AN INTERESTING CASE OF RESPIRATORY STRIDOR IN AN INFANT

Respiratory obstruction and stridor are not uncommon in infants and children. Laryngomalacia is the most common cause of stridor in the newborn, accounting for 75 of the cases where as congenital laryngeal anomalies are relatively rare. However, they may present with life-threatening respiratory problems in neonates and infants. we report a 5 month old infant who presented with respiratory distress at the pediatric casuality who required assited ventilation as O2 saturation declined. On intubation a cystic mass was visualized in the larynx. CT neck revealed a mass diagnosed as vallecular cyst of the larynx. Cyst was removed by marsupialization. Post operative period was uneventful and the child had no breathing difficulty after laryngeal cyst removal. Laryngeal cysts are among the causes of laryngeal stridor in neonates and make up the differential diagnosis against laryngomalacia, vocal cord paralysis, congenital subglottic stenosis, laryngeal web, and laryngocele etc. Symptoms are often non-specific and are common to other causes of laryngeal obstruction. Prompt recognition and management of laryngeal cysts is important because of the high mortality associated with undiagnosed conditions. Cyst may lead to stridor andor respiratory distress in neonates and young infants because of their relatively small airway and cause severe airway obstruction and even death. The symptoms may also include hoarseness, cyanosis and feeding problems, usually appear by first day, but may be delayed up to several weeks or even years. Laryngeal cyst have varied modes of presentation and can be fatal (40) if not diagnosed on time hence high degree of suspicion and early treatment is necessary. An accurate diagnosis of laryngeal cyst can be made by eliciting a good history, by endoscopic visualization of the lesion, and by computed tomography. Although surgical removal may be the treatment of choice, other modalities such as endoscopic marsupialization, excision, and deroofing of the cyst have been recently developed. Marsupialization under general anesthesia is a safe and definitive procedure, especially when performed by CO2 laser. Simple aspiration of the cyst is not advised because of its high recurrence rate.