Endoscopic Management of Laryngopyoceles: A Report of Two Cases.

Laryngoceles are rare pathological air-filled dilatations of the laryngeal saccule. Rarely, laryngoceles can become infected and pus-filled, forming laryngopyoceles. If untreated, they can lead to life-threatening complications including airway obstruction and deep neck space sepsis. The generally accepted management of laryngopyoceles is surgical, but there are no consensus guidelines available. We present two cases of elderly patients (89- and 90-year-old) with laryngopyoceles who were successfully managed with endoscopic laryngeal surgery. Both presented with worsening airway symptoms on the background of progressive dysphonia. Fibreoptic nasal laryngoscopy showed large supraglottic masses/swellings, and they underwent emergent microlaryngoscopy and deroofing of an infected laryngocele. Airway management was shared between the ENT and anaesthetics teams. One patient had awake fibreoptic intubation, while the other was trialled with apnoeic/Optiflow and insertion of a microlaryngeal tube via an operative laryngoscope, but required tracheostomy due to limited access. They recovered well in the hospital with intravenous dexamethasone and antibiotics. Both patients were asymptomatic at the one-month follow-up, with no laryngocele recurrence on repeat flexible nasendoscopy. Histopathology did not show any malignancy. The rarity of laryngopyoceles highlights the importance of maintaining a high index of suspicion in patients presenting with signs of airway compromise or potential deep neck space infection. Suspected cases should usually undergo prompt CT and flexible nasal laryngoscopy evaluation, with early ENT referral. Consideration should also be given to the most suitable approach to managing the airway and the surgical approach to drainage and excision. Early recognition and definitive management of laryngopyoceles are important to prevent potentially life-threatening complications.