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Transoral approach for direct and complete excision of vallecular cysts in children
Eunice Y Chen1, Jae Lim, Emily F Boss
1Division of Pediatric Otolaryngology, Section of Otolaryngology, Department of Surgery, Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
Insights
Vallecular cysts in children can cause respiratory distress and swallowing issues. Transoral excision is an effective treatment, with no recurrences observed in this study.
Area of Science:
- Pediatric Otolaryngology
- Congenital Airway Anomalies
- Surgical Innovation
Background:
- Vallecular cysts are rare congenital anomalies affecting the pediatric airway.
- These cysts can lead to significant respiratory distress and feeding difficulties in infants and children.
Purpose of the Study:
- To review the clinical presentation, diagnostic methods, and treatment outcomes for pediatric vallecular cysts.
- To introduce and evaluate a transoral excision technique for vallecular cysts in children.
Main Methods:
- A retrospective case series of seven children diagnosed with vallecular cysts between 2001 and 2008.
- Data analysis included presenting symptoms, diagnostic modalities (flexible fiberoptic laryngoscopy, MRI), surgical approach, and follow-up for recurrence.
Main Results:
- Five of seven children presented with respiratory distress and/or swallowing difficulties.
- All patients underwent successful transoral excision of the vallecular cyst.
- No recurrences were noted during a mean follow-up of 233 days.
Conclusions:
- Vallecular cysts require consideration in pediatric patients with respiratory and swallowing symptoms.
- Flexible fiberoptic laryngoscopy is crucial for diagnosis.
- Transoral excision is a preferred and effective treatment with a low recurrence rate.
Objective:
To review the presentation, evaluation, and treatment of children with vallecular cysts and introduce a new technique of transoral excision for this entity.
Methods:
Retrospective case series of children diagnosed with vallecular cyst between 2001 and 2008 at a single tertiary care children's hospital. Data collected, including age at diagnosis, presenting symptoms, additional diagnoses, diagnostic modality, prior and subsequent surgical therapy, length of hospital stay, length of follow-up, and recurrence were analyzed with descriptive statistics.
Results:
Seven children (mean age 198 days, range 2 days to 2.9 years) were included in this series. Five children presented with respiratory distress and/or swallowing difficulties. Vallecular cyst was diagnosed by initial flexible fiberoptic laryngoscopy (5/7), MRI (1/7), and intubating laryngoscopy (1/7). All children underwent complete cyst excision via transoral surgical approach. Two children underwent additional supraglottoplasty for concomitant laryngomalacia, one of whom underwent tracheotomy for persistent respiratory distress and vocal cord immobility. The average length of hospital stay postoperatively was 9.5 days, and four patients stayed less than 2 days. No patients experienced recurrence of the vallecular cyst at last follow-up (range 4-755 days, mean 233 days).
Conclusions:
Vallecular cysts are rare but should be considered in children with respiratory distress and dysphagia. Awake, flexible fiberoptic laryngoscopy with particular attention to the vallecular region should be performed on any child presenting with these symptoms. Direct, transoral approach for excision of the vallecular cyst is our preferred method of treatment with no recurrences to date.
