Epiglottic cysts are non-cancerous, fluid-filled sacs that develop on the epiglottis, a leaf-shaped piece of cartilage located at the base of the tongue. The epiglottis functions primarily as a protective flap, folding down to guard the entrance of the windpipe (larynx) during swallowing, ensuring food and liquids pass safely into the esophagus. While these cysts are typically benign lesions, their presence can potentially interfere with the normal processes of breathing, speaking, and eating. The resulting symptoms depend greatly on the cyst’s size and exact position within the throat.
Location and Development of Epiglottic Cysts
The epiglottis is situated in the supraglottic region of the larynx, positioned above the vocal cords and near the back of the tongue. Epiglottic cysts most commonly arise on the lingual aspect (the side facing the tongue) or within the vallecula (the space between the base of the tongue and the epiglottis). These lesions are classified as laryngeal cysts and represent approximately 5% of all benign lesions found in this area.
Cyst formation usually involves the obstruction of ducts of submucosal mucous glands. When the duct is blocked, mucus builds up, forming a retention cyst (or ductal cyst). Chronic irritation or inflammation in the upper airway, perhaps due to factors like smoking, chronic cough, or reflux, can contribute to this blockage. Less commonly, cysts are congenital, arising from developmental anomalies like a saccular cyst, which results from the dilation of a pouch in the laryngeal ventricle.
Identifying Symptoms and Potential Risks
Many epiglottic cysts, particularly smaller ones, remain asymptomatic and are discovered incidentally during unrelated medical procedures. When symptoms occur, they are non-specific, beginning with throat discomfort or a persistent sensation of a lump in the throat (globus sensation). As the cyst enlarges, it can mechanically interfere with swallowing, causing dysphagia, or may lead to a chronic, irritating cough.
The proximity of the cyst to the vocal apparatus can also cause subtle changes in the voice, such as hoarseness or a muffled, “hot potato” quality of speech. The primary concern is the risk of airway obstruction, which becomes serious as the mass grows. A large cyst can physically block the passage of air, leading to inspiratory stridor, which is a high-pitched, harsh sound heard during inhalation, and dyspnea (difficulty breathing).
If the cyst becomes acutely inflamed or infected, it can lead to a life-threatening emergency requiring immediate intervention. Patients with large cysts risk acute airway compromise, especially when associated with acute epiglottitis. In these urgent scenarios, the rapid swelling or obstruction can necessitate an emergency procedure to secure the airway, such as a tracheostomy.
Diagnosis and Current Treatment Modalities
The diagnostic process for an epiglottic cyst begins with a thorough history and physical examination, focusing on the onset and nature of throat and breathing complaints. A definitive diagnosis is achieved through flexible fiberoptic laryngoscopy, a minimally invasive procedure where a scope is passed through the nose to visualize the epiglottis and surrounding structures. During this procedure, the cyst appears as a well-defined, smooth, and fluid-filled mass, often originating from the lingual surface.
Imaging studies, such as CT or MRI, provide supplementary information regarding the cyst’s size, extent, and relationship to neighboring structures. These scans confirm the benign, fluid-filled nature of the mass and help rule out other, more concerning lesions in the laryngeal area. Treatment selection is based primarily on whether the cyst is causing symptoms or posing a risk of airway blockage.
Asymptomatic or very small cysts require watchful waiting with periodic follow-up examinations. When intervention is necessary, the goal is the complete removal of the cyst wall to prevent recurrence, which is achieved through various surgical techniques. Endoscopic excision is the preferred approach, often using a CO2 laser for precise removal with minimal bleeding. Marsupialization is another common technique, where the cyst is opened and its edges are sewn to create a permanent pouch for continuous drainage. Newer approaches include the use of a microdebrider, a powered instrument that allows for clear visualization and simultaneous removal of the cyst tissue, useful for wide-based lesions.
Long-Term Management and Recurrence
Following surgical removal, recovery is straightforward, with resolution of pre-operative symptoms like globus sensation and dysphagia. Patients should expect brief throat soreness managed with medication and dietary modifications. Complete healing of the surgical site is achieved within a few weeks.
Long-term management focuses on monitoring for recurrence, as the cyst may return if any portion of the secretory lining remains after the initial procedure. Although the recurrence rate is low after complete excision, post-operative check-ups are necessary to ensure proper healing and detect early signs of a new cyst. For patients who experienced simultaneous acute epiglottitis, the risk of recurrence is higher, making close, long-term surveillance important.