#1 Vallecular Cysts and Tumors

SASS Clinical Note #1

Vallecular Cysts and Tumors

The mucosa lining the vallecula has the potential to develop a squamous carcinoma, although rarely. These tumors are especially concerning due to their potential to obstruct the airway and can present a difficult challenge for both the airway team and the otolaryngologist who must resect the tumor.

Vallecular cysts are also potential manifestations in this region. The incidence of these cysts is unknown due to the rare nature of this pathology, but some report 1 in 1,250 to 1 in 4,200.  They are also called epiglottic mucus retention cysts or base of tongue cysts and arise when the duct of a mucous gland or lingual tonsillar crypt becomes obstructed and dilates. They are caused by inflammation, irritation, or trauma.  Ductal cysts may occur at any location lined by mucous and can be found at any site in the larynx other than the free edge of the true vocal folds. Vallecular cysts are often multiple.

Cysts are most common in pediatric patients, although they can potentially occur in adulthood. They most commonly present in infants and affect both genders equally. They can arise after obstruction of the mucosal ducts. There are also potential origins for these cysts from malformations of the third branchial arch, or a thyroglossal duct cyst. Thyroglossal duct cysts develop from a remnant of the thyroid gland that failed to obliterate during migration of the thyroid away from the base of the tongue.

Infants classically will present with difficulty with feeding, failure to thrive, and potentially respiratory distress. For adults, difficulty swallowing is the most common presenting complaint. The peak incidence is in the fifth decade of life and the majority of cysts occur in men. As the cyst or tumor enlarges, shortness of breath on exertion can be the primary presenting complaint. Diagnosis of these cysts often includes nasopharyngeal laryngoscopy or bronchoscopy. Treatment requires excision as these cysts will often recur if only drained. Treatment may include marsupialization, excision with a carbon dioxide laser, or coblation. Marsupialization is a procedure where the cyst is opened, and a permanent pouch is formed to allow continuous drainage of the cyst.

Taken from: Faiss, KR & Sharma, S. (2019) Anatomy, Head and Neck, Trachea Epiglottic Valleculae. StatPearls Publishing PubMed Books.

Romak et al. (2010). Bilateral vallecular cysts as a cause of dysphagia: Case report and literature review. International Journal of Otolaryngology,doi:10.1155/2010/697583