Vallecular cysts (VCs) are rare benign lesions arising from the obstruction of mucous gland ducts. VCs are uncommon anomalies found in both pediatric and adult populations. They are also known as mucous-retention cysts, preepiglottic cysts, ductal cysts, base-of-tongue cysts, and epiglottis cysts. VCs are often asymptomatic in adults and may present with nonspecific symptoms such as globus sensation, voice changes, dysphagia, hoarseness, or airway obstruction when symptomatic. This case report details a rare occurrence of a giant VC in an adult male, emphasizing the diagnostic approach and surgical management and highlighting the importance of managing the airway in such cases and the advantages of endoscopic procedures.

Congenital vallecular cyst is one of the rare etiologies of upper airway obstruction. Due to the scarcity of literature review, the exact incidence is not known. We report the case of a 10-month-old infant, who came to to Aga Khan University Hospital (AKUH) for the first time with signs of upper airway obstruction; was initially misdiagnosed as foreign body aspiration for which an emergency bronchoscopy was performed that did not reveal any foreign body. The patient was then managed in the pediatric intensive care unit, where he was diagnosed as a congenital vallecular cyst on a subsequent laryngoscopy after extubation failure. The cyst was aspirated and cauterized by the ENT team. The patient was successfully extubated without any signs of upper airway obstruction. In evaluating a child with signs and symptoms of upper airway obstruction, it is crucial to consider not only common causes like foreign body, acute epiglottitis, and croup, but also rare factors such as laryngeal cysts.

A vallecular cyst is a rare diagnosis in newborns presented with stridor, which poses a significant threat to the well-being of infants. This potentially life-threatening condition is associated with a range of complications, including respiratory distress, feeding difficulties, and failure to thrive. Through this case series, we aim to shed light on the suspicion of vallecular cysts in newborns presenting with stridor and the complexities encountered during their management, highlighting the importance of early recognition and intervention. We presented a case series consisting of three newborns who presented with stridor and respiratory distress symptoms to our center. All three cases were diagnosed using a flexible laryngoscope, and surgical intervention was done. The vallecular cyst was removed, and subsequent follow-up showed no recurrence of the lesion. This case series highlights the importance of early suspicion and recognition of vallecular cysts in newborns, emphasizing the thorough examination during diagnostic evaluations. Proper surgical planning and appropriate ventilation strategies are essential for the successful management and resolution of symptoms.

UNASSIGNED: Congenital laryngeal cysts are a rare cause of stridor in infants, and vallecular cysts account for 10.5-20.1% of all congenital laryngeal cysts. Large cysts can lead to airway obstruction and death. Nasopharyngolaryngoscopy is needed to confirm the diagnosis. Surgical treatment relieves symptoms and prevent serious complications. We report a congenital laryngeal cyst on the lingual surface of the epiglottis in a female newborn that was successfully excised without any complications.
METHODS: A 15-day-old female newborn presented with stridor, dysphagia and dyspnea that worsened and eventually led to a diagnosis of a large serous cyst on the epiglottis\'s lingual surface, compressing the entrance to the larynx. Surgery was performed under general anesthesia and the entire cyst was excised using rigid endoscopy. After the surgery, the infant made a quick recovery with no complications or recurrence.
UNASSIGNED: Vallecular cysts are a rare type of laryngeal cysts and an uncommon cause of congenital stridor that requires immediate diagnosis and management to prevent upper airway obstruction and death. Clinical features vary depending on the patient\'s and cyst\'s characteristics. Laryngoscope can help in confirming the final diagnosis. Complete excision is a better than aspiration, as it has a lower recurrence rate.
CONCLUSIONS: Vallecular cysts are a life-threatening condition that requires early diagnosis and immediate management to avoid any potential complications. It must be taken into account in the presence of congenital stridor. Marsupialization and excision (extirpation) have equal effectiveness and low recurrence rate, making them definitive surgical treatments for vallecular cysts.

In adults, vallecular cysts are usually asymptomatic but can present with respiratory and gastrointestinal manifestations. A 45-year-old man presented with a four-month progressive history of dysphonia, dysphagia to solid, snoring, choking, apnea, and aspiration. On examination, the patient was vitally stable with no remarkable local and physical examination. Flexible nasoendoscopy, computer tomography, and subsequent micro-laryngoscopy revealed a non-pulsating, non-congested 3 x 2 cm cyst obscuring vocal cord visualization. The cyst was removed completely by cold and hot techniques and was sent for biopsy. This case report presents the successful management of a symptomatic vallecular cyst through electrocautery.

Laryngeal cysts are largely asymptomatic and typically described in the context of incidental discovery on routine laryngoscopy. These cysts, in adults are even rarer and can have catastrophic consequences in an anaesthetized patient if airway management is inappropriate. We describe a case of difficult endotracheal intubation and the treatment of an adult patient with an asymptomatic, giant vallecular cyst that was discovered during rapid-sequence induction of general anesthesia in urgent surgery. In conclusion, vallecular cysts can cause extreme problems in securing the airway. It is important to avoid complications associated with repeated attempts at intubation, airway loss, or cyst rupture causing difficulty visualizing vocal cords and aspiration. The use of King Vision® videolaryngoscope is a good alternative in these cases. Close attention to logistics and the immediate availability of an otolaryngologist is vital.