Laryngocele: causes, symptoms, diagnosis, treatment

Laryngocele is a cystic, air-containing tumor that develops at the level of the laryngeal ventricles with a certain predisposition to this defect. This formation is rare, mainly in middle-aged men. Medicine owes the first observations of this disease to the surgeon of Napoleon's army Larey, who observed it in the inhabitants of Egypt during Bonaparte's Egyptian expedition of 1798-1801. In 1857, V.L. Gruber proved that phylogenetically laryngocele is an analogue of the so-called air sacs in anthropoid apes - orangutans and gorillas. The term "laryngocele" was first introduced by R. Virchow in 1867.

Cause of laryngocele. Laryngoceles are divided by origin into true (congenital), caused by an anomaly of embryonic development of the larynx, and symptomatic, i.e. acquired as a result of the occurrence of any obstacles to the exhaled air stream in the larynx (tumor, granuloma, cicatricial stenosis, etc.). Normally, the ventricles of the larynx do not contain air, and their walls are in close contact with each other. Under certain conditions, especially with forced exhalation, insufficient opening of the respiratory slit and convergence of the folds of the vestibule, exhaled air penetrates the ventricles of the larynx and opens them under pressure, stretching and thinning the mucous membrane and submucous layer. Multiple repetition of this phenomenon leads to the formation of laryngocele. Usually, such a mechanism of formation of acquired laryngoceles is observed in glassblowers, trumpeters, and sometimes in singers.

The data presented by N. Costineеu (1964) are quite curious, according to which laryngeal diverticula, from which laryngoceles can form under appropriate conditions, are far from rare. Thus, in almost all children who died for various reasons, diverticula extending upwards are found at autopsy, and according to Kordolev, 25% of adults have laryngeal diverticula reaching the area of the sublingual-epiglottic membrane, while none of them showed signs of laryngoceles during life.

Pathological anatomy. According to localization, laryngoceles are divided into internal, external and mixed. Having initially arisen in the area of the laryngeal ventricles, laryngoceles spread towards the vestibule of the larynx and into the anterolateral region of the neck. The saccular tumor is formed due to a herniated protrusion of the mucous membrane of the laryngeal ventricle, which penetrates into the thickness of the tissue either through a gap in the thyrohyoid membrane or by its stratification in places of its least strength.

The diagnosis of laryngocele is established by laryngoscopy and examination of the anterior surface of the neck.

Internal laryngocele is a swelling covered with normal mucous membrane, located at the level of the ventricle and aryepiglottic fold. This swelling can occupy most of the vestibule of the larynx, covering the vocal folds and causing breathing and voice production disorders. External laryngocele develops slowly - over many months and even years; it is located on the anterolateral surface of the neck, on the larynx or in front of the sternocleidomastoid muscle. It has the appearance of an oval swelling covered with normal skin. When palpating the tumor, the symptom of crepitus, as in subcutaneous emphysema, is not detected; the swelling is painless, not fused with the surrounding tissues, when pressing on the tumor it decreases, when the pressure stops it quickly acquires its previous shape, when straining it increases, filling the laryngocele with air occurs silently. On palpation of the tumor, a depression can be identified above the upper edge of the thyroid cartilage, which leads to the place where the pedicle of the laryngocele pierces the thyroid membrane. Percussion of the tumor reveals a tympanic sound. During phonation or swallowing, the internal laryngocele empties silently, while the release of air from the external laryngocele is accompanied by a characteristic noise produced by the air stream. This noise can be heard at a distance or auscultated with a phonendoscope.

During radiographic examination, laryngocele is visualized as a round-oval enlightenment of varying density on one or both sides near the larynx with clearly defined boundaries, either only in the area of the projection of the laryngeal ventricles, or extending outward from the large horn of the thyroid cartilage and lateral to the latter; in lateral projection, this enlightenment can extend to the hyoid bone, pushing the aryepiglottic fold back, but in all cases, laryngocele maintains a connection with the laryngeal ventricle.

An accidental detection of a laryngocele should always alert the physician to the possibility of a secondary origin of this anomaly as a result of a tumor in the ventricle of the larynx or some other laryngeal localization. The combination of laryngocele and laryngeal cancer is not a rare phenomenon, described by many authors (Lebogren - 15%; Meda - 1%; Leroux - 8%; Rogeon - 7%).

Differential diagnosis is carried out with cysts of the laryngeal vestibule, benign and malignant tumors, infectious granulomas and various other developmental defects of the larynx.

Treatment of laryngocele involves excision of the air sac from external access, which is easily separated from the surrounding tissues without being fused to them. Some authors suggest removing laryngocele using the endolaryngeal method, which has been greatly simplified due to the introduction of microlaryngosurgical techniques into widespread practice. However, relapses of laryngocele cannot be ruled out with the endolaryngeal method. Prevention of infectious complications is carried out by prescribing antibiotics and antihistamines in the postoperative period.

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