Coblator assisted marsupialization of vallecular cyst

The lesion was misdiagnosed elsewhere as laryngomalacia and spontaneous recovery were assured without intervention. Endoscopic evaluation was not done. The baby was brought to our center due to failure to thrive, feeding difficulty, repeated choking episodes, and worsening physical findings. Preoperative fiber optic laryngoscopy was done which revealed a cystic lesion at the vallecula obstructing the laryngeal inlet, pushing the epiglottis forward (Fig. 2). MRI scan showed a well-defined nonenhancing thin-walled cystic lesion measuring 14.8x14.2mm at vallecula and the diagnosis was confirmed (Fig. 3). Surgery was planned. Intubation was attempted but failed. The baby was tracheostomized before the procedure for ventilation, anticipating postoperative surgical site edema as well. Uncuffed tracheostomy tube size 3 was used. A direct laryngoscope straight blade with zero degree endoscope was held by the anesthetist to view the cyst and the EVAC-70 coblation wand was held in the right hand by the surgeon. The settings of the coblator were maintained at 70-30, coblation and coagulation respectively. The wand was used in both coblator and coagulation mode based on need. The anterior cyst wall was completely removed by coblation, and the cyst was thus marsupialized.