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RACS ASC 2024

Massive laryngeal saccular cyst: an uncommon cause of airway obstruction

Poster

Presentation Description

Institution: Western Health - Victoria, Australia

Background Laryngeal saccular cysts are uncommon dilations of the laryngeal saccule, commonly presenting with dysphonia. We report a case of a massive and rapidly enlarging saccular cyst causing stridor, requiring complex preoperative airway planning. Case report A 79-year-old lady was transferred from a rural hospital to our tertiary centre following a fall and femur fracture. She developed stridor, dysphonia and dysphagia 10 days prior. She had a history of a small saccular 12 months prior which was being monitored. Cross-sectional imaging demonstrated interval enlargement of the cyst. Examination demonstrated a large supraglottic swelling entirely obstructing the laryngeal inlet, presenting a difficult airway scenario. After extensive discussions, the patient was successfully intubated. The patient proceeded to undergo marsupialisation of the cyst, and femur fixation. She was extubated safely the next day, and discharged 3 days later. Discussion Saccular cysts are uncommon and benign. Although dysphonia is common, dyspnoea and airway obstruction are possible. When small, complete excision with CO2 laser is usually achievable, and associated with better outcomes. In this case, the interval enlargement necessitated complex airway planning. This case highlights the need for close monitoring in these situations, and a low threshold for early excision to prevent future airway complications. Conclusion Saccular cysts are uncommon; early excision or marsupialisation is associated with better outcomes. Large cysts can result in airway obstruction, and present a greater challenge to the anaesthetist and airway surgeon.

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Authors

Authors

Dr Eren Tan - , Mr Simon Ellul -