Presentasi Jurnal Laryngocele

8/10/2019 Presentasi Jurnal Laryngocele

1/13

External Laryngocele: Points to rememberTiara Rachmaputeri Arianto07120100100


2/13

Abstract

Laryngocele rare cystic swelling Saccule of the larynx

Seen mostly

Often associated with underlying malignancy

Case

external laryngocele in a young farmer who did not have any of the

above mentioned associations.

KeywordsLaryngocele, malignancy, Neck swelling, resection


3/13

Introduction

Laryngocele Cystic dilatation of the saccule of the larynx

Generally filled with air

Communication cyst-laryngeal

lumenoccluded

Fluid accumulate within the sac

Saccular cyst

= mucus retentionarise from

mucus gland of the sacculefilled ONLY with mucus

Incidence

1 in 2.5 million population

Males 50 and 60 years of agePossible mechanism

Increase in intraluminal laryngeal pressure


4/13

Case Report25 yo male

Complaints Painless swelling in the upper right side of the neck for the

past 3 years

Increase in size during coughing and straining

Examination

Compressible swelling3 x 4 cm

Right anterior triangle of neck

Non-tender, soft, cystic, fluctuant, mobile

Swelling increased in sizecoughing, valsava

maeuver

Radiograph

Antero-posterior view

Air-filled sac suggestive of external laryngocele

Ultrasonogram confirmed EXCISION


5/13

Procedure

1. General anesthesia and endotracheal intubation

2. Aseptic precautions

3. Horizontal skin incision, over the swelling

4. After raising skin flaps and dissecting soft tissues, laryngocele was identified

5. Seperated from surrounding tissues

6. Mobilized up to its neck as far as the thyrohyoid membrane

7. Neck (or fundus) was transected8. Skin was closed after placing a drain

Post operativesutures removed after 7 days

Histopatologic Examination Confirmed laryngocele and exclude malignancy


6/13

Discussion

Etiology Congenital

Acquired

Large ventricular appendix

causes respiratory distress

Increase in intra-glottic pressure

Excessive caughing, playing a wind instrument, glass

blowing, valsava maneuver

causes

Extend

Internally

Into the airway

Externally

Through the thyroid membrane

Medial to thyroid

cartilage

Lateral to thyroid

cartilage

Laryngocele expands Air-filled communication

become tenous

Pressure changes still betransmitted through it

Increase in size with cough and

valsava maneuver


7/13

Symptoms

Internal Mixed

Globus sensation

Sore throat

Cough

Pain

Snoring

Increasing stridor

Hoarseness

Airway obstruction (if large)

External

Visible or palpable mass in the neck

Laryngoscopic Examination

Globular swelling in the

laryngeal

lumen/submucosal

fullness

But may miss internalcomponent of mixed

laryngocele (if it small)

Differentiated

True cyst classified as

EpithelialMost common! Include

saccular cyst

Oncocytic In ventricle, elderly, higher

rate of recurance, behave

like benign neoplasmTonsillar

Region of vallecula,

epiglottis/pyriformissinus


8/13

Laryngeal pseudocyst

Discrete

Unilateral Localized area of Reinkes edema

Occuringmid-portion of the free-edge striking zone

Diagnostic

Most accurate!

Defining spatial relationships between the

laryngocele and laryngeal structures and

extra-laryngeal soft-tissues

Differentiating the laryngocele from other

cystic formations and

Identifying the coexistence of a laryngeal

malignancy.

Computed tomography


9/13

Marsupialization CO2laser

Done through an endolaryngeal, endoscopic, or microscopic approach

For internalor mixedlaryngoceles

External cervical approachwith or without tracheotomy

Employed for mixed and externallaryngocele

Should be dissected carefully

To prevent damage to the neurovascular bundle

Penetrates the thyrohyoid membrane at the site of exit to

the external laryngocele


10/13

Learning Point

Laryngocele should be considered in any patient presenting with acompressible neck swelling

Laryngoscopic examination must be repeateddetermine wheter is internal,

external or mixedfor appropriate treatment


11/13

References

1. Michael M, Parikh S. Benign laryngeal lesions. Ballengers Otorhinolaryngology, Headand Neck Surgery. 17th ed. CBS Publishers & Distributors Pvt. Ltd.; 2009. p. 880.

2. Drozd M, Szuber K, Szuber D. The significance of the valve mechanism in pathology of

laryngocele. Otolaryngol Pol 1996;50:17-20.

3. Dray TG, Waugh PF, Hillel AD. The association of laryngoceles with ventricular

phonation. J Voice 2000;14:278-81.

4. Gallivan KH, Gallivan GJ. Bilateral mixed laryngoceles: Simultaneousstrobovideolaryngoscopy and external video examination. J Voice 2002;16:258-66.

5. Pennings RJ, van den Hoogen FJ, Marres HA. Giant laryngoceles: A cause of upper

airway obstruction. Eur Arch Otorhinolaryngol 2001;258:137-40.

6. Akbas Y, Unal M, Pata YS. Asymptomatic bilateral mixed-type laryngocele and

laryngeal carcinoma. Eur Arch Otorhinolaryngol 2004;261:307-9.

7. Zawadzka-Glos L, Frackiewicz M, Brzewski M, Biejat A, Chmielik M. Difficulties indiagnosis of laryngeal cysts in children. Int J Pediatr Otorhinolaryngol 2009;73:1729-

31.

8. Ramesar K, Albizzati C. Laryngeal cysts: Clinical relevance of a modified working

classification. J Laryngol Otol 1988;102:923-5. Salerno G, Mignogna C, Cavaliere M,

DAngelo L, Galli V. Oncocytic cyst of the larynx: An unusual occurrence. Acta

Otorhinolaryngol Ital 2007;27:212-5.


12/13

References

9. Oliveira CA, Roth JA, Adams GL. Oncocytic lesions of the larynx. Laryngoscope1977;87:1718-25.

10. Koufman JA, Belafsky PC. Unilateral or localized Reinkes edema (pseudocyst) as a

manifestation of vocal fold paresis: The paresis podule. Laryngoscope

2001;111:576-80. McDonald SE, Pinder DK, Sen C, Birchall MA. Oncocytic cyst

presenting as laryngocele with surgical emphysema. Eur Arch Otorhinolaryngol

2006;263:237-40.11.Uguz MZ, Onal K, Karagz S, Gke AH, Firat U. Coexistence of laryngeal cancer

and laryngocele: A radiologic and pathologic evaluation. Kulak Burun Bogaz Ihtis

Derg 2002;9:46-52.

12. Ettema SL, Carothers DG, Hoffman HT. Laryngocele resection by combined external

and endoscopic laser approach. Ann Otol Rhinol Laryngol 2003;112:361-4.

13. Martinez Devesa P, Ghufoor K, Lloyd S, Howard D. Endoscopic CO2 lasermanagement of laryngocele. Laryngoscope 2002;112:1426-30.

14. Ingrams D, Hein D, Marks N. Laryngocele: An anatomical variant. J Laryngol Otol

1999;113:675-7.


13/13

Thankyou

Presentasi Jurnal Laryngocele

Documents

Transcript of Presentasi Jurnal Laryngocele