Anesthetic Management for the Excision of a Pedunculated Vallecular Cyst Causing Airway Obstruction: A Case Report

TL;DR

This case report describes the anesthetic approach for removing a large vallecular cyst that caused breathing difficulties.

Contribution

The paper presents a successful strategy using awake fiberoptic intubation in the lateral position for airway management.

Findings

Awake fiberoptic intubation in the lateral position allowed safe airway management during cyst excision.

Carefully titrated airway anesthesia and sedation were effective in minimizing airway complications.

The approach avoided airway collapse during induction and facilitated successful surgery.

Abstract

Anesthetic management of vallecular cysts presents unique challenges, and available literature on the subject remains limited and varied. A 41-year-old female presented with dysphagia and positional dyspnea. Evaluation using video laryngoscopy revealed a 4 × 4 cm pedunculated cyst on the left side of the vallecula. The cyst was mobile, occasionally crossing the midline, and extended to the laryngeal surface, obscuring the laryngeal inlet. Visualization of the bilateral vocal cords was difficult and only possible with extensive maneuvering around the cyst. The cyst was scheduled for excision under general anesthesia, with anticipated challenges including abnormal positioning and potential airway collapse during induction. Awake fiberoptic intubation with a reinforced tube, performed in the lateral position, provided the safest approach. This case highlights that fiberoptic intubation with carefully titrated airway anesthesia and sedation, performed in the lateral position, can be a successful strategy in managing vallecular cysts.

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