Laryngoceles and Saccular Cysts

Introduction:

The laryngeal saccule is a small pouch covered with a mucous membrane and is situated between the inner side of the thyroid cartilage and the false fold (vestibular fold) of the larynx. The laryngeal saccule has around fifty to one hundred mucous-secreting glands and is responsible for providing lubrication to the vocal cords, especially when one is speaking or even swallowing.

What Is a Laryngocele?

Laryngocele is an abnormal medical condition that is characterized by abnormal dilation of the laryngeal saccule while maintaining a connection with the laryngeal lumen. Laryngocele is filled with air. Laryngocele usually occurs only on one side, but it can involve both sides of the larynx.

What Are the Types of Laryngocele?

Depending on the location of the laryngocele, it may be classified as:

• Internal Laryngocele - Laryngocele is formed within the larynx. Symptoms of internal laryngocele may include shortness of breath or dyspnea, change or hoarseness of voice, a sensation of a lump in the throat, and in severe cases, individuals may experience an obstruction of the airway.

• External Laryngocele - Laryngocele can enlarge and penetrate the adjacent thyrohyoid membrane and forms a protrusion in the neck. Symptoms of external laryngocele are similar to the symptoms of internal laryngocele and also include a visible swelling or protrusion in the neck.

• Mixed Laryngocele - When the internal laryngocele enlarges and protrudes outside the laryngeal saccule and forms an external laryngocele, it is considered a mixed laryngocele.

• Laryngopyocele - A condition in which the laryngocele gets infected is referred to as laryngopyocele. In this case, individuals will also present with symptoms of pain and fever.

What Is a Saccular Cyst?

A cyst within the laryngeal saccule is termed a saccular cyst. Saccular cysts are filled with fluid or mucus. Saccular cysts do not extend and maintain a connection with the laryngeal lumen. A saccular cyst can occur in the laryngeal saccule of only one side or may involve both sides. A saccular cyst may develop when the mucous-secreting glands within the laryngeal saccule get blocked.

What Are the Types of Saccular Cysts?

Saccular cysts are of different types based on the location of the cyst.

• Anterior Saccular Cyst - Saccular cyst extends inward toward the midline of the larynx.

• Lateral Saccular Cyst - Saccular cyst extends to the back and side of the larynx. The lateral saccular cyst may be further classified as internal, external, or combined similar to laryngocele.

What Are the Causes of Laryngocele and Saccular Cysts?

Laryngocele may be congenital (present at birth) due to developmental defects of the larynx or the surrounding structures. It may also be acquired (developed later in life) due to activities such as blowing trumpets or forceful coughing. The increased pressure and strain on the laryngeal saccule may subsequently cause the development of laryngocele.

Saccular cysts may develop due to an infection, prolonged insertion of a breathing tube (intubation), or the presence of a tumor or laryngeal mass that cause obstruction of the opening of the saccule.

How to Diagnose Laryngocele and Saccular Cysts?

Diagnosis of laryngocele and saccular cysts involves clinical examination followed by various imaging tests.

• Clinical Examination - On presentation of symptoms, the doctor will examine the larynx for any visible mass or abnormality.

• Flexible Fiberoptic Laryngoscopy - The doctor evaluates the laryngeal conditions using a thin, flexible tube with a camera that is inserted through the nose or mouth.

• Stroboscopy - The doctor uses a special device that has a small camera, a microphone as well as a flashing light to examine the vocal fold vibrations in slow motion in order to detect any abnormality of the larynx, in this case, laryngocele.

• Endoscopy - A rigid or flexible laryngoscope may be used to directly visualize the larynx and to assess the size, location, and extent of the laryngocele or saccular cyst.

• Computed Tomography Scan of the Neck With Intravenous Contrast - This procedure uses a contrast agent that is injected into a vein to enhance the visibility of the blood vessels and structures while scanning. The location and extension of laryngocele or saccular cysts can be visualized using this technique.

• Magnetic Resonance Imaging (MRI) - MRI scan of the neck may also be used to detect the extent and content (air-filled or fluid-filled) of the swelling in the neck.

How to Treat Laryngocele and Saccular Cysts?

The treatment measures involved in the management of laryngocele and saccular cysts depend on the size, location, and extent of the condition in the surrounding structures. Some of the treatment measures include:

• Observation - It is recommended to observe laryngocele and saccular cysts if asymptomatic, small in size, and do not cause any discomfort or pain for the individual. However, regular monitoring is necessary to detect any changes, at the earliest, in the condition.

• Surgical Drainage - Surgical drainage may be required for laryngocele or saccular cysts in severe cases where the condition may cause obstruction of the airway. Surgical drainage can be done through a transcervical (through the neck) approach or using an endoscope (a flexible tube that is used to visualize the laryngocele or a saccular cyst can be used to drain the same).

• Endoscopic Excision - Endoscopic excision is a minimally invasive procedure for removing internal laryngoceles and saccular cysts. Using a small tube with a camera and laser, the surgeon makes an incision through the false vocal fold to access the cyst. They carefully remove the cyst while preserving surrounding structures. This approach offers faster recovery and lower risk compared to open surgery.

• Transcervical Excision - Transcervical excision is a surgical procedure used to remove large external components of laryngoceles and saccular cysts. It involves making an incision in the neck, dissecting the lesion, and removing it while preserving the internal laryngeal component. Laryngofissure is rarely necessary.

Conclusion:

Laryngocele and saccular cysts are rare conditions. The conditions seem to affect more men than women. They are often asymptomatic or present minor discomforts, but if left untreated or unmonitored, they could develop into serious complications. Early diagnosis and appropriate treatment measures are key for managing laryngocele and saccular cysts.