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Published on: August 2, 2024
Stridor Secondary to Acquired Subglottic Cyst: Rarity Makes it Missed
1Department of Otorhinolaryngology-Head Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
Insights
Subglottic cysts (SGCs) are rare airway obstructions in infants, often misdiagnosed. Marsupialization via laryngoscopy is the gold standard treatment for these challenging pediatric cases.
Area of Science:
- Pediatric Otolaryngology
- Neonatal Medicine
- Respiratory Medicine
Background:
- Subglottic cysts (SGCs) are uncommon causes of pediatric airway obstruction.
- Increased reporting linked to advances in neonatal care and diagnostics, particularly in premature infants.
- SGCs can present with diverse symptoms including stridor, dysphonia, and dysphagia, often mimicking other conditions.
Purpose of the Study:
- To highlight the diagnostic challenges and clinical presentation of SGCs in infants.
- To present two cases of SGCs managed at a single center.
- To emphasize the importance of considering SGCs in infants with persistent respiratory symptoms.
Main Methods:
- Case report of two infants with subglottic cysts.
- Review of clinical presentation, diagnostic process, and treatment.
- Comparison with existing literature on SGCs.
Main Results:
- Both cases involved infants with a history of prematurity and intubation.
- Initial misdiagnosis as laryngomalacia and croup occurred in both instances.
- Successful treatment involved direct laryngoscopy with marsupialization.
Conclusions:
- Subglottic cysts require high clinical suspicion, especially in premature infants with respiratory issues.
- Misdiagnosis is common, delaying appropriate management.
- Prompt diagnosis and surgical marsupialization are crucial for favorable outcomes.
Abstract:
Subglottic cysts (SGCs) are a rare cause of airway obstruction in children. Medical advances, higher survival rates for preterm infants, and improved diagnostic equipment have increased the number of reported cases of SGCs over the last three decades, the majority occurring in infants who had been extremely premature neonates and had suffered from respiratory distress, therefore having been intubated and managed in neonatal ICUs. Symptoms of laryngeal cysts depend on the size and the location of the cyst and include a change in the tone of voice, dysphonia, hoarseness, dysphagia, stridor, and dyspnea. This condition is often misdiagnosed as laryngomalacia, asthma, croup, or other diseases, due to the fact that it manifests as recurring respiratory infections, stridor, and wheezing. Death can occur in severe cases that are not treated. When present, it may account for severe inspiratory stridor that compromise the airway. The accepted gold standard treatment is direct laryngoscopy with marsupialization of the cyst to prevent recurrence. Two cases of subglottic cyst in our centre are described here. Although all cases presented differently, but in both of our cases, which have previous history of intubation with prematurity were initially diagnosed as laryngomalacia and croup.
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