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.