Laryngocele
| Classification according to ICD-10 | |
|---|---|
| Q31.3 | Laryngocele (congenital) |
| J38.7 | Other diseases of the larynx |
| ICD-10 online (WHO version 2019) | |
A laryngocele , including laryngeal fracture is a congenital or acquired later in life aneurysm of the laryngeal ventricle ( sinus Morgagni or ulcer Morgagnii ) in the larynx , ie the lateral bulge between vocal and vestibular folds, or the saccule laryngis , a little from the laryngeal ventricle outgoing blind sack. The bulge leads through the thyroid membrane to a "bubble" that can be felt on the neck under the skin.
Symptoms and course of the disease
IL = inner laryngocele
AL = outer laryngocele
H = hyoid (hyoid bone )
T = pocket ligament ( plica vestibularis )
S = vocal cord ( plica vocalis )
K = cricoid cartilage ( cricoid )
In addition to an air-filled bladder that can be felt on the side of the neck at the level of the larynx, breathing difficulties and voice disorders can exist. When pressing and coughing or when playing a wind instrument, the bladder typically becomes larger, which is also the case with glass blowers for professional reasons .
A distinction is made between an external and an internal laryngocele. The outer laryngocele spreads cystically between the hyoid bone and thyroid cartilage into the soft tissues of the neck. It represents a ventricular bulge , ventriculi morgagnii through the thyreohyoid membrane. It is usually palpable as a bump on the neck. In the case of the internal laryngocele, the cyst is located within the larynx, where it lies endolaryngeally in the area of the pocket ligament . The laryngoceles are often symptomatic of dyspnoea or dysphonia .
An internal laryngocele that forms inside the larynx initially remains symptom-free for a long time. In the later stage hoarseness sets in, which gradually increases. Usually a foreign body sensation or the feeling of a stronger accumulation of mucus is felt.
However, the symptoms increase rapidly, especially in the case of acute inflammation of the laryngocele. Pain then also occurs and acute shortness of breath can set in. An outer laryngocele is easier to recognize because it bulges visibly on the neck and increases in volume when pressed. In an advanced stage, an external laryngocele becomes noticeable through increasing shortness of breath.
A laryngocele can be congenital or acquired.
diagnosis
In addition to the tactile findings and the typical behavior when pressing , the computed tomography in particular provides the decisive information (air-filled cavity).
histology
The wall lining of the sac consists of a real respiratory epithelial tissue , i.e. a ciliated epithelium with goblet cells and glands. Round cell infiltrates ( lymphocytes and plasma cells ) are often found as a sign of non-specific inflammation . The zelensack contains air, but also mucous or purulent secretions.
therapy
If a laryngocele produces abnormal symptoms that lead to severe shortness of breath, urgent treatment is indicated. However, the procedure must be carried out immediately after the diagnosis to prevent further damage. Since there is no known drug treatment that would lead to the regression of a laryngocele, only surgical ectomy or marsupialization in the case of an external laryngocele remains . The laryngocele is opened and the wound edges are fixed so that they cannot close at first in order to achieve permanent drainage .
A marsupialization is then applied if complete removal is not indicated, because, for example, the risk of vocal cord injury is high. Depending on the diagnosis and location of the laryngocele, the procedure can also be carried out in a minimally invasive manner by removing the tissue using a laser or other suitable methods.
literature
- W. Becker, HH Naumann, CR Pfaltz: Ear, nose and throat medicine . Thieme Verlag, Stuttgart 1989, ISBN 3-13-583004-7 .
- Richard v. Hippel: About throat sac formation in humans (laryngocele ventricularis). In: German journal for surgery . November 1910, Volume 107: pp. 477-560.
Web links
- RadioGraphics January 1999 vol. 19 no. 1 121-146, schematic representation of the laryngocele from a radiological point of view
- drtbalu's otolaryngology online
Individual evidence
- ↑ W. Becker, HH Naumann, CR Pfaltz: Ear, Nose and Throat Medicine. Short textbook with atlas part. Georg Thieme Verlag, Stuttgart / New York 1986, ISBN 3-13-583003-9 , p. 401.
