Cisto sacular congênito da laringe O cisto sacular da laringe é uma das causas de estridor laríngeo no recém-nascido, sendo diagnóstico diferencial de . Quiste sacular congénito de laringe: reporte de un caso y revisión de la literatura. sacular laríngeo congénito y su tratamiento mediante abordaje endoscópico y . Cuestas G. Quiste sacular congénito de laringe: una causa rara de estridor. TRAQUEOMALACIA Debilidad de las paredes de la tráquea obstrucción de vía aérea con la inspiración. LARINGOMALACIA CLÍNICA.
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Congenital saccular cyst of the larynx. Case report and literature review. Ricardo Enrique Guerra, MD. Diana Patricia Anzola, MD. Congenital saccular cyst is a rare but benign lesion, caused by a dilated la ryngeal sac full of mucus that does not com municate with the laryngeal lumen.
Its definitive treatment is surgical according to the literature. To review the literature and report a case of congenital laryngeal saccular cyst, as well as its treatment by endoscopic approach and radiofrequency, which is most easily found in our country.
Presentation of a case report and literature review in PubMed and Tripdatabase using the described keywords. This is a rare condition with an inci dence of 1.
Diagnosis is achieved by laryngeal endoscopy, images or clinical review. The case reported here corresponds to a newborn patient with respiratory distress and stridor, who was diag nosed with laryngeal saccular cyst that was re sected surgically by means of endoscopy and radiofrequency, with no subsequent recurrence. Understanding this disease is high ly important to achieve proper diagnosis and provide treatment using the resources avail able in our country, such as radiofre quency.
Despite the lack of case reports, knowing the characteristics of con genital saccular cyst is necessary to indicate proper treatment based on the available re sources. Laryngeal stridor is an important sign related to several pathologies of the airway. When it occurs in neonates and is associated with respiratory distress, it must be treated urgently.
One of its causes, although rare, is congenital laryngeal saccular cyst 1 ; however, differential diagnoses include more frequent pathologies such as laryngomalacia, tracheomalacia, subglottic stenosis, vocal cord paralysis, laryngocele, laryngeal membrane, among others 2.
Saccular cyst is a benign supraglottic lesion that is usually unilateral, does not have an opening to the laryngeal ventricle and is greater than 1cm 3.
Since this is a very rare pathology and there is no exact data on its incidence, although some authors state that it is 1. The patient presented with respiratory deterioration 10 minutes after birth due to severe stridor and dysphonia.
Respiratory distress was observed, which required supplementary oxygen as first measure, soon moving to non-invasive mechanical ventilation without improvement, and ending with orotracheal intubation. Diagnostic nasofibrolaryngoscopy was performed, finding a cystic-appearing lesion that occupied the right piriform sinus and obstructed the airway Figure 1.
Contrast computed tomography CT of the larynx with 3D reconstruction under sedation was requested to assess the extension of the lesion.
A right cystic-appearing lesion 1. Based on the findings, congenital laryngeal saccular cyst was diagnosed. Nasofibrolaryngoscopy with cystic image on the right aryepiglottic fold, extended towards the ipsilateral piriform sinus and laryngeal ventricle. Own elaboration based on the data obtained in the study.
Contrast coronal CT scan of the neck showing a cystic lesion extending from the piriform sinus to the trachea with a significant decrease in the caliber of the airway. The mucosa from the roof of the lesion was cauterized, the capsule incised, the cystic lesion resected at the superior level, and the dissection continued until achieving communication of the cystic cavity with an ipsilateral laryngeal ventricle ventriculostomy. Pre-surgical findings included a cystic lesion that compromised the right aryepiglottic fold and extended to the posterior ipsilateral cricopharyngeal region —rejected by the right ventricular band until the laryngeal ventricle—, healthy vocal cords and free subglottis.
The patient was intubated for 9 days and treated with antibiotic therapy and dexamethasone IV due to postoperative edema. On day 10, adequate extubation tolerance was achieved. Considering the circumstances, a checkup with microlaryngoscopy was performed 8 days after surgery, and adequate healing of the lesion and non-reproduction of cyst, glottis and free subglottis were observed Figure 3.
A postoperative control was performed after a year using nasofibrolaryngoscopy without new surgical interventions, no recurrence of the cyst, and adequate epithelization and laryngeal development. Microlaryngoscopy A Immediate postoperative period after marsupialization and resection of saccular cyst.
B Postoperative day eight with scarring in the aryepiglottic fold and without evidence of cyst reproduction. The saccular cyst consists of a dilation of the laryngeal ventricle filled with mucus that does not communicate with the laryngeal lumen 9.
The sac is a diverticular structure that lies between the ventricular bands and the vocal cords, projects vertically upward between the base of the epiglottis and the medial portion of the thyroid cartilage, and contains a stratified and cylindrical pseudostratified squamous epithelium with large numbers of mucous glands, which are believed to be used for the lubrication of the vocal cords 10,4.
The main symptom of this pathology alringeo stridor at birth that can conceal laryngomalacia or congenital vocal cord paralysis, which appear with stridor in the first weeks of life Other symptoms depend on the size of the lesion estridod its location; for example, dysphagia may occur if the cyst occupies larjngeo hypopharynx 12 or if there is progressive respiratory distress until total airway obstruction, cyanosis, apnea, hoarse cry and low-pitched cry, especially with changes of position or agitation.
If the cyst is on the right side, the symptoms are accentuated in the contralateral ulnar position 4. Two types of saccular cysts are described in the literature: Anterior cysts are characterized by a submucosal mass dependent on the false vocal cord that protrudes through the anterior portion of the ventricle, while lateral cysts, usually the most common, occupy the entire ventricular band and exit the pharynx through the mucosa of the aryepiglottic fold The etiology of this pathology is not clear since it can be congenital or acquired.
The first is caused by obstruction or atresia of the sac, which, depending on its location, will make the cyst more extensive or not. This obstruction can be caused by the abnormal migration of the tissue from the fourth branchial arch generating the cystic formation 14 or by the isolation of the cells of the eatridor due to the abnormal migration of mesenchymal cells through persistent fetal vessels in the larynx.
The second may be a consequence of sac obstruction larkngeo to neoplasia, trauma or inflammation with subsequent fibrosis Most of the literature found on congenital saccular cyst is based on case reports; in the most extensive study, data on 20 cases were collected in larinyeo period of 15 years 16which makes the low incidence of this pathology evident. Diagnosis can be made through imaging studies such as lateral radiography of soft tissues of the neck, where a sac full of mucus is visualized in the supraglottic region; using CT or nuclear magnetic resonance is also possible.
Several authors state that diagnostic confirmation is achieved through congejito visualization of the lesion, either by direct or optical fiber laryngoscopy 17,15as described here. The treatment of this pathology is mainly surgical and includes the aspiration of the cystic content with needle and marsupialization, and even cyst excision via endoscopy or external approach 17, The first two are considered insufficient treatments because, in the first case, the mucosa glands of the cyst continue to secrete lsringeo, thus generating reappearance, and in the second, multiple procedures are required due to cyst recurrence that can easily generate laryngeal stenosis with subsequent tracheotomy 8, The excision of the cyst by microlaryngoscopy and larinbeo approach are the treatments with the highest success rates according to the literature.
However, some authors, such as Ward et al. There are case reports such as Khodaei et al. Another endoscopic approach that has shown lower morbidity is CO2 laser vestibulectomy, since it reduces surgical time, avoids vascular or superior laryngeal nerve damage and accelerates tissue recovery.
The definitive management, as stated in the literature, is microlaryngoscopy, since most reports and case series use CO 2 laser for estridkr resection 3,19, In Colombia, this laser is not available in all hospitals, so the procedure, in this case, was performed using radiofrequency.
Of all the articles reviewed, only the series by Kumar et al. In this case, not only the cyst was resected, but a vestibulectomy was also performed, leading to a lower risk of recurrence 1. Despite the low frequency of this pathology, it is important to know and be able to diagnose and treat it safely and effectively with the resources available in most hospitals in Colombia.
It was possible to resect a laryngeal saccular cyst smaller than 3cm in a safe and effective manner laringdo microlaryngoscopy and radiofrequency, despite the lack of case reports regarding the use of this method.
Laryngocele and Saccular Cysts. Ann Otol Rhinol Laryngol. M onnier P, editor.
Saccular Cyst of Larynx. Int J Phonosurg Laryngol. Laryngeal Obstructing Saccular Cysts: Arch Otolaryngol Head Neck Surg. Stridor in a newborn caused by a congenital laryngeal saccular cyst. Int J Pediatr Otorhinolaryngol Extra.
Three case studies and review of the literature. A current review of characteristics and management. Laryngeal saccular cyst in an infant. Ear Nose Throat J. Congenital laryngeal saccular cyst: Saccular cyst in an infant: Cysts of the larynx–classification. Radiofrequency ablation of laryngeal saccular cyst in infants: A series of six cases. Int J Pediatr Extridor.
Airway obstruction in a newborn due to a congenital laryngeal cyst. T habet MH, Kotob H. Lateral saccular cysts of the larynx. Aetiology, diagnosis and management. Flexible carbon dioxide laser-assisted endoscopic marsupialization and ablation of a laryngeal saccular cyst in a neonate.
Cysts of the Infant Larynx. Case larinbeo and literature review Palabras clave: