Dr. B. Umakanth Goud, Dr. A.V.S. Hanumantha Rao, Dr. D. Satyanarayana, Dr. Manish Kumar Gupta, Dr. Juveria Majeed
ABSTRACT: Laryngoceles are rare, cystic dilatation of saccule of ventricle of larynx. Three types are recognized –internal, external and mixed types. Many of the laryngoceles are asymptomatic, few require surgical excision via internal/endoscopic or external approach. Contrast CT is the investigation of choice. A 40year old male presented to our OPD with a neck Scar, later diagnosed as laryngocele. Here is the case report about presentation, diagnosis and management of a large mixed layngocele.
Keywords: Layngocele, Neck swelling, Saccule, Ventricle of larynx
40yrs old Male Agricultural laborer presented with history of swelling on right side of Neck increasing in size associated with cough from last 3yrs. Patient was operated 3 times earlier. On examination a horizontal scar mark of about 4cm size with sinus opening was found. CT Scan Neck was suggestive of air filled sac bulging into the neck through the Thyrohyoid membrane of about 6cm X 3cm X 2cm size. Video Laryngoscopy shows bulge above the right vocal card. Cervical exploration was done by the vertical incision of about 8cm, 1cm lateral to midline in right side extending from hyoid bone to adam’s apple. Dissection was carried out air filled saccule was identified the laryngeal opening was closed with 00 proline. Superior Laryngeal nerve, Recurrent Laryngeal nerve, Ansa cervicalis and hypoglossal nerve where identified and preserved. Postoperative period was uneventful. Histopathology report of excised sac is not suggestive of any malignancy. Patient is under follow up after surgery from last one month.
DISCUSSION: A LARYNGOCELE is an abnormal saccular dilatation of the appendix of the laryngeal ventricle of Morgagni forming an air sac lined with pseudo-stratified, ciliated, columnar epithelium, which maintains its communication with the ventricle by means of a narrow stalk.1 The laryngeal ventricle of Morgagni is normally a small elliptical recess located between the false cords above and the true cords below. The anterosuperior aspect of this recess ends in a blind pouch, which is called the appendix or appendage of the ventricle of Morgagni.1,2 According to Burke and Goldlen3 if the appendage extends above the upper border of the thyroid cartilage, it is abnormally long. Such a long appendage is considered to be congenital in origin and is found in I5 to 30 per cent of adults.3
It is uncommon lesion which usually occurs in the middle age but may be rarely seen in infancy, when it can produce respiratory distress which typically becomes worse on crying due to increased distension of laryngocele with air.4
A laryngocele is classified as internal it it is contained entirely with the laryngeal framework, external if it pierces the thyrohyoid membrane and combined, if there are both external and internal components.4
Many laryngoceles are asymptomatic; sometimes they may cause a cough, hoarseness, stridor, sore throat, globus sensation and may present as a swelling on one or both sides of the neck.5 More commonly unilateral6, 7 and rarely bilateral internal8 and bilateral external laryngoceles9 also exist .Sometimes a laryngocele may obstruct and becomes filled with mucus or become infected (laryngopyocele), thus becomes indistinguishable from saccular cyst.4