Endoscopic surgical approach to laryngoceles and saccular cysts

Laryngeal saccular disorders are rare lesions presenting as abnormal saccular dilation, either mainly filled with air (laryngoceles) or fluid (saccular cysts). These are further categorized as internal when confined in the endolarynx, external, or combined. In adults, saccular disorders are mostly idiopathic with various reported proportion associated with laryngeal cancer or increased transglottic pressure. Patients may present with voice disorders, respiratory, or swallowing issues. Workup should include directed history taking, laryngeal endoscopy, neck examination, and imaging. Priority should be given for securing the airway when indicated. The endoscopic approach via direct laryngoscopy with complete resection (by cold, hot instruments, or CO₂ laser) is the treatment of choice for internal saccular disorders or small combined ones. The transoral robotic approach was also recently reported. Needle aspiration or marsupialization can be performed by the less experienced surgeon and provide rapid decompression when needed, although with higher recurrence rates.