Objective
Laryngoceles are congenital or acquired expansions of the laryngeal saccule that create air filled sacs within the neck. Treatment of laryngoceles involves surgical excision, however in certain cases observation may be appropriate.
Methods
Retrospective case review.
Results
An 86-year-old female presented to the emergency department with acute onset dysphagia and development of a neck mass that appeared suddenly after several episodes of emesis. She was unable to maintain PO intake due to discomfort, causing significant weakness and decline in functional status. On exam, patient had a right level II/III mobile, well-circumscribed soft neck mass. Flexible laryngoscopy demonstrated effacement of the right piriform sinus and edema of the right aryepiglottic fold and arytenoid. CT scan of the neck with contrast revealed a 2.4 x 4.0 x 1.8 cm peripherally enhancing cystic structure extending laterally from the caudal aspect of the right hyoid consistent with a laryngocele. Patient was treated with intravenous antibiotics and steroids with improvement in symptoms and exam after 36 hours. Throughout this time she remained cognitively intact. After consideration of her clinical improvement as well as her frailty and comorbidities, decision was made to defer surgical excision indefinitely. She was discharged on oral antibiotics, however did not complete the full course. Three weeks later, she was seen for follow up and was found to have successful decompression of laryngocele with minimal fullness of the right neck and resolution of symptoms.
Conclusions
Observation and medical management of laryngoceles with concern for superinfection may be considered in a subset of patients. This consideration is particularly relevant in the geriatric population, in whom surgical decision-making is complex.
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