Incidental finding of two epiglottic cysts: Case report and literature review

Epiglottic cysts are rare benign lesions of the larynx, frequently discovered incidentally. Though usually asymptomatic, they can occasionally result in life-threatening airway obstruction. This case report details the incidental discovery of two epiglottic cysts in an adult female during an elective surgical procedure and outlines their clinical presentation, diagnostic evaluation, and surgical management, supported by a literature review. The report adheres to the SCARE criteria.

A 43-year-old medically free female presented for elective umbilical hernia repair under general anesthesia. During intubation, two epiglottic cysts were unexpectedly visualized, partially obstructing the glottic view and complicating airway management. The procedure proceeded with a laryngeal mask airway. Subsequent flexible laryngoscopy revealed two round, smooth, cystic lesions on the lingual surface of the epiglottis. Contrast-enhanced neck CT demonstrated two well-defined epiglottic cysts measuring 17 × 11 mm on the left and 10 × 8 mm on the right. Surgical excision was performed via cold dissection. Histopathological analysis confirmed both lesions as tonsillar-type epiglottic cysts.

Epiglottic cysts may present asymptomatically or with severe airway compromise, particularly during anesthesia. Histologically, they are classified into ductal and saccular types, with tonsillar cysts being less common. Surgical options include cold excision, CO₂ laser, and coblation, all effective in preventing recurrence. In this case, cold dissection reduced rupture risk and enabled complete excision. Current evidence supports minimally invasive techniques, though additional comparative studies are warranted to determine the most effective and safest approaches.

This case emphasizes recognizing epiglottic cysts as potential airway risks and reviews management strategies for this uncommon entity.