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Background <p>Vallecular cysts are rare benign retention cysts arising from the lingual surface of the epiglottis. In infants, they can cause critical airway obstruction due to the combination of distorted anatomy and limited physiological reserve. Airway management in such cases remains challenging, with no clear consensus in the literature.</p> Case presentation <p>We report the successful management of a 6-month-old infant with a large vallecular cyst obstructing the glottis. The child presented with noisy breathing and feeding difficulties. Imaging confirmed a cyst measuring 15 × 14 × 13&#xa0;mm at the tongue base. During induction, spontaneous ventilation was maintained with sevoflurane, and para-oxygenation was provided with nasal prongs. Endotracheal intubation was achieved using a novel “combi technique” — displacing the cyst with a Miller’s blade while railroading a cuffed endotracheal tube over a rigid bronchoscope. The cyst was excised by coblation, and the child recovered uneventfully.</p> Conclusion <p>This case demonstrates a safe and reproducible strategy for securing the pediatric airway in vallecular cysts. The combi technique highlights the importance of meticulous planning, para-oxygenation, and a multidisciplinary approach in managing complex airway emergencies.</p>

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Airway Management of a Large Vallecular Cyst in an Infant: A Novel Combi Technique

  • 期刊论文

  • 发表日期：

    2025年11月8日

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  • Shubhkarman Kahlon,
  • Anudeep Jafra,
  • Ramandeep Singh Virk,
  • Gautham Patel,
  • N. Prashanth

摘要

Background

Vallecular cysts are rare benign retention cysts arising from the lingual surface of the epiglottis. In infants, they can cause critical airway obstruction due to the combination of distorted anatomy and limited physiological reserve. Airway management in such cases remains challenging, with no clear consensus in the literature.

Case presentation

We report the successful management of a 6-month-old infant with a large vallecular cyst obstructing the glottis. The child presented with noisy breathing and feeding difficulties. Imaging confirmed a cyst measuring 15 × 14 × 13 mm at the tongue base. During induction, spontaneous ventilation was maintained with sevoflurane, and para-oxygenation was provided with nasal prongs. Endotracheal intubation was achieved using a novel “combi technique” — displacing the cyst with a Miller’s blade while railroading a cuffed endotracheal tube over a rigid bronchoscope. The cyst was excised by coblation, and the child recovered uneventfully.

Conclusion

This case demonstrates a safe and reproducible strategy for securing the pediatric airway in vallecular cysts. The combi technique highlights the importance of meticulous planning, para-oxygenation, and a multidisciplinary approach in managing complex airway emergencies.