|LETTER TO THE EDITOR
|Year : 2012 | Volume
| Issue : 1 | Page : 42-43
Recurrent neck abscess - A clue to laryngopyocele
Nitish Baisakhiya, Ginni Dutta, Dalbir Singh, Sanaha Mahajan
Department of ENT, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
|Date of Web Publication||9-Apr-2012|
Block-F, QN-18, MMU campus, Mullana, Ambala, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Baisakhiya N, Dutta G, Singh D, Mahajan S. Recurrent neck abscess - A clue to laryngopyocele. J Laryngol Voice 2012;2:42-3
Abnormal dilatation of the saccule with air is termed as Laryngocele.  Laryngopyoceles occur following the secondary infection of laryngoceles. We here present a case which was presented to us as a recurrent neck abscess.
A 45-year-old male presented with a sensation of lump in the throat since 9 months and a swelling on the right side of the neck below the mandible since 3 months. He had occasional difficulty in swallowing to all types of food since 6 months. He gave history of significant improvement in dysphagia and in the sensation of lump after spitting sticky yellowish material 3 months back. The symptoms had however slowly reappeared again since 6 months duration. There was a past history of Incision and Drainage procedure for a neck abscess about 6 months back. Examination revealed about 6 × 6 cm soft tissue swelling with ill-defined margins extending from the right submandibular region to the anterior triangle without any signs of acute inflammation. It was soft to firm and slightly compressible in the center and non-pulsatile. Indirect laryngeal examination with a mirror revealed a smooth, soft tissue bulge in the right lateral pharyngeal wall from the level of base tongue to the valleculae pushing the larynx towards left. A contrast-enhanced CT scan revealed well-defined multiloculated hypodense cystic lesion on the right side of the neck pushing the supraglottis towards the left side. Inferiorly, it extended till the level of the vocal cords. It was seen piercing the thyro-hyoid membrane and reaching up to the ventricle [Figure 1]. The patient was taken up for surgery via the external approach via a horizontal incision at the level of between hyoid bone and superior thyroid notch. After draining the abscess, the sac was traced up to the laryngeal ventricle. Sac was removed completely without removing thyroid cartilage. Sac along with the tract was sent for the histopathological examination to rule out the presence of any associated malignancy. A repeat scan done one month postoperatively demonstrated no residual lesion [Figure 2].
|Figure 1: Preoperative CT scan showing well-defined multiloculated hypodense cystic lesion on the right side of the neck reaching up to the ventricle|
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|Figure 2: Postoperative follow-up CT scan showing complete disappearance of the lesion|
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A neck abscess is a collection of pus from an infection in spaces between the structures of the neck. As the amount of pus increases, the soft tissue spaces expand and push against the structures in the neck, such as the larynx, tongue, and, in extreme cases, the trachea. Though there are many causes for neck abscess, most abscesses are due to secondary involvement. For e.g. peritonsillar, retropharyngeal, parapharyngeal, mastoid abscess, Ludwig's angina and laryngopyocele. Common primary causes of neck abscesses include an infected wound, acute lymphadenitis and tuberculosis.
Laryngopyocele, the infective correlate of laryngocele usually occurs when the neck of the Laryngocele gets obstructed and the mucus-filled Laryngocele is infected.  Laryngocele are classified into three groups: internal Laryngocele lies within the internal laryngeal lumen; external Laryngocele protrudes through the thyrohyoid membrane to the neck; mixed Laryngocele is the most common and has both internal and external components.  The exact etiology of its formation is not clear but it may be congenital or acquired.  The most important factor is the presence of a dilated saccule and small contribution by the presence of thinness of the periventricular connective tissue, lax thyrohyoid membrane and thyroepiglottic muscle. This condition when associated with chronically increased intralaryngeal pressure like in trumpet blowers and in supraglottic malignancy leads to the formation of Laryngocele.  In about12-13% of the person it's an accidental finding in routine radiological evaluation of the neck.  It rarely presents with recurrent neck abscess as in the present case.  We are reporting this case to highlight the importance of keeping this diagnosis in mind when dealing with a case of recurrent neck abscess.
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[Figure 1], [Figure 2]