Transoral power-assisted marsupialization of vallecular cysts under local anesthesia.

INTRODUCTION Vallecular cysts (VCs), also known as epiglottic mucous retentions or base of the tongue cysts, are ductal cysts resulting from obstruction and retention of mucus in the collecting ducts of the submucosal glands located at the base of the tongue. VCs are covered with ductal cells rather than with acinar cells, and this supports the hypothesis that they are dilated ducts and not distended glands. VCs are usually considered self-limiting lesions of the larynx, but in early infancy, this entity may be associated with severe airway obstruction and feeding difficulties. In adults, VCs are most frequently asymptomatic, and apart from causing nonspecific throat discomfort, are usually discovered during routine laryngeal examinations. Large VCs can become symptomatic, usually causing various degrees of dysphagia. Less frequently, VCs are discovered during the induction of general orotracheal anesthesia when they cause difficulty in endotracheal intubation. Moreover, infection of a VC can initiate acute epiglottitis with or without abscess formation, and thus may be associated with life-threatening acute airway obstruction also in adults. VCs are quite rare entities, and most publications in the literature are case reports that describe neonatal airway obstruction or difficult intubation in adults. Recently, Berger et al. performed a retrospective analysis of 38 adult patients, in which they identified two types of adult VCs: the first by acute onset of infection that extends to the epiglottis with abscess formation and possible airway obstruction, and the second by a less ominous disease with prolonged mild symptoms that result from pressure effects on neighboring tissues. Conservative management (wait and see) is usually performed in asymptomatic VCs. Moreover, in symptomatic cases, treatment options include cyst aspiration, marsupialization, surgical debulking, and laser excision. In this article we propose an innovative and effective surgical technique, consisting of transoral power-assisted marsupialization of VCs under local anesthesia using a curved microdebrider.