Adult acute epiglottitis in association with infection of an epiglottic cyst

Epiglottic cyst incidentally discovered during screening endoscopy: a case report and review of literature

From the endoscopists' point of view, although the main focus of upper gastrointestinal endoscopic examination is the esophagus, stomach, and duodenum (usually bulb and 2nd portion including ampulla of Vater), the portions of the upper airway may also be observed during insertion and withdrawal of the endoscope, such as pharynx and larynx. Thus, a variety of pathologic lesions of the upper airway can be encountered during upper endoscopy. Among these lesions, an epiglottic cyst is relatively uncommon. The cyst has no malignant potential and mostly remains asymptomatic in adults. However, if large enough, epiglottic cysts can compromise the airway and can be potentially life-threatening when an emergency endotracheal intubation is needed. Thus, patients may benefit from early detection and treatment of these relatively asymptomatic lesions. In this report, we present a case of epiglottic cyst in an asymptomatic adult incidentally found by family physician during screening endoscopy, which was successfully removed without complication, using a laryngoscopic carbon dioxide laser.

Acute airway obstruction, an unusual presentation of vallecular cyst

A 18-year-old female presented to us with acute respiratory obstruction, unconsciousness, severe respiratory acidosis, and impending cardiac arrest. The emergency measures to secure the airway included intubation with a 3.5-mm endotracheal tube and railroading of a 6.5-mm endotracheal tube over a suction catheter. Video laryngoscopy done after successful resuscitation showed an inflamed swollen epiglottis with a swelling in the left vallecular region, which proved to be a vallecular cyst. Marsupialisation surgery was performed on the 8^th post admission day and the patient discharged on 10^th day without any neurological deficit.

Airway obstruction by laryngeal masses in sudden and homicidal deaths

We present two cases of autopsy detection of laryngeal masses with medico-legal implications. The first is a 56-year-old man who died suddenly of asphyxia due to upper airway obstruction caused by a large glosso-epiglottic retention cyst and glottic oedema. Hypothesis of medical liability was raised, due to delayed tracheotomy as the result of repeated failed attempts at oral intubation by various physicians. Difficult oral intubation due to the presence of a laryngeal mass in an asphyxiating subject requires rapid tracheotomy. The second case deals with a 43-year-old woman who died of asphyxia due to airway obstruction, as a result of injury of a cavernous laryngeal haemangioma after homicidal manual strangulation, with severe haemorrhagic infiltration of the surrounding soft tissues. Damage to laryngeal/hypopharyngeal masses should be considered as a possible sign of manual strangulation, as well as neck skin bruises/abrasions and laryngeal haemorrhages.

Laryngeal cyst and sudden death

Laryngeal cysts are relatively uncommon and account for about five per cent of benign laryngeal lesions. The commonest location is the epiglottis. Pathologically these lesions may be divided into epithelial, tonsillar or oncocytic types. The patients may be asymptomatic or present with hoarseness, dysphagia, cough or airway obstruction. Epithelial cysts of the larynx, although histologically benign, may produce sudden and unexpected death from asphyxia. A case is presented of a 32-year-old female who was sexually assaulted and later found dead. Death was most likely due to laryngeal obstruction caused by an epiglottic cyst. Alcohol intoxication (BAC = 0.25g%) is likely to have been a contributory factor. In this case the results of the autopsy helped to exonerate the accused from being charged with murder. Other medico-legal problems that may be encountered with laryngeal cysts are difficulty in intubation and accidental rupture of a cyst during intubation or otolaryngeal examination.