Lateral saccular laryngeal cyst and unexpected asphyxial death

We present the case of a 41-year-old man with a herniated saccular laryngeal cyst in the left cervical region who died unexpectedly at home from acute asphyxia. A few days before death the patient complained an obvious palpable swelling on the left side of the neck. The autopsy showed an oval-shaped mass originating on the wall of the larynx and herniating into the extralaryngeal region. The critical reduction of the laryngeal lumen originated from an intense oedema of the laryngeal mucosa above the cyst, concurrent with an inflammatory process of the cystic wall, with probable associated glottis laryngospasm mediated by the superior laryngeal nerve. The rapid evolution of oedema was favoured by the extreme relaxation of the connective tissue of the laryngeal mucosa in the supraglottic and aryepiglottic regions which explains the sudden death. The case is useful for delineating the problems related to the possible evolution of laryngeal cysts, the mechanisms of asphyxial complications, the pathological diagnosis and the medico-forensic aspects.