Med Laser 2022; 11(1): 61-64  https://doi.org/10.25289/ML.2022.11.1.61
Epiglottic Cyst Treated with Electrocautery: A Case Report
Ji Hyeok Choi, Sang Joon Lee, Phil-Sang Chung, Seung Hoon Woo
Department of Otolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
Correspondence to: Seung Hoon Woo
E-mail: lesaby@hanmail.net
ORCID: https://orcid.org/0000-0001-7560-1140
Received: January 7, 2021; Accepted: January 31, 2021; Published online: March 30, 2021.
© Korean Society for Laser Medicine and Surgery. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Epiglottic cysts which usually occur on the lingual side of the epiglottis, are often benign lesions. This is a case report of a 40-year-old woman who visited our hospital and was found to have an epiglottic cyst during a gastroscopy procedure. We removed the epiglottic cyst via laryngo-microsurgery using electrocautery. After the surgery, the shape and function of the epiglottis were completely preserved, and complications such as aspiration symptoms did not occur. Therefore, it is believed that the procedure could be established as an alternative or complementary surgical method for the removal of epiglottic cysts.
Keywords: Epiglottic cyst; Electrocautery
INTRODUCTION

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.

CASE REPORT

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.

DISCUSSION

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.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

AUTHOR CONTRIBUTIONS

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.

FUNDING

None.

References
  1. Chung, PS, Chung, YW, Park, SJ & Kim, MC (2004). A clinicopathologic study of epiglottic and vallecular cysts. Korean J Otorhinolaryngol-Head Neck Surg. 47, 157-60.
  2. Henderson, LT, Denneny, JC 3rd & Teichgraeber, J (1985). Airway-obstructing epiglottic cyst. Ann Otol Rhinol Laryngol. 94(5 Pt 1), 473-6.
    Pubmed CrossRef
  3. Lee, WS, Tsai, CS, Lin, CH, Lee, CC & Hsu, HT (2000). Airway obstruction caused by a congenital epiglottic cyst. Int J Pediatr Otorhinolaryngol. 53, 229-33.
    Pubmed CrossRef
  4. Su, CY & Hsu, JL (2007). Transoral laser marsupialization of epiglottic cysts. Laryngoscope. 117, 1153-4.
    Pubmed CrossRef
  5. Luo, CM, Yang, SW & Chen, TA (2009). Treatment of wide-based epiglottic cyst by microdebrider. Med Devices (Auckl). 2, 41-5.
    Pubmed KoreaMed CrossRef
  6. Park, S, Jung, KY, Park, MW, Hwang, J, Lee, SY & Baek, SK (2013). A single-arm, prospective study of laser-assisted marsupialization for epiglottic cysts in adults. Med Laser. 2, 64-6.
    CrossRef
  7. Hwang, SM, Lee, DY, Im, NR, Lee, HJ, Kim, B & Jung, KY, et al (2015). Office-based laser surgery for benign laryngeal lesion. Med Laser. 4, 65-9.
    CrossRef
  8. Stuart, TP (1907). The functions of the epiglottis and of the glosso-epiglottic fossae. J Physiol. 35, 446-59.
    Pubmed KoreaMed CrossRef
  9. Sun, BC, Dai, ZY, Han, ZL, Wang, F, Yang, SZ & Han, JH, et al (2014). Clinical effect analysis of microscopic surgery for epiglottis cysts with coblation. Indian J Otolaryngol Head Neck Surg. 66, 267-71.
    Pubmed KoreaMed CrossRef
  10. Perotti, P, Ferrari, M, Montalto, N, Lancini, D, Paderno, A & Incandela, F, et al (2018). Anatomical cadaver study of endolaryngeal vascularization: focus on the glottis, supraglottis, and subglottis from the transoral microsurgical point of view. Front Oncol. 8, 138.
    Pubmed KoreaMed CrossRef
  11. Mu, L & Sanders, I (2000). Sensory nerve supply of the human oro- and laryngopharynx: a preliminary study. Anat Rec. 258, 406-20.
    Pubmed CrossRef
  12. Cho, JG, Jung, J, Park, MW, Baek, SK, Kwon, SY & Jung, KY, et al (2014). Implication of margin of glottic cancer: laser surgery. Med Laser. 3, 71-4.
    CrossRef
  13. Ju, YH, Jung, KY, Kwon, SY, Woo, JS, Cho, JG & Park, MW, et al (2012). The usefulness of CO2 laser-assisted phonomicrosurgery using a computer-guided scanner in benign vocal fold mucosal disorders. Med Laser. 1, 16-20.
    CrossRef
  14. Choe, H, Jung, KY, Cho, JG, Park, MW & Baek, SK (2013). The preliminary assessment for the feasibility of CO2 laser-assisted phonomicrosurgery using computer-guided scanner in broad-based vocal polyps. Med Laser. 2, 19-23.
    CrossRef
  15. Kim, KH, Sung, MW, Baek, CH, Son, YI, Kim, SY & Choi, SH, et al (2013). Treatment outcome and prognostic factors of CO2 laser cordectomy for early glottic cancer. Med Laser. 2, 24-8.
    CrossRef
  16. Siddaiah-Subramanya, M, Tiang, KW & Nyandowe, M (2017). Complications, implications, and prevention of electrosurgical injuries: corner stone of diathermy use for junior surgical trainees. Surg J (N Y). 3, e148-53.
    Pubmed KoreaMed CrossRef


This Article

e-submission

Archives