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A 0-day-old female neonate exhibited loud stridor and respiratory distress at birth. The pregnancy was uncomplicated, and prenatal ultrasonography results were normal. After spontaneous vaginal delivery at 37 weeks’ gestation, the neonate immediately developed tachypnea, severe retractions, barking cough, hoarse cry, and dusky appearance with oxygen desaturations to 60%, which required continuous positive airway pressure. Despite respiratory support, she was intubated within the first hour of life. The intubating clinician noted a large flesh-colored laryngeal mass and placed a size 3.5 uncuffed endotracheal tube. Ear, nose, and throat evaluation noted that the neonate was intubated and ventilating easily. No craniofacial abnormalities or obvious oral cavity, oropharyngeal, or neck masses were present. Chest radiography was obtained, and results were normal. The patient was subsequently taken to the operating room for direct laryngoscopy and bronchoscopy. Intraoperative evaluation revealed a large submucosal mass involving the left side of the epiglottis, false fold, aryepiglottic fold, and arytenoid that was soft and fluctuant on palpation (Figure 1).
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C. Lateral saccular cyst
Congenital laryngeal cysts are a rare yet important cause of stridor, respiratory distress, and airway obstruction in neonates. Timing of presentation can vary from shortly after birth, to late infancy, to early childhood.1- 7 Saccular cysts are fluid-filled submucosal lesions that arise from the laryngeal saccule and often appear in the anterior aspect of the ventricle. These cysts do not communicate with the laryngeal lumen, as opposed to laryngoceles, which typically contain air or air-fluid levels because they are open to the lumen. However, some controversy exists in the nomenclature of these lesions because they are histologically similar. DeSanto et al2 classified laryngeal saccular cysts into 2 types: anterior and lateral. Anterior cysts enlarge medially and posteriorly between the true and false vocal folds. Lateral cysts progress in a posterosuperior direction, which results in distention of the false vocal fold and aryepiglottic fold, as seen in this neonate.
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Corresponding Author: John Faria, MD, Department of Otolaryngology, University of Rochester, 125 Lattimore Rd, Rochester, NY 14620 (firstname.lastname@example.org).
Published Online: November 7, 2019. doi:10.1001/jamaoto.2019.3367
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient’s mother for granting permission to publish this information.
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