A 55 year old patient came to the ENT outpatient department with foreign body sensation in the throat for > 4 months. Patient gives history of reflux symptoms. He was otherwise asymptomatic with no history of dysphagia, dyspnoea, change of voice, loss of weight, loss of appetite. Patient was a chronic tobacco chewer with no other systemic illness. Patient had taken local treatment at various places, but had not achieved any symptomatic relief for the same. Considering the age, habits and the Indian setting, most likely consideration is malignancy. Keeping the history in mind, a thorough clinical examination was done.

Patient, a farmer by occupation was a moderately built and nourished with normal general physical and systemic examination. Patient had poor oral hygiene. On laryngoscopic examination, a well-formed cystic lesion was seen on the lingual surface of the epiglottis closer to the tip measuring 3 mm X 1 mm (Figure 1).

Figure 1: The lingual surface of the epiglottis closer to the tip measuring 3 mm X 1 mm (laryngoscopic examination).

Rest of the larynx showed no abnormality. Hence, malignancy was ruled out after examination of larynx. There were no other clinical findings noted in examination of Ear, Nose and Neck. Patient was treated symptomatically with anti-reflux medications and multivitamin supplements and was asked to follow up after 15 days. On follow up, patient was symptomatically better. On repeat laryngoscopic examination, the cyst had ruptured by itself with no remnant visible. Hence, no surgical intervention was done on the patient as only symptomatic treatment was found apt as part of treatment. Patient was also advised to follow dietary modifications as part of anti-reflux measures to keep in check the laryngopharyngeal reflux.

Epiglottic cyst is a benign tumor that fall under 4-6% of all benign laryngeal tumors. Based on its presentation it ranges from asymptomatic to fatal depending on its size and location. Epiglottic cyst can occur irrespective of any age most common at 5th-6th decade of life as in this patient [1].

As per Asherson classification, 3 types of laryngeal cysts are Ductal cysts, Saccular cysts and Thyroid-cartilage foraminal cysts. Ductal cysts (Retention or Mucous cysts) are very common and occur as a result in obstruction of collecting ducts of salivary glands in larynx. They occur at any place of larynx within mucous membrane covered with squamous or ciliated columnar epithelium. Saccular cysts (Congenital embryonic cysts) are submucosal lesions covered with mucosa delivered from saccule of laryngeal appendage. They are often seen in neonates sometimes in adults even. Saccular cysts are larger than ductal cysts and occur in laryngeal ventricle, true and false cords and aryepiglottic fold. Thyroid-cartilage foraminal cysts are rare that occur in thyroid cartilage. They are due to residual embryonic vessels in thyroid cartilage protruded with mucosa [2,3]. Epiglottic cysts are often ductal cysts and the most common location is lingual surface of epiglottis as in this case. Sometimes they extend to aryepiglottic fold or laryngeal surface of epiglottis as seen in this case report. The differential diagnosis includes thyroglossal duct cyst, haemangioma, papilloma, lymphangioma and lingual thyroid [4]. The diagnosis of this condition depends on proper history and clinical examination. The lesion can be seen through Indirect laryngoscopy using Rigid (70 or 90 degree) laryngoscope and Flexible fiberoptic laryngoscopy. Radiologically, plain lateral neck films, thyroid scan and computed tomography scans provide additional information to arrive at diagnosis [4]. The treatment of choice for epiglottic cyst is surgical removal. Usually, microlaryngeal surgery or carbon bicarbonate laser under microscopy is planned. Complete excision of cyst reduces chances of recurrence but needs longer surgical and anaesthetic time. Also at the time of excision, there are plenty of confines such as surgical field limitations under microscopy like frequent adjustments and mobility of laryngoscopy [5]. In case of wide-based epiglottic cyst, excision gets difficult due to small and immobile surgical field as there would be blurring of surgical field by blood. The surgical field seems better with laser, but excision of wide-based epiglottic cyst is not easy due to adjustment issues with the microscope as well as the laryngoscope. Off lately, powered instrumentation like microdebrider has been tried for excision of epiglottic cysts which have shown effective results. But, in this patient the cyst burst on itself following symptomatic treatment prior to adoption of any surgical intervention [6,7].

Epiglottic cysts, though is a rare and benign condition must not be neglected and ignored because it can lethal causing airway obstruction at times. Usually they go unnoticed and overlooked upon as patients with this condition end up to the surgeon’s desk at extreme stages. With respect to its inception and location, management to the patient must be immediate and instant. Hence, this aspect can prevent adverse complications and hitches at the earliest thereby improving mortality of the patient.

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