presentasi jurnal laryngocele
TRANSCRIPT
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External Laryngocele: Points to rememberTiara Rachmaputeri Arianto07120100100
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Abstract
Laryngocele rare cystic swelling Saccule of the larynx
Seen mostly
Often associated with underlying malignancy
Case
external laryngocele in a young farmer who did not have any of the
above mentioned associations.
KeywordsLaryngocele, malignancy, Neck swelling, resection
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Introduction
Laryngocele Cystic dilatation of the saccule of the larynx
Generally filled with air
Communication cyst-laryngeal
lumenoccluded
Fluid accumulate within the sac
Saccular cyst
= mucus retentionarise from
mucus gland of the sacculefilled ONLY with mucus
Incidence
1 in 2.5 million population
Males 50 and 60 years of agePossible mechanism
Increase in intraluminal laryngeal pressure
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Case Report25 yo male
Complaints Painless swelling in the upper right side of the neck for the
past 3 years
Increase in size during coughing and straining
Examination
Compressible swelling3 x 4 cm
Right anterior triangle of neck
Non-tender, soft, cystic, fluctuant, mobile
Swelling increased in sizecoughing, valsava
maeuver
Radiograph
Antero-posterior view
Air-filled sac suggestive of external laryngocele
Ultrasonogram confirmed EXCISION
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Procedure
1. General anesthesia and endotracheal intubation
2. Aseptic precautions
3. Horizontal skin incision, over the swelling
4. After raising skin flaps and dissecting soft tissues, laryngocele was identified
5. Seperated from surrounding tissues
6. Mobilized up to its neck as far as the thyrohyoid membrane
7. Neck (or fundus) was transected8. Skin was closed after placing a drain
Post operativesutures removed after 7 days
Histopatologic Examination Confirmed laryngocele and exclude malignancy
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Discussion
Etiology Congenital
Acquired
Large ventricular appendix
causes respiratory distress
Increase in intra-glottic pressure
Excessive caughing, playing a wind instrument, glass
blowing, valsava maneuver
causes
Extend
Internally
Into the airway
Externally
Through the thyroid membrane
Medial to thyroid
cartilage
Lateral to thyroid
cartilage
Laryngocele expands Air-filled communication
become tenous
Pressure changes still betransmitted through it
Increase in size with cough and
valsava maneuver
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Symptoms
Internal Mixed
Globus sensation
Sore throat
Cough
Pain
Snoring
Increasing stridor
Hoarseness
Airway obstruction (if large)
External
Visible or palpable mass in the neck
Laryngoscopic Examination
Globular swelling in the
laryngeal
lumen/submucosal
fullness
But may miss internalcomponent of mixed
laryngocele (if it small)
Differentiated
True cyst classified as
EpithelialMost common! Include
saccular cyst
Oncocytic In ventricle, elderly, higher
rate of recurance, behave
like benign neoplasmTonsillar
Region of vallecula,
epiglottis/pyriformissinus
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Laryngeal pseudocyst
Discrete
Unilateral Localized area of Reinkes edema
Occuringmid-portion of the free-edge striking zone
Diagnostic
Most accurate!
Defining spatial relationships between the
laryngocele and laryngeal structures and
extra-laryngeal soft-tissues
Differentiating the laryngocele from other
cystic formations and
Identifying the coexistence of a laryngeal
malignancy.
Computed tomography
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Marsupialization CO2laser
Done through an endolaryngeal, endoscopic, or microscopic approach
For internalor mixedlaryngoceles
External cervical approachwith or without tracheotomy
Employed for mixed and externallaryngocele
Should be dissected carefully
To prevent damage to the neurovascular bundle
Penetrates the thyrohyoid membrane at the site of exit to
the external laryngocele
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Learning Point
Laryngocele should be considered in any patient presenting with acompressible neck swelling
Laryngoscopic examination must be repeateddetermine wheter is internal,
external or mixedfor appropriate treatment
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References
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References
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Thankyou