Infected Epiglottic Cyst Presenting With Stridor in an Adult: A Case Report

Epiglottic cyst is a benign tumour that can occur at all ages. Considering that the diameter of the respiratory tract is smaller in infants and children, an epiglottic cyst may easily obstruct the airway and large cysts may present as stridor, cyanosis with feeding and respiratory difficulty. On the other hand most adult epiglottic cysts remain benign and asymptomatic. Rarely they may progress to epiglottitis or epiglottic abscess, leading to airway obstruction and respiratory arrest. We report the case of a 20 year old male patient who presented to us with abrupt onset of dyspnoea and stridor. Our foremost priority was to secure the airway and emergency tracheostomy was done. Laryngoscopic examination revealed a large cyst occupying lingual surface of epiglottis including the free margin. Contrast enhanced CT scan of neck demonstrated prominent epiglottis with hypodense lesions suggestive of abscess within it. The patient underwent microlaryngoscopy with marsupialization of the cyst wall. Patient was subsequently decannulated and on follow up showed no recurrences of cyst.

Epiglottic Cyst Incidentally Discovered During Screening Endoscopy: A Case Report and Review of Literature / 가정의학회지

From the endoscopists' point of view, although the main focus of upper gastrointestinal endoscopic examination is the esophagus, stomach, and duodenum (usually bulb and 2nd portion including ampulla of Vater), the portions of the upper airway may also be observed during insertion and withdrawal of the endoscope, such as pharynx and larynx. Thus, a variety of pathologic lesions of the upper airway can be encountered during upper endoscopy. Among these lesions, an epiglottic cyst is relatively uncommon. The cyst has no malignant potential and mostly remains asymptomatic in adults. However, if large enough, epiglottic cysts can compromise the airway and can be potentially life-threatening when an emergency endotracheal intubation is needed. Thus, patients may benefit from early detection and treatment of these relatively asymptomatic lesions. In this report, we present a case of epiglottic cyst in an asymptomatic adult incidentally found by family physician during screening endoscopy, which was successfully removed without complication, using a laryngoscopic carbon dioxide laser.

Difficult endotracheal intubation due to an undiagnosed epiglottic cyst :A case report / 대한마취과학회지

An epiglottic cyst is a common form of laryngeal cysts which are rare causes of upper airway obstruction. A congenital laryngeal cyst always causes neonatal respiratory distress, but an acquired cyst shows very wide spectrum of symptoms such as no specific complaints, dysphagia, respiratory difficulty, or even death according to its size, location, or age. From anesthesiologists' point of view, an asymptomatic undiagnosed laryngeal cyst is a major concern. Unexpectedly, it can cause difficult airway such as 'cannnot intubate' or 'cannot intubate and cannot ventilate' situation during anesthesia. Recently we discovered an undiagnosed epiglottic cyst obscuring laryngeal inlet, leading to difficult intubation during general anesthesia for decompression and fusion of lumbar vertebrae. Fortunately, mask ventilation was possible, and after failed attempts of direct laryngoscopy, we could perform oral fiberoptic bronchoscope-aided intubation. He was discharged 10 days later with no harmful events.

Postextubation Airway Obstruction and Negative-pressure Pulmonary Edema Due to a Laryngeal Cyst: A case report / 대한마취과학회지

Laryngeal cysts, including epiglottic cysts, are rare lesions which are clinically asymptomatic in many cases. Rarely laryngeal cysts cause unexpected airway management difficultties perioperatively. We report up on a case of laryngeal cyst that caused postextubation airway obstruction and negative-pressure pulmonary edema. A 25-year-old man was admitted for brain surgery with neurofibromatosis. He did not have any specific airway problem preoperatively, and anesthesia was done uneventfully. But when he was extubated after surgery, he revealed symptoms of upper airway obstruction in the recovery room. We reintubated him easily, and then we found a laryngeal cyst. Though negative-pressure pulmonary edema occurred after reintubation, he responded to conservative treatment and was discharged without specific problems. We present a review of postextubation airway obstruction and negative-pressure pulmonary edema due to a laryngeal cyst.

Difficult Endotracheal Intubation Due to an Asymptomatic Epiglottic Cyst / 대한마취과학회지

Airway problems are easiest to manage when they are anticipated. Difficult intubation might, however, occur in patients with no obvious signs or symptoms suggesting airway obstruction. We describe a case of difficult intubation where the laryngeal inlet was obscured by a large epiglottic cyst that was discovered during rapid-sequence induction of general anesthesia. A 3-year-old male weighing 15 kg was admitted for an emergency appendectomy. After preoxygenation, a rapid-sequence induction was carried out. Direct laryngoscopy (Macintosh 1 blade) revealed a large 2-cm cyst arising from the lingual surface of the epiglottis. The cyst completely obstructed the view of the epiglottis and larynx, and several attempts at endotracheal intubation were unsuccessful. Fortunately, the patient was mask ventilated without difficulty and oxygen saturation was 98 99%. After a second 10 mg dose of succinylcholine, intubation was attempted using the same laryngoscope blade and a styletted 4.5 mm endotracheal tube by another anesthesiologist as cricoid pressure was maintained. By using the tube to push the cyst upward, intubation of the trachea was performed after a brief view of the arytenoid cartilages. Anesthesia and the operation then proceeded uneventfully. Following an appendectomy, an ENT surgeon removed the cyst.

Congenital Epiglottic Cysts / 대한이비인후과학회지

Epiglottic cyst are relatively uncommon and account for about five percent of benign laryngeal lesions. The most common location is the epiglottis. We experienced two cases of congenital epiglottic cysts, one in an infant who showed dyspnea at birth and was incubated and the other in a 1-month-old infant with increasing stridor during the first month of life. In both cases, each cysts were completely removed under suspension laryngoscopy under general anesthesia with satisfactory results. We reviewed the clinical characteristics, diagnostic modalities, treatments, and prognosis of the epiglottic cyst.