Congenital laryngeal saccular cysts are mucus-filled cysts that are found within the larynx. The larynx is the area made of cartilage within the neck that sits above the trachea and esophagus, and includes the voice box. Laryngeal cysts present in approximately 1.8 per 100,000 live births. Saccular cysts are rare, accounting for approximately 25% of laryngeal cysts, with the other 75% being ductal cysts.
With direct access to the lungs, occlusions in the larynx can lead to a blockage of the respiratory tract and potentially death. These cysts develop prior to birth, which is why they are referred to as congenital. These cysts can vary in size from small to large. The larger the cyst, the more emergent the treatment is. Small cysts may go unnoticed in infancy and be discovered during childhood or adulthood as the cyst grows and vocal abnormalities become present.
In others, it may be apparent immediately or within the first few months of life when a child manifests with respiratory complications. These types of cysts are rare but can lead to life-threatening respiratory obstructions, and it is extremely important that they be treated appropriately.
What Symptoms Should You Watch For?
Congenital laryngeal saccular cysts are typically first noticed when there are audible respiratory abnormalities. The cyst compromises some or all of the airway, causing the following symptoms:
Stridor: This sound is heard when the infant inhales or breathes in. It is a high-pitched sound due to the narrowed passageway. This sound can be heard at various times, whether the child is eating, sleeping, or playing.
Hoarse voice or muffled cry: This symptom occurs when a cyst impacts the vocal cords. It can be found in infants and children, as well as adults. For adults who have had a congenital cyst that was potentially undiagnosed, this is often one of the symptoms noticed in adulthood.
Breathing difficulties: Children with laryngeal cysts may have difficulty breathing, meaning they must work harder to breathe because of the narrow airway. This includes labored breathing, fast breathing, or abnormal breathing. Parents or healthcare providers may also notice accessory muscle use. The muscles in between, above, or beneath the ribs contract or pull inward to help with breathing. Accessory muscle use for breathing is not normal and indicates that extra muscles are at work to aid in breathing.
Cyanosis: If the cyst is large enough and causes severe respiratory issues, the skin or lips will become discolored and have a pale, blue, purple, or white coloration.
Feeding difficulties: Infants with laryngeal cysts may present with feeding difficulties. Infants may avoid feeding because of the difficulty in eating and breathing in a coordinated manner with an obstructing cyst. Some children find it too exhausting to both eat and breathe, and breathing becomes the priority.
Fatigue: With less oxygen being delivered to the body, fatigue may be present. Fatigue can also be present because of the excess energy the body is using to breathe.
Unresponsiveness: If the cyst has become so large that it occludes the airway, the infant will become unresponsive because of the lack of oxygen to the brain. Immediate help must be sought, and life-saving measures must be attempted right away.
Congenital laryngeal saccular cysts are not visible externally. It is imperative that if any of these signs are noticed, the child be evaluated by a healthcare professional to determine if a cyst is present and causing these complications. It is important to recognize that cysts can grow in size, causing different symptoms at different times.
How Are These Cysts Diagnosed?
Diagnosis for a laryngeal cyst is done by laryngoscopy. A flexible tube with a camera is placed through the mouth and down to the larynx to allow for direct visualization of the area and to determine if a cyst is present. A computed tomography (CT) scan is often done to get a better understanding of the severity and size of the cyst.
The healthcare provider will do an exam assessing breathing characteristics such as breath sounds, work of breathing, accessory muscle use, or any cyanosis or discoloration of the skin. They will also question the caregiver about any feeding difficulties or fatigue. It is important to confirm that the cyst is indeed fluid-filled and not tissue.
What Kind of Treatment Can Be Done?
Treatment for congenital laryngeal saccular cysts depends on the severity and location of the cyst. Treatment can vary from needle aspiration to excision. The severity and location can also impact how emergent treatment or surgery may need to be performed. For smaller cysts or for temporary treatment, needle aspiration can be performed to drain the cyst. One disadvantage is that needle aspiration has a higher level of recurrence than excision. A large cyst that is impacting breathing would need immediate treatment.
The most common and reliable treatment is external endoscopic excision. Endoscopic excision involves surgically removing the cyst under general anesthesia. Access is gained by going through the mouth to the larynx. The patient would be intubated during this time, which means a breathing tube would be placed to help maintain proper respiratory efforts.
The difficulty level of removal can also vary depending on the location of the cyst, the size, and whether the vocal cords are involved. Care is taken to avoid any alteration of the vocal cords, leading to voice changes.
Some individuals may have lingering hoarseness due to the proximity of the cyst to the vocal cords. A steroid medication is often given after treatment to decrease inflammation of the larynx and associated tissues from surgery. Inflammation is the bodys natural response to injury, but too much swelling in the larynx can also narrow the airway.
It is important to be aware that these cysts do have the potential to recur or refill with mucus. The healthcare provider will complete an additional exam or examinations after the operation to check for any recurrence.
What to Expect from Surgical Recovery
Recovery from surgical excision of a cyst includes special care and monitoring. Caregivers should be aware of and monitor for any further breathing difficulties. Feeding difficulties can occur after the operation due to pain in the involved area. Pain management is important for comfort and to decrease the amount of stress on the body during the healing process. Follow the medication recommendations suggested by the healthcare provider and take medications appropriately.
For newborns or small infants who cannot express pain, watch for fussiness, excessive crying, or any signs of discomfort. Infections can occur after any invasive procedure, so talk to a healthcare provider if any fevers or other signs of infection arise.
In Conclusion
Congenital laryngeal saccular cysts can be life-threatening if they are large enough to cause respiratory occlusion. Parents should be educated on life-saving measures should their child become unresponsive. Call 911 immediately and begin cardiopulmonary resuscitation (CPR) if this is the case. Chest compressions should be deep and fast to circulate blood throughout the body.
The child needs prompt treatment to prevent death in this situation. For children whose cysts impact breathing, infection could further compromise the airway. With a narrow airway, additional mucus from an upper respiratory tract infection could cause occlusion or extreme breathing difficulties. If a child does have a cyst, precautions should be taken to prevent disease transmission, including proper hand hygiene and distancing from sick individuals.
Always consult with a healthcare provider regarding any concerns or questions. Congenital laryngeal saccular cysts are rare, but for those who do have this condition, extreme caution should be taken, and medical help should be sought.
About the Author:
Rachel Pugmire is a registered nurse and freelance writer. She received her Bachelor of Science in Nursing in 2018, with a minor in gerontology. Her areas of expertise include emergency medicine, pediatrics, and pharmaceutical clinical trials. Medical writing has given her a platform to do what she is passionate about, which is educating patients, their families, and other healthcare professionals.
Rachel is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely those of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
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