Laryngeal Cysts in Adults: Simplifying Classification and Management

Abstract

Objective Laryngeal cysts may occur at any mucosa-lined location within the larynx and account for 5% to 10% of nonmalignant laryngeal lesions. A number of proposed classifications for laryngeal cysts exist; however, no previously published classification aims to guide management. This review analyzes contemporary laryngeal cyst management and proposes a framework for the terminology and management of cystic lesions in the larynx. Data Sources PubMed/Medline. Review Methods A primary literature search of the entire Medline database was performed for all titles of publications pertaining to laryngeal cysts and reviewed for relevance. Full manuscripts were reviewed per the relevance of their titles and abstracts, and selection into this review was according to their clinical and scientific relevance. Conclusion Laryngeal cysts have been associated with rapid-onset epiglottitis, dyspnea, stridor, and death; therefore, they should not be considered of little significance. Symptoms are varied and nonspecific. Laryngoscopy is the primary initial diagnostic tool. Cross-sectional imaging may be required, and future use of endolaryngeal ultrasound and optical coherence tomography may revolutionize practice. Where possible, cysts should be completely excised, and there is growing evidence that a transoral approach is superior to transcervical excision for nearly all cysts. Histology provides definitive diagnosis, and oncocytic cysts require close follow-up. Implications for Practice A new classification system is proposed that increases clarity in terminology, with the aim of better preparing surgeons and authors for future advances in the understanding and management of laryngeal cysts.

A radiologic review of hoarse voice from anatomic and neurologic perspectives

“…These are often asymptomatic and found incidentally, but occasionally can present with hoarseness and stridor. Symptoms may be episodic due to intermittent filling and resultant one-way valve effect, or due to infection [4].…”

“…4). Types of laryngoceles are defined by their relationship to the thyrohyoid membrane—internal and external/mixed [4]. Internal (or simple) laryngoceles are confined to the paraglottic space of the supraglottis, and are found lateral to the thyrohyoid membrane.…”

Concomitant tonsillar cyst and papilloma in larynx

“…Although marsupialization has been reported to be highly successful, the remaining base of the cyst can lead to cyst reaccumulation. [ 11 ] Our preference was to completely remove the cyst. Therefore the lesion in our patient was completely excised with RFA, which has been proven safe and effective, with improved surgical precision, minimal bleeding, and better healing.…”

Bilateral Aryepiglottic Cysts

“…Acute infection of laryngeal or epiglottic cysts may trigger epiglottitis associated with high risk of respiratory distress and death. 1,2 Moreover, epiglottitis was reported to recur in patients with cysts. 3 It is recommended that the aryepiglottic cysts be managed either by endoscopic excision or by marsupialization of the cysts to prevent rare complications such as acute airway obstruction.…”