Vallecular cysts are typically present at birth in the tongue base of affected infants. The origin of the cyst is unclear. 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.
What are the symptoms of vallecular cysts?
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
How are vallecular cysts diagnosed?
Vallecular cyst in the pediatric airway
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.
How are vallecular cysts treated?
Vallecular cyst excision performed in the pediatric airway.
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.
Postoperatively, patients generally do very well 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.
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.