst Histopathology and Its Clinical Presentation

To understand the frequency and clinical presentation of the four types of vocal-fold cyst described by the Koren classification. Glottic cysts operated in a 1-year period were grouped retrospectively into Koren A, B, C and D (KA, KB, KC, KD). The age and sex of the patient, cyst location, laterality, associated lesions, profession, daily water consumption, duration of symptoms prior to surgery and postoperative healing time were noted. Of 30 cysts, 14 KA, 10 KB, 4 KC and 2 KD were identified. Average age of symptoms in KA to KD was 45, 52, 40 and 37 years. KC and KD were found only in females unlike the male predominance of KA and KB. Striking zone was the location of 28/30 cysts with a focal pit in 1 KC and mucosal bridge in 1 KD. There was no significance to laterality or profession. Average daily water consumption was 1.8, 1.75, 2 and 2 L in KA to KD. Average duration of symptoms up-till surgery for KA to KD was 2.6 years, 1.4 years, 2.9 years and 1 month. Post-operative healing time for KA to KD was 6.6, 7.4, 11.7 and 10 weeks. KA was the commonest cyst excised followed by KB, KC and KD. The KD patients were earliest and youngest to present. All KC and KD cysts were found in females unlike the male predominance of KA and KB. As majority of the cysts were found on the striking zone, phonotrauma may be one of the etiologies for all four cysts.

Aryepiglottic Cyst Developed Hours After Tracheal Intubation Causing Acute Upper Airway Ball-Valve Obstruction: A Case Report

This is the first case report describing an aryepiglottic cyst resulting in critical airway compromise after an uneventful tracheal intubation. We present the case of a 55-year-old woman who developed acute dyspnea and stridor several hours after the surgery. She was found to have significant upper airway obstruction owing to a large left aryepiglottic cyst with a ball-valve effect.

Clinical effect of CO2 laser resection of the epiglottic cyst under micro-laryngoscope suspension

BACKGROUND

Epiglottic cysts are common diseases and have multiple morbidity, and traditional surgery causes intraoperative bleeding and postoperative recurrence.

OBJECTIVE

To investigate the therapeutic effect of CO₂ laser resection on epiglottic cyst when compared with traditional surgery.

METHOD

Eighty patients with epiglottic cysts were randomly enrolled into the CO₂ laser group (44 patients) and the high-frequency electrocautery group (36 patients).

RESULTS

The CO₂ laser group had a shorter operation time, less blood loss and fewer intraoperative ruptured cysts (p < .05). The duration of sore throat and the time before wound redness and swelling subsidence in the CO₂ laser group were significantly shorter than those in the high-frequency electrocautery group (p < .05). Within one year after the operation, the incidence of epiglottic scar contracture in the CO₂ laser group was significantly lower than that in the high-frequency electrocautery group (p < .05).

CONCLUSION

The CO₂ laser group has the advantages of minimally invasive, less bleeding, short operation time and less postoperative complications, and it is worthy of applying as clinical routine to treat epiglottic cysts.

Partial laryngectomy for the management of laryngeal masses in six cats

OBJECTIVES

Partial laryngectomy is an organ-sparing surgical procedure for the removal of laryngeal masses which has not been described in cats. The aim of this study was to report on the surgical procedure and the short- and long-term clinical outcomes of cats that underwent partial laryngectomy.

METHODS

Medical records were retrospectively collected over a 4-year period in two institutions. The following data were retrieved: signalment, history, clinical signs, diagnostic test results, surgical procedure, postoperative management, complications and outcome.

RESULTS

Six cats underwent partial laryngectomy. The most common clinical signs in cats with laryngeal masses were stridor (n = 4) and dyspnoea (n = 4). In all cats, a full-thickness portion of one or several laryngeal cartilages was resected, including thyroid cartilage alone (n = 2), thyroid cartilage and arytenoid (n = 2), and arytenoid cartilage and epiglottis (n = 2). The resected laryngeal masses were reported to be lymphoma (n = 3), carcinoma (n = 1), laryngeal cyst (n = 1) and inflammatory laryngeal disease (n = 1). All cats survived the surgical intervention of partial laryngectomy. Four cats showed varying degrees of respiratory distress in the short-term postoperative period. A temporary tracheostomy tube was placed in two cats. No other postoperative complications were noted in the short- or long-term. Four cats were still alive at the time of writing. These cats survived at least 252 days.

CONCLUSIONS AND RELEVANCE

In a small number of cases, our results show that successful long-term outcomes after partial laryngectomy are achievable, with longer survival times than previously reported. Therefore, partial laryngectomy should be considered as a viable treatment option in cats with laryngeal masses.

Laryngeal oncocytic cystadenoma mimicking a combined laryngomucocele

Laryngeal oncocytic cystadenomas are rare benign tumours lined by oncocytic epithelium and arising from the salivary glands; they usually present as a supraglottic mass. Oncocytic changes are very uncommon in the larynx and occur mainly in ventricles and false vocal cords, where seromucinous glands predominate. The authors present the case of a 62-year-old woman who reported a 6-month history of hoarseness associated with a soft and non-compressible upper left side neck swelling. Transnasal fiberoptic laryngoscopy revealed a left submucosal supraglottic mass involving the false vocal fold and the vallecula, partially obstructing the airway. CT scan showed a homogeneous isodense cystic lesion centred at the left laryngeal ventricle, with extension through the thyrohyoid membrane. The patient was successfully managed by a lateral thyrotomy approach. Histopathological examination of the specimen revealed a papillary oncocytic cystadenoma and excluded malignancy. There was no evidence of recurrence after 9 months of follow-up.

Gold laser removal of a large ductal cyst on the laryngeal surface of the epiglottis

Laryngeal cysts are rare lesions of the larynx that are often described on incidental discovery. We report an unusual presentation of a large ductal cyst located on the laryngeal surface of the epiglottis. The patient presented with a low tone voice while displaying bilateral normal appearing vocal cords with normal mobility. Computed tomography scans and flexible laryngoscopy showed a round supraglottic mass approximately 2 cm in diameter on the right lateral laryngeal surface of the epiglottis. The mass was removed surgically during microsuspension laryngoscopy with excision of the mucocele utilizing a gold laser. Postoperatively, the patient's voice returned to baseline with no complications.

Videolaryngoscope-assisted coblation of epiglottic cysts

PURPOSE

This study aims to investigate the safety and effectiveness of videolaryngoscope-assisted coblation of epiglottic cysts (VACECs) under general anesthesia.

METHODS

Twenty-eight consecutive patients with epiglottic cysts (ECs), underwent VACECs in this prospective clinical series from January 2015 to March 2019. The pre-operative electronic flexible laryngoscopic or 70° rigid laryngeal endoscopic examination was carried out to assess the location and size of ECs. There was a periodical follow-up survey for all patients.

RESULTS

A total 28 of patients were enrolled, including 12 men and 16 women, with an average age of 55 (range 24-78). The patient's medical history ranged from half a month to 2 years. The size of the cyst arranged from 0.8 to 1.5 cm. All patients were cured without pharyngeal or systemic complications. No tooth loss occurred in five patients (17.9%) with loose anterior teeth. Specimen pathology confirmed the diagnosis in all patients. No recurrence was found after more than half a year's follow-up.

CONCLUSIONS

VACECs brings together the advantages of videolaryngoscope and coblation. It is a simple, safe and feasible procedure for patients with ECs and is worthy of clinical application.

A radiologic review of hoarse voice from anatomic and neurologic perspectives

The differential diagnosis for hoarseness is extensive and includes a multitude of etiologies that span a large geographic area from the brainstem to the mediastinum. Therefore, localizing a causative lesion can be extremely difficult for clinicians and radiologists alike. In this review, we will first discuss the normal anatomy of the larynx and its innervation via the vagus and recurrent laryngeal nerves. We will then proceed with a guided tour of the various infectious/inflammatory, neoplastic, congenital, and traumatic/iatrogenic causes of hoarseness subdivided by anatomic location (brainstem, skull base, carotid sheath, thyroid, larynx, and superior mediastinum). Along the way, we will discuss the various cross-sectional imaging modalities best suited to detect the often subtle signs of recurrent laryngeal nerve injury. With thorough knowledge of these entities, radiologists can impact patient care by suggesting the appropriate imaging test and tailoring their search patterns to detect the subtle findings of laryngeal dysfunction.

An innovative method based on cloud model learning to identify high-risk pollution intervals of storm-flow on an urban catchment scale

Identifying high-risk storm-flow pollution intervals in an urban watershed is critical for watershed pollution control decision-making. High-risk pollution intervals of storm-flow are defined as storm-flow intervals that contribute more than the background pollutant load, and whose load contribution rank in the top 20%. However, the identification of high-risk pollution intervals is difficult due to variations in the flow-concentration relationship among rain events, uncertainty inherent in stormwater quality data, and physically-based stormwater models requiring a substantial number of parameters. A new method for identifying high-risk pollution intervals during different rain events is proposed. A dataset of the urban watershed located in Shenzhen, southern China, was used to demonstrate the proposed method. A "cut-pool" strategy was initially used to pre-process the dataset for maximizing valuable information hidden in existing datasets and to investigate the impact of rainfall on flow-concentration relationships. Gaussian cloud distribution was then introduced to capture the trend, dispersing extent and randomness of stormwater quality data at any flow interval. Interval Overlapping Ratio (IOR) and Load contribution of storm-flow high-risk pollution intervals was used to assess the performance of the method. Results show that storm-flow high-risk Chemical Oxygen Demand (COD) pollution intervals of the Shiyan watershed was 0.5-1.5 mm under light rain (0-13 mm), 1-3 mm under moderate rain (13-27 mm) and 5-7 mm under heavy rain (27-43 mm). The accuracy of the identified high-risk pollution intervals (IOR) was 63-66% under light rain, 64-67% under moderate rain. Moreover, COD load can be reduced by 44-48% with high-risk storm-flow under light rain; 43-49% under moderate rain; 32% under heavy rain. This method is very useful for effectively controlling storm-flow pollution on an urban catchment scale.

Concomitant tonsillar cyst and papilloma in larynx: A case report

RATIONALE

Laryngeal cysts are rare lesions that may occur at any mucosa-lined location within the larynx. Papillomas are also benign lesions of the larynx.

PATIENT CONCERNS

We report a 34 year-old-patient with a laryngeal cyst incidentally found during screening endoscopy and presenting as a soft tissue mass on a computerized tomography scan. A papilloma concomitant with the cyst was detected intraoperatively.

DIAGNOSES

Concomitant tonsillar cyst and papilloma of the larynx.

INTERVENTIONS

The lesion was completely resected with a bipolar radiofrequency plasma ablation (RFA) device.

OUTCOMES

Pathologic examination showed a tonsillar cyst and papilloma in the larynx. Six months later, there has been no evidence of recurrence.

LESSONS

To our knowledge, this is the first report of a concomitant tonsillar cyst and a papilloma in the larynx. Asymptomatic laryngeal cysts can be detected endoscopically. RFA is safe and effective for endoscopic management.