Epiglottic cyst occurs mostly on the lingual side of the epiglottis, and it is mainly a benign lesion.¹ Depending on the location and size of the lesion, it can appear in various clinical patterns. The large size of the epiglottic cyst can cause dyspnea through airway obstruction not only in children but also in adults.^2,3

If the cyst is small and does not cause symptoms, it needs only periodic progress observations. However, if it causes any symptoms obstructing daily life, the gold standard choice of treatment is surgical resection. Besides the traditional method in which carbon dioxide (CO₂) laser is used, laryngo-microsurgery using microdebriders can effectively remove lesions.^4-7

This case report is about a 40-year-old woman with an epiglottic cyst found incidentally during a gastroscopy, who visited our hospital. We removed the epiglottic cyst via laryngo-microsurgery using an electrocautery.

The patient was a 40-year-old woman who had a laryngeal cyst incidentally found during gastroscopic examination and was approximately 1 cm in diameter at the lingual side of the epiglottis (Fig. 1). Although the patient is said to have been experiencing intermittent mild globus sensation, there was a little inconvenience in her daily life because of the symptoms.

Figure 1. A cyst at right lingual side of epiglottis on laryngoscope.

The operation was conducted under general anesthesia. The laryngoscope was placed deep enough to expose the lingual side of the epiglottis. A circular incision line was made on the surface of the cyst using the electrocautery tip and the mucoid content of the cyst was aspirated. The residual lesion, including the inner wall of the cyst, was then completely removed using the electrocautery (Fig. 2).

Figure 2. (A) Exposure of epiglottic cyst with laryngoscope involving skin. (B) Incision on epiglottic cyst using bovie tip. (C) Aspiration and debulking of epiglottic cyst. (D)Complete removal of epiglottic cyst.

After the surgery, the shape and function of the epiglottis were completely preserved, and complications such as aspiration symptoms did not occur. The cyst was proven to be a benign laryngeal cyst and after 2 weeks of observation at the outpatient clinic, not only were the symptoms much improved, but the lesion was also well-healed. The patient has provided written informed consent for the publication of this case report.

The epiglottis is a cartilaginous flap included in the supraglottis, which is essential for preventing the food, when being swallowed, from being aspirated into the airway by folding back and blocking the airway.⁸ The cause of formation of the cyst in the epiglottis is unknown, but they are generally believed to be due to a cystic dilation caused by a stagnant mucus due to the closure of the mucous gland of the larynx.¹ The epiglottis is a highly sensitive laryngeal structure with abundant nerve and vascular distribution; thus, external stimuli such as surgery can cause laryngospasm or edema and bleeding during surgery or postoperative pain.⁹ The epiglottis is principally innervated by the internal laryngeal branch of the superior laryngeal nerve for its sensory and has vascular distribution mainly by superior laryngeal artery.^10,11

For epiglottic cyst causing any symptoms, surgical resection is the gold standard of treatment, and laryngeal microsurgery using CO₂ laser is often performed.¹ This traditional surgical method provides a good surgical field by cutting and stanching small vessels simultaneously, allows for detailed resection, and also has little complication such as edema, atrophy, and scar formation.^1,12-15 However, the disadvantage is that surgery takes a relatively long time and provides a relatively narrow surgical field.^1,4

Therefore, besides CO₂ laser, other surgical instruments, such as microdebriders and coblators, have been used in an alternative or complementary method. Luo CM et al.⁵ described that the use of microdebriders can save surgery time and simultaneously provide precise cutting through the prompt exposure of surgical field and synchronized suction and thus can be an effective alternative method. Additionally, Sun et al.⁹ described an alternative surgical method in which the use of coblators as complementary instruments could shorten the surgery time, reduce intraoperative bleeding, and relieve postoperative pain.

Electrocautery, sales name “Bovie (Covidien)”, which is used in this report, is also a frequently used instrument in the part of otolaryngology surgery since it is easy to use and has a relatively short learning curve and is thus actively utilized for laryngeal surgery. It also has the advantage of being able to effectively handle bleeding from the surgical site while lesions are being cut off. However, the heat energy of this surgical instrument can cause thermal damage to the surrounding structures or form secondary scarring.¹⁶ In the present case, using an electrocautery, the epiglottic cyst was completely removed without damaging the surrounding tissue or bleeding, and the patient recovered without specific complications after the surgery.

The epiglottic cyst must be completely resected to prevent recurrence after surgery, and aside from forcep and CO₂ lasers, several surgical procedures are being attempted with the use of other various instruments. Among them, it is believed that a surgical method in which electrocautery is utilized could be established as an alternative or complementary method, as in the present case.

Concept and design: SHW. Analysis and interpretation: JHC. Data collection: JHC. Writing the article: JHC. Critical revision of the article: SJL, PSC, SHW. Final approval of the article: SHW. Statistical analysis: JHC. Obtained funding: SHW. Overall responsibility: SHW.