Pharyngoceles: a photo-anatomic study and novel management

Pharyngoceles are outpouchings of the lateral pharyngeal wall through the thyrohyoid membrane. These entities are inconsistently documented in the literature given the varying terminology and poor anatomic description. Open surgical repair has been the mainstay of treatment for symptomatic pharyngoceles.

A systematic literature review was conducted to identify articles presenting cases of pharyngoceles. Two case reports supplement the data found.

Through a PubMed search, articles were examined specifically for anatomical discussions, presenting symptoms, and management strategies. To this data, we add two cases of bilateral symptomatic pharyngoceles with full multimedia documentation, including one patient treated successfully with novel endoscopic suture pharyngoplasties.

Twenty-five articles were identified that described 59 cases of pharyngoceles, for a total of 61 patients reviewed. Few articles include descriptive anatomy and correlate in vivo examples, and none describe intraluminal pharyngocele structure in detail. Both patients at our institution had complete resolution of their symptoms, as determined by interviews and oropharyngeal motility studies.

Relatively few true pharyngoceles have been reported in the surgical literature. We offer the first detailed endoscopic anatomic description and formal evaluation of swallowing outcomes, as well as an anatomically-based endoscopic approach. These lesions may be amenable to endoscopic repair with minimal long-term morbidity.