Laryngocele, an abnormal dilation of the appendix of the laryngeal ventricle filled with air, is a rare condition predominantly presenting unilaterally. However, bilateral occurrences are exceedingly rare. In this article, we present a case of bilateral laryngocele along with a comprehensive literature review. A 57-year-old male presented with dyspnea, stridor, and bilateral neck masses. His medical history included chronic cough and intermittent hoarseness. Over a 3 month period, the neck masses progressively enlarged, resulting in respiratory distress. Interestingly, he denied experiencing weight loss, decreased appetite, or fever. Clinical examination revealed sizable, soft masses on both sides of the neck, obstructing lymph node assessment. Computed tomography (CT) imaging confirmed the presence of a left combined laryngopyocele and a right combined laryngocele. Subsequently, the patient underwent tracheostomy. Benign biopsy results excluded malignancy. Surgical excision of bilateral laryngoceles resulted in an uneventful recovery. The term \"laryngocele\" was introduced by Virchow in 1867 to describe the abnormal dilation of the saccule associated with Morgagni\'s ventricle. Diagnosis involves a thorough patient history, physical examination, and radiological imaging, notably CT, to differentiate laryngoceles from other conditions. Typically asymptomatic, they are often incidentally discovered around age 50, although symptoms such as voice changes or breathing difficulties can manifest. A review of the literature identified 77 documented cases, primarily in males, exhibiting various symptoms and treatment modalities. This case underscores the rarity of bilateral combined laryngocele, emphasizing the importance of timely diagnosis and surgical intervention for favorable outcomes. Comprehensive research reveals diverse clinical aspects, highlighting the necessity for continued investigation to enhance management strategies.

Laryngeal air cyst (laryngocele) is a rare disease that is an abnormal cystic expansion of the deep structures of the laryngeal ventricle. They can be accompanied by serious complaints, such as shortness of breath, difficulty breathing during exercise, as well as at rest with large cysts. Computed tomography is the most effective method for determining the type, localization and degree of laryngocele. Although surgical treatment is considered the method of choice in cases of laryngeal air cyst, the approach significantly depends on the size of the lesion.
Воздушная киста гортани (ларингоцеле) — редкое заболевание, представляющее собой аномальное кистозное расширение глубоких структур гортанного желудочка. Симптоматика ларингоцеле вариабельна: от незначительных жалоб на дискомфорт при глотании и фонации, затруднение дыхания вплоть до одышки при физической нагрузке и/или в покое. В дополнение к визуализации гортани при эндоскопическом осмотре может быть использована компьютерная томография, которая является эффективным методом определения типа, локализации и степени ларингоцеле. Оперативное лечение — основной метод лечения данной патологии; способ хирургического подхода зависит от размера и локализации патологического процесса.

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本文报道1例发生于老年男性内含囊液的喉外型喉气囊肿。患者男，63岁，因“右颌下肿物渐进性增大10年余”就诊。术前磁共振（MRI）提示右颌下腺下方类圆形异常信号影，内可见气液平面。在全身麻醉下行颈外入路肿物完整切除手术。大体检查示，囊肿呈微黄色，囊壁为致密结缔组织包膜，术后病理诊断为喉气液囊肿。术后3 d出院，出院至今复查未见肿物复发，预后良好。.

Introduction  Laryngocele is an air-filled dilatation of the laryngeal saccule that can be classified according to its extent (internal, external, or combined) and contents (laryngocele or laryngopyocele). To date, there is no consensus on the best treatment for laryngocele. Objective  The present study aims to demonstrate for the first time the effectiveness of CO2 laser marsupialization for internal and combined laryngoceles. Methods  A retrospective study was accomplished in our ENT Clinic of the University Hospital, from 2010 to today, recruiting patients according to strict criteria. All patients had internal or combined laryngocele/laryngopyocele treated with CO2 laser marsupialization. Results  A total of 15 patients were enrolled for a total of 17 laryngoceles; 66.67% of the patients were males and the mean age was 54.4 (±14.12) years old. Internal laryngoceles accounted for 64.71% of the total, and only 7 cases were laryngopyoceles. At the 3-year follow-up, no signs of recurrence were found. Conclusion  CO2 laser marsupialization is efficacious in the treatment of laryngocele or laryngopyocele, both internal and combined, in terms of efficiency, safety, and fast postoperative recovery, without need for tracheotomy or open surgery.

Objective: To summarize clinical features and our experience of the diagnosis and treatment of laryngocele. Methods: Clinical data of 11 laryngocele patients in department of Otorhinolaryngology Head and Neck Surgery of the Second Affiliated Hospital of Shanxi Medical University from January 2012 to December 2021 were retrospectively reviewed, including 9 men and 2 women, aged from 12 to 75 years, with median age of 56 years. Electronic laryngoscope was performed in 10 of all patients, laryngeal CT in 10 and cervical color ultrasound in 5 before operation.All the operations were performed under general anesthesia, and the external cervical approach was used for external and combined laryngocele. The internal laryngocele was resected by low temperature plasma through transoral endoscopy. Patients were followed up regularly after operation to evaluate the effect. Clinical feature, types of lesions, imaging findings, surgical approaches and follow-up results were analyzed through descriptive statistical method. Results: Eleven laryngocele patients were divided into mixed type (n=6), internal type (n=4) and external type (n=1).Nine patients presented with hoarseness or dysphonia, 7 with cervical mass and 1 with airway obstruction. Surgical resections were done through external cervical approach (n=7)or transoral endoscopic approach (n=4). All the operations were successful and no complication occurred. All cases were followed up from 17 to 110 months. No recurrence was encountered. Conclusions: Laryngocele is a rare lesion with atypical clinical presentation. Preoperative imaging including CT scan and electronic laryngoscope is essential to evaluate the location, and extent of the lesion, and to make the surgical plan.Complete surgical excision is required. Surgical resection is the only effective method for the treatment of laryngocele.
目的： 总结喉气囊肿的临床特点及诊疗经验。 方法： 回顾性分析2012年1月至2021年12月山西医科大学第二医院耳鼻咽喉头颈外科收治的11例喉气囊肿患者的临床资料，其中男9例，女2例，年龄12~75岁，中位年龄56岁。患者术前行电子喉镜（10例）、喉CT（10例）和颈部彩色超声（5例）检查。手术均在全身麻醉下进行：喉外型和混合型病变采取颈外入路；喉内型病变采取经口内镜下低温等离子切除。采用描述性统计学方法分析其主要临床表现、病变类型、影像学结果、手术入路、并发症及随访结果。 结果： 11例喉气囊肿患者病变类型分为混合型（6例）、喉内型（4例）及喉外型（1例）。主要临床表现为声嘶或发声不清者9例，颈部肿块者7例，气道阻塞者1例。手术入路包括颈外入路（7例）和经口内镜入路（4例），全部患者手术顺利，术中无并发症出现。术后随访17~110个月，全部病变无复发。 结论： 喉气囊肿临床罕见，临床表现缺乏特异性。术前CT及电子喉镜检查有助于评估病变的部位、范围，并指导手术治疗。手术切除是治疗喉气囊肿唯一有效的方法。.

To demonstrate the feasibility of transoral resection of, even large, combined laryngoceles by endoscopic CO2 laser resection using the inversion technique.
A retrospective study over a 25-year period of 20 patients with 22 combined laryngoceles. All patients were operated on using the CO2 laser inversion technique. Pre- and postoperative computed tomography (CT)-scans or magnetic resonance (MR) imaging were available in all patients.
There were no surgical problems during all procedures. One patient required a tracheotomy pre-operatively due to a compromised airway. All procedures were without intraoperative complications. Postoperatively, there were two complications: one hemorrhage, and one patient developed a granuloma with airway compromise. In two patients, residual disease was detected on postoperative imaging. One of them was re-operated several years later due to the progression of this residual external component of the laryngocele. One patient had a non-significant small internal laryngocele recurrence. The recurrence rate in this series was 2/22 (9.1%). The majority of patients (15/20) could be discharged from the hospital the day after surgery.
The results of this study show excellent control of combined laryngoceles using the CO2 laser inversion technique, with a short hospital stay and a low rate of complications and recurrence. Even in large combined laryngoceles, CO2 laser excision using the inversion technique should be considered.
4 Laryngoscope, 133:2742-2746, 2023.

Laryngocele is very uncommon and no consensus regarding its surgical management is yet established. While traditional external approach is still being recommended some suggest a better microlaryngoscopic management assisted by CO2 laser that has gained popularity. Recurrence is better known with conservative surgery but this paper presents a modified single stage endolaryngeal technique for combined laryngoceles to overcome the same. The salient features are (1) A comparatively larger operculum is created and all the visible mucosa is excised; (2) the base of residual postoperative cavity is moistened with cotton soaked with concentrated carbolic acid for 1 min and (3) the residual \'charred\' base with intermittent oozing is packed with single layer of surgicel. The reader is further encouraged to see surgical video of entire procedure.

本文报道2例发生于中年男性的单侧喉内型喉气囊肿。例1患者，53岁，因“咽部不适3年，声嘶半个月”入院。例2患者，58岁，因“咽部异物感2年，加重2个月”入院。2例患者术前影像学检查均提示喉部肿物内含气体。入院后全身麻醉下经口硬质支撑弯喉镜辅助的内镜手术（curved laryngoscope assistant transoral surgery，CLATOS，即下咽镜技术）完整切除肿物。术后病理回报均为喉部囊肿，术后随访至今未见肿物复发。.