Asymptomatic Vallecular Cyst: Case Report

Abstract

A 56-year-old man presented himself for an intracranial glioblastoma multiforme excision. After being routinely monitored, he was preoxygenated. We induced anesthesia and paralysis with 200 mg propofol, 50 μg fentanyl and 9 mg vecuronium. Direct laryngoscopy with a Macintosh 3 blade revealed a 2x2 cm cyst, pedunculated, arising from the right side of the vallecula preventing the endotracheal intubation. While the patient remained anesthetized, we urgently consulted an otolaryngologist and aspirated the cyst with a 22-gauge needle and syringe under direct laryngoscopy. We aspirated 10 cc of liquid content. This was followed by an uneventful tracheal intubation with a 9.0 enforced spiral cuffed tube. An alternative to fiberoptic intubation may be careful cyst aspiration to facilitate the intubation.

Le kyste de la vallécule symptomatique chez l’adulte: à propos de 4 cas

“…Toutefois, une étiopathogénie congénitale a également été envisagée car certains kystes valléculaires ont été décrits chez des nouveau-nés [ 1 , 3 , 5 , 6 ]. Le kyste de la vallécule survient à tout âge mais il est moins fréquent chez les enfants que chez les adultes [ 6 , 7 ]. Les symptômes varient selon l'âge et la taille du kyste.…”

Large Vallecula Lipoma: An unusual clinical entity

“…Anticipating difficult intubation and early referral to the anesthetic team is vital to avoid fatal complications. Awake flexible fibreoptic intubation is an option to secure the airway in a patient undergoing excision in an elective setting 7 . The presence of an experienced anaesthetist and an otolaryngologist is mandatory during masked ventilation.…”

“…The presence of an experienced anaesthetist and an otolaryngologist is mandatory during masked ventilation. If the patient cannot be intubated, an emergency tracheostomy may be necessary to secure the airway 7 .…”

Near-obstructive vallecular cyst

“…There is a paucity of literature on recommendations for optimal airway management in such a situation, with prior reports having described using rigid and flexible bronchoscopy, a stylet, a bougie, transtracheal jet ventilation, and the McCoy laryngoscope. 1,2 Our case was unique as the cyst was abutting the posterior pharyngeal wall, obscuring vision of the glottis. We planned to keep the patient awake until intubation was accomplished with the intent of obtaining active help from the patient to facilitate the intubation.…”