Huge Tonsillar Cyst with Unanticipated Difficult Intubation: Case Report

Abstract

Laryngeal cyst, particularly epiglottic cyst, was usually benign. This was uncommon and constituted approximately 5% of benign laryngeal lesions. There was usually asymptomatic in adult, but might be symptoms, such as hoarseness, foreign-body sensation, pain, or dysphagia. Although a laryngeal cyst was harmless to the patient, the discovery of this in the intubation of anesthesia was a potentially life-threatening problem. We experienced a case of the large asymptomatic laryngeal cyst which caused the unanticipated difficult intubation. A 70-year-old man had a lumbar herniation of nucleus pulposus. At the elective discectomy of neurosurgical department, the anesthetist noted a large mass at epiglottis and had difficulty with the oropharyngeal intubation. This patient had transferred to oto-rhino-laryngologic department. Direct laryngoscopy revealed about 5 cm sized cystic mass on the lingual surface of epiglottis occupying vallecular area. Despite its size, the patient had remained asymptomatic. After some days, we performed the awake needle aspiration of epiglottic cyst, and then this was excised by CO 2 laser under microscopic laryngoscopy. Histologically, this cyst was the tonsillar cyst lined by the squamous epithelium with underlying lymphoid follicles according to modified working classification. 7) Eighth months later, there was no recurrence.