New Laryngeal Cyst Classifications Highlight Increased Clarity, Oncocyte Presence

by Amy E. Hamaker •

COMMENT: This review article attempts to standardize the confusing and disparate nomenclature relevant to all types of acquired and congenital laryngeal cysts into a cohesive naming system in the hope of guiding care management for this diverse and challenging clinical disease spectrum.—Jonathan Bock, MD

How are laryngeal cysts currently managed, and is a more concise framework for terminology and management possible?

BOTTOM LINE

Although the proposed classification mechanism is more complex than those previously described, the added cystic descriptors recognize the need to highlight oncocyte presence and allow for increased clarity in terminology between surgeons and pathologists.

Background: Several proposed classifications for laryngeal cysts exist, but none aim to guide management. It may soon be possible to precisely anatomize supraglottic cystic lesions preoperatively, allowing for better differentiation in patient counseling and surgical planning. With these foreseeable advances, the need for surgeons and authors need to be better able to define laryngeal cyst location and type.

Study design: Systematic literature review, with preference given to articles published since 2006.

Setting: PubMed/Medline databases.

Synopsis: In diagnosis, videolaryngoscopy is the initial modality for most laryngeal disorders, but there is significant overlap among cysts of varying locations and with alternative differential diagnoses. Stroboscopic video is the current standard for vocal fold vibration evaluation. Imaging, including computed tomography, magnetic resonance imaging, and more recently endolaryngeal ultrasound and optical coherence tomography, is an adjunct to narrow the differential and to plan management. In management, needle aspiration is associated with extremely high recurrence rates, and its use should be strictly limited to the acute setting for airway management or to ease definitive surgical resection. Microlaryngoscopy with laser has replaced cold instruments among many laryngologists. Debate on surgical enrollment for epiglottic and vallecular cysts is primarily focused on whether transoral laser marsupialization or complete cyst removal provides better long-term outcomes. Complete excision by endoscopic laser microsurgery is the accepted gold-standard treatment of internal saccular lesions, with transoral robotic surgery allowing for effective visualization of hidden areas. Cystic epithelial lining is a key determinant to diagnosis of cystic lesions. Following appropriate surgical management, laryngeal cyst recurrence is relatively rare. Histopathologic diagnosis of an oncocytic cyst, however, is associated with greater likelihood of recurrence. The authors propose that cysts be described by their anatomic location and not otherwise specified until analyzed.

Citation: Heyes R, Lott DG. Laryngeal cysts in adults: simplifying classification and management. Otolaryngol Head Neck Surg. 2017;157:928–939.