Transoral approach for direct and complete excision of vallecular cysts in children

Abstract

Objective To review the presentation, evaluation, and treatment of children with vallecular cysts and introduce a new technique of transoral excision for this entity. Methods Retrospective case series of children diagnosed with vallecular cyst between 2001 and 2008 at a single tertiary care children’s hospital. Data collected, including age at diagnosis, presenting symptoms, additional diagnoses, diagnostic modality, prior and subsequent surgical therapy, length of hospital stay, length of follow-up, and recurrence were analyzed with descriptive statistics. Results Seven children (mean age 198 days, range 2 days to 2.9 years) were included in this series. Five children presented with respiratory distress and/or swallowing difficulties. Vallecular cyst was diagnosed by initial flexible fiberoptic laryngoscopy (5/7), MRI (1/7), and intubating laryngoscopy (1/7). All children underwent complete cyst excision via transoral surgical approach. Two children underwent additional supraglottoplasty for concomitant laryngomalacia, one of whom underwent tracheotomy for persistent respiratory distress and vocal cord immobility. The average length of hospital stay postoperatively was 9.5 days, and four patients stayed less than 2 days. No patients experienced recurrence of the vallecular cyst at last follow-up (range 4–755 days, mean 233 days). Conclusions Vallecular cysts are rare but should be considered in children with respiratory distress and dysphagia. Awake, flexible fiberoptic laryngoscopy with particular attention to the vallecular region should be performed on any child presenting with these symptoms. Direct, transoral approach for excision of the vallecular cyst is our preferred method of treatment with no recurrences to date.

Endoscopic surgical management of inspiratory stridor in newborns and infants

“…We also agree that awake, beside flexible fiberoptic laryngoscopy should be performed on stridolous infants and would like to emphasize that particular attention should be directed at the base of tongue and vallecula in newborns and infants to evaluate for a vallecular cyst, as this diagnosis may be missed and mistakenly attributed to laryngomalacia. Our surgical approach and outcomes also echo and confirm their success [8].…”

Vallecular cyst in an infant with stridor: a case report

“…Treatment options of vallecular cyst include conservative management (wait and see) for asymptomatic patients [28], cyst aspiration, marsupialization [29], surgical debulking, laser excision [3,11,12,30]. As treatment with aspiration only results more chance of recurrence, it isn't recommended [5].…”

Vallecular Cyst: Report of Two Cases

“…Kistin total eksizyonu tedavide sık olarak kullanılan başka bir yöntemdir. Özellikle transoral yaklaşım ile total eksizyon eksternal yaklaşıma göre daha az komplikasyon riski nedeniyle tercih edilmektedir 12 . Bunun yanında, kistin karbon dioksit lazer ile eksizyonu, kisti çevreleyen epi- telin vaporizasyonu sayesinde rekürrens riskini azaltır 13 .…”