Airway Management in a Patient With an Incidental Findingof Vallecular Cyst During Induction of General Anesthesia

Abstract

Vallecular cysts are benign retention cysts of the minor salivary glands and the most common site is the lingual surface of epiglottis, which causes distortion to the epiglottis when increased in size and eventually fill the vallecular that can block the laryngeal inlet causing severe respiratory distress. Although not common this is a potentially dangerous condition that causes stridor and this has been associated with sudden airway obstruction resulting to death. This is a case of a 9-day old male neonate referred from General Surgery as a direct to Operating Room case due to imperforate anus. He is full term, delivered normally via vaginal delivery with a birth weight of 3kg. Upon administration of general anesthesia, the vallecular cyst was initially identified and during the PACU stay of the patient, stridor was noted after extubation, which resulted reintubation to stabilize him. Appropriate referral was made and a confirmed diagnosis of vallecular cyst was made. Patient then underwent marsupialization of the cyst. In conclusion, the presence of vallecular cysts poses a challenge to anesthesiologists especially on incidental findings during the administration of general anesthesia. They must be familiar with the algorithms of care for patients with vallecular cysts and should have necessary skills in identifying signs of distress to avoid unfavorable circumstances and demise.