Vallecular Cysts

What are vallecular cysts?

Vallecular cysts are typically present at birth in the tongue base of affected infants. Some believe that the cyst develops because of an obstruction of a minor salivary gland while others believe that the cyst is a variant of a thyroglossal duct cyst.

Vallecular cysts are rare and are typically not associated with other anomalies or syndromes.

Signs and symptoms

Patients with vallecular cysts often have similar symptoms/signs as those with laryngomalacia.

  • Inspiratory stridor is usually present at birth (noisy inhale)
  • Feeding difficulties
  • Minimal, moderate or severe respiratory distress

Testing and diagnosis

If the cysts are very small, diagnosis may be delayed until the child is older and begins to complain of swallowing difficulties. In the majority of patients, the cyst is large enough to bring the patient to the attention of the otolaryngologist who can then confirm the diagnosis using flexible laryngoscopy. Imaging (CT scans, X-rays, etc.) is not required for patients with vallecular cysts.

See how a vallecular cyst appears in the pediatric airway. 

Treatment

Vallecular cysts need to be decompressed surgically. Surgery is performed endoscopically. Once the airway is secured with an endotracheal tube, the cyst is either marsupialized (widely opened) or removed using either microlaryngeal instruments or a laser.

Patients generally do very well after surgery and most often resume normal diet with no breathing issues. Occasionally, patients may require some support for secondary laryngomalacia or reflux until the airway grows sufficiently. Recurrence of the cyst is very rare following treatment.

Watch a vallecular cyst excision performed in the pediatric airway.

Aero-digestive Evaluation

Infants with vallecular cysts need to be evaluated for both airway and feeding issues. Management of the airway often requires a combination of supportive, medical and surgical care. Feeding and swallowing issues are common in children with these conditions and often need to be addressed by speech pathologists and GI specialists.


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