(1059) Surgical Management of Pediatric Laryngeal Saccular Cysts: A Systematic Review and Meta-analysis

Introduction: Laryngeal saccular cysts are rare lesions attributed to an obstruction at the ventricle. We aim to compare outcomes of various surgical procedures in pediatric patients with laryngeal saccular cysts including open approaches, endoscopic without laser approaches, and laser approaches.

Methods: PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov were searched following PRISMA guidelines (Preferred Reporting Items for Systematic Review and Meta-analysis) on 6/20/2023 with no date restriction. Multiple variables were analyzed including demographics, presenting symptoms, extralaryngeal extension, size of cyst, surgical approach, tracheostomy rate, decannulation rate, recurrences, complications, and follow-up.

Results: A total of 842 articles were reviewed: 40 articles met inclusion criteria and 74 patients were included in the analysis. 57 patients who had initial endoscopic surgery without laser underwent tracheostomy 22% (13/57) of the time and had a 35% (20/57) chance of recurrence. The 11 patients with laser intervention never underwent tracheostomy, and they had a 63% (7/11) chance of recurrence. The 6 patients with open intervention never underwent tracheostomy at the time of surgery or later, and they had a 17% (1/6) chance of recurrence. Extralaryngeal cyst extension was described in 6 cases, 50% of which were treated initially with open surgery. There were no recorded mortalities in any group.

Conclusions: Pediatric patients with laryngeal saccular cysts who undergo initial endoscopic surgery with laser are more likely to experience cyst recurrence. Cyst recurrence decreases with an endoscopic approach without laser and even more with an open surgical approach. It may be beneficial to use an open surgical approach in cysts with extralaryngeal extension. Children are more likely to avoid eventual tracheostomy with a laser or open approach.