Question

Enumerate various causes of neonatal stridor. How will you manage a case of saccular cyst of larynx?

Hint:

Early diagnosis and appropriate intervention, including surgical removal when needed, are essential for managing a saccular cyst of the larynx to prevent airway obstruction.

Answer 1

Step 1: Causes of Neonatal Stridor:
Neonatal stridor is a high-pitched sound during inspiration caused by airway obstruction. It can be caused by various conditions:
1. Laryngomalacia: This is the most common cause of neonatal stridor. It occurs when the soft tissues of the larynx collapse inward during inhalation due to weak cartilage.
2. Vocal Cord Paralysis: Damage to the recurrent laryngeal nerve, often caused by trauma during delivery, leads to vocal cord paralysis, which can cause stridor.
3. Subglottic Stenosis: This is a narrowing of the subglottic region, which can lead to stridor. It may be congenital or acquired.
4. Congenital Laryngeal Web: A membrane that forms between the vocal cords can cause airway obstruction and stridor.
5. Cystic Lesions (e.g., Saccular Cyst): These can cause airway obstruction, leading to stridor in neonates.
6. Tracheomalacia: A soft or weak tracheal wall that collapses during breathing, leading to stridor.
7. Foreign Body Aspiration: Rare in neonates but can occur and cause stridor due to obstruction.

Step 2: Management of Saccular Cyst of Larynx:
A saccular cyst of the larynx is a congenital or acquired condition where a cyst forms in the saccule, a small sac-like structure of the larynx. The management approach includes:
1. Diagnosis:
- The diagnosis is confirmed by laryngoscopy or imaging, such as CT or MRI, to identify the cyst's location, size, and effect on the airway.
- Flexible laryngoscopy is typically the preferred diagnostic tool, allowing visualization of the cyst and assessment of airway patency.

2. Conservative Management:
- In some cases, small cysts causing minimal obstruction may resolve with time, and conservative management, such as monitoring and supportive care, is sufficient.
- Observation is necessary to ensure that the cyst does not cause further airway compromise or lead to respiratory distress.

3. Surgical Management:
- Cyst Aspiration: If the cyst is large and causing significant obstruction, it can be aspirated under local anesthesia. This may provide temporary relief.
- Cyst Excision: In cases where the cyst causes significant airway obstruction or fails to resolve with conservative treatment, surgical excision is often necessary. This is typically performed through an endoscopic approach.
- Laser Surgery: Laser resection can be performed if the cyst is located in a difficult area or if traditional surgery is not feasible.

4. Post-Operative Care:
- Post-surgical care may include airway management, monitoring for respiratory complications, and possible prolonged observation in a neonatal intensive care unit (NICU).
- Early intervention is important to prevent complications such as aspiration, choking, or worsening stridor.