Anesthetic and Surgical Considerations in Giant Vallecular Cyst with Coexistent Laryngomalacia of Neonate

Case Report

Austin J Otolaryngol. 2015; 2(7): 1054.

Anesthetic and Surgical Considerations in Giant Vallecular Cyst with Coexistent Laryngomalacia of Neonate

Verma RK¹*, Panda NK¹ and Bhatia N²

¹ Department of Otolaryngology and Head & Neck Surgery, PGIMER, India

²Department of Anaesthesia, PGIMER, India

*Corresponding author: Roshan k Verma, Department of Otolaryngology and Head & Neck Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

Received: November 17, 2014; Accepted: September 05, 2015; Published: September 05, 2015

Abstract

Vallecular cyst in neonate is rare and can cause of respiratory obstruction and death. It may sometimes co-exist with laryngomalacia and may be cause of severe respiratory obstruction and feeding difficulty in the neonate. We report a case of 1 month old female child with giant vallecular cyst and its co-presentation with laryngomalacia. Marsupialization of the vallecular cyst was done with Laryngeal skimmer blade. Respiratory and feeding difficulty improved after surgical Intervention. The case is being presented to highlight the anesthetic and surgical problems encountered in managing such lesion in neonate.

Keywords: Giant vallecular cyst; Laryngomalacia; Stridor; Failure to thrive

Introduction

Vallecular cysts are rare but are well recognized cause of upper airway obstruction and death in infancy or immediately after birth [1]. Vallecular cyst synchronous with laryngomalacia is even rare. A mortality rate of 40% in children has been reported in the English literature [2]. Vallecular cysts are usually unilocular cystic mass of variable sizes arising from the lingual surface of epiglottis and contain clear fluid [3]. They usually present with severe inspiratory stridor and failure to thrive and require urgent surgical intervention. They may also present challenges to the anaesthetist as bag and mask ventilation and intubation might be difficult. A coordinated approach between surgeons and anaesthetist is must for successful outcome.

We report a case of large vallecular cyst in neonate and highlight the surgical and anaesthetic difficulties encountered in managing such lesions.

Case Presentation

An urgent otolaryngology consultation was sought by the NICU for a 28 day old female baby who had presented with complaints of noisy breathing and feeding difficulty since 8 days of birth. She also had weak cry. She also had history of intermittent episodes of severe respiratory distress with cyanotic spells which was relieved partly on changing to prone position. She also had difficulty in feeding with failure to thrive. There no history of fever or cough. The child was born full term cesarean delivery in local hospital with birth weight of 2 Kg.

On examination, child had inspiratory stridor; she was tachypnoeic with respiratory rate of 54/min and SPO2-90%. There was in drawing of suprasternal notch and intercostal spaces and accessory muscles of respiration were active. Direct Laryngoscopy was done to assess the airway under sedation, showed cystic lesion in the region of vallecula obstructing the airway. Computed tomographic scan of neck region was done which showed well defined cystic lesion of 3x3 cm in the occupying the vallecula pushing the epiglottis. Rest of the airway was normal (Figure1).

Citation: Verma RK, Panda NK and Bhatia N. Anesthetic and Surgical Considerations in Giant Vallecular Cyst with Coexistent Laryngomalacia of Neonate. Austin J Otolaryngol. 2015; 2(7): 1054. ISSN :2473-0645