Podcast
Questions and Answers
What is the anatomical location of the saccule in the larynx?
What is the anatomical location of the saccule in the larynx?
What percentage of saccules measured 10 mm or greater in Broyles' study?
What percentage of saccules measured 10 mm or greater in Broyles' study?
Which of the following might be a documented cause of saccular cysts?
Which of the following might be a documented cause of saccular cysts?
How many of the reviewed cases of laryngocele or saccular cyst involved infants and children?
How many of the reviewed cases of laryngocele or saccular cyst involved infants and children?
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Which symptom is commonly associated with saccular cysts in infants?
Which symptom is commonly associated with saccular cysts in infants?
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What is the primary function of the mucous glands within the saccule?
What is the primary function of the mucous glands within the saccule?
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What abnormal feature may arise due to obstruction of the saccular orifice?
What abnormal feature may arise due to obstruction of the saccular orifice?
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Which demographic had the majority of the laryngeal cyst cases documented in the review?
Which demographic had the majority of the laryngeal cyst cases documented in the review?
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What is the preferred surgical approach for large recurrent lateral saccular cysts according to the report by Hogikyan and Bastian?
What is the preferred surgical approach for large recurrent lateral saccular cysts according to the report by Hogikyan and Bastian?
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How many patients required hospitalization for observation after complete endoscopic removal of saccular cysts?
How many patients required hospitalization for observation after complete endoscopic removal of saccular cysts?
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What factor may influence the choice between an endoscopic or external approach for removing a saccular cyst?
What factor may influence the choice between an endoscopic or external approach for removing a saccular cyst?
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What should be excluded during the initial evaluation of adults with saccular disorders?
What should be excluded during the initial evaluation of adults with saccular disorders?
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What is a common issue that a surgeon might encounter when attempting to remove a large lateral saccular cyst?
What is a common issue that a surgeon might encounter when attempting to remove a large lateral saccular cyst?
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What is the recommended intervention if a larger cyst presents during endoscopy?
What is the recommended intervention if a larger cyst presents during endoscopy?
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What type of imaging is typically employed to evaluate saccular disorders?
What type of imaging is typically employed to evaluate saccular disorders?
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What can happen to the visibility of a lateral cyst when transitioning from awake endoscopy to general anesthesia?
What can happen to the visibility of a lateral cyst when transitioning from awake endoscopy to general anesthesia?
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What primary symptom is most commonly associated with large lateral saccular cysts?
What primary symptom is most commonly associated with large lateral saccular cysts?
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What substance fills a saccular cyst with a blocked orifice?
What substance fills a saccular cyst with a blocked orifice?
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Which classification describes a laryngocele that is confined internally within the larynx?
Which classification describes a laryngocele that is confined internally within the larynx?
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What diagnostic procedure is primarily used to determine the contents and size of a laryngeal cyst?
What diagnostic procedure is primarily used to determine the contents and size of a laryngeal cyst?
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Which symptom is least commonly associated with laryngoceles?
Which symptom is least commonly associated with laryngoceles?
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What surgical management technique is traditionally used for treating cysts and laryngoceles in infants?
What surgical management technique is traditionally used for treating cysts and laryngoceles in infants?
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What is a common post-operative necessity following endoscopic procedures for saccular cysts in children?
What is a common post-operative necessity following endoscopic procedures for saccular cysts in children?
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Which surgical approach is more likely preferred for definitive removal of adult laryngoceles with external components?
Which surgical approach is more likely preferred for definitive removal of adult laryngoceles with external components?
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In which scenario is careful endoscopic examination especially necessary before surgery?
In which scenario is careful endoscopic examination especially necessary before surgery?
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What is one of the potential complications noted in reports of children with saccular cysts?
What is one of the potential complications noted in reports of children with saccular cysts?
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What is the typical consequence of a large anterior saccular cyst on the vocal folds?
What is the typical consequence of a large anterior saccular cyst on the vocal folds?
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Which treatment method was noted for recurrent anterior saccular cysts?
Which treatment method was noted for recurrent anterior saccular cysts?
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What common symptom results from the downward pressure on the vocal folds caused by anterior saccular cysts?
What common symptom results from the downward pressure on the vocal folds caused by anterior saccular cysts?
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Which option best describes the filling of a laryngopyocele's interior?
Which option best describes the filling of a laryngopyocele's interior?
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Study Notes
Saccular Disorders
- Saccular Disorders are abnormalities of the laryngeal ventricle's saccule, a small outpouching at its anterior end.
- The saccule is a blind sac that contains mucous glands and empties into the ventricle.
- Variation in size is normal, with most measuring 6-8mm in length, some up to 15mm.
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Etiology:
- In infants, saccular disorders appear to be congenital.
- In adults, causes are unclear, but may be related to increased transglottic pressure from activities like trumpet playing or glassblowing.
- Laryngeal carcinoma can cause obstruction of the saccular orifice, leading to saccular cysts.
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Clinical Scenario:
- Saccular cysts can occur in infants and adults.
- In infants, symptoms appear early, including respiratory distress, stridor, abnormal cry, cyanosis, and dysphagia.
- In adults, hoarseness is common, along with dyspnea, dysphagia, pain, and neck mass (with large or infected lateral cysts).
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Classification:
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By contents:
- Air-filled = laryngocele
- Mucus-filled = saccular cyst
- Purulence-filled = laryngopyocele
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By size and direction:
- Anterior saccular cyst: Protrudes from the anterior ventricle, may cause dysphonia.
- Lateral saccular cyst/laryngocele (internal only): Dissects superiorly and laterally, bulging false and aryepiglottic folds, and potentially into the piriform sinus.
- Lateral saccular cyst/laryngocele (internal/external): Similar to internal variety but also penetrates the thyrohyoid membrane, causing a neck swelling.
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By contents:
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Diagnosis:
- Diagnosis is made by combining history, laryngeal and neck examination, and CT scan to determine contents and size/direction of expansion.
- Symptoms vary depending on the cyst type, with common symptoms including hoarseness, stridor, dysphagia, sore throat, snoring, and cough.
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Treatment:
- Management is surgical.
- In infants with congenital lateral saccular cysts, airway should be secured first, followed by cyst aspiration or endoscopic marsupialization.
- In adults, management depends on the cyst type and surgeon preference.
- Anterior saccular cysts: Endoscopic removal with cup forceps is effective with low recurrence.
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Lateral saccular cysts:
- Endoscopic marsupialization or external approach may be used.
- Complete endoscopic excision has shown good results even for large or recurrent cysts, but requires careful dissection and experience.
- External approach: Involves transcervical approach following the external portion of the cyst.
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Important Considerations:
- Before definitive surgery, rule out laryngeal carcinoma, especially in adults with saccular cysts.
- For large lateral cysts, the surgeon must be aware that they can shrink under general anesthesia, requiring careful endoscopic dissection.
- Endoscopic management is suitable for many patients with large cysts.
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Summary:
- Saccular disorders are diagnosable through history, physical examination, and imaging.
- Treatment options vary based on patient factors, cyst type, and surgeon preference.
- Both endoscopic and external approaches are viable with potential advantages and disadvantages.
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Description
This quiz explores saccular disorders, focusing on the abnormalities of the laryngeal ventricle's saccule. It covers etiology, clinical scenarios, and symptoms in both infants and adults. Test your knowledge about this fascinating area of otolaryngology.
