The epiglottis, a small, leaf-shaped flap of cartilage located behind the tongue, serves a protective role by covering the windpipe during swallowing to prevent food and liquids from entering the airway. Epiglottic cysts are benign, fluid-filled sacs on this structure. They are often discovered incidentally, but understanding them can help those with throat discomfort or related concerns.
Understanding Epiglottic Cysts
Epiglottic cysts are non-cancerous growths that develop on the epiglottis, most commonly on its lingual (tongue-facing) surface or within the vallecula, a space just in front of the epiglottis. These cysts are smooth, rounded, and filled with mucus. They are a type of laryngeal cyst, which collectively account for approximately 5% of benign laryngeal lesions.
Types include vallecular and true epiglottic cysts, often categorized as ductal cysts. They arise from the obstruction and dilation of submucous ducts or glands, leading to mucus retention. While some can be congenital, acquired cysts are more common in adults, often appearing around age sixty. Chronic mucosal inflammation is considered a contributing factor to their development, though they can also be idiopathic.
Recognizing the Symptoms
Symptoms vary widely, often depending on the cyst’s size and location. Many small cysts are asymptomatic and discovered incidentally during other medical examinations. When symptoms do manifest, they frequently involve throat discomfort or a foreign body sensation.
Difficulty swallowing (dysphagia) is a common complaint, particularly as the cyst grows larger and interferes with the epiglottis’s normal function. Changes in voice quality, such as hoarseness, can also occur. Some patients might experience a “hot potato voice,” characterized by muffled speech. Less frequently, larger cysts can lead to breathing difficulties, including stridor (a high-pitched whistling sound during breathing), or even acute airway obstruction, particularly if the cyst is voluminous or becomes inflamed. Symptoms may worsen when lying down.
Diagnosis and Evaluation
Diagnosis typically begins with a thorough physical examination, focusing on the throat and airway. Direct visualization of the epiglottis is usually performed using indirect laryngoscopy (a small mirror and light source) or fiberoptic laryngoscopy. Fiberoptic laryngoscopy, using a thin, flexible tube with a camera, allows for a detailed view, helping to identify the cyst’s size, location, and characteristics.
Beyond direct visualization, imaging techniques further evaluate the cyst and rule out other conditions. A computed tomography (CT) scan of the neck provides cross-sectional images, revealing the cyst’s dimensions, fluid-filled nature, and its relationship to adjacent structures. Magnetic resonance imaging (MRI) may also be used, particularly for complex cases or to differentiate the cyst from other masses. These imaging modalities confirm the benign appearance of the cyst and ensure that the mass is not a more serious lesion, such as an abscess or tumor.
Treatment Approaches
Management depends on the cyst’s size, symptom severity, and any potential for airway compromise. Small, asymptomatic cysts are often managed with observation, as they may not require intervention. Regular monitoring helps ensure the cyst does not grow or cause problems.
For symptomatic cysts, particularly those causing swallowing difficulties, voice changes, or breathing issues, surgical removal is typically recommended. One common surgical technique is marsupialization, where the cyst is opened, drained, and its edges sewn to the surrounding mucosa to prevent reaccumulation, creating a permanent opening. Alternatively, complete endoscopic excision can be performed using a CO2 laser or a microdebrider. The CO2 laser allows precise cutting and vaporization, while the microdebrider provides continuous suction and cutting, which can be particularly advantageous for wide-based cysts by maintaining a clear surgical field. The goal is to alleviate symptoms, prevent complications such as airway obstruction, and achieve a low recurrence rate.