Microdebrider-assisted endoscopic excision for congenital laryngeal cysts in infants
Journal
Kaohsiung Journal of Medical Sciences
Journal Volume
28
Journal Issue
1
Pages
61-62
Date Issued
2012
Author(s)
Chen, Ching-Chung
Abstract
Dear Editor: Congenital laryngeal cysts are a rare but curable disease of airway obstruction in infants. They frequently cause inspiratory stridor, voice change, episodes of cyanosis, chest wall retraction, and feeding difficulty. Early recognition and treatment of these disorders are important because of high mortality associated with undiagnosed conditions [1]. Several different surgical techniques have been proposed to treat congenital laryngeal cysts [1]. We present a new surgical technique to remove congenital laryngeal cysts by microdebrider-assisted endoscopic excision in three infants. In our three cases, we used an 11-cm-long, 2.9-mm-diameter, straight shaft microdebrider to remove the entire cyst under video-telescope-guided baby-Lindholm laryngoscope. The average time of operation was around 20 minutes. There were no immediate complications, such as airway obstruction, postoperative fever, or hemorrhage. They were able to be extubated on postoperative Day 1 or Day 2, start oral feeding soon after extubation, and be discharged soon after operation. There were no recurrences and no long-term complications during more than 2 years' follow-up. The clinical details of these three cases are summarized in Table 1. Several different surgical techniques of treating congenital laryngeal cysts are reported in literatures, which range from minimally invasive endoscopic needle aspiration to more involved procedures, such as endoscopic marsupialization, endoscopic carbon dioxide laser excision, endoscopic extended ventriculotomy, and external cervical approach. Classically, endoscopic treatment is regarded as the treatment of choice while external cervical approach is reserved for recurrence [2]. Clinical experience has proven needle aspiration to be insufficient because glandular elements lining the cyst continue to secrete mucus and can explain the refilling of the cyst [3]. Civantos and Holinger [4] described endoscopic marsupialization as “rarely adequate” because of common surgical failures and repeated surgical excisions that often caused excessive glottic scarring and the possible development of subglottic stenosis. Carbon dioxide laser vaporization of the cyst lining carries the risk of thermal injury to the larynx. Although endoscopic extended ventriculotomy showed that very little laryngeal edema was encountered in the perioperative period, one case was extubated late for airway protection and others underwent reoperation because of symptom recurrence [5]. External approach through the thyrohyoid membrane puts the internal branch of the superior laryngeal nerve at significant risk and is usually carried out with a tracheotomy in place [5]. The microdebrider, a powered rotary dissection device with suction assistance, is designed to remove hard and soft tissue as well as to minimize trauma for normal tissues. Simultaneous removal of tissue and blood by the microdebrider allows for greater visualization during resection. This provides precise and complete tissue reduction without thermal damage or injury to the neighboring tissue. We introduced a novel surgical technique, microdebrider-assisted endoscopic excision, which can avoid damage of superior laryngeal nerve, reduce operative time, and speed up recovery without comorbidity. We consider microdebrider-assisted endoscopic excision to be one of the best initial choices for treating congenital laryngeal cysts with more effectiveness and safety in both symptom control and making infants disease free. Sincerely, Ching-Chung Chen and Wei-Chung Hsu
SDGs
Other Subjects
case report; clinical feature; congenital larynx cyst; cyst; endoscopic surgery; excision; female; follow up; human; laryngoscope; letter; male; microdebrider; newborn; operation duration; surgical equipment; surgical technique; treatment outcome; Cysts; Dissection; Endoscopy; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Larynx; Male
Type
journal article