Laryngocele: Diagnosis and Treatment
Immediate Diagnostic Approach
Laryngoscopy is the essential diagnostic procedure for any patient with suspected laryngocele, and should be performed promptly when clinical features suggest this diagnosis—particularly in patients presenting with hoarseness, neck swelling, stridor, or throat discomfort. 1, 2
Key Clinical Presentations Requiring Urgent Evaluation
- Hoarseness with neck swelling is the most common presentation of laryngocele and warrants immediate laryngoscopic examination 3, 4
- Stridor, fever, and hoarseness together should raise immediate concern for laryngopyocele (infected laryngocele), which can cause life-threatening airway obstruction 5, 6
- Progressive dysphagia or chronic sore throat are explicit indications for laryngoscopy per American Academy of Otolaryngology-Head and Neck Surgery guidelines 2
Diagnostic Imaging
CT scan of the neck is the most effective imaging method for definitive diagnosis and should be obtained once laryngoscopy identifies a suspicious lesion 6, 4
- CT demonstrates the cystic air-filled or fluid-filled mass arising from the laryngeal saccule and defines its extent (internal, external, or combined) 5, 4
- Ultrasound with trumpet maneuver (patient performing Valsalva) can be used as an adjunct for external laryngoceles 7
Critical Pitfall: Association with Malignancy
Always evaluate for supraglottic squamous cell carcinoma, as laryngoceles may be associated with laryngeal cancer 6, 4
- This association makes tissue evaluation and complete visualization mandatory
- Delays in diagnosis beyond 3 months lead to higher cancer stages and worse prognosis 1
Treatment Algorithm
Emergency Management (Laryngopyocele with Airway Compromise)
If acute airway obstruction is present (stridor, respiratory distress, sepsis), perform emergency tracheostomy immediately to secure the airway 5
- Laryngopyocele can cause near-complete (up to 100%) airway obstruction 5
- After airway is secured, perform immediate endoscopic drainage of the infected laryngocele 5
Definitive Surgical Treatment Based on Type
For internal laryngoceles: Endoscopic CO2 laser resection is the preferred approach 3
- Provides complete resection with minimal laryngeal trauma 3
- Shorter operative time and hospital stay compared to open approaches 3
- No tracheostomy required perioperatively 3
For combined (mixed) laryngoceles: Lateral thyrotomy via V-shaped approach is recommended 3
- Allows safe, precise, and complete resection under direct visualization 3
- Single-approach technique for both internal and external components 3
- Recurrence rates are minimal with complete excision 3
Timing of Definitive Surgery
- Definitive surgical excision can be performed immediately after endoscopic drainage or delayed after resolution of acute infection 5
- Surgery is the treatment of choice for all laryngoceles to prevent recurrence and rule out malignancy 6, 4
Post-Treatment Surveillance
Mean follow-up of 8.5 months is adequate to detect recurrence, though longer surveillance may be warranted given the malignancy association 3, 4