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Clinical Image
2 (
2
); 106-107
doi:
10.25259/WJWCH_35_2023

Surgical approach to congenital vallecular cyst with concomitant laryngomalacia

Department of Pediatric ENT, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
Corresponding author: Utpal Sarmah, Department of Pediatric ENT, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India. laptu.hamras@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Kurup B, Sarmah U, Prabhat D, Pereira C. Surgical approach to congenital vallecular cyst with concomitant laryngomalacia. Wadia J Women Child Health 2023;2(2):106-7.

A 10-day-old girl, brought with stridor, feeding difficulties, and persistent cough, tachypnea along with suprasternal and subcostal retractions. Airway assessment revealed a left vallecular cyst pressing on the lingual surface of the epiglottis leading to Type 3 laryngomalacia (posteriorly displaced floppy epiglottis) in addition to bilateral short ary-epiglottic folds (Type 2 Laryngomalacia), further narrowing the upper airway [Figure 1a]. The vallecular cyst was marsupialised with cauterization of the base [Figure 1b]. The short aryepiglottic folds were cut on both sides using microlaryngoscopy scissors and epiglottopexy was performed using 16G needles and 2-0 prolene sutures that were buried beneath the anterior neck skin crease above the level of thyroid cartilage to further widen the supraglottic airway [Figure 1a-d]. The baby recovered well and was completely weaned off oxygen by the 4th postoperative day. Vallecular cyst is a rare cause of neonatal airway obstruction (1.87–3.49 cases per 100,000 live births).[1] In addition to cyst marsupialization, supraglottoplasty with epiglottopexy is the mainstay of treatment of vallecular cyst with concomitant severe type 3 laryngomalacia.[2]

Figure 1:
(a) Vallecular cyst causing posterior displacement of epiglottis (Type 3 Laryngomalacia); (b) Appearance after marsupialisation and cauterisation of base of cyst; Bilateral aryepiglottic folds lysed (Supraglottoplasty); (c) Epiglottopexy done with 16G needles; (d) Final result with an open larynx.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The author(s) confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Financial support and sponsorship

Nil.

References

  1. , , , . Treatment of vallecular cysts in infants with and without coexisting laryngomalacia using endoscopic laser marsupialization: Fifteen-year experience at a single-center. Int J Pediatr Otorhinolaryngol. 2013;77:424-8.
    [CrossRef] [PubMed] [Google Scholar]
  2. , . Congenital laryngeal anomalies. Otolaryngol Clin North Am. 1981;14:203-18.
    [CrossRef] [Google Scholar]

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