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.

UNASSIGNED: A plunging ranula may present initially as an extensive vallecular cyst and correct diagnosis may be reached with the use of ultrasound, fluid aspiration for amylase detection, and MRI imaging.
UNASSIGNED: The ranula is a pseudocyst of the sublingual salivary gland and can be divided into two known subtypes. The simple ranula and plunging ranula. While the simple type can be found in the floor of the mouth, the plunging ranula usually pervades the mylohoid muscle and presents as a cervical swelling. The presented case should outline the difficulties in diagnostic and treatment of an uncommon expression of a mucocele above the mylohoid muscle without presenting either a cervical or an intraoral swelling, only extending towards the vallecula. We present a previously unreported clinical manifestation of a ranula of an 18-year old male, which extends posteriorly, remaining confined in the supramylohyoid muscle space. The cystic lesion protrudes in the oropharynx, and clinically appears as an extensive vallecular cyst. On magnetic resonance imaging the initial suspected diagnosis of a vallecular cyst was changed to the final diagnosis of a plunging ranula. The marsupialization of the cyst sac was performed. Outpatient follow-up revealed a persisting ostium, indicating a continuous extravasation of the sublingual gland. The present case report describes an unusual clinical presentation of a plunging ranula, remaining above the mylohyoid muscle and protruding into the oropharynx, misdirecting to the first suspected diagnosis of a vallecular cyst. The case highlights the useful contribution of the MRI imaging for differential diagnoses and the need for criteria to indicate further investigations.

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: Cryptoccous infection or cryptococcosis is a severe opportunistic infection occurring mainly in immunocompromised patients. Laryngeal cryptococcus infection is rare. In an immunocompetent patient, inhaled corticosteroid was reported to be a possible risk factor.
METHODS: We discuss a case of right vocal fold cryptococcus infection in a healthy, immunocompetent 71-year-old man with no history of inhaled corticosteroid, presented with hoarseness and intermittent aspiration symptom for 1 year duration. Further examination showed right anterior vocal fold mass with presence of right vallecular cyst.
UNASSIGNED: Patient underwent direct laryngoscopy, excision of right vocal fold mass and marsupialization of vallecular cyst. Histopathological examination revealed cryptococcal infection. Patient subsequently treated with oral fluconazole 400 mg daily for 6 months. To date, hoarseness and aspiration symptoms have resolved.
CONCLUSIONS: We are sharing our experience in managing laryngeal cryptococcus infection in an immunocompetent patient where the associated risk factors discussed in previous literatures are absent.

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.

OBJECTIVE: A large proportion of infants with vallecular cyst (VC) have coexisting laryngomalacia (LM). Feeding difficulties, regurgitation, occasional cough, and sleep-disordered breathing are the common symptoms in moderate to severe cases. The surgical management of these cases is more challenging and remains controversial. The purpose of this study is to help surgeons select the effective surgical strategies by computer-aided design (CAD) and computational fluid dynamics (CFD) simulations of the upper airway flow characteristics.
METHODS: The three dimensional (3D) geometric model of the upper airway was reconstructed based on two dimensional (2D) medical images of the patient with VC accompanied with LM. Virtual surgeries were carried out preoperatively to simulate three possible post-operative states in silico. The different outcomes of virtual surgical strategies were predicted based on computational evaluations of airway fluid dynamics including pressure, resistance, velocity, and wall shear stress (WSS).
RESULTS: The CFD results of this study suggested the importance of the angle between the rim of epiglottis and arytenoid epiglottic (AE) fold. There was a small impact on the upper airway flow field while the VC was removed and the angle of epiglottis was unchanged. The partial lifting of epiglottis can further improve the flow field. With performing supraglottoplasty (SGP) and the marsupialization of VC, epiglottis was completely recovered, and the flow field was significantly improved. The clinical symptoms of this patient improved greatly after surgeries and no recurrence or growth retardation were noted during 1-year follow-up. The clinical prognosis was consistent with the prediction of the CFD results.
CONCLUSIONS: The state of epiglottis needs to be carefully checked to evaluate the necessity of performing further SGP in the patients with VC accompanied with LM. CFD and CAD could be developed as a new approach to help surgeons predict the post-operative outcomes through quantification of the airflow dynamics, and make the optimal and individualized surgical approaches for patients with airway obstruction.

The vallecular cyst is a rare cause of stridor, respiratory distress, and failure to thrive in infants. Large vallecular cysts may present with serious complications such as life-threatening airway obstruction. This report is of an infant who presented with stridor and failure to thrive. The patient\'s condition was diagnosed as the presence of a vallecular cyst using flexible laryngoscopy. The vallecular cyst was successfully managed using endoscopic marsupialization. After the procedure, the patient was asymptomatic and dramatically gained weight within a few months. This case report serves as a reminder for clinicians to consider vallecular cysts as a differential diagnosis of stridor and failure to thrive in infants. It also emphasizes that early diagnosis and management lead to favorable clinical outcomes.

OBJECTIVE: Vallecular cyst is an uncommon but potentially life-threatening disease. The aim of this study was to review the presentation, evaluation, and treatment of vallecular cysts in children.
METHODS: Medical records of 156 patients treated for vallecular cysts between 2013 and 2016 were retrospectively reviewed. The patients were divided into four age groups for comparison of clinical data: A, < 1 month; B, 1-6 months; C, 7-12 months; and D, > 1 year.
RESULTS: The median age of all patients (98 males and 58 females) was 12.1 months (range 1 day-11 years), including 21, 86, 21, and 28 patients in group A, B, C, and D, respectively. A diagnosis of vallecular cysts was made for 135 patients using a combination of flexible laryngoscopy and ultrasound, and ten patients (all in group A) required pre-surgery ventilation support. The most common symptoms were wheezing (59.6%) and stridor (36.5%). Ten patients experienced difficulty with intubation. Endoscopic-assisted transoral coblation marsupialization was performed for all patients, combined with supraglottoplasty for 41 out of 68 patients with concurrent laryngomalacia. Patients in group D had a longer operation time and higher incidence of intraoperative bleeding, two of whom experienced post-operation recurrence, and symptoms resolved after a second operation in both cases.
CONCLUSIONS: Flexible laryngoscopy and ultrasound are recommended for a diagnosis in suspected cases of vallecular cysts. Coblation marsupialization has advantages of minor damage, low recurrence rate, and suitability for all age groups.