Combined laryngocele: A cause of stridor and cervical swelling

A laryngocele is usually a cystic dilatation of the laryngeal saccule. The etiology behind its occurrence is still unclear, but congenital and acquired factors have been implicated in its development. In this study, we present a rare case of laryngocele occurring in a 72-year-old woman. During physical examination the external component of the laryngocele was seen as a swelling in the neck. The swelling became larger during Valsalva maneuver. On the endoscopic examination of the larynx, she had a bulging near the ventricular fold and the right aryepiglottic fold. Diagnosis of laryngocele was made and confirmed with physical examination, indirect laryngoscopy and magnetic resonance imaging (MRI).     

Ein Fall Von Einer Laryngocele Beim Neugeborenen

A case of anew-born infant, aged 35 days old, with laryngocele was succesfully treated by laryngomicroscopic operation under general anaesthesia.He was suffered from congenital inspiratory dyspnea due to cystic swelling of the left arytenoid region.Although therapeutic efforts had been made by repeated punctions for the laryngeal cystic swelling, inspiratory dyspnea did not improve. Total removal of laryngocele by laryngomicro-surgery seems to be appropriate for this lesions.     

Laryngopyozele

A laryngopyocele forms when a laryngocele, as a dilatation of the laryngeal ventricle, becomes infected and fills with mucopus. Laryngopyoceles are rare, as only few cases have been previously reported in the literature. The case of a 75-year-old woman who was treated twice because of a deep cervical infection is described. First of all the cause remained unknown but 3 years after the first manifestation air could be aspirated from a now non-infected neck swelling. A laryngocele was revealed as the cause of the relapsing infection. The surgical resection led to a final healing and the patient remained free from disease. When dealing with a clinical picture of an unknown deep cervical infection, an external or mixed laryngocele should be considered in the differential diagnosis as a rare cause.     

Laryngopyocele (a report of two cases)

A laryngocele is an air-filled dilatation of the saccule of the larynx. An infected laryngocele is called a laryngopyocele. Our experience with two cases of laryngopyoceles are presented. Only 29 cases of laryngopyoceles have so far been reported in the literature (Illum and Nehen, 1980). Case one had a right-sided combined laryngopyocele and case two had a right-sided combined laryngopyocele and a left-sided combined laryngocele. Both our cases had their lesions excised via an external approach, as described by Yarington and Frazer (1966), with case two having a bilateral excision.     

Computerized tomography imaging of laryngocele. Its importance in the differential diagnosis of tumors of the larynx and pharynx

The laryngocele is a dilatation of the laryngeal ventricle and represents a rare condition. In most cases there is a typical history. Patients with an internal laryngocele usually complain of hoarseness, dyspnea and cough. Laryngoscopy shows a swelling of the false cord on one side. The external laryngocele presents as a swelling in the neck. In some cases the clinical presentation is not that typical, so that computed tomography (CT) can be a helpful, additional investigation. CT scans show either an air- or mucus-containing tumor at the level of the false cord. This internal laryngocele may proceed into an external one, which presents as a swelling at the level of the hyoid bone. We now present 13 cases of laryngoceles with special regard to the CT and intraoperative findings. In the differential diagnosis other tumors of the larynx are considered, since the mucus-filled laryngocele is difficult to distinguish.     

Multifocal presentation of cystadenolymphoma (Warthin tumor) in the parotid gland and larynx

Warthin's tumour of the larynx is an unusual finding. In present literature only four cases have been described. A fifth case of a 77-year-old woman suffering from Warthin's tumour of the left parotid gland and the left false cord is presented. Moreover, this patient had an inner and outer laryngocele. This combination of Warthin's tumour of the larynx with a laryngocele has not been described before in literature. The theories about the development of Warthin's tumours are discussed, in particular their relationship to the development of the branchial cleft apparatus.     

Laryngocele: a case report and review

A 60 year old man had a symptomless mass in the neck for two years. Over two weeks he developed hoarseness and dysphagia and successfully underwent excision of a combined internal and external laryngocele. There is some disagreement in the literature as to when an enlarged saccule is a laryngocele and also as to whether laryngoceles result from chronic straining such as playing a wind instrument. Laryngeal carcinoma occasionally occurs in association with a clinical laryngocele. When sought for in laryngectomy specimens the incidence of laryngocele in patients with laryngeal carcinoma has been recorded at 18%.     

Phlebectasia of left anterior jugular vein

We present a rare case of unilateral phlebectasia of the anterior jugular vein in a 56-year-old male patient whose complaint is a neck swelling that appears during talking. Although in this age group the most common cause of such a mass in the anterior aspect of the neck increasing in size during any type of straining or Valsalva manoeuvre is a laryngocele, phlebectasia of the anterior jugular vein should be considered in the differential diagnosis. Doppler ultrasound and computed tomography are the most useful and non-invasive methods to use for the investigation. Treatment should be conservative.     

A case of orbital emphysema associated with internal laryngocele

Orbital emphysema (OE) is usually the result of a fracture of lamina papyrecea or maxillary roof allowing air to pass from the sinuses into the orbit. OE without evidence of any significant trauma is a rare occurrence. Thorough literature search revealed that no case of OE due to the rupture of internal laryngocele has been reported. A case is reported here of bilateral orbitopalpebral emphysema associated with internal laryngocele, in the absence of facial skeleton trauma, in a healthy young adult male. It should be kept in mind that laryngocele rupture would be one of the underlying causes of OE or OE would be the presenting symptom of laryngocele rupture.     

Asymptomatic bilateral mixed-type laryngocele and laryngeal carcinoma

A laryngocele is an abnormal dilatation of the laryngeal saccule. The relationship between layngoceles and laryngeal carcinoma is still debated. We present the case of a 45-year-old male patient with bilateral asymptomatic laryngocele and laryngeal squamous cell carcinoma. We discuss the possible etiopathogenetic influence of increased intralaryngeal pressure with preoperative CT and explorative findings, and the current literature is reviewed.     

Bilateral internal laryngocele with open nasality--report of a case

Laryngocele is an abnormal saccule dilatation of the ventricle in direct communication with the laryngeal lumen. It is usually filled by air and mostly asymptomatic. This case is reported due to its rarity. A bilateral internal laryngocele with open nasality in 66-year-old man is described. Patient has been observed for 8 years with stable course of the disease and good general condition. Because the squamous cell carcinoma is known to occur in association with laryngocele necessity of control evaluation is very important. The etiology, classification, evaluation is discussed.     

Coincidental appearance of laryngocele and laryngeal carcinoma

The authors present a case of a 54-year-old male patient suffering from a laryngocele with concomitant laryngeal cancer. The patient had a three-month history of hoarseness. The clinical examination as well as the endoscopic evaluation did not reveal any signs of malignancy inside the larynx. MR imaging, however, showed an endolaryngeal cystic process surrounded by a soft tissue mass. Resection of the lesion revealed the concomitant occurrence of both laryngocele and laryngeal carcinoma. Etiology, symptoms, diagnostic management and differential diagnosis are presented and discussed according to the relevant literature.     

Internal laryngopyocele as a cause of acute airway obstruction: an extremely rare case and review of the literature

The laryngocele is an abnormal cystic dilatation of the saccule or appendix of the laryngeal ventricle, filled with air and communicating with the lumen of the larynx. When the neck of the laryngocele is obstructed, it becomes filled with mucus of the glandular secretion and is changed to a laryngomucocele. When this lesion becomes infected, a laryngopyocele is formed. The laryngocele is fairly rare and laryngopyocele occurs even more rarely. Overall, 39 cases of laryngopyocele have been reported in the world literature. Only in 4 cases was a laryngopyocele reported to have caused acute airway obstruction and only one case of internal laryngopyocele causing acute airway obstruction has been reported until now. This is the first case reported in the literature of an internal laryngopyocele in a female patient in a septic condition, which caused almost 100% obstruction of the airway. An emergency tracheotomy was performed in order to secure the airway. Computed tomography of neck was performed which revealed a cystic 29 mm hypodense mass extending from the right false vocal cord to the level of the epiglottis, narrowing the laryngeal cavity and causing an almost 100% airway obstruction. Laryngopyoceles may present with a rapid and alarming obstruction of the airway and, therefore, an urgent tracheotomy may be inevitable. It is an emergency case, in the field of otolaryngology, and should be included in the differential diagnosis of acute airway obstruction, especially when hoarseness, stridor and fever are present. Diagnosis requires a high index of suspicion for these lesions and scrupulous clinical and radiological evaluation. A computed tomography scan is critical in determining the nature and site of the lesion. The recommended treatment of laryngopyocele is immediate endoscopic drainage. Definitive management of laryngopyoceles is surgical excision which can be performed immediately after endoscopic drainage or some time thereafter.     

Endoscopic CO2 Laser Management of Laryngocele

Objective To report on the management of laryngoceles by CO₂ laser‐assisted endoscopic excision. Study Design A 15‐year retrospective study of 12 adult patients (7 men and 5 women) who presented with a laryngocele. Nine patients had an internal laryngocele, one patient had an external laryngocele, and two patients had combined internal‐external components. Two laryngoceles were right‐sided, six were left‐sided, and four were bilateral. Methods An endoscopic examination of the laryngocele was carried out for both diagnostic and therapeutic purposes. Once identified the air‐ or mucus‐filled cyst (extending from the laryngeal ventricle into the paraglottic space and beyond the thyrohyoid membrane in some cases), the laryngocele was excised in toto, with its surrounding capsule, via endoscopic approach using the CO₂ laser. Results The main presenting symptom was dysphonia in seven patients, visible or palpable mass in the neck in three, and upper airway obstruction in the remaining two. All laryngoceles were treated with endoscopic laser excision of the internal and external components when required. The average postoperative stay in hospital was 1.8 days. Only two of the patients treated had a tracheotomy; both cases presented elsewhere with an emergency airway obstruction, which necessitated tracheotomy. In these two cases, decannulation was subsequently performed. There were no significant complications. The follow‐up ranged from 6 months to 5 years. Conclusion CO₂ laser‐assisted endoscopic excision of a laryngocele is a quick, precise, and safe alternative to an external approach excision (lateral thyroidotomy, laryngofissure) with fewer complications than its external counterparts, resulting in speedier rehabilitation of both the patient and his or her voice.     

Laryngocele and squamous cell carcinoma of the larynx

We present a case report of a lady with a laryngocele and a squamous cell carcinoma of the larynx. The pathogenesis of the relationship between these two entities is discussed and the literature reviewed. This association means a carcinoma must be outruled if a laryngocele is detected clinically or radiologically.     

Laryngeal chondroma presenting as a laryngopyocele

The abnormal dilatation of saccules in direct communication with the laryngeal lumen is termed laryngocele. A simple laryngocele is an air-filled dilatation of the saccule and is mostly asymptomatic. When the neck of the laryngocele is obstructed, the laryngocele becomes filled with mucus. If a mucus-filled laryngocele is infected, it is called a laryngopyocele. The etiology of laryngoceles is not well understood. However, there is an association between laryngoceles and carcinoma of the supraglottic larynx. The main reasons are probably obstruction and mucosal retention of the saccule, increasing intralaryngeal pressure due to airway obstruction or abnormal contraction of the involved laryngeal muscles due to tumoral spreading. We present a patient with laryngopyocele that arose because of a laryngeal chondroma     

Excision of laryngocele via transcervical midline approach

Acute airway obstruction in the adult can be caused by a rapidly enlarging laryngeal cyst that may present unusually as a midline neck mass. In this case report we present a different surgical technique for the removal of a large combined laryngocele via midline transcervical approach that did not require laryngofissure. This technique allowed simple and fast access, excellent exposure and complete removal of the lesion without resection of thyroid cartilage or associated morbidities.     

Use of B-mode sonography in the diagnosis of laryngocele

A case of a combined laryngocele is presented, including clinical features, the histopathological findings, and the treatment of the disease. The article stresses the value of imaging methods such as CT-scan and high-resolution real-time sonography for preoperative diagnosis. Especially note-worthy is the fact that the internal and external parts of laryngoceles, filled with fluid and with air, can be shown by sonography.     

Laryngeal amyloidosis with laryngocele.

Both laryngocele and laryngeal amyloidosis are uncommon, and simultaneous occurrences of these entities are extremely rare. A case of laryngeal amyloidosis with laryngocele in which the computed tomography (CT) and magnetic resonance (MR) imaging of the larynx, clearly demonstrating both disease processes, is discussed. Diagnosis is confirmed by histopathologic specimens. Only two cases have been reported in the world literature, and this is the third case of laryngeal amyloidosis associated with laryngocele.     

Intraoperative inflation of laryngocele with LMA

Objectives

Laryngoceles are pathologic air filled dilations of the laryngeal ventricle. They are most often benign and incidental findings. Resection may be necessary in the setting of infection, airway obstruction, dysphagia, and phonatory disturbances. External laryngoceles are almost universally treated with open resection via a lateral or midline cervical approach. Care must be taken to resect the laryngocele in its entirety to avoid recurrence. In cases of recurrent infection, normal surgical planes are often fibrosed and obscured increasing the risk of neurovascular sacrifice and functional losses.

Methods

We are reporting a case of recurrent infections in a large, palpable external laryngocele. During resection the patient was ventilated using an endotracheal tube (ETT). Additionally, a laryngeal mask airway (LMA) was inserted posterior to the ETT, resting in the hypopharynx and attached to a Jackson Rees circuit. Air was passed through the LMA to inflate the laryngocele and better define its borders. The LMA was also used to identify the root of the laryngocele in the paraglottic space and ensure its airtight closure.

Results

The LMA assisted our dissection and helped progress the surgery safely in a fibrosed surgical field. We have not seen this method described previously. The patient continues to be free of recurrence 2 years after surgery.

Conclusion

While in most cases, with careful surgical technique, even a fibrotic and scarred laryngocele can be excised in its entirety without neurovascular sacrifice. In some cases where this may be difficult with a traditional approach, we offer the intra-operative trumpet maneuver as a viable method of better delineating the borders of a laryngocele.