Laryngocele

A laryngocele is an air-filled dilation of the laryngeal saccule, a small pouch of the ventricle of Morgagni that lies between the false vocal cords and the thyroid cartilage. It typically communicates with the laryngeal lumen and may remain confined inside the larynx or extend through the thyrohyoid membrane into the neck.

Laryngocele is classified by content and location. When filled with air, it is referred to as a laryngocele; if the saccule becomes mucus-filled, it is called a laryngomucocele; if infection accompanies the dilation, it is termed a laryngopyocele. Laryngoceles can be internal (entirely within the larynx) or external (extending through the thyrohyoid membrane to the neck), or mixed.

Etiology involves increased intralaryngeal pressure and/or structural predisposition. Activities that raise intralaryngeal pressure, such as playing wind instruments, forceful coughing, or heavy lifting, have been associated with laryngoceles. They are more common in adults and show a male predominance; risk factors include chronic coughing, chronic obstructive airway disease, and upper airway lesions.

Clinical presentation ranges from incidental finding to symptomatic masses causing hoarseness, neck swelling that enlarges with Valsalva, dysphagia, cough, or airway obstruction in large lesions. Infected laryngoceles (laryngopyoceles) may present with fever and tenderness. Diagnosis is by laryngoscopy (indirect or flexible) and imaging, with CT or MRI delineating the extent and content.

Treatment depends on symptoms and extent. Small, asymptomatic lesions may be observed. Symptomatic, enlarging, or infected laryngoceles require surgical management, through endoscopic marsupialization or excision, with external cervical approaches for external lesions. Antibiotics are used for infection, and airway management may be necessary in acute obstruction. Recurrence is uncommon after appropriate surgery.