Atypical Presentation of a Combined Internal/External Saccular Cyst: A Case Report

A saccular cyst is an uncommon mucus-containing dilatation of the laryngeal saccule. It is typically classified as anterior (presenting from the anterior ventricle) or lateral (deep to the false and aryepiglottic folds), with 85.7% being anterior in one study.1 Lateral saccular cysts are further classified as internal (confined to the endolarynx), external (presenting into the neck), or combined.Saccular cysts may be asymptomatic and diagnosed incidentally on flexible laryngoscopy or radiography. An anterior saccular cyst typically appears as a round submucosal mass protruding from the anterior ventricle, while lateral saccular cysts present as a bulge in the aryepiglottic fold, pyriform sinus, or lateral vallecula. If the distended saccule (mucus or air filled) dissects over the top of the thyroid cartilage, it can also appear as a lateral neck mass.2 In this case report, we discuss an unusual infraglottic presentation of a combined internal/external saccular cyst.