Youjin Li1, Alexandria L Irace1, Natasha D Dombrowski1, Antonio R Perez-Atayde2, Caroline D Robson3, Reza Rahbar4. 1. Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA 02115, USA. 2. Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pathology, Harvard Medical School, Boston, MA 02115, USA. 3. Department of Radiology, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Radiology, Harvard Medical School, Boston, MA 02115, USA. 4. Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA 02115, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA 02115, USA. Electronic address: Reza.rahbar@childrens.harvard.edu.
Abstract
OBJECTIVE: To review the presentation of pediatric vallecular cysts and outline an approach for evaluation and management. METHODS: Medical records of patients diagnosed with vallecular cyst between 2005 and 2017 were reviewed. Data on demographics, clinical characteristics, diagnostic methods, surgical procedures, and outcomes were collected and analyzed. A comprehensive literature search for pediatric cases of vallecular cyst was conducted for comparative analysis. RESULTS: Twenty patients underwent surgery for congenital vallecular cysts during the study period. Age at diagnosis ranged from birth to 8 years (median age = 1.1 years). The most common preoperative symptom was inspiratory stridor (45%) followed by feeding difficulties (40%). Eight patients (40%) initially presented with laryngomalacia and 7 (35%) with feeding difficulties. Imaging was obtained in 16 patients and consisted of plain films, ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). Marsupialization of the cyst was performed in all 20 patients. Three patients (15%) presented with recurrence. CONCLUSION: Vallecular cysts can cause feeding difficulties due to upper airway obstruction and pressure at the laryngeal inlet. Diagnostic work-up for vallecular cysts should include a detailed medical history, complete head and neck examination including endoscopic examination, and appropriate imaging, as each of these components complements the histopathologic findings. Our findings indicate that performing marsupialization is associated with low rate of recurrence or complication.
OBJECTIVE: To review the presentation of pediatric vallecular cysts and outline an approach for evaluation and management. METHODS: Medical records of patients diagnosed with vallecular cyst between 2005 and 2017 were reviewed. Data on demographics, clinical characteristics, diagnostic methods, surgical procedures, and outcomes were collected and analyzed. A comprehensive literature search for pediatric cases of vallecular cyst was conducted for comparative analysis. RESULTS: Twenty patients underwent surgery for congenital vallecular cysts during the study period. Age at diagnosis ranged from birth to 8 years (median age = 1.1 years). The most common preoperative symptom was inspiratory stridor (45%) followed by feeding difficulties (40%). Eight patients (40%) initially presented with laryngomalacia and 7 (35%) with feeding difficulties. Imaging was obtained in 16 patients and consisted of plain films, ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). Marsupialization of the cyst was performed in all 20 patients. Three patients (15%) presented with recurrence. CONCLUSION: Vallecular cysts can cause feeding difficulties due to upper airway obstruction and pressure at the laryngeal inlet. Diagnostic work-up for vallecular cysts should include a detailed medical history, complete head and neck examination including endoscopic examination, and appropriate imaging, as each of these components complements the histopathologic findings. Our findings indicate that performing marsupialization is associated with low rate of recurrence or complication.