A Case of Endoscopically Resected Neonatal Epiglottic Cyst

Abstract

Although laryngeal cysts are rare among the diseases causing congenital laryngeal stridor, they require prompt treatment because large cyst lesions can cause severe respiratory distress due to obstruction of the upper airway. Our case was a 1-day-old boy. He was born by scheduled cesarean section due to pelvic position at 38 weeks and 2 days of gestation, and was brought to our hospital with inspiratory stridor and decrease in arterial blood oxygen saturation (SpO₂) from about 2 hours after birth. Laryngoscopy revealed a white transparent, smooth cystic lesion extending from the oropharynx to the larynx. A plain CT scan of the cervical region showed a cystic lesion 14×10 mm in size in the epiglottis vallecula. Suspecting upper airway obstruction due to the cyst, we decided to perform a transoral endoscopic epiglottic cystectomy. A pediatric laryngoscope was used to lift the base of the tongue to secure a clear view, and a flexible endoscope was used to perform a laryngotracheal cystectomy. The postoperative course was good, and the patient was discharged from the hospital without any problems in breathing or feeding. Neonatal epiglottic cysts are considered to be a rare disease. The treatment options are puncture aspiration of the cyst, (open window) resection, or excision of the cyst, but it is generally believed that (open window) resection is sufficient rather than a total excision, which requires increased operating time and tissue invasion, and thus increases the burden of surgery on the newborn. However, there have been past reports of recurrent cases and cases of asphyxia from cyst contents. Neonatal epiglottic cysts should be treated in collaboration with obstetrics, pediatrics, and anesthesiology, taking into consideration the method of securing the airway, surgical invasion, and the risk of recurrence in each case.