[Laryngocele: analysis of 18 cases and review of the literature].

18 cases of laryngocele (8 combined, 6 external, 4 internal) treated at the E.N.T. Clinic from January 1968 to December 1989 are reported. The review of the literature is specifically focussed on some controversial issues (i.e. nomenclature, association with laryngeal cancer, pre-operative work-up, surgical procedures). The main symptoms at presentation have proved to be airway obstruction (44.4%), hoarseness (44.4%) and a cervical mass (44.4%). In 12 cases (66.6%) surgical excision was performed by means of an extralaryngeal approach, median thyrotomy was used in 2 cases (11.1%). In 4 cases (22.2%) in which the laryngocele was associated with a laryngeal cancer, a total laryngectomy proved necessary, four patients required a second operation for a recurrence of the laryngocele. Major complications included pyocele (33.3%) and acute airway obstruction (22.2%). CT scan proved to be the most accurate radiological method for defining the spatial relationship between the laryngocele and the laryngeal structures and extralaryngeal soft tissues, in differentiating the laryngoceles from other cystic formations and in identifying the co-existence of a laryngeal cancer. Surgery is the treatment of choice. An extralaryngeal approach, according to Stell and Maran (1975) provides the most adequate exposure of the laryngocele, preserving the integrity of the laryngeal framework. Only in cases of small internal laryngoceles can endoscopic CO2 laser excision be considered a valid alternative. Tracheotomy is usually not indicated.