ArticlePublisher preview availableLiterature Review

Internal Hypopharyngeal Cyst: A Review of Literature

August 2019
Dysphagia 34(5)

Authors:

Sohag University

Detailed information on the hypopharyngeal cyst presentation, terminology, classification, diagnosis, management, and possible complication is scarce though it would lead to life-threatening symptoms. This review article, therefore, meticulously presents and analyzes the majority of the pertaining literature. In this context, a particular emphasis has been placed on the embryological development of the branchial arches while discussing each entity that would improve the current understanding of different pharyngeal cyst’s pathologies.

Schematic view of the pharyngeal arches and pouches and their derivates. I–V denote the arches and 1–4 the endodermal pouches (Adapted from Langman J. Medical embryology. 3rd ed. Baltimore: Williams & Wilkins, 1975; 234-236.) [3]

…

Figures - available from: Dysphagia

This content is subject to copyright. Terms and conditions apply.

A preview of this full-text is provided by Springer Nature.

Learn more

Content available from Dysphagia

This content is subject to copyright. Terms and conditions apply.

Vol.:(0123456789)

1 3

Dysphagia (2019) 34:487–498

https://doi.org/10.1007/s00455-019-10003-2

REVIEW

Internal Hypopharyngeal Cyst: AReview ofLiterature

MohammedElrabieAhmed1· MonaEl‑RabieAhmed2 · AhmedMahmoudElBatawi3·

HeshamMostafaAbdelfattah4· NouraJelassi5

Received: 16 October 2018 / Accepted: 23 March 2019 / Published online: 29 March 2019

Abstract

Detailed information on the hypopharyngeal cyst presentation, terminology, classiﬁcation, diagnosis, management, and pos-

sible complication is scarce though it would lead to life-threatening symptoms. This review article, therefore, meticulously

presents and analyzes the majority of the pertaining literature. In this context, a particular emphasis has been placed on the

embryological development of the branchial arches while discussing each entity that would improve the current understand-

ing of diﬀerent pharyngeal cyst’s pathologies.

Keywords Foregut-derived choristoma· Bronchogenic· Retention· Lymphoepithelial· Deglutition· Deglutition disorders

Introduction

Cysts of the pharynx and, particularly, of the hypopharynx

are tremendously rare. The patient’s complaints are directly

related to the cyst’s size and location, and they range from

asymptomatic to life-threatening symptoms. Three diﬀerent

types of pharyngeal cysts had been documented according

to their locations, namely nasopharyngeal, oropharyngeal,

and hypopharyngeal. The ﬁrst two types (nasopharyngeal,

oropharyngeal) were frequently addressed and classiﬁed in

the literature, but detailed information about hypopharyn-

geal cyst is rather limited. Thus, the aim of the current

review is to meticulously present and analyze the majority

of literature pertaining to diﬀerent types of hypopharyngeal

cysts, terminology, presentation, classiﬁcation, diagnosis,

management, and possible complications. Special concern

has been devoted in this article to the embryological devel-

opment of the branchial arches and the anatomical structures

of the head and neck derive from each arch, a discussion that

would lead to better understanding of diﬀerent pharyngeal

cyst’s pathologies.

Embryological development ofthepharynx

Hypopharynx is a striated muscular tube with a stratiﬁed

squamous epithelium which has clear cell appearance due

to the high glycogen content. At the pyriform fossa, lym-

phocytes located immediately beneath the epithelium occa-

sionally form lymphoid follicles with rich lymphatic vessel

plexus. The submucosa contains glands made up of both

mucous and serous acini that open on the surface by occa-

sional ducts [1].

In fact, the human pharynx development is complex.

It arises embryologically from the branchial apparatus.

The primitive pharynx tissue has ﬁve branchial arches

lined externally by four ectodermal recesses, referred to

as branchial clefts, and internally by ﬁve internal endo-

dermal branchial pouches. The branchial arch is a core of

mesenchyme derived from a combination of lateral plate

mesoderm, somite, and neural crest cells [2, 3] (Figure1).

Each arch is associated with a cranial nerve, a muscle or

a group of muscles, an artery, and a group of skeletal or

cartilaginous derivatives. These clefts and pouches are

* Mona El-Rabie Ahmed

drmonaahmedpho@gmail.com; daimahmoud@yahoo.com

1 Department ofOtorhinolaryngology-Head andNeck

Surgery, Sohag University, Sohag, Egypt

2 Department ofPhoniatrics, Otorhinolaryngology-Head

andNeck Surgery, Sohag University, Egypt-Sohag-Nasr City,

Eastern Avenue, University Street, Sohag82524, Egypt

3 Department ofOtorhinolaryngology-Head andNeck Surgery,

Cairo University, Cairo, Egypt

4 Department ofOtorhinolaryngology-Head andNeck Surgery,

Alexandria University, Alexandria, Egypt

5 Department ofOtorhinolaryngology-Head andNeck Surgery,

Faculty ofMedicine, Tunisia University, Tunis, Tunisia

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Isolated oropharyngeal abscess with hypopharyngeal extension recurring 12 years after initial surgical management: A case report and review of the literature

Article

Full-text available

Apr 2022

Pharyngeal abscesses require urgent management as they have the propensity to cause severe and life-threatening complications. The introduction of antibiotics has led to a dramatic decline in the incidence of these infections. Regardless, abscess formation continues to be observed in the peritonsillar, parapharyngeal, and retropharyngeal spaces. Oropharyngeal and hypopharyngeal abscesses that cause airway obstruction are scarcely reported and tend to be secondary to other processes. Herein, we describe the case of an 83-year-old man presenting with an idiopathic, obstructive, oropharyngeal wall abscess, extending from the infratonsillar region to the hypopharynx, which recurred after initial surgical management 12 years prior for the same process. He required reintervention during both episodes for rapid reaccumulation. A detailed electronic literature search of PubMed and MedLine was performed for studies reporting on recurrent pharyngeal abscesses and their management. Results were limited to articles published in English from inception to August 2021. The timely management of pharyngeal infections acutely obstructing the airway is crucial. Physicians should adopt close and frequent monitoring and have a low threshold for reimaging should symptoms worsen or fail to improve after the initial surgical intervention.

Thinking out of the tube: Endoskopische Befunde in Mundhöhle, Pharynx und Larynx im Rahmen der flexiblen Ösophagogastroduodenoskopie

Article

Feb 2025
Z GASTROENTEROL

Zusammenfassung Während einer flexiblen Ösophagogastroduodenoskopie (ÖGD) können in der Regel die Mundhöhle, Oropharynx, Hypopharynx und Larynx mit einer hohen optischen Auflösung eingesehen werden. In diesem Abschnitt des Verdauungstrakts kommen zahlreiche benigne und maligne Befunde von klinischer Relevanz vor, welche im Rahmen einer Gastroskopie diagnostiziert und einer entsprechen Therapie zugeführt werden können. Insbesondere gilt dies für Kopf-Hals-Tumore, welche eine heterogene Gruppe bösartiger Erkrankungen darstellen und bis ca. 4% der in Deutschland diagnostizierten Krebserkrankungen des Mannes ausmachen. In dieser Übersichtsarbeit werden benigne und maligne Befunde in Mundhöhle, Pharynx- und Larynxbereich exemplarisch gezeigt, welche während der gastroenterologischen Routine-Endoskopie erhoben wurden, und in den Kontext einer ausführlichen Literaturrecherche gestellt. Benigne und maligne Befunde in Mundhöhle, Oropharynx, Hypopharynx und Larynx sind mit einem vertretbaren zusätzlichen Zeitaufwand optisch einfach zu diagnostizieren. In ausgewählten Fällen ist eine histologische Sicherung möglich. Wir beschreiben einen Vorschlag für einen strukturierten Untersuchungsablauf. Durch eine sorgfältige routinemäßige Inspektion von Mundhöhle, Oropharynx, Hypopharynx und Larynx im Rahmen der Gastroskopie können vor allem bei Risikopersonen, aber auch in der Allgemeinbevölkerung, pathologische Befunde dargestellt und potenziell im Frühstadium diagnostiziert werden.

A Large Adult Postcricoid Lymphatic Malformation: A Case Report and Literature Review

Article

Feb 2024
Ear Nose Throat J

Adult-onset lymphatic malformations arising at the postcricoid, a subsite of the hypopharynx, are sporadic. Only one case has been previously reported. In this study, we presented a 36-year-old female presented with globus sensation, dysphagia, and upper airway obstruction, requiring a tracheostomy. A computed tomography scan identified a 5 cm × 4.5 cm × 3 cm multilocular hypodense lesion in the postcricoid. Due to its considerable size, complete resection with function preservation was crucial, and a standard microscopic direct laryngoscopy approach may result in inadequate exposure, while an open transcervical approach may affect functional outcomes and increase surgical complications. We successfully performed an en bloc resection with a transoral endoscopic approach, using laryngeal suspension and a laparoscopic ultrasonic scalpel to preserve aerodigestive functions, ensure rapid recovery, and avoid neck scarring. The patient was decannulated within 2 weeks and remained disease-free after 1 year. The reported cases of adult-onset lymphatic malformations at the postcricoid and hypopharynx were reviewed and summarized for educational purposes.

Review of oral and pharyngolaryngeal benign lesions detected during esophagogastroduodenoscopy

Article

Full-text available

Jul 2023

During endoscopy, an endoscopist is inevitably faced with the occasional “difficult colonoscopy,” in which the endoscopist finds it challenging to advance the endoscope to the cecum. Beyond optimization of technique, with minimized looping, minimal insufflation, sufficient sedation, and abdominal splinting when needed, sometimes additional tools may be needed. In this review, we cover available techniques and technologies to help navigate the difficult colonoscopy, including the ultrathin colonoscope, rigidizing overtube, balloon-assisted colonoscopy and the abdominal compression device.

A rare cause of dysphagia due to retropharyngeal foregut duplication cyst: case report and review of the literature

Article

Full-text available

Jul 2023

Background The retropharyngeal space is a deep compartment of the head and neck region which extends from the base of the skull to the mediastinum, between the posterior pharyngeal wall and vertebral muscles, delimited laterally by carotid sheaths. Pathological processes of the retropharyngeal space are rarely encountered, generally are isolated and painless masses often cystic, and they usually originate from branchial arch anomalies, but only in rare cases, they turn out to be foregut duplication cysts. Foregut duplication cyst is rare congenital malformations arising along primitively derived alimentary tract during the first trimester in the developing embryo, mostly seen in the thorax and abdomen, with just few cases reported in the head and neck region. We report an extremely rare case of a foregut duplication cyst lined with respiratory epithelium located in the retropharyngeal space, at the level of the oropharynx, of an adult patient with dysphagia surgically treated, and we also made an analysis of the published literature about this very uncommon condition. Case presentation A 63-year-old male patient with chronic dysphagia was diagnosed with a retropharyngeal cystic lesion, which was surgically treated. Final pathologic evaluation confirmed the diagnosis of a rare foregut duplication cyst lined with respiratory epithelium. A review of the pertaining published literature about the head and neck foregut duplication cysts was made, with a particular emphasis on retropharyngeal ones. Conclusions Retropharyngeal foregut duplication cysts are a very rare congenital cyst of the head and neck. Clinical symptoms such as dysphagia and dyspnea should be evaluated with fibrolaryngoscopy, and CT and MRI scans are of great significance for definitive diagnosis, which should include the possibility of a foregut duplication cyst in the differential diagnosis. Surgical excision is the elective treatment for this lesion, in order to prevent complications including infection and compression symptoms or eventually malignant transformation.

Nasopharyngeal Presentation of a Pharyngeal Cleft Cyst in a Dog

Article

Nov 2022
J AM ANIM HOSP ASSOC

A 2 yr old castrated male shih tzu was presented for assessment of worsening chronic snoring since first detected at 3 mo of age. An upper respiratory endoscopic examination and a computed tomographic scan showed a well-circumscribed, fluid-filled nasopharyngeal mass located in the median plane on the nasal side of the soft palate. This lesion was removed using a ventral approach to the nasopharynx by blunt-sharp dissection from the submucosal tissues of the soft palate. Histopathology revealed a cystic lesion lined by a single layer of a pseudostratified columnar ciliated epithelium, characteristic of a pharyngeal cyst. Follow-up 5 mo after surgery revealed complete resolution of the clinical signs with no evidence of local recurrence. Pharyngeal cysts are developmental abnormalities of the branchial apparatus. Most derive from the second branchial arch and cause cysts, sinuses, and fistulae to develop in the neck region. In our case, the lesion was located in the nasopharynx, leading to snoring and exercise intolerance. This condition should be included in the differential diagnosis of suspected nasopharyngeal obstruction.

Stridor caused by duplication cyst in a female infant and temporary vocal cord paralysis. A case report

Article

Full-text available

Aug 2022

Introduction and importance Congenital hypopharynx duplication cysts are a medical rarity; nevertheless, they offer an important differential diagnosis in neonatal dyspnea or feeding problems. Case report Herein, we describe a case of delayed diagnosis but successful surgical removal of a large congenital hypopharynx cyst in a 4-month-old infant presenting with stridor. Clinical discussion Early and proper diagnosis and surgical handling of hypopharynx cyst can help to achieve the best prognosis and outcome. Conclusion We present the successful management of a newborn with a pharyngeal duplication cyst. In our case, the temporary postoperative laryngeal nerve palsy resolved within four weeks. Overstretching of recurrent laryngeal nerve might have caused this complication.

Branchial cleft anomalies: a pictorial review of embryological development and spectrum of imaging findings

Article

Full-text available

Dec 2015

The branchial arches are the embryological precursors of the face, neck and pharynx. Anomalies of the branchial arches are the second most common congenital lesions of the head and neck in children, with second branchial arch anomalies by far the most common. Clinically, these congenital anomalies may present as cysts, sinus tracts, fistulae or cartilaginous remnants with typical clinical and radiological findings. We review the normal embryological development of the branchial arches and the anatomical structures of the head and neck that derive from each arch. The typical clinical and radiological appearances of both common and uncommon branchial arch abnormalities are discussed with an emphasis on branchial cleft anomalies. Key points • Anomalies of the branchial arches usually present as cysts, sinuses or fistulae. • Second branchial arch anomalies account for approximately 95 % of cases. • There are no pathognomonic imaging features so diagnosis depends on a high index of suspicion and knowledge of typical locations. • Persistent cysts, fistulae or recurrent localised infection may be due to branchial arch anomalies. • Surgical excision of the cyst or tract is the most common curative option.

Transoral robotic surgery for oncocytic ductal cyst of hypopharynx: a lesion with a high probability of recurrence

Article

Nov 2017

Hypopharyngeal cysts are very uncommon pathology. They are presented in adult people over 60 years. Although oncocytic cysts are benign tumors, an incomplete resection causes recurrence. The symptoms are not specific, but the more frequent are dyspnea and foreign body sensation upon swallowing. Diagnosis usually is under general anesthesia during intubation. A flexible fiberoptic laryngoscopy could be insufficient; the trumpet maneuver during this examination can reveled occult cysts. To perform a total resection, the surgeon must have a complete exposition of the operative field. We present a new case of a patient with a symptomatic hypopharyngeal cyst successfully treated with transoral robotic extirpation; our view was tridimensional magnified and the robotic instruments provided great range of movement that permitted complete and safe removal hypopharyngeal lesion.

Ear, Nose and Throat Histopathology

Book

Jan 2001

Tumors of the esophagus, Atlas of the tumor pathology

Article

Hypopharyngeal lymphoepithelial cyst in a patient with a history of difficult intubation

Article

Jan 2017

The Yale Pharyngeal Residue Severity Rating Scale

Book

Jan 2016

This text is a reliable, validated, anatomically defined, and image-based tool to determine residue location and severity when performing fiberoptic endoscopic evaluation of swallowing (FEES). Based upon research by Drs. Leder and Neubauer, an easily interpreted, readily learned, and hierarchically organized pharyngeal residue severity rating scale was developed for speech-language pathologists, otolaryngologists, and other health care professionals who perform and interpret FEES. The Yale Pharyngeal Residue Severity Rating Scale works equally well for any swallow of interest, whether it is the first, subsequent clearing, or last swallow. The endoscopist simply has to match their chosen swallow with its scale mate. The Yale Pharyngeal Residue Severity Rating Scale can be used for both clinical advantages and research opportunities. Clinically, clinicians can now accurately classify vallecula and pyriform sinus residue severity as none, trace, mild, moderate, or severe for diagnostic purposes, determination of functional therapeutic change, and precise dissemination of shared information. Research uses include tracking outcomes for clinical trials, investigating various swallowing interventions, demonstrating efficacy of specific interventions to reduce pharyngeal residue, determining morbidity and mortality associated with pharyngeal residue in different patient populations, and improving the training and accuracy of FEES interpretation by students and clinicians. The Yale Pharyngeal Residue Severity Rating Scale is an important addition to the deglutologist’s tool box.

Cysts of the larynx--Classification

Article

Dec 2015

Hypopharynx: Anatomy, Histology and Pathology

Chapter

Jan 2001

The hypopharynx extends from the level of the hyoid bone above to that of the lower border of the cricoid cartilage below. For purposes of classification of the position and extent of carcinoma, the hypopharynx is divided into three areas: 1. Pharyngo-oesophageal junction (postcricoid area). 2. Piriform sinus. 3. Posterior pharyngeal wall.1

Fehlbildungen, Heterotopien und Anomalien der Mund-, Kiefer- und Gesichtsregion

Chapter