Saccular laryngeal cysts. Three case studies and review of the literature

Supraglottic laryngeal cysts are benign lesions that usually are easily recognized and simply managed. Among these lesions saccular cysts are uncommon, usually large, anomalies of the larynx and can cause severe airway obstruction and even death. Three patients with a saccular cyst were successfully treated by endoscopic CO(2)-laser excision of their lesions. Before microlaryngoscopy and laser procedure, an urgent tracheostomy was required in 1 of our cases.     

Congenital laryngeal cyst: a case report

Congenital laryngeal cysts are a rare cause of stridor in the neonate. Nevertheless, delayed diagnosis and treatment can cause life-threatening airway obstruction. Even though the diagnosis is easily made by careful inspection, treatment results often in recurrence. These facts are illustrated by a case of a baby with a saccular cyst. Immediately after diagnosis and 5 days later the cyst was de-roofed using a CO2 laser via an endolaryngeal approach. Because of a second recurrence an excision of the cyst was performed via a lateral cervical approach.     

Endoscopic CO2 Laser Excision of Large or Recurrent Laryngeal Saccular Cysts in Adults

Saccular cysts are uncommon disorders that represent cystic dilatation of the laryngeal saccule. They are distinguished from laryngoceles by their lack of lumenal continuity with the endolarynx, and the fact that they are not air filled. Voice change is the most common clinical presentation in adults, whereas airway compromise is more common in infants. Management recommendations range from observation of asymptomatic lesions, to endoscopic marsupialization or excision, to excision through a laryngotomy or the thyrohyoid membrane. The literature states that large or recurrent saccular cysts require the exposure afforded by a transcervical approach. This report describes complete endoscopic laser excision of large, symptomatic saccular cysts in seven adults. Four of the seven patients were referred with recurrent cysts after the failure of endoscopic marsupialization procedures. None required tracheotomy, and only three of seven were observed overnight in the hospital. Surgical technique with emphasis on complete excision, pre- and postoperative radiographic and surgical anatomy, and treatment outcome are discussed.     

Laryngoceles and saccular cysts in infants and children.

Laryngoceles and saccular cysts are an unusual cause of respiratory obstruction in infants and children. Laryngoceles in particular are less common in the pediatric population than in adults. They typically produce intermittent upper airway obstruction and hoarseness (due to episodic filling with air), and are, therefore, difficult to diagnose. Saccular cysts produce similar symptoms but are not episodic. While smaller anterior saccular cysts are readily managed by endoscopic excision, larger saccular cysts tend to recur repeatedly. Review of experience with 20 infants and children having saccular pathologic changes (17 saccular cysts and three laryngoceles) suggests that saccular lesions are more troublesome than is generally appreciated. The clinical course is typically a lengthy one, with multiple endoscopic procedures. Most patients required tracheotomy, some under emergent conditions. Three patients acquired subglottic stenosis; one was clinically significant. A fourth patient had a congenital subglottic stenosis. Saccular cysts can be managed endoscopically in many cases, but if persistent after two or three endoscopic procedures, a prolonged course can be anticipated. Complete excision, endoscopically or through an external surgical approach, may shorten the clinical course.     

Treatment of recurrent respiratory papillomatosis in children with the microdebrider

The mainstay of treatment of children with recurrent respiratory papillomatosis has been CO2 laser laryngoscopy. Powered microdebriders allow precise removal of laryngeal lesions without thermal damage. The microdebrider may reduce costs by reducing operative time and limiting the need for expensive laser-related equipment. To compare the use of the microdebrider with that of the CO2 laser in children undergoing surgery for recurrent respiratory papillomatosis, we retrospectively reviewed the charts of 18 patients from 2 institutions covering a treatment period between December 1998 and October 2001. These patients were initially treated with the CO2 laser, but were switched to microdebrider resection during the review period. We recorded the number of procedures, the technique(s) of resection used, and the operative time for each procedure. We identified 18 patients, 11 male and 7 female, ages 18 months to 14 years. A total of 127 procedures were performed with the CO2 laser, and a total of 50 procedures were performed with the microdebrider. The mean number of procedures per patient was 10 (range, 2 to 17 procedures). The mean surgical time per procedure using the CO2 laser was 59.2 minutes (range, 8 to 130 minutes). The mean time per procedure with the microdebrider was 32.4 minutes (range, 12 to 47 minutes). This reduction in operative time was clinically and statistically significant (p = .0001, unpaired Student's t-test). We concluded that microdebrider resection of laryngeal papilloma in children allowed more rapid surgery with potentially reduced treatment costs. Other advantages of this technique include precise excision without thermal injury. Our report details useful refinements of technique with the microdebrider.     

Subglottic haemangioma in children: experience with open surgical excision

Subglottic haemangioma is a potentially life-threatening condition for which various treatment modalities are available. The objective of this study was to evaluate our results for open excision of subglottic haemangioma. The study assessed 18 patients who had been treated at a paediatric tertiary referral centre. Most of these patients (83.3 per cent) had undergone open surgical excision without post-operative tracheostomy and had been intubated for several days post-operatively (single-stage procedure). In most of these patients (66.7 per cent), an anterior cartilage graft had been used for reconstruction. The average follow up in this study was 25 months. All the patients in this series had achieved an adequate airway after the procedure. One patient had developed a recurrence of haemangioma in the trachea at a later date. The results of open surgical excision in this study were very encouraging. Seventeen out of 18 (94.4 per cent) patients had avoided tracheostomy or had been decannulated as a direct result of surgery. One of these 18 patients (5.6 per cent) had required a temporary post-operative tracheostomy for 13 months as the subglottis cleared; this was classed as a partial success. Our experience is that open excision is a highly successful 'one stop' treatment for subglottic haemangioma, which avoids prolonged use of steroids and multiple endoscopic procedures. No patient in this series developed subglottic stenosis, which can be a significant complication of laser application.     

Vallecular cyst: report of four cases--one with co-existing laryngomalacia

Congenital vallecular cysts are rare. In this report, four infants having vallecular cysts encountered over a six-year period from 1992 to 1997 were reviewed. All of them presented with upper aerodigestive tract symptoms. Marsupialization was performed in three of them and CO2 laser excision was performed in the fourth patient. There was no recurrence of the cyst in any patient. One of them also had co-existing laryngomalacia. The degree of airway collapse caused by laryngomalacia improved after cyst removal. The laryngomalacia resolved spontaneously. Cyst fluid culture was performed in one of the patients and yielded Staphylococcus aureus but there was no other definite indicator of infection. Staphylococcus aureus could also be isolated in the respiratory tract from two of the other patients.     

CO2 laser cordectomy as a day-case procedure

OBJECTIVE: To evaluate the safety of CO2 laser cordectomy in the treatment of glottic carcinoma as a day-case procedure. STUDY DESIGN: This was a retrospective study of a cohort of 73 patients with glottic carcinoma treated by laser cordectomy as a day-case procedure using a CO2 laser, between January 2000 and June 2004. RESULTS: There were no major complications and no patients required reintubation. More than 90 per cent of the patients were discharged on the day of the procedure. There were seven unplanned admissions to hospital but none of these appeared to be the direct result of the surgery, and the patients were discharged the next day. All the patients stated they would have further surgery in this manner if required. CONCLUSION: Laser cordectomy for glottic carcinoma can be safely performed as an out-patient procedure if patients are carefully selected according to specific criteria.     

The clinical characteristics of congenital laryngeal saccular cysts

Conclusion: The first step when treating newborns and infants with hoarseness and dyspnea is to consider the possibility of CLSCs. The appropriate operation can then be chosen based on the cyst sub-type. Complete resection of the cyst wall is the key to preventing recurrence. Background: A laryngeal saccular cyst is an unusual congenital lesion that appears clinically during the neonatal period or early infancy. Because few reports on congenital laryngeal saccular cysts (CLSCs) exist, this study investigated the clinical features of patients with a history of CLSCs to determine the clinical characteristics of this disease. Methods: The data from 28 CLSC patients admitted to Beijing Tongren Hospital from July 2004 to September 2014 were reviewed. Gender, age at onset of symptoms, number of surgical procedures performed, effect of the operation, and CLSC classification were analyzed. Results: CLSCs accounted for 0.79% of laryngeal operations during the study period. Of the cases examined, 35.7% (10/28) had first been treated as laryngomalacia. With respect to cyst type, 17.9% (5/28) were anterior laryngeal saccular cysts, and 82.1% (23/28) were lateral saccular cysts. The patients underwent a total of 53 surgeries, including 21 procedures performed at other hospitals. The time to recurrence of the cysts following needle aspiration ranged from 5–10 days. The time to recurrence after the roof of the cyst was excised ranged from 1–10 months. There were no recurrences after the complete resection of the cyst wall using a CO₂ laser and microsuturing of the wound surfaces via an endoscopic procedure, which is much better than the 41% of endoscopic de-roofing cases which recurred reported by Mitchell et al.     

Enlarged adenoid and adenoidectomy in adults: endoscopic approach and histopathological study

Adenoid enlargement is uncommon in adults and because examination of the nasopharynx by indirect posterior rhinoscopy is inadequate, many cases of enlarged adenoid in adults are misdiagnosed and accordingly maltreated. This study was conducted on 35 cases of enlarged adenoid aged between 20 and 42 years. The nasal endoscope was utilized to identify the adenoid mass. Adenoidectomy under transnasal endoscopic control was performed and all the excised material was sent for histopathological examination. Adenoidectomy resulted in marked improvement in 94 per cent of cases without major complications. Histopathological examination revealed non-specific inflammatory reaction in 15 cases (43 per cent), pure reactive changes, predominantly follicular hyperplasia, in two cases (6 per cent) and mixed pattern in 18 cases (51 per cent). Endoscopic follow-up for an average 17 months identified recurrence in only two patients. It was concluded that enlarged adenoid tissue in adults has some histopathological differences from that in children and adenoidectomy under transnasal endoscopic control is safe and reliable.     

光纤CO2激光的可靠性和有效性：39例患者的前瞻性研究

第一次报道使用科医人公司的新产品Fiber Lase光纤CO2激光（AcuPulse40WG）行经口咽CO2激光手术的患者，目的是为了检验其可靠性和有效性。患者的入选标准为年龄大于18岁，13腔、咽、喉或气管内有良性或癌前病变，均在签署知情同意书之后纳入研究。这项前瞻性研究于2010年10月～2011年5月在2家三级治疗大学医院中完成。本研究共包含39例患者，平均年龄47．9岁（18～86岁）其中21例女性，18例男性。13例淋巴组织肥大（腭部和，或舌部），9例肉芽肿病变，4例渗出性声带病变，3倒严重的异型增生（声门和声门上），3例黏膜自斑，2例声带囊肿，2例喉乳头状瘤，2例双侧声带麻痹，1例痉挛性发音障碍。82％的手术在全麻联合气管插管下完成。光纤CO2激光插入手具内使用，大多数与外科显微镜联合使用。输送激光的参数为超脉；中或CW模式，平均功率为9W（3～15W），连续曝光。光纤CO2激光耐用程度高，术中无需更换。术中未见光纤CO2激光导致的并发症。8例扁桃体手术使用了双极烧灼术来控制出血。光纤CO2激光是一种安全可靠，简单易用的经口腔激光手术工具。该器械具有足够的耐用性，可以完成整个手术过程，术中无需更换另外的光纤。经口咽光纤CO2激光手术的成功取决于病灶的位置和类型、CO2激光组织效应及手术者的经验。     

Acute and latent mastoiditis in children

During the period from 1974 to 1981, surgery for acute mastoiditis was performed on 12 ears, giving an annual incidence of 0.004 per cent among cases of acute otitis media. All ears made a full long-term recovery. The low incidence is ascribed to the world-wide early use of antibiotics. During the same period 52 ears with secretory otitis media (SOM) underwent mastoidectomy. Histologically extensive mastoid inflammation was found in 96 per cent. The changes appeared as formation of secretory cells and cysts, resorption of bone, and infiltration of soft tissues with both mononuclear cells and polymorphonuclear leucocytes. The number of SOM patients undergoing mastoid operations account for 1.4 per cent of the patients admitted to hospital because of SOM. Thirty-four ears (65 per cent) have healed during the follow-up period (mean 2.9 years), while the tympanostomy tube is still in place in 18 ears (35 per cent). In the latter group, factors causing oedema in the pharyngeal end of the Eustachian tube are apparently still present.     

CO2激光治疗舌根部肿物18例

目的 探讨CO₂激光治疗舌根肿物的疗效。 方法 对舌根部肿物18例,包括舌根部囊肿8例、舌根血管瘤5例、舌根乳头状瘤3例、甲舌囊肿2例,应用CO₂激光行手术切除治疗。 结果 手术均取得成功,1例舌根部血管瘤术后2 d出血,对症处理后血止。18例术后1个月复诊,症状消失13例,减轻3例;2例舌根部囊肿患者无变化,分别在术后5个月和术后7个月复发,分别予以再次CO₂激光手术切除,未再复发。 结论 CO₂激光治疗舌根肿物,术中出血量较少,疗效确切。     

„Ein-Schuss-CO2-Laser-Stapedotomie“

BACKGROUND: In order to further optimize the surgical technique with CO(2) laser in stapes surgery, a scanner system was used to obtain a footplate perforation of 0.5-0.6 mm with only one laser application ("one-shot" stapedotomy). PATIENTS AND METHODS: A total of 255 patients with otosclerosis were submitted to primary CO(2) laser stapedotomy with a SurgiTouch scanner. This study discusses the surgical technique and clinical results. RESULTS: An adequately large perforation diameter could be achieved with a single shot in 68% of the patients treated. In 14% of the patients, a second laser application at the same site was necessary. In 18% the perforation had to be enlarged by several slightly overlapping laser applications without using the scanner. There was no evidence of laser dependent inner ear affections. CONCLUSION: CO(2) laser, combined with modern scanner systems, is well suited for application in stapes surgery.     

Pleomorphic adenomas of the parotid gland: superficial parotidectomy or limited excision?

In this retrospective study of parotid tumours, 57 patients with pleomorphic adenomas were treated with superficial parotidectomy and 33 patients with limited excision. The follow-up period has been 4-14 years. When the operation was superficial parotidectomy, recurrences occurred in 8.7 per cent compared to 6 per cent in cases of limited excision. Side-effects such as permanent weakness of the facial nerve or post-operative gustatory sweating were also more common when superficial parotidectomy was performed. The post-operative results observed suggest that limited excision under magnification is more favourable than superficial parotidectomy in the treatment of pleomorphic adenomas.     

Endoscopic laser treatment in pre-malignant and malignant vocal fold epithelial lesions

Endoscopic laser treatment was performed in 43 patients with pre-malignant or malignant vocal fold epithelial lesions, 10 were treated with endoscopic laser surgery for dysplasia, 12 for carcinoma in situ (CIS), five for verrucous carcinoma and 16 patients for squamous cell carcinoma (SCC). Thirty-two patients received laser therapy as their first therapy, whereas 11 patients had had previous radiation therapy for laryngeal carcinoma (n = 9) or CIS (n = 2). Recurrence after initial laser therapy necessitating re-treatment (a second laser treatment or radiotherapy) occurred in nine out of 32 patients (28 per cent), thus 23 (72 per cent) were maintained free of disease during the follow-up period. Besides the 32 patients without previous therapy, patients who had already undergone radiation therapy were also included in this study. In this group there were nine patients with SCC, one patient with CIS and one with dysplasia. They all underwent laser therapy. Four were free of disease during follow-up (36 per cent) and seven developed recurrences. Six (58 per cent of all patients with previous radiation therapy) underwent total laryngectomy.     

Occurrence and recurrence of basal cell carcinoma of the head and neck in Negroid and albinoid Africans

A study of sixty patients with basal cell carcinoma of the head and neck region carried out over a six-year period (1979-1985) is hereby presented. Sixteen (26.72 per cent) were albinos and 44 (73.28 per cent) negroids. Forty-eight (80 per cent) were outdoor workers. The negroid patients presented between the 3rd and 4th decades while the albinos presented a decade earlier. The commonest site involved in the head and neck was the forehead. The midface showed the highest recurrence rate in both groups, even after adequate excision. The frequency of recurrence in tumours presenting with a size of 2-5 cm. diameter was significantly higher in the albinos than in the negroid (P less than 0.05), whereas, with tumours of a size larger than 5 cm., there was no statistically significant difference between the albino and the negroid. However, the overall recurrence rate was significantly higher in the albinos (P less than 0.005). The mortality among the albinos was 25 per cent while there were no deaths in the negroid Africans.     

Laryngeal cysts: clinical relevance of a modified working classification

Laryngeal cysts from 72 patients were examined and reclassified according to a modified working classification. In this series, 47 patients (66 per cent) had epithelial cysts, 11 patients (15 per cent) oncocytic cysts and 14 patients (19 per cent) tonsillar cysts. Epithelial cysts were commonest in the region of the epiglottis (20/47) and laryngeal ventricle (24/47). Oncocytic cysts tended to lie in the region of the ventricle whereas tonsillar cysts occurred almost exclusively in the valleculae, epiglottis and pyriform region (13/14). The authors conclude that the modified working classification of laryngeal cysts is easy to apply, of clinical relevance, and allows classification of cysts where operative trauma to the specimen obscures the relationship of the cyst to the surface epithelium. The origin and significance of tonsillar cysts are discussed and a relationship to the lympho-epithelial cyst of the oral cavity is suggested.     

Our experience in the surgical treatment of T1 carcinoma of the vocal cord

From 1971 to 1986, 94 patients suffering from T1 glottic carcinoma underwent cordectomy at the University ENT Clinic of Thessaloniki, Greece. There were five female and 89 male patients with a median age of 61.7 years. Two year survival rate was 93.7 per cent; five year survival rate was 93.2 per cent. Seventeen of the patients suffered recurrence, but 11 of them after laryngectomy or radiotherapy are alive with no sign of the disease. Tracheostomy was not performed in the majority of our cases. The relationship between the site of recurrence and survival as well as the role of radiotherapy before and after cordectomy in some of our patients are discussed. We believe that despite the good results of radiotherapy in T1 carcinoma of the vocal cord and the introduction of other treatment modalities such as CO2 laser, cordectomy by laryngofissure is still of value with very good survival results and minimal discomfort for the patient.