Asymptomatic bilateral mixed-type laryngocele and laryngeal carcinoma

Undiagnosed laryngocele: an airway emergency

Laryngoceles are rare dilated laryngeal saccules that can present as acute airway obstruction and lead to airway emergencies. A man, presented to the emergency room, with difficulty in breathing and change in voice. An unevaluated pulsatile swelling was present on the left side of neck. Since, the patient was in stridor, an awake fiberoptic bronchoscopy (FOB)-guided intubation was planned with readiness for emergency tracheostomy, if needed. On FOB, an edematous supraglottic area with a narrowed glottic opening was observed. The procedure was abandoned and a surgical tracheostomy was performed to secure the airway. Postoperative contrast-enhanced CT neck revealed a huge laryngocele in left cervical region. We recommend that a high index of suspicion for presence of laryngocele should be kept in mind when a patient presents with stridor with pulsatile neck swelling. Timely aspiration of laryngocele may help in amelioration of the respiratory distress avoiding emergency tracheostomy.

Laryngocele: A Rare Case Report and Review of Literature

Laryngocele is an abnormal cystic dilatation of the saccule of the larynx. It communicates with the laryngeal lumen and contains air. Laryngocele can be classified as internal (within the larynx), external (outside the larynx) and mixed (both). It is a rare entity. Hereby, we are reporting a case of laryngocele, which presented to us with a diagnostic quandary. After confirming the diagnosis by radiology, patient was operated upon by external approach. In the following article, we also discuss the establishment of the diagnosis and review different surgical modalities for the management of various types of laryngocele.

Bilateral Laryngocele Causing Epiglottic Deformity and Upper Airway Obstruction

Laryngocele is the cystic dilatation of laryngeal ventricle. Most cases are asymptomatic and incidentally diagnosed in radiologic examinations. Although the etiology is unclear, obstruction, laryngeal pressure, congenital defects are possible risk factors. Computed tomography is the best method for diagnosis. Endoscopic, external or combined approaches have been described in the surgical treatment. Laryngocele should be kept in mind in patients with acute upper airway obstruction. Such patients may require tracheostomy. Some patients with laryngocele can also have laryngeal cancer, in which case direct laryngoscopy must be performed. This report presents a case with respiratory distress associated with bilateral laryngocele, and his management in the light of the literature.

A Rare Case of Laryngopyocele with Airway Obstruction

Laryngocele is a rare entity and can be defined as an abnormal cystic dilatation of saccule of the laryngeal ventricle with communication to the lumen of larynx. Laryngopyocele is a rare complication of laryngocele when it is infected. Patients may present with fever, neck swelling, shortness of breath, and hoarseness. Acute presentation can develop rapidly with alarming symptom, such as stridor, which signifies airway obstruction and warrants immediate treatment and airway protection. Computed tomography and endoscopy are useful in making the diagnosis and delineate the severity of disease. Laryngopyocele should be treated with antibiotics, drainage of purulent content, and followed by definitive surgical excision.

Acutely Obstructed Airway Resulting from Complications of a Laryngopyocoele

Laryngocoeles are rare cystic dilatations of the laryngeal ventricle. Obstruction of its outlet can cause entrapment of mucus and superimposed infection causes a laryngopyocoele. Such presentations, although rare, have potential to cause airway obstruction. A 67-year-old lady presented with a one-week history of hoarseness and shortness of breath. On examination, she was stridulous and had fullness of the left side of the neck. Nasendoscopy revealed large bilateral vocal cord polyps and near-complete glottis obstruction. She was taken to emergency theatre for restoration of a viable airway. Upon excision of the polyps, pus was visualised originating from the laryngeal ventricle. Literature proposes that laryngocoeles develop secondary to a one-way valve caused by an obstructing lesion distorting the saccule neck. We propose that the laryngocoele developed secondary to large obstructing polyps. Urgent excision of the polyps allowed decompression of the laryngopyocoele and reestablishment of a patent airway.

Mixed pyolaryngocele: Uncommon presentation of deep spaces neck infection

Introduction

Pyolaryngocele is a very rare and serious complication of laryngocoele. It can present as deep spaces neck infection and mislead the diagnosis. Our aim is to attract the intention of the surgeon to this unusual entity and describe its clinical features.

Case summary

We report a case of 45 years old male patient with five-week history of neck swelling, dysphonia, mild dyspnea and odynophagia. An urgent C.T scan showed a mixed pyolaryngocele. The management consisted high dose antibiotic and an excision of the residual laryngocoele via an external approach.

Discussion and conclusion

A pyolaryngocele is an unusual complication of laryngocoele that becomes secondarily infected causing serious symptoms. Excision of the laryngocoele, still the best treatment option to prevent this complication and recurrence.

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Laryngpyocoeles are rare complication of laryngocoeles. They can present with serious complaints like dyspnea and sepsis.

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They should be kept in mind in the differential diagnosis of upper deep neck infection with hoarseness and odynoaphagia.

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An emergency CT scan is mandatory in order to establish an accurate diagnosis, and begin appropriate treatment to avoid undesirable evolution.

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External approach resection of laryngopyocele in emergency situations is advocated, which gave adequate exposure of the lesion.

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Endoscopic laser indications are very limited in this type of presentation.

Treatment of Laryngoceles: what is the progress over the last two decades?

OBJECTIVES

To review surgical techniques used in the treatment of laryngoceles over the last two decades and point out developments and trends.

MATERIALS AND METHODS

PubMed, the Cochrane Library, and the JBI Library of Systematic Reviews were searched using the term "laryngocele." Demographic data, type of laryngocele, presence of a laryngopyocele, type of treatment and need for a tracheotomy were assessed.

RESULTS

Overall, data on 86 patients were analyzed, culled from 50 articles, of which 41 were case reports and 9 were case series. No single systematic review or meta-analysis or randomized controlled trial has been published on the topic. Altogether, 71 laryngoceles in 63 patients met the criteria for further analysis focusing on surgical treatment. An external approach was selected in 25/29 (86.2%) cases of combined laryngoceles. Microlaryngoscopic resection using a CO2 laser was performed in three cases and endoscopic robotic surgery in one case. The majority of patients with an internal laryngocele, 31/42 (73.8%), were treated using the microlaryngoscopy approach.

CONCLUSIONS

Microlaryngoscopy involving the use of a CO2 laser has become the main therapeutic procedure for the treatment of internal laryngoceles during the past 20 years. An external approach still remains the main therapeutic approach for the treatment of combined laryngoceles.

Combined laryngocele secondary to localized laryngeal amyloidosis

Laryngocele is a benign condition due to abnormal dilatation of the laryngeal saccule. Localized amyloidosis causing laryngocele is a rare entity with few reports in the literature. We present a young male patient with a large combined laryngocele secondary to laryngeal amyloidosis.

[Laryngopyocele. Rare cause of relapsing cervical infections]

A laryngopyocele forms when a laryngocele, as a dilatation of the laryngeal ventricle, becomes infected and fills with mucopus. Laryngopyoceles are rare, as only few cases have been previously reported in the literature. The case of a 75-year-old woman who was treated twice because of a deep cervical infection is described. First of all the cause remained unknown but 3 years after the first manifestation air could be aspirated from a now non-infected neck swelling. A laryngocele was revealed as the cause of the relapsing infection. The surgical resection led to a final healing and the patient remained free from disease. When dealing with a clinical picture of an unknown deep cervical infection, an external or mixed laryngocele should be considered in the differential diagnosis as a rare cause.

Laryngocele: a rare long-term complication following neck surgery?

INTRODUCTION

Laryngocele is an abnormal dilatation of the laryngeal saccule. Suggested etiologies include congenital enlargement of the saccule, weakness of laryngeal tissues, and increased intralaryngeal pressure. Only a few reports have described the late evolution of laryngocele following neck surgery.

CASE PRESENTATION

Two heavy smoking patients presented with hoarseness in voice because of laryngocele, which has evolved many years following ipsilateral neck surgery: hemithyroidectomy 20 years earlier and frontolateral hemilaringectomy 12 years earlier. Both patients were treated similarly by an endoscopic laser-assisted resection of the laryngocele. No other risk factor could have been attributed to its development. Follow-up was unremarkable.

DISCUSSION

Laryngeal locus minoris violation may result in the development of laryngocele in the long run following neck surgery and may be considered as a late rare surgical complication. In addition, heavy smoking or its sequelae may predispose this condition.

Unilateral combined laryngocoele with recurrent respiratory papillomatosis: case report

Objective:

We report a case of unilateral combined laryngocoele occurring in conjunction with recurrent respiratory papillomatosis.

Methods:

Case report and review of the literature concerning the physiology underlying laryngocoele formation.

Results:

A laryngocoele is an abnormal, air-filled dilation of the laryngeal saccule which communicates with the laryngeal lumen. We report a case of a 53-year-old man with a unilateral combined laryngocoele occurring in conjunction with recurrent respiratory papillomatosis. Microlaryngoscopy demonstrated a papilloma obstructing the laryngeal saccule. Removal of papillomata via laser excision and marsupialisation of the left laryngocoele improved the patient's vocal symptoms. There was no recurrence of papillomata or the laryngocoele.

Conclusion:

While many laryngocoeles can be explained by altered laryngeal physiology, the papilloma described in this case acted as an anatomical obstruction that trapped air within the saccule, creating an environment conducive to laryngocoele formation.

Laryngeal squamous cell carcinoma presenting as a prelaryngeal, air-filled structure (pseudolaryngocoele)

OBJECTIVE

We report a unique case of a squamous cell carcinoma of the larynx presenting as a large pseudolaryngocoele, arising through a thyroid cartilage defect.

METHOD

Case report and review of the literature.

CASE REPORT

A 47-year-old man presented with a two-month history of hoarseness and a large, midline neck swelling. Endoscopic examination revealed a transglottic carcinoma involving the anterior commissure. Fine needle aspiration of the neck mass showed it to be an air-filled structure which transiently collapsed but refilled within minutes. Subsequent computed tomography scanning and histopathological examination revealed that the air-filled mass was created by a defect in the thyroid cartilage, with formation of a pseudolaryngocoele.

CONCLUSIONS

The anatomy of the anterior commissure region and its effect on the spread of laryngeal carcinoma is reviewed in order to explain the pathophysiology of this unusual presentation. We highlight the need for a high index of suspicion of malignancy if a laryngocoele or pseudolaryngocoele is detected clinically.

Laryngocele: a rare complication of surgical tracheostomy

BACKGROUND

A laryngocele is usually a cystic dilatation of the laryngeal saccule. The etiology behind its occurrence is still unclear, but congenital and acquired factors have been implicated in its development.

CASE PRESENTATION

We present a rare case of laryngocele occurring in a 77-year-old Caucasian woman. The patient presented with one month history of altered voice, no other associated symptoms were reported. The medical history of the patient included respiratory failure secondary to childhood polio at the age of ten; the airway management included a surgical tracheostomy. Flexible naso-laryngoscopy revealed a soft mass arising from the posterior pharyngeal wall obscuring the view of the posterior commissure and vocal folds. The shape of the mass altered with respiration and on performing valsalva maneuver. A plain lateral neck radiograph revealed a large air filled sac originating from the laryngeal cartilages and extending along the posterior pharyngeal wall. The patient was then treated by endoscopic laser marsupialization and reviewed annually.We discuss the complications of tracheostomy and the pathophysiology of laryngoceles and in particular the likely aetiological factors in this case.

CONCLUSION

A laryngocele presenting in a female patient with tracheostomy is extremely rare and has not been to date reported in the world literature. A local mechanical condition may be the determinant factor in the pathogenesis of the disease.

[Imaging diagnostics of the pharynx and larynx]

The pharynx and larynx represent very sophisticated regions and may be involved in a diverse range of pathologic conditions. Evaluation of the head and neck has developed significantly with the establishment of CT and MRI as they provide true insights into the endoscopically blind areas as well as depth of tumor infiltration, its submucosal growth and contralateral involvement, cartilage invasion, bone marrow invasion, and nonpalpable adenopathy. Inflammations in the head and neck region are only exceptionally imaged with CT or MRI; indications are the diagnosis of retrotonsillar and parapharyngeal abscesses and ensuing complications. The different imaging modalities of malignant pharyngeal and laryngeal tumors and their differential diagnosis are presented in this paper.