Combined open and endoscopic excision of a large congenital laryngeal cyst causing airway obstruction in an infant: a case report

Congenital laryngeal cysts are rare airway anomalies with an incidence of ∼1.82 per 100,000 live births. These lesions can present with a range of respiratory symptoms, including stridor and feeding difficulties, and may be life-threatening if not diagnosed and managed promptly. We report a case of a 9-month-old male, born preterm at 36 weeks, who presented with failure to thrive, poor feeding, and intermittent stridor since birth. Clinical evaluation revealed a midline neck swelling, and flexible laryngoscopy identified a laryngeal cyst. Imaging studies (CT angiography and MRI) demonstrated a large, multicystic lesion causing significant airway compression. The patient underwent surgical excision via a combined endoscopic and open approach. Postoperatively, he was managed in the pediatric intensive care unit (PICU) and was successfully extubated after two weeks. At follow-up, he showed marked improvement in respiratory function, feeding, and growth. This case highlights the importance of considering congenital laryngeal cysts in infants with persistent stridor and feeding difficulties. While endoscopic techniques are often preferred, large or complex cysts may necessitate an open surgical approach to ensure complete excision and prevent recurrence. Multidisciplinary evaluation and timely intervention are essential for optimizing outcomes and promoting normal growth and development.