General Considerations

A laryngocele is a rare congenital or acquired laryngeal lesion that appears within and around the laryngeal saccule. Laryngeal cysts account for approximately 5% of benign laryngeal lesions [177, 265]. DeSanto presented a classification of laryngeal cysts in which the lesions were divided into ductal, saccular and thyroid cartilage foraminal cysts [80]. This classification, which is more clinically adjusted, is based on the intramucosal depth of the cyst and its location. Newman and co-workers found it difficult to apply and proposed a new one, dividing the lesions into tonsillar, epithelial (sac-cular and ductal) and oncocytic cysts. According to the original article, more than half of all laryngeal cysts were epithelial, one quarter tonsillar and less than 15% oncocytic [265].

Laryngocele is defined as an excessive elongation and dilatation of the air-filled laryngeal saccule (ventricular appendix), which communicates directly with the laryngeal lumen. According to its site, there are three types of lesions: internal, external, and mixed. An internal laryngocele extends in a superior-posterior direction, towards the area of the false vocal cord and aryepiglottic fold. An external one expands cranially and laterally to the neck through the weak zone of the thyrohyoid membrane. It presents as a lateral neck mass that varies in size depending on variations of the intralaryngeal pressure. A mixed or combined form has both internal and external components with a swelling of the neck and endolaryn-geal bulging [14, 15, 53]. The combined laryngocele is the most common (44%), followed by internal (30%) and external (26%) forms [50].

A laryngocele is quite a rare lesion, occurring as congenital [60] or acquired, most frequently observed in infants and adults between 50 and 60 years. A male predominance is evident with a ratio of 7:1 [227, 287]. Most laryngoceles are unilateral. Aetiologically, the lesion occurs in persons with a congenital large sac-cule and weakness of the periventricular soft tissue. In adults, various conditions involving a repeated increase in intralaryngeal pressure, such as inflicting glass-blowers, wind instrument musicians, singers, professional speakers, and patients with a chronic cough, are reported [227]. Stenosis of the saccule neck, which functions as a valve system, may also lead to the occurrence of a laryngocele. The leading symptoms of an internal or compound lesion are hoarse ness, cough, dyspnoea, dysphagia, and the sensation of a foreign body.

The lesion may, however, be also asymptomatic in approximately 12% of the cases [62]. The diagnosis is established by the history, and by physical and radiological examination, especially computed tomography (CT).

Histologically, a cystic extension of the saccule is evident and its wall tends to lose its folded surface. The laryngocele is covered by the respiratory epithelium; occasionally an oncocytic or cuboidal metaplasia is present. Focally, chronic mononuclear inflammatory cells are seen in the subepithelial stroma. Laryngocele-re-lated complications include infection (laryngopyocele), aspiration and subsequent pneumonia [287]. There is also a relationship between laryngocele and laryngeal squamous cell carcinoma in 4.9 to 28.8% of cases [140]. The endoscopic surgical treatment of laryngocele is the method of choice [354].

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