What is a Vallecular Cyst?
Vallecular cysts are infection pockets that form at the base of the tongue. They are frequently present from birth but progressively worsen over time. The term “vallecular cyst” refers to a specific type of cystic enlargement in the region between the base of the tongue and the epiglottis.
When an infant is born with vallecular cysts, they typically already possess them at the base of their tongue. Some have proposed that the cyst is a variation of a thyroglossal duct cyst, while others have hypothesized that it forms when a small salivary gland becomes obstructed.
Vallecular cysts are uncommon and are usually not connected with other malformations or disorders. They are categorized as lymphoepithelial cysts, ductal cysts, and retention cysts. The etiology of the lesion is unknown, but it is likely caused by inflammation, irritation, or trauma.
Symptoms
A vallecular cyst can cause dysphagia, sometimes known as trouble swallowing, as well as discomfort in the throat and, in rare cases, obstruction of the airway. Dysphagia is the most prevalent symptom, affecting two-thirds of patients. They are frequently present at birth, although they usually get worse with time. Patients who suffer from vallecular cysts frequently exhibit signs and symptoms that are comparable to those of laryngomalacia, including the following:
- Inspiratory stridor is frequently present at birth.
- Feeding complications.
- Mild, moderate, and severe respiratory discomfort.
Vallecular cysts can make it difficult to feed because they obstruct the upper airway and put pressure on the laryngeal intake.
Vallecula cysts can cause a wide range of clinical symptoms. Vallecular cysts in adults are typically asymptomatic and detected during a normal laryngoscopy or anesthetic induction. However, dyspnea, Globus, dysphonia, dysphagia, and odynophagia also develop. Vallecular cysts must be addressed in the evaluation of these symptoms. If a vallecular cyst is discovered, thorough transoral laser excision often results in cyst clearance and improved symptoms.
Causes
It is unclear what causes vallecular cysts. They can be caused by a salivary gland that is blocked or by other cysts, like thyroglossal duct cysts.
Cysts are more prevalent in children, however, they can also potentially arise in adults. They manifest themselves in infants most frequently and equally impact both sexes in the same way. They can occur as a result of mucosal duct obstruction. The third branchial arch malformation or a thyroglossal duct cyst is a further possible source for these cysts’ genesis. A thyroglossal duct cyst forms when the thyroid fails to destroy a remnant of the thyroid gland near the base of the tongue during migration.
Vallecular cysts are believed to be secondary cysts resulting from ductal blockage of mucous glands or tongue cystic lesions resulting from misplaced embryonic remains of the foregut.
Vallecular cysts are unilocular cysts that form on the epiglottis’ lingual surface and contain clear sterile fluid.
Treatment
The preferred course of treatment for vallecular cysts is surgery. Endoscopic surgery is carried out. Aspiration, marsupialization, or excision with micro laryngeal equipment or a laser can be done after an endotracheal tube secures the airway. Patients with vallecular cysts are also treated with marsupialization through Coblation. The technique of Coblation makes use of radiofrequency and normal saline to generate an isoelectric field of sodium and chloride ions traveling at high speeds. This field possesses the necessary amount of energy to break down tissues.
Microlaryngeal devices or a laser can be used to remove or marsupialize (widely open) smaller cysts. Potassium titanyl phosphate (KTP) laser therapy is also used to eliminate vallecular cysts, and this method has been proven to be effective, with no bad effects or complications recorded. Radiofrequency ablation of pediatric vallecular cysts, the transoral technique for direct, and CO2 laser treatment for infantile vallecular cysts, and full excision of vallecular cysts in children are alternative therapeutic options.
After surgery, patients often recover well and resume their normal diets with no respiratory problems. Occasionally, subsequent laryngomalacia or reflux may necessitate some support until the airway is properly developed. After treatment, it is extremely uncommon for the cyst to return.