Difficult intubation in a patient with vallecular cyst

Abstract

Although rare, vallecular cysts can have catastrophic consequences in an anaesthetised patient if airway management is inappropriate. We report a case of difficult intubation in a 46-year-old man with a vallecular cyst, and detail the methods and strategies for successful endotracheal tube insertion. Following a review of the current literature, we also discuss airway management options in adult patients with vallecular cysts.

A Case Report of a Vallecular Cyst and Literature Review

“…One theory as to why cysts can develop in the vallecular region states that ducts of the mucous gland or lingual tonsillar crypt can become obstructed from inflammation, irritation, or trauma, thus causing dilatation and cystic formations. 2 The DeSanto Q4 classification subdivided laryngeal cysts into ductal, saccular, and thyroid cartilage foraminal cysts. More recent classifications have divided these lesions into congenital, retention, inclusion, and web 4C=FPO 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 lymphoepithelial cysts.…”

“…Asymptomatic cysts in the vallecula can cause difficulty with intubation as was the case with the present patient and a GlideScope had to be used. 2 When these lesions are small, they are usually asymptomatic; however, when they reach a large enough size, they can cause symptoms, such as dysphagia, odynophagia, and a change in the quality of the voice. Another important complication that can arise is when these cystic lesions become secondarily infected.…”

“…When they reach a large enough size, they can cause dysphagia, odynophagia, and acute airway complications. 1,2 With the expanded scope of oral and maxillofacial surgery, the proper diagnosis and management of vallecular lesions could become a routine part of oral and maxillofacial surgical practice and aid in further development of the specialty. This report describes the case of a benign lymphoepithelial cyst of the vallecula.…”

Airway Management in An Adult Patient with A Large Vallecular Cyst: A Case Report

“…These cysts might be asymptomatic or might be associated with airway obstruction, feeding difficulties and failure to thrive during infancy, and even with death due to severe laryngeal obstruction [3][4][5]. In cases with laryngeal inlet obstruction due to a vallecular cyst, the airway management sometimes might be a challenge [5][6][7]. In this case report, the airway management of an adult patient with difficult airway due to a large vallecular cyst completely obstructing the pharynx was presented.…”

Asymptomatic vallecular cyst causing challenging intubation

“…[2] Asemptomatik kistler ise bazen genel anestezi sırasında entübasyon zorluğuna neden olarak tanı alır. [3] Valleküler kistler ilk olarak 1970 yılında DeSanto tarafından duktal kistler olarak sınıf landırılmıştır. Submukozal bez duktuslarının tıkanması sonucu mukus retansiyonu ile kistler ortaya çıkmaktadır.…”