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ORGAN SYSTEMS Otolaryngeal system (ENT)

Laryngocele

Rare, cystic dilatation of the laryngeal saccule that may extend internally into the airway or externally through the thyrohyoid membrane.

Rare, cystic dilatation of the laryngeal saccule that may extend internally into the airway or externally through the thyrohyoid membrane.

  • Virchow introduced the term laryngocele, in 1867, to describe an abnormal dilatation of the saccule forming an air sac.

Clinical features

Many laryngoceles are asymptomatic; sometimes, they may cause a cough, hoarseness, stridor, sore throat and may present as a swelling on one or both sides of the neck. Based on location, three types of laryngocele have been described.

Patient with soft swelling approximately 5 cm in diameter located in latero-cervical area, decreasing upon palpation. | Lancella, A., Abbate, G., & Dosdegani, R. (2007). Mixed laryngocele: a case report and review of the literature. Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale, 27(5), 255–257.

Internal laryngocele:

Confined to interior of larynx and extends posterosuperiorly into the false vocal cord and the aryepiglottic fold
  • Dysphonia, dyspnea, sore throat and globus pharyngeous with associated discomfort in the neck.
  • Appears on laryngoscopy as a smooth swelling of the supraglottis.

External laryngocele:

Extends superiorly to appear laterally in the neck through the opening in the thyrohyoid membrane for the superior laryngeal nerve and vessels
  • Clinically present as neck swelling at the level of the hyoid bone anterior to the sternocleidomastoid muscle.

Combined/mixed laryngocele:

Simultaneous existence of both internal and external features

Complications

  • Laryngomucocele: Laryngocele obstructed and filled with mucous
  • Laryngopyocele (10% cases): Secondarily infected laryngomucocele
    • Presents as an airway obstruction and/or an infected neck mass.
  • Associated with supraglottic squamous cell carcinoma

Diagnosis

Clinical diagnosis:

  • Valsalva maneuver: Swelling becomes larger
  • Bryce sign: Hissing sound on compression of swelling due to sudden gush of excess air into larynx

CT scan: Neck

M/important examination for correct diagnosis
Image showing A) a plain soft tissue x-ray of the neck showing the shadow of the bilateral laryngocele. B) axial and C) coronal CT scan section of larynx confirmed bilateral combined laryngocele. Red arrows points to the laryngoceles | Suqati, A. A., Alherabi, A. Z., Marglani, O. A., & Alaidarous, T. O. (2016). Bilateral combined laryngocele. Saudi medical journal, 37(8), 902–903. https://doi.org/10.15537/smj.2016.8.15104

Management

Surgical management:

Excision of the laryngocele can be performed by endoscopic and/or external or combined approach. The choice of the approach depends on the type and size of the laryngocele.
  • External cervical approach
  • Endoscopic laser treatment
Clinical photos showing the A) preoperative laryngoscopy showed significant airway compromise, B) preoperative planning, and C) intraoperative exposure of left laryngocele. | Suqati, A. A., Alherabi, A. Z., Marglani, O. A., & Alaidarous, T. O. (2016). Bilateral combined laryngocele. Saudi medical journal, 37(8), 902–903. https://doi.org/10.15537/smj.2016.8.15104

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